Clinician miscalibration of survival estimate in hypothermic cardiac arrest: HOPE-estimated survival probabilities in extreme cases.

Patients with hypothermic cardiac arrest may survive with an excellent outcome after extracorporeal life support rewarming (ECLSR). The HOPE (Hypothermia Outcome Prediction after ECLS) score is recommended to guide the in-hospital decision on whether or not to initiate ECLSR in patients in cardiac arrest following accidental hypothermia. We aimed to assess the HOPE-estimated survival probabilities for a set of survivors of hypothermic cardiac arrest who had extreme values for the variables included in the HOPE score. Survivors were identified and selected through a systematic literature review including case reports. We calculated the HOPE score for each patient who presented extraordinary clinical parameters. We identified 12 such survivors. The HOPE-estimated survival probability was ≥10% for all (n = 11) patients for whom we were able to calculate the HOPE score. Our study confirms the robustness of the HOPE score for outliers and thus further confirms its external validity. These cases also confirm that hypothermic cardiac arrest is a fundamentally different entity than normothermic cardiac arrest. Using HOPE for extreme cases may support the proper calibration of a clinician's prognosis and therapeutic decision based on the survival chances of patients with accidental hypothermic cardiac arrest

Perceived Hospital Preparedness Is Negatively Associated With Pandemic-Induced Psychological Vulnerability in Primary Care Employees: A Multicentre Cross-Sectional Observational Study.

The COVID-19 pandemic had a profound negative impact on the psychological wellbeing of healthcare providers (HPs), but little is known about the factors that positively predict mental health of primary care staff during these dire situations. We conducted an online questionnaire survey among 702 emergency department workers across 10 hospitals in Switzerland and Belgium following the first COVID-19 wave in 2020, to explore their psychological vulnerability, perceived concerns, self-reported impact and level of pandemic workplace preparedness. Participants included physicians, nurses, psychologists and nondirect care employees (administrative staff). We tested for predictors of psychological vulnerability through both an exploratory cross-correlation with rigorous correction for multiple comparisons and model-based path modelling. Findings showed that the self-reported impact of COVID-19 at work, concerns about contracting COVID-19 at work, and a lack of personal protective equipment were strong positive predictors of Depression, Anxiety, and Stress, and low Resilience. Instead, knowledge of the degree of preparedness of the hospital/department, especially in the presence of a predetermined contingency plan for an epidemic and training sessions about protective measures, showed the opposite effect, and were associated with lower psychological vulnerability. All effects were confirmed after accounting for confounding factors related to gender, age, geographical location and the role played by HPs in the hospital/department. Difficult working conditions during the pandemic had a major impact on the psychological wellbeing of emergency department HPs, but this effect might have been lessened if they had been informed about adequate measures for minimizing the risk of exposure

Analgesic and Anxiolytic Effects of Virtual Reality During Minor Procedures in an Emergency Department: A Randomized Controlled Study.

We aimed to assess the analgesic and anxiolytic efficacy of distraction, a nonpharmacologic intervention provided by 3-dimensional (3D) virtual reality (VR) compared with that provided by 2-dimensional (2D) VR during minor emergency department (ED) procedures. This randomized controlled study conducted in the ED of a teaching hospital included patients aged more than or equal to 18 years undergoing minor procedures. The patients watched the same computer-generated VR world either in 3D in a head-mounted display (intervention) or in 2D on a laptop screen (control). Our main outcomes were pain and anxiety during the procedure, assessed on a 100-mm visual analog scale. Secondary outcomes included the impression of telepresence in the computer-generated world assessed using the Igroup Presence Questionnaire, and the prevalence and intensity of cybersickness measured on a 100-mm visual analog scale. The final analysis included 117 patients. The differences in median procedural pain and anxiety levels between the 2D and 3D VR groups were not significant: -3 mm (95% confidence interval [CI] -14 to 8) and -4 mm (95% CI -15 to 3), respectively; the difference in telepresence was 2.0 point (95% CI 0 to 2.0), and the proportion difference of cybersickness was -4% (95% CI -22 to 14), with an intensity difference of -5 mm (95% CI -9 to 3). During minor procedures in adult patients in the ED, distraction by viewing a 3D virtual world in a head-mounted VR display did not result in lower average levels of procedural pain and anxiety than that by 2D viewing on a screen despite a higher sense of telepresence. There were no significant differences in the prevalence and intensity of cybersickness between the 2 groups

Prevalencia de intervenciones de terapia ocupacional en un hospital de agudos

The aim of this study is to know the process of Occupational Therapy treatment given to Rheumatology outpatient, and Clinical and Medical Intensive Care Unit inpatient of Tornú Hospital   Methodology: descriptive, comparative, observational, retrospective, cross-sectional and quantitative instrument; Residence registration evaluation forms and internal evolution.   Results: the most prevalent intervention was the Therapeutic use of Occupations and Activities with 41.04% in inpatient and 47% in outpatients (Rheumatology). Among these the Preparatory Methods are highlighted in both areas with a 56.33% in inpatients and 84.7% in outpatients (Rheumatology). A significant difference was found in Interconsultation with a 28.32% in inpatients and 5% in outpatients (Rheumatology).   Lastly, the most frequent reason for discharge from Occupational Therapy treatment in inpatients was clinical discharge with 56% (n = 43), followed by goal achievement 4% (n = 10), and the least frequent was denial to receive treatment 1, 6% (n = 1). Only two reasons were identified in Rheumatology: non-compliance with treatment 65% (n = 43) and goal achievement with 34% (n = 22).   Conclusions: The most prevalent intervention in both areas is due to the large percentage of preparatory methods used, being higher in Rheumatology since these are associated with symptomatic relief.   The Interconsultation was not performed with the frequency required by the acute patient´s complexity. According to these results we consider relevant to develop new communication strategies with the team.El objetivo del presente trabajo consiste en conocer el proceso de tratamiento de Terapia Ocupacional en las áreas de consultorios externos de Reumatología e internación de Clínica Médica y Unidad de Terapia Intermedia del Hospital Tornú.   Metodología: estudio descriptivo y comparativo, observacional, retrospectivo, transversal, cuantitativo; instrumento: fichas de registro de evaluación y evolución internas de la Residencia.   Resultados: la intervención más prevalente fue: Uso terapéutico de las actividades y ocupaciones con un 41,04 % en Internación y 47 % en Reumatología. Entre estos se destacan las métodos preparatorios con un 56,33% en Internación y un 84,7 % en Reumatología. Se observó diferencia significativa en la Interconsulta con 28.32 % en Internación y 5% en Reumatología.   Por último, el motivo de alta más frecuente en Internación fue alta médica con el 56 % (n:43), seguido de cumplimiento de objetivos con el 16, 4% (n: 10), y el menos frecuente fue Negativa con el 1,6% (n: 1). En Reumatología solo se registraron dos motivos abandono de tratamiento con el 65% (n: 43) y cumplimiento de objetivos con el 34 % (n: 22).   Conclusiones: la intervención que más prevaleció en ambas áreas se debe al gran porcentaje de métodos preparatorios, siendo mayor en Reumatología dado que éstos se vinculan con el alivio sintomático. La Interconsulta no se realizó con la frecuencia necesaria que requiere la complejidad del paciente agudo, por lo que consideramos relevante plantear estrategias de comunicación con el equipo

Prevalencia de intervenciones de terapia ocupacional en un hospital de agudos

The aim of this study is to know the process of Occupational Therapy treatment given to Rheumatology outpatient, and Clinical and Medical Intensive Care Unit inpatient of Tornú Hospital   Methodology: descriptive, comparative, observational, retrospective, cross-sectional and quantitative instrument; Residence registration evaluation forms and internal evolution.   Results: the most prevalent intervention was the Therapeutic use of Occupations and Activities with 41.04% in inpatient and 47% in outpatients (Rheumatology). Among these the Preparatory Methods are highlighted in both areas with a 56.33% in inpatients and 84.7% in outpatients (Rheumatology). A significant difference was found in Interconsultation with a 28.32% in inpatients and 5% in outpatients (Rheumatology).   Lastly, the most frequent reason for discharge from Occupational Therapy treatment in inpatients was clinical discharge with 56% (n = 43), followed by goal achievement 4% (n = 10), and the least frequent was denial to receive treatment 1, 6% (n = 1). Only two reasons were identified in Rheumatology: non-compliance with treatment 65% (n = 43) and goal achievement with 34% (n = 22).   Conclusions: The most prevalent intervention in both areas is due to the large percentage of preparatory methods used, being higher in Rheumatology since these are associated with symptomatic relief.   The Interconsultation was not performed with the frequency required by the acute patient´s complexity. According to these results we consider relevant to develop new communication strategies with the team.El objetivo del presente trabajo consiste en conocer el proceso de tratamiento de Terapia Ocupacional en las áreas de consultorios externos de Reumatología e internación de Clínica Médica y Unidad de Terapia Intermedia del Hospital Tornú.   Metodología: estudio descriptivo y comparativo, observacional, retrospectivo, transversal, cuantitativo; instrumento: fichas de registro de evaluación y evolución internas de la Residencia.   Resultados: la intervención más prevalente fue: Uso terapéutico de las actividades y ocupaciones con un 41,04 % en Internación y 47 % en Reumatología. Entre estos se destacan las métodos preparatorios con un 56,33% en Internación y un 84,7 % en Reumatología. Se observó diferencia significativa en la Interconsulta con 28.32 % en Internación y 5% en Reumatología.   Por último, el motivo de alta más frecuente en Internación fue alta médica con el 56 % (n:43), seguido de cumplimiento de objetivos con el 16, 4% (n: 10), y el menos frecuente fue Negativa con el 1,6% (n: 1). En Reumatología solo se registraron dos motivos abandono de tratamiento con el 65% (n: 43) y cumplimiento de objetivos con el 34 % (n: 22).   Conclusiones: la intervención que más prevaleció en ambas áreas se debe al gran porcentaje de métodos preparatorios, siendo mayor en Reumatología dado que éstos se vinculan con el alivio sintomático. La Interconsulta no se realizó con la frecuencia necesaria que requiere la complejidad del paciente agudo, por lo que consideramos relevante plantear estrategias de comunicación con el equipo

Management of respiratory distress following prehospital implementation of noninvasive ventilation in a physician-staffed emergency medical service: a single-center retrospective study.

Noninvasive ventilation (NIV) is recognized as first line ventilatory support for the management of acute pulmonary edema (APE) and chronic obstructive pulmonary disease (COPD) exacerbations. We aimed to study the prehospital management of patients in acute respiratory distress with an indication for NIV and whether they received it or not. This retrospective study included patients ≥18 years old who were cared for acute respiratory distress in a prehospital setting. Indications for NIV were oxygen saturation (SpO <sub>2</sub> ) <90% and/or respiratory rate (RR) >25/min with a presumptive diagnosis of APE or COPD exacerbation. Study population characteristics, initial and at hospital vital signs, presumptive and definitive diagnosis were analyzed. For patients who received NIV, dyspnea level was evaluated with a dyspnea verbal ordinal scale (D-VOS, 0-10) and arterial blood gas (ABG) values were obtained at hospital arrival. Among the 187 consecutive patients included in the study, most (n = 105, 56%) had experienced APE or COPD exacerbation, and 56 (30%) received NIV. In comparison with patients without NIV, those treated with NIV had a higher initial RR (35 ± 8/min vs 29 ± 10/min, p < 0.0001) and a lower SpO <sub>2</sub> (79 ± 10 vs 88 ± 11, p < 0.0001). The level of dyspnea was significantly reduced for patients treated with NIV (on-scene D-VOS 8.4 ± 1.7 vs 4.4 ± 1.8 at admission, p < 0.0001). Among the 131 patients not treated with NIV, 41 (31%) had an indication. In the latter group, initial SpO <sub>2</sub> was 80 ± 10% in the NIV group versus 86 ± 11% in the non-NIV group (p = 0.0006). NIV was interrupted in 9 (16%) patients due to either discomfort (n = 5), technical problem (n = 2), persistent desaturation (n = 1), or vomiting (n = 1). The results of this study contribute to a better understanding of the prehospital management of patients who present with acute respiratory distress and an indication for NIV. NIV was started on clinically more severe patients, even if predefined criteria to start NIV were present. NIV allows to improve vital signs and D-VOS in those patients. A prospective study could further elucidate why patients with a suspected diagnosis of APE and COPD are not treated with NIV, as well as the clinical impact of the different strategies. The study was approved by our institutional ethical committee ( CER-VD 2020-01363 )

Lessons from COVID-19 syndromic surveillance through emergency department activity: a prospective time series study from western Switzerland.

We aimed to assess if emergency department (ED) syndromic surveillance during the first and second waves of the COVID-19 outbreak could have improved our surveillance system. We did an observational study using aggregated data from the ED of a university hospital and public health authorities in western Switzerland. All patients admitted to the ED were included. The main outcome was intensive care unit (ICU) occupancy. We used time series methods for ED syndromic surveillance (influenza-like syndrome, droplet isolation) and usual indicators from public health authorities (new cases, proportion of positive tests in the population). Based on 37 319 ED visits during the COVID-19 outbreak, 1421 ED visits (3.8%) were positive for SARS-CoV-2. Patients with influenza-like syndrome or droplet isolation in the ED showed a similar correlation to ICU occupancy as confirmed cases in the general population, with a time lag of approximately 13 days (0.73, 95% CI 0.64 to 0.80; 0.79, 95% CI 0.71 to 0.86; and 0.76, 95% CI 0.67 to 0.83, respectively). The proportion of positive tests in the population showed the best correlation with ICU occupancy (0.95, 95% CI 0.85 to 0.96). ED syndromic surveillance is an effective tool to detect and monitor a COVID-19 outbreak and to predict hospital resource needs. It would have allowed to anticipate ICU occupancy by 13 days, including significant aberration detection at the beginning of the second wave