An Utstein-based model score to predict survival to hospital admission: The UB-ROSC Score

Abstract Aims To develop and validate a multi-parametric practical score to predict the probability of survival to hospital admission of an out-of-hospital cardiac arrest (OHCA) victim by using Utstein Style-based variables. Methods All consecutive OHCA cases occurring from 2015 to 2017 in two regions, Pavia Province (Italy) and Canton Ticino (Switzerland) were included. We used random effect logistic regression to model survival to hospital admission after an OHCA. We computed the model area under the ROC curve (AUC ROC) for discrimination and we performed both internal and external validation by considering all OHCAs occurring in the aforementioned regions in 2018. The Utstein-Based ROSC (UB-ROSC) score was derived by using the coefficients estimated in the regression model. The score value was obtained adding the pertinent score components calculated for each variable. The score was then plotted against the probability of survival to hospital admission. Results 1962 OHCAs were included (62% male, mean age 73 ± 16 years). Age, aetiology, location, witnessed OHCA, bystander CPR, EMS arrival time and shockable rhythm were independently associated with survival to hospital admission. The model showed excellent discrimination (AUC 0.83, 95%CI 0.81–0.85) for predicting survival to hospital admission, also at internal cross-validation (AUC 0.82, 95%CI 0.80–0.84). The model maintained good discrimination after external validation by using the 2018 OHCA cohort (AUC 0.77, 95%CI 0.74–0.80). Conclusions UB-ROSC score is a novel score that predicts the probability of survival to hospital admission of an OHCA victim. UB-ROSC shall help in setting realistic expectations about sustained ROSC achievement during resuscitation manoeuvres

Dupilumab in the treatment of severe uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP): A multicentric observational Phase IV real-life study (DUPIREAL)

Background Chronic rhinosinusitis with nasal polyps (CRSwNP) is associated with significant morbidity and reduced health-related quality of life. Findings from clinical trials have demonstrated the effectiveness of dupilumab in CRSwNP, although real-world evidence is still limited. Methods This Phase IV real-life, observational, multicenter study assessed the effectiveness and safety of dupilumab in patients with severe uncontrolled CRSwNP (n = 648) over the first year of treatment. We collected data at baseline and after 1, 3, 6, 9, and 12 months of follow-up. We focused on nasal polyps score (NPS), symptoms, and olfactory function. We stratified outcomes by comorbidities, previous surgery, and adherence to intranasal corticosteroids, and examined the success rates based on current guidelines, as well as potential predictors of response at each timepoint. Results We observed a significant decrease in NPS from a median value of 6 (IQR 5–6) at baseline to 1.0 (IQR 0.0–2.0) at 12 months (p < .001), and a significant decrease in Sino-Nasal Outcomes Test-22 (SNOT-22) from a median score of 58 (IQR 49–70) at baseline to 11 (IQR 6–21; p < .001) at 12 months. Sniffin' Sticks scores showed a significant increase over 12 months (p < .001) compared to baseline. The results were unaffected by concomitant diseases, number of previous surgeries, and adherence to topical steroids, except for minor differences in rapidity of action. An excellent-moderate response was observed in 96.9% of patients at 12 months based on EPOS 2020 criteria. Conclusions Our findings from this large-scale real-life study support the effectiveness of dupilumab as an add-on therapy in patients with severe uncontrolled CRSwNP in reducing polyp size and improving the quality of life, severity of symptoms, nasal congestion, and smell

EuReCa ONE—27 Nations, ONE Europe, ONE Registry A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe

AbstractIntroductionThe aim of the EuReCa ONE study was to determine the incidence, process, and outcome for out of hospital cardiac arrest (OHCA) throughout Europe.MethodsThis was an international, prospective, multi-centre one-month study. Patients who suffered an OHCA during October 2014 who were attended and/or treated by an Emergency Medical Service (EMS) were eligible for inclusion in the study. Data were extracted from national, regional or local registries.ResultsData on 10,682 confirmed OHCAs from 248 regions in 27 countries, covering an estimated population of 174 million. In 7146 (66%) cases, CPR was started by a bystander or by the EMS. The incidence of CPR attempts ranged from 19.0 to 104.0 per 100,000 population per year. 1735 had ROSC on arrival at hospital (25.2%), Overall, 662/6414 (10.3%) in all cases with CPR attempted survived for at least 30 days or to hospital discharge.ConclusionThe results of EuReCa ONE highlight that OHCA is still a major public health problem accounting for a substantial number of deaths in Europe.EuReCa ONE very clearly demonstrates marked differences in the processes for data collection and reported outcomes following OHCA all over Europe. Using these data and analyses, different countries, regions, systems, and concepts can benchmark themselves and may learn from each other to further improve survival following one of our major health care events

Esmolol for the treatment of recurrent ventricular tachycardia

Cardiac arrest and electrical storm are two major emergencies. The use of beta blockers in these clinical conditions has been proposed; however, definite data about the emergency use of beta blockers in recurrent ventricular tachycardia with pulse have never been published. We report two cases of recurrent ventricular tachycardia, which were unresponsive to the standard pharmacological treatment but successfully responsive to esmolol infusion. Both cases showed a reduced left ventricle ejection fraction due to an acute myocardial infarction and to an idiopathic dilated cardiomyopathy respectively. Nevertheless, the use of esmolol was shown to be both safe and effective without inducing low output syndrome

Cardiac arrest and coronavirus disease 2019

The impact of the coronavirus disease 2019 (COVID-19) on the cardiovascular system has been highlighted since the very first weeks after the severe acute respiratory syndrome coronavirus 2 identification. We reviewed the influence of COVID-19 pandemic on cardiac arrest, both considering those occurred out of the hospital (OHCA) and in the hospital (IHCA)

Global T waves inversion and QT prolongation. An uncommon presentation of acute pulmonary embolism

This is the case of a man presenting to the emergency department for dyspnea. Despite a very common symptom he presented an uncommon twelve leads electrocardiogram (ECG). At a first glance it could have suggested an acute coronary syndrome, a Takotsubo cardiomyopathy or a hypertrophic cardiomyopathy. However the further investigations showed an acute pulmonary embolism (APE) whose pre-test probability was low with a Wells score of 0 and a Geneva simplified score of 1. Negative T waves have been described in APE, however, such a morphology associated with QT prolongation is a very rare presentation. This case confirms how the diagnosis of APE could be often insidious representing a challenge for the emergency physician

Il ruolo delle tecnologie 4.0 nel supporto alle decisioni strategiche. Un’analisi empirica nel settore dell’agricoltura di precisione

The sustainable and efficient management of agricultural activities currently plays a key role in meeting the environmental objectives set by the European Union. Digital technologies that simplify our everyday lives and are changing all sectors of the economy, from mobility to industry, promise to improve agriculture concerning its effectiveness, efficiency and sustainability. Today, there are numerous innovative solutions of agriculture 4.0, digital and connected, which allow farmers to optimize production processes. This article analyses the convenience of using decision support systems (DSS) dedicated to olive growing, and useful for monitoring the operations to be performed in the field. Thanks to precision agriculture, it is possible to optimize field interventions such as phytosanitary treatments, fertilization and irrigation. There are numerous types of agriculture 4.0 solutions and many of these are aimed to achieve the same results. Existing studies available on this topic have allowed the authors to evaluate the convenience in the use of two different types of DSS systems: the first one involves the use of climatic data and their analysis through algorithms that allow to predict the development of pathogens and the level of infection; the second one is based on the processing of satellite images, useful for monitoring the vegetative and water conditions of the fields. Through these solutions it is possible, in fact, to reduce the intake of fertilizers such as nitrogen, phosphorus and potassium, as well as to obtain a reduction in irrigation and phytosanitary treatments. The main contribution of this study is to identify, through the results of a cost-benefit analysis, the reduction of costs related to the aforementioned interventions. The analyses are based on data collected on a sample of companies operating in the olive sector and concerning the potential of precision agriculture in improving operational efficiency, environmental sustainability and business profitability by making a comparison between traditional agriculture and precision

Innovazione dei processi lavorativi e ruolo degli artefatti nei modelli di cultura organizzativa: un’indagine empirica sulla trasformazione digitale della Pubblica Amministrazione

La digital transformation sta imponendo alla PA uno sforzo notevole per innovare l’organizzazione e l’erogazione dei propri servizi. Il contributo affronta il tema degli artefatti digitali e come possano essere favoriti i processi di digitalizzazione dei back-office e front-office, permettendone la riprogettazione e l’adattamento ai vari contesti sociali delle PA locali e centrali

ERP 4.0 per una corretta gestione dei rifiuti

The world of waste management industry is changing rapidly, and more and more companies are relying on advanced technologies enhanced by state-of-the-art waste management software, able to exploit innovative technologies never seen before. In the waste management industry, as in any other production sector, transparency and clarity of information are required. Indeed, these values are the foundations of the ongoing digital transformation. Specific ERP software applica-tions have been specifically developed to improve the control of each process and fraction, coordinating the management of waste, vehicles and personnel, with the aim of optimizing time and minimizing costs