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Early warning scores are clinical tools capable of identifying prehospital patients with high risk of deterioration. We sought here to contrast the validity of seven early warning scores in the prehospital setting and specifically, to evaluate the predictive value of each score to determine early deterioration-risk during the hospital stay, including mortality at one, two, three and seven- days since the index event. Methods: A prospective multicenter observational based-ambulance study of patients treated by six advanced life support emergency services and transferred to five Spanish hospitals between October 1, 2018 and December 31, 2019. We collected demographic, clinical, and laboratory variables. Seven risk score were constructed based on the analysis of prehospital variables associated with death within one, two, three and seven days since the index event. The area under the receiver operating characteristics was used to determine the discriminant validity of each early warning score. Results: A total of 3,273 participants with acute diseases were accurately linked. The median age was 69 years (IQR, 54–81 years), 1,348 (41.1%) were females. The overall mortality rate for patients in the study cohort ranged from 3.5% for first-day mortality (114 cases), to 7% for seven-day mortality (228 cases). The scores with the best performances for one-day mortality were Vitalpac Early Warning Score with an area under the receiver operating characteristic (AUROC) of 0.873 (95% CI: 0.81-0.9), for two-day mortality, Triage Early Warning Score with an AUROC of 0.868 (95% CI: 0.83-0.9), for three and seven-days mortality the Modified Rapid Emergency Medicine Score with an AUROC of 0.857 (0.82-0.89) and 0.833 (95% CI: 0.8-0.86). In general, there were no significant differences between the scores analyzed. Conclusions: All the analyzed scores have a good predictive capacity for early mortality, and no statistically significant differences between them were found. The National Early Warning Score 2, at the clinical level, has certain advantages. Early warning scores are clinical tools that can help in the complex decision-making processes during critical moments, so their use should be generalized in all emergency medical services. [ABSTRACT FROM AUTHOR]

Purpose:The main objective was to assess the change in the functional independence in basic activities of daily living (ADL) following a pre-prosthetic intervention in people with lower-limb amputation (LLA). Secondary objectives were to identify the factors contributing to the success of this intervention, and to analyze the effects on the presence of unmet needs for home adaptation. Method:The ADL intervention was early and pre-prosthetic; it was focused on six self-care activities. Fifty-two adults with LLA, who required assistance in self-care, were included. Functional independence (Barthel) was assessed at baseline and after intervention (T2). Successful intervention was defined as independent performance of all self-care activities. Results:There was a significant improvement in Barthel scores between baseline and T2 in toileting (p < 0.001), bed-chair transfers (p < 0.001), dressing (p < 0.001), bathing/showering (p < 0.001), and feeding (p = 0.025). The proportion of homes with an unmet need for adaptation decreased significantly in bathroom (p = 0.008) and other internal areas (p = 0.031). Intervention was successful for 61.5% of participants. In a multivariate model, age was significantly associated with successful intervention (OR 0.66, 95%CI 0.52–0.83). Conclusions:A short and pre-prosthetic ADL intervention improves functional independence and reduces the need for home adaptation. ADL programs should be included in rehabilitation strategies.Implications for RehabilitationBecause basic activities of daily living (ADL) can be seriously compromised after a lower-limb amputation, it is important for this population to improve or maintain their level of independence.A short and pre-prosthetic ADL intervention is an effective method for an early recovery of functional independence in self-care activities and promotes home adaptation.Age is an important determinant of functional recovery, and most subjects can achieve independence in basic ADL regardless of the level of amputation.A pre-prosthetic ADL program should be included in rehabilitation strategies for adults with lower-limb amputation. [ABSTRACT FROM AUTHOR]

Purpose: This paper studies the relationship between computed tomography (CT) scan on admission, according to Marshall’s tomographic classification, and quality-of-life (QoL) after 1 year in patients admitted to the Intensive Care Unit (ICU) with traumatic brain injury (TBI). Methods: This study used validated scales including the Glasgow Outcome Scale and the PAECC (Project for the Epidemiologic Analysis of Critical Care Patients) QoL questionnaire. Results: We enrolled 531 patients. After 1 year, 171 patients (32.2%) had died (missing data = 6.6%). Good recovery was seen in 22.7% of the patients, while 20% presented moderate disability. The PAECC score after 1 year was 9.43 ± 8.72 points (high deterioration). Patients with diffuse injury I had a mean of 5.08 points vs 7.82 in those with diffuse injury II, 11.76 in those with diffuse injury III and 19.29 in those with diffuse injury IV (p< 0.001). Multivariate analysis found that QoL after 1 year was associated with CT Marshall classification, depth of coma, age, length of stay, spinal injury and tracheostomy. Conclusions: Patients with TBI had a high mortality rate 1 year after admission, deterioration in QoL and significant impairment of functional status, although more than 40% were normal or self-sufficient. QoL after 1 year was strongly related to cranial CT findings on admission. [ABSTRACT FROM PUBLISHER]

Objective:To explore the intention of Spanish patients who were undergoing a reproductive donation treatment to disclose their offspring’s origins.Background:In Spain, the law establishes the anonymity of the donation process and prohibits revealing the donor’s identity to the offspring or the parents. Method: The design was a prospective observational study in a private institution. The participants were Spanish family units (heterosexual couples, homosexual couples and single women) undergoing a reproductive donation treatment in FivMadrid, Madrid, Spain. One hundred and thirty family units accepted and returned the complete questionnaire specially designed for this study.Results:Of the participants, 61% intend to disclose their offspring’s origins; 85% of those who want to reveal will do so during childhood (between 3 and 8 years of age); 95% think it is a good decision to undergo a gamete donation treatment; 95% feel the future child is theirs; 64% of the participants are concerned about the physical characteristics of the donors; 63% consider psychological counselling to be important during treatment, and 55% during pregnancy and after delivery. In all these results there were no significant differences (P< 0.05) between traditional families (heterosexual couples) and non-traditional families (lesbian couples and single women).Conclusions:Even though Spanish legislation does not allow families and donors to know each other, our results are consistent with others presented in different European countries where legislations are different and the offspring and the families are permitted to meet their donors. Many of the Spanish parents studied plan to take a responsible and coherent decision about disclosing their origins to their children, choosing an honest and open relationship. [ABSTRACT FROM PUBLISHER]

Objective: This study explored 12-month outcome and its associations to social adjustment-related variables in patients with first-episode non-affective psychosis in Finland and Spain. Methods: Forty-nine Finnish and 37 Spanish patients were evaluated at admission on various characteristics of social adjustment. Outcome was measured for 68 (79%) patients by the Brief Psychiatric Rating Scale, Global Assessment Scale, and Grip on Life. Results: One-fourth of the patients experienced psychotic symptoms at follow-up. Sixty per cent of the patients showed good global functioning and Grip on Life. In both patient groups, poor earlier global functioning, weak social network, poor Grip on Life, and psychological dependence on family of origin were associated with poor outcome. In the Finnish group, few social contacts, lack of social recreational activities, and lack of stability in couple relations were related to poor outcome. In the Spanish group, low parental criticism was associated with poor outcome. Conclusion: Our findings support the notion that the level of earlier social adjustment is important in recovery from first-episode psychosis. However, different aspects of social adjustment, i.e., peer relations in the Finnish group and family relations in the Spanish group, appear to have prognostic importance in these two social environments. [ABSTRACT FROM AUTHOR]