The Human Plasma Proteome History, Character, and Diagnostic Prospects

European Resuscitation Council Guidelines for Resuscitation.

In contrast to adults, cardiac arrest in infants and children does not usually result from a primary cardiac cause. More often it is the terminal result of progressive respiratory failure or shock, also called an asphyxial arrest. Asphyxia begins with a variable period of systemic hypoxemia, hypercapnea, and acidosis, progresses to bradycardia and hypotension, and culminates with cardiac arrest.1

Another mechanism of cardiac arrest, ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT), is the initial cardiac rhythm in approximately 5% to 15% of pediatric in-hospital and out-of-hospital cardiac arrests;2,–,9 it is reported in up to 27% of pediatric in-hospital arrests at some point during the resuscitation.6 The incidence of VF/pulseless VT cardiac arrest rises with age.2,4 Increasing evidence suggests that sudden unexpected death in young people can be associated with genetic abnormalities in myocyte ion channels resulting in abnormalities in ion flow (see “Sudden Unexplained Deaths,” below).

Since 2010 marks the 50th anniversary of the introduction of cardiopulmonary resuscitation (CPR),10 it seems appropriate to review the progressive improvement in outcome of pediatric resuscitation from cardiac arrest. Survival from in-hospital cardiac arrest in infants and children in the 1980s was around 9%.11,12 Approximately 20 years later, that figure had increased to 17%,13,14 and by 2006, to 27%.15,–,17 In contrast to those favorable results from in-hospital cardiac arrest, overall survival to discharge from out-of-hospital cardiac arrest in infants and children has not changed substantially in 20 years and remains at about 6% (3% for infants and 9% for children and adolescents).7,9

It is unclear why the improvement in outcome from in-hospital cardiac arrest has occurred, although earlier recognition and management of at-risk patients on general inpatient units …

https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.110.971101

Part 14: Pediatric Advanced Life Support 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

A meta-analysis was performed to evaluate the accuracy of determination of procalcitonin (PCT) and C-reactive protein (CRP) levels for the diagnosis of bacterial infection. The analysis included published studies that evaluated these markers for the diagnosis of bacterial infections in hospitalized patients. PCT level was more sensitive (88% [95% confidence interval [CI], 80%-93%] vs. 75% [95% CI, 62%-84%]) and more specific (81% [95% CI, 67%-90%] vs. 67% [95% CI, 56%-77%]) than CRP level for differentiating bacterial from noninfective causes of inflammation. The Q value for PCT markers was higher (0.82 vs. 0.73). The sensitivity for differentiating bacterial from viral infections was also higher for PCT markers (92% [95% CI, 86%-95%] vs. 86% [95% CI, 65%-95%]); the specificities were comparable (73% [95% CI, 42%-91%] vs. 70% [95% CI, 19%-96%]). The Q value was higher for PCT markers (0.89 vs. 0.83). PCT markers also had a higher positive likelihood ratio and lower negative likelihood ratio than did CRP markers in both groups. On the basis of this analysis, the diagnostic accuracy of PCT markers was higher than that of CRP markers among patients hospitalized for suspected bacterial infections.

/pdf/serum-procalcitonin-and-c-reactive-protein-levels-as-markers-510g6f49jv.pdf

Serum Procalcitonin and C-Reactive Protein Levels as Markers of Bacterial Infection: A Systematic Review and Meta-analysis

Emergency department visits and rehospitalization are common after hospital discharge. Jack and colleagues demonstrated that a nurse discharge advocate and clinical pharmacist working together to c...

/pdf/a-reengineered-hospital-discharge-program-to-decrease-gcroarxbis.pdf

A Reengineered Hospital Discharge Program to Decrease Rehospitalization

Background: Screening medical patients for excessive alcohol drinking is important because minimal intervention by physicians is effective in reducing excessive consumption. Screening tests, such as biologic markers of alcohol consumption, should therefore be investigated to assess their validity to detect alcohol drinking. Method: Levels of carbohydrate-deficient transferrin (CDT), γ-glutamyltransferase (GGT), and mean corpuscular volume (MCV) were determined in 1202 consecutive patients (20 to 75 years old) seen at the medical emergency ward (n=552) and the primary care center (n=650) of a city and teaching hospital. Each eligible patient was administered a CAGE questionnaire (an acronym for questions regarding cutting down on drinking,annoyanceat others' concern about drinking, feelingguiltyabout drinking, and using alcohol as aneye-openerin the morning), and for each CAGE-positive patient (score ≥1) as well as for a random sex-matched sample of CAGE-negative patients, standardized data about the recent level of alcohol drinking, morbidities, drug therapy, and smoking were recorded. The operating characteristics of CDT, GGT, and MCV were determined according to alcohol consumption and the CAGE test. Sensitivities, specificities, and receiver operating characteristic curves were computed to compare the tests at different cutoff values. Results: Levels of CDT were elevated in 21% of men and 7% of women. According to recent alcohol consumption in men (>60 g/d), the respective sensitivity and specificity of the tests were 0.58 and 0.82 for CDT, 0.69 and 0.65 for GGT, and 0.27 and 0.91 for MCV. Overall, receiver operating characteristic curves demonstrated similar performance of the three tests for screening of excessive alcohol drinking or alcohol abuse. However, in young men ( Conclusions: The study suggests that CDT determination may be a useful test for screening programs of excessive alcohol drinking in young male medical patients. (Arch Intern Med. 1995;155:1907-1911)

Screening for Excessive Alcohol Drinking: Comparative Value of Carbohydrate-Deficient Transferrin, ?-Glutamyltransferase, and Mean Corpuscular Volume

Background Depressive symptoms have been associated with higher mortality in hospitalized elderly persons, but few data are available associating depressive symptoms with other outcomes. Objective To determine the association between depressive symptoms and the risk of hospital readmission, nursing home admission, and death as well as inpatient services utilization during a 6-month follow-up period in a cohort of elderly medical inpatients. Methods We enrolled 401 patients, 75 years and older, admitted to the internal medicine service of an academic hospital in Lausanne, Switzerland. Data on demographic, medical, physical, social, and mental status were collected on admission. Depressive symptoms were defined as a score of 6 or higher on the Geriatric Depression Scale short form. Follow-up data were gathered from the centralized billing system (hospital and nursing home admissions) and from proxies (in cases of death). Results In bivariate analysis, depressive symptoms were associated with an increased risk of hospital readmission, nursing home placement, and death. After adjustment for demographic, socioeconomic, and functional status and comorbidity, depressive symptoms remained associated with an increased risk of hospital readmission (adjusted hazard ratio, 1.50; 95% confidence interval, 1.03-2.17; P = .03). In addition, depressive symptoms were associated with increased average costs of both acute and rehabilitation services, resulting in higher overall costs of inpatient services. ($175.70 vs $126.00; P P = .07). Conclusions Elderly medical inpatients with depressive symptoms were more likely than those without to be readmitted and had higher inpatient services utilization during the follow-up period, independent of functional and health status. These results emphasize the need for interventions directed at improving management of depressive symptoms, given the low recognition and treatment rates of this problem in elderly populations.

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/649583/ioi00889.pdf

Depressive symptoms as a predictor of 6-month outcomes and services utilization in elderly medical inpatients.

Health-related quality of life (HRQoL) was evaluated in a sample of alcohol-dependent patients with the 36-item Medical Outcome Study Short-Form Health Survey (MOS-SF-36). the instrument was administered to 147 patients (77% males), aged 26–78, with a DSM-III-R diagnosis of alcohol dependence. the Hamilton Depression Scale (HDS), the Severity of Alcohol Dependence Questionnaire (SADQ), and the Addiction Severity Index (ASI) were also administered to the first 100 patients included in the study. the reliability and validity of the MOS-SF-36 were evaluated. Test-retest intraclass coefficients for a 10-day interval were in the range. 65 to. 79, whereas the Cronbach a coefficient indicated good internal consistency (range. 70 to. 89). Compared to scores observed in the general population, MOS-SF-36 scores for alcohol-dependent patients were relatively low (indicating worse perception of HRQoL), especially in the psychological and role dimensions (range 52/100 to 55/100), but were closer to populational values...

MOS-SF-36 in evaluating health-related quality of life in alcohol-dependent patients.

Leadership skills are described by the American College of Surgeons' Advanced Trauma Life Support (ATLS) course as necessary to provide care for patients during resuscitations. However, leadership is a complex concept, and the tools used to assess the quality of leadership are poorly described, inadequately validated, and infrequently used. Despite its importance, dedicated leadership education is rarely part of physician training programs. The goals of this investigation were the following: 1. Describe how leadership and leadership style affect patient care; 2. Describe how effective leadership is measured; and 3. Describe how to train future physician leaders.
We searched the PubMed database using the keywords "leadership" and then either "trauma" or "resuscitation" as title search terms, and an expert in emergency medicine and trauma then identified prospective observational and randomized controlled studies measuring leadership and teamwork quality. Study results were categorized as follows: 1) how leadership affects patient care; 2) which tools are available to measure leadership; and 3) methods to train physicians to become better leaders.
We included 16 relevant studies in this review. Overall, these studies showed that strong leadership improves processes of care in trauma resuscitation including speed and completion of the primary and secondary surveys. The optimal style and structure of leadership are influenced by patient characteristics and team composition. Directive leadership is most effective when Injury Severity Score (ISS) is high or teams are inexperienced, while empowering leadership is most effective when ISS is low or teams more experienced. Many scales were employed to measure leadership. The Leader Behavior Description Questionnaire (LBDQ) was the only scale used in more than one study. Seven studies described methods for training leaders. Leadership training programs included didactic teaching followed by simulations. Although programs differed in length, intensity, and training level of participants, all programs demonstrated improved team performance.
Despite the relative paucity of literature on leadership in resuscitations, this review found leadership improves processes of care in trauma and can be enhanced through dedicated training. Future research is needed to validate leadership assessment scales, develop optimal training mechanisms, and demonstrate leadership's effect on patient-level outcome.

https://serval.unil.ch/resource/serval:BIB_9F4967C998D6.P001/REF.pdf

Leadership and Teamwork in Trauma and Resuscitation

https://www.annemergmed.com/article/S0196-0644(07)00079-0/pdf

Bertrand Yersin

Papers

Screening for Excessive Alcohol Drinking: Comparative Value of Carbohydrate-Deficient Transferrin, ?-Glutamyltransferase, and Mean Corpuscular Volume

Depressive symptoms as a predictor of 6-month outcomes and services utilization in elderly medical inpatients.

MOS-SF-36 in evaluating health-related quality of life in alcohol-dependent patients.

Leadership and Teamwork in Trauma and Resuscitation

Oligoanalgesia in the Emergency Department: Short-Term Beneficial Effects of an Education Program on Acute Pain