Multimodal approach to predict neurological outcome after cardiac arrest: A single-center experience

Introduction: The aims of this study were to assess the concordance of different tools and to describe the accuracy of a multimodal approach to predict unfavorable neurological outcome (UO) in cardiac arrest patients. Methods: Retrospective study of adult (>18 years) cardiac arrest patients who underwent multimodal monitoring; UO was defined as cerebral performance category 3-5 at 3 months. Predictors of UO were neurological pupillary index (NPi) 64 2 at 24 h; highly malignant patterns on EEG (HMp) within 48 h; bilateral absence of N20 waves on somato-sensory evoked potentials; and neuron-specific enolase (NSE) > 75 \u3bcg/L. Time-dependent decisional tree (i.e., NPi on day 1; HMp on day 1-2; absent N20 on day 2-3; highest NSE) and classification and regression tree (CART) analysis were used to assess the prediction of UO. Results: Of 137 patients, 104 (73%) had UO. Abnormal NPi, HMp on day 1 or 2, the bilateral absence of N20 or NSE >75 mcg/L had a specificity of 100% to predict UO. The presence of abnormal NPi was highly concordant with HMp and high NSE, and absence of N20 or high NSE with HMp. However, HMp had weak to moderate concordance with other predictors. The time-dependent decisional tree approach identified 73/103 patients (70%) with UO, showing a sensitivity of 71% and a specificity of 100%. Using the CART approach, HMp on EEG was the only variable significantly associated with UO. Conclusions: This study suggests that patients with UO had often at least two predictors of UO, except for HMp. A multimodal time-dependent approach may be helpful in the prediction of UO after CA. EEG should be included in all multimodal prognostic models

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Dall'"ardore giovanile" all'omaggio postumo. Viktor Popkov alla Biennale di Venezia (1962, 1982) / From "youthful fervour" to posthumous tribute. Viktor Popkov at the Venice Biennale (1962, 1982)

Aim: To explore the potential of mobile eye-tracking to identify healthcare students' area of visual interest and its relationship to performance ratings. Background: Eye-tracking identifies an individual's visual attention focus, and has been used as a training technique in medicine and in nursing. In this study participants wore a point of view (PoV) camera within a spectacle frame during simulation education experiences. Methods: Thirty-nine final year nursing and paramedicine students individually participated in three 8 minute clinical simulations with debriefing using videoed eye-tracking recordings. Coloured dots on the video depicted the participant's pupil fixation on five targeted areas. Data extracted from the video camera were collated to report time spent on each target (their 'gaze'). Results: The mean total gaze of expert designated targets in the environment for three 8 minute scenarios was 40-77%. Of 35 participants' focus on three main areas of interest, their priority was the patient's head (34%), the patient's trunk (24%) and their clinical assistant (5%), with significant differences between nursing and paramedic disciplines (P < 0.05). Objectively rated clinical performance improved significantly by the third scenario (P ≤ 0.001). Participants were positive regarding use of eye tracking during debriefing. Conclusions: Eye tracking has the potential to enhance debriefing and educational outcomes, although there are limitations to gaze capture in high fidelity environments and resource cost is high. Further study is warranted to enable better understanding of how expert clinicians achieve high levels of performance. © 2016 Elsevier Ltd

Efficacy, Safety and Feasibility of Superior Vena Cava Isolation in Patients Undergoing Atrial Fibrillation Catheter Ablation: An Up-to-Date Review

Pulmonary vein isolation (PVI) is the cornerstone in atrial fibrillation (AF) ablation; yet, the role of arrhythmogenic superior vena cava (SVC) is increasingly recognized and different ablation strategies have been employed in this context. SVC can act as a trigger or perpetuator of AF, and its significance might be more pronounced in patients undergoing repeated ablation. Several cohorts have examined efficacy, safety and feasibility of SVC isolation (SVCI) among AF patients. The majority of these studies explored as-needed SVCI during index PVI, and only a minority of them included repeated ablation subjects and non-radiofrequency energy sources. Studies of heterogeneous design and intent have explored both empiric and as-needed SVCI on top of PVI and reported inconclusive results. These studies have largely failed to demonstrate any clinical benefit in terms of arrhythmia recurrence, although safety and feasibility are undisputable. Mixed population demographics, small number of enrollees and short follow-up are the main limitations. Procedural and safety data are comparable between empiric SVCI and as-needed SVCI, and some studies suggested that empiric SVCI might be associated with reduced AF recurrences in paroxysmal AF patients. Currently, no study has compared different ablation energy sources in the setting of SVCI, and no randomized study has addressed as-needed SVCI on top of PVI. Furthermore, data regarding cryoablation are still in their infancy, and regarding SVCI in patients with cardiac devices more safety and feasibility data are needed. PVI non-responders, patients undergoing repeated ablation and patients with long SVC sleeves could be potential candidates for SVCI, especially via an empiric approach. Although many technical aspects remain unsettled, the major question to answer is which clinical phenotype of AF patients might benefit from SVCI

Immunologic Dysregulation and Hypercoagulability as a Pathophysiologic Background in COVID-19 Infection and the Immunomodulating Role of Colchicine

In 2020, SARS-COV-2 put health systems under unprecedented resource and manpower pressure leading to significant number of deaths. Expectedly, researchers sought to shed light on the pathophysiologic background of this novel disease (COVID-19) as well as to facilitate the design of effective therapeutic modalities. Indeed, early enough the pivotal role of inflammatory and thrombotic pathways in SARS-COV-2 infection has been illustrated. The purpose of this article is to briefly present the epidemiologic and clinical features of COVID-19, analyze the pathophysiologic importance of immunologic dysregulation and hypercoagulability in developing disease complications and finally to present an up-to-date systematic review of colchicine&apos;s immunomodulating capacity in view of hindering coronavirus complications

Phonological Processing and Reading and Writing Skills in Literacy

Estudos sugerem a influência do processamento fonológico sobre a alfabetização, embora haja controvérsias sobre as habilidades cognitivas subjacentes a esse constructo. Este estudo investigou a contribuição da consciência fonológica, memória de trabalho fonológica, nomeação rápida e processamento visual no desempenho em leitura e escrita de uma amostra de 50 alunos do 3º Ano do Ensino Fundamental de uma escola pública. Os resultados indicaram que a consciência fonológica e a memória de trabalho fonológica são as habilidades que mais contribuem para o desempenho inicial em leitura e escrita. Quanto às habilidades de nomeação rápida, apenas a nomeação de letras apresentou correlação significativa com a leitura e escrita, não havendo correlação destas últimas com o processamento visual. A análise fatorial exploratória sugeriu o agrupamento das variáveis estudadas em três fatores, o primeiro formado pela memória de trabalho fonológica e consciência fonológica, o segundo, pela nomeação rápida e o terceiro, pelo processamento visual.Studies suggest the influence of phonological processing on literacy, although there is controversy about the cognitive skills underlying this construct. This study investigated the contribution of phonological awareness, phonological memory, rapid naming and visual processing in reading and writing performance of a sample of 50 students of the 3rd grade of an Elementary Public School. The results indicated that phonological awareness and phonological memory are the skills that contributed most to the initial performance in reading and writing. In respect of rapid naming, only the letters naming showed significant correlation with reading and writing and there was no correlation between visual processing and reading or writing. The exploratory factor analysis suggested the grouping of variables in three factors, the first formed by the phonological memory and phonological awareness, the second formed by the rapid naming and the third by the visual processing.Estudios sugieren la influencia del procesamiento fonológico en la alfabetización, aunque existen controversias sobre las habilidades cognitivas subyacentes a este constructo. Este estudio investigó la contribución de la conciencia fonológica, memoria fonológica, denominación rápida y procesamiento visual en la lectura y escritura de una muestra de 50 estudiantes de tercer año en una escuela primaria pública. Los resultados indicaron que la conciencia fonológica y la memoria fonológica son las habilidades que mas contribuyen al rendimiento inicial en la lectura y la escritura. En cuanto a la denominación rápida, sólo la denominación de letras mostró correlación significativa con la lectura y la escritura, pero no hubo correlación de estas habilidades con el procesamiento visual. El análisis factorial exploratorio sugiere la agrupación de las variables en tres factores, el primero formado por la memoria fonológica y la conciencia fonológica, el segundo por la denominación rápida y el tercero por el procesamiento visual