Public Access Defibrillation

The single most important cause of death in the adult population of the industrialized word is sudden cardiac death (SCD) due to coronary artery disease (CAD). In a population based study the overall yearly incidence of SCD was 1 per 1000 persons aged20 to 75 years of age. Overall 21% of deaths in men and 15% in women were sudden and unexpected. The vast majority of out of hospital deaths occur at home and about 15% in a public place or on the street. Forty percent of SCDs were unwitnessed. Themajority of patients have ventricular tachycardia or fibrillation as the first recorded rhythm after patients collapse

Automatic External Defibrillator: Training and Practical Issues

Sudden cardiac death is the single most important cause of death in the industrialized countries. In general, traditional Emergency Medical Systems (EMS) have been only minimally effective in treating out-of-hospital cardiac arrest, and this occurred mainly due to unacceptably long times from patient collapse to defibrillation. The use of automated external defibrillators (AED) by non-medical personnel, offers an appealing solution of this problem. It can be used safely and effectively by a variety of crews of social security services and public responders who have the potential of approaching the victims of cardiac arrest earlier than the ambulance crews. Therefore time to defibrillation may be shortened. For public access defibrillation (PAD) programs to be effective, they should be integrated into an emergency medical system strategy for treating patients with cardiac arrest.  All aspects of implementation should be planned very carefully. Recommended elements for PAD programs include a planned and practiced approach, training of anticipated rescuers in cardiopulmonary resuscitation (CPR) / AED, link with the local EMS, continuous program review and quality improvement.  Emphasis should be placed not only on making potential rescuers familiar with CPR/AED practice, but also in giving detailed directives for successful resuscitation of cardiac arrest victims in the specific location where the PAD program has been implemented

Concurrent development of testicular seminoma and choriocarcinoma of the superior mediastinum, presented as cervical mass: a case report and implications about pathogenesis of germ-cell tumours

BACKGROUND: Synchronous presentation of more than one germ cell tumours of different histology in the same patient is considered to be very rare. In these cases of multiple germ cell tumours, strong theoretical and clinical data suggest an underlying common pathogenetic mechanism concerning genetic instability or abnormalities during the pluripotent embryonic differentiation and maturation of the germ cell. CASE PRESENTATION: A 25 year-old young man presented with an enlarging, slightly painful left cervical mass. Despite the initial disorientation of the diagnosis to a possible thyroid disorder, the patient underwent complete surgical resection of the mass revealing mediastinal choriocarcinoma. Subsequent ultrasound of the scrotum indicated the presence of a small lobular node in the upper pole of the left testicle and the patient underwent radical left inguinal orchiectomy disclosing a typical seminoma. Based on these results, the patient received 4 cycles of Bleomycin, Etoposide and Platinum chemotherapy experiencing only mild toxicity and resulting in complete ongoing clinical and biochemical remission. CONCLUSION: The pathogenesis of concurrent germ cell tumours in the same patient remains an area of controversy. Although the genetic instability of the pluripotent germ cell offers an adequate explanation, the possibility of metastasis from the primary, less differentiated tumour to a distant location as a more mature subtype cannot be excluded. Possible development of a metastatic site of different histology and thus biological behaviour (e.g choriocarcinoma) should be anticipated. Furthermore, urologists, pathologists and medical oncologists should be meticulous in the original pathological diagnosis in these patients, since there is a significant frequency of germ cell tumours with mixed or overlapping histological elements with diverse potential of evolution and differentiation

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Effects of different P-sources in soil on increasing growth and mineral uptake of mycorrhizal <em>Vitis vinifera</em> L. (cv Victoria) vines

The effect of different P-sources on growth, leaf chemical composition, and fruit soluble solids and acid content was evaluated in mycorrhizal Victoria grapevine variety gralted onto the rootstocks 3309C or 11 OR. Mycorrhizal and non mycorrhizal plants were grown in 20 L pots containing 20 kg soil supplemented with different P-forms: (Calcium bis-dihydrogen-phosphate, tri-calcium phosphate, aluminium phosphate, iron (III) phosphate) with different solubility, equivalent to 90 kg P.ha-1. The percent of mycorrhizal root colonization was higher in insoluble P-form treatments compared to control or to soluble P-form treatment (CaDP), ranging from 66 to 84 % in treatments receiving insoluble P, from 36.67 to 38.33 % in control and from 25.33 to 27.33 % in soluble P-form treatments. The roots of 110R rootstock showed higher colonization rate compared to the 3309C. Mycorrhizal colonization increased both the pruning weight and number of nodes of the vines, up to 9 and 1.9 times respectively, according to the rootstock- P form combination. Mycorrhizal vines showed increased leaf concentrations in N, P, K, Ca. Fruit total soluble solids of mycorrhizal vines were about 30 % lower compared with those of the non mycorrhizal vines. Both factors, mycorrhizal colonization and P-forms had no significant effect in fruit titratable acidity