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IntroductionEconomic hardship is a major threat to children’s health, implying that pediatric out-of-hospital cardiac arrest (pOHCA) might be promoted by lower incomes and child poverty. To target resources, it is helpful to identify geographical hotspots. Rhode Island is area-wise the smallest state in the United States of America. It has one million inhabitants and is comparable to many larger cities worldwide. We aimed to investigate possible associations of pOHCA with economic factors and the COVID-19 pandemic. We tried to identify high-risk areas and evaluated whether the COVID-19 pandemic had an influence on delays in prehospital care.MethodsWe analyzed all pOHCA cases (patients under 18 years of age) in Rhode Island between March 1st, 2018, and February 28th, 2022. We performed Poisson regression with pOHCA as dependent and economic risk factors (median household income and child poverty rate from the United States Census Bureau) as well as the COVID-19 pandemic as independent variables. Hotspots were identified utilizing Local Indicators of Spatial Association (LISA) statistics in ArcGIS Pro (Esri Corp., Redlands). We used linear regression to assess the association of EMS related times with economic risk factors and COVID-19.ResultsFifty-one cases met our inclusion criteria. Lower median household incomes (incidence-rate ratio (IRR) 0.99 per 1,000$ MHI; p=0.01) and higher child poverty rates (IRR 1.02 per percent; p=0.02) were significantly associated with higher numbers of ambulance calls due to pOHCA. The pandemic did not have a significant influence (IRR 0.9; p=0.7). LISA identified 12 census tracts as hotspots (p

Objectives: This study aimed to compare the clinical outcomes of mechanical and biological valve prostheses in patients with infective endocarditis presenting with stroke. Methods: Ninety-five adults with infective endocarditis complicated by stroke at baseline who underwent aortic and/or mitral valve replacement were analyzed retrospectively. The primary outcome was a composite outcome of all-cause mortality, ischemic stroke, hemorrhagic stroke, and re-endocarditis. Secondary outcomes included the individual components of the composite outcome and modified Rankin scale deterioration during follow-up. Results: Among the study cohort, 34 patients (35.8%) received mechanical valve prostheses and 61 (64.2%) received biological valve prostheses. Implantation of a mechanical valve prosthesis seems to be associated with a decreased risk of attaining the composite outcome (adjusted HR 0.46, 95% CI 0.22–0.96, and p = 0.037). Analyses of the individual components of the composite outcome showed that implantation of a mechanical valve prosthesis might not be associated with an increased risk of ischemic stroke, hemorrhagic stroke, and all-cause mortality during the follow-up period. Further, the risk of re-endocarditis was significantly lower in recipients of a mechanical valve prosthesis (adjusted HR 0.15, 95% CI 0.06–0.77, p = 0.026). Notably, a trend toward decreased risk of modified Rankin scale deterioration throughout the follow-up period was observed in this group (adjusted odds ratio 0.22, 95% CI 0.05–1.02, p = 0.053). Conclusions: Implantation of mechanical valve prostheses in patients presenting with infective endocarditis complicated by stroke seems to be beneficial in terms of a reduced risk of experiencing a composite outcome. Analyses of larger cohorts are required to validate our findings. [ABSTRACT FROM AUTHOR]

This document provides a description of three different severity scores for atrial fibrillation (AF) disease: the Atrial Fibrillation Severity Scale (AFSS), Atrial Fibrillation Symptom and Burden (AFS-B), and Quality of Life in Atrial Fibrillation (QLAF). These scores assess the frequency, duration, and severity of AF episodes and symptoms, as well as the impact of AF on quality of life. The AFSS is recommended as the most widely used and validated scoring system, but further research is needed to improve the questionnaire and include a larger study population. [Extracted from the article]

Abstract Background Cardiopulmonary resuscitation in mountain environment is challenging. Continuous chest compressions during transport or hoist rescue are almost impossible without mechanical chest compression devices. Current evidence is predominantly based on studies conducted by urbane ambulance service. Therefore, we aimed to investigate the feasibility of continuous mechanical chest compression during alpine terrestrial transport using three different devices. Methods Randomized triple crossover prospective study in an alpine environment. Nineteen teams of the Austrian Mountain Rescue Service trained according to current ERC guidelines performed three runs each of a standardised alpine rescue-scenario, using three different devices for mechanical chest compression. Quality of CPR, hands-off-time and displacement of devices were measured. Results The primary outcome of performed work (defined as number of chest compressions x compression depth) was 66,062 mm (2832) with Corpuls CPR, 65,877 mm (6163) with Physio-Control LUCAS 3 and 40,177 mm (4396) with Schiller Easy Pulse. The difference both between LUCAS 3 and Easy Pulse (Δ 25,700; 95% confidence interval 21,118 – 30,282) and between Corpuls CPR and Easy Pulse (Δ 25,885; 23,590 – 28,181) was significant. No relevant differences were found regarding secondary outcomes. Conclusion Mechanical chest compression devices provide a viable option in the alpine setting. For two out of three devices (Corpuls CPR and LUCAS 3) we found adequate quality of CPR. Those devices also maintained a correct placement of the piston even during challenging terrestrial transport. Adequate hands-off-times and correct placement could be achieved even by less trained personnel.

OBJECTIVES Evidence on long-term clinical outcomes considering suture-securing techniques used for surgical aortic valve replacement is still uncertain. METHODS A total of 1405 patients who underwent surgical aortic valve replacement between January 2016 and December 2022 were included and grouped according to the suture-securing technique used (automated titanium fastener versus hand-tied knots). The occurrence of infective endocarditis during follow-up was set as the primary study end-point. As secondary study end-points, stroke, all-cause mortality and a composite outcome of either infective endocarditis, stroke, or all-cause mortality were assessed. RESULTS The automated titanium fastener was used in 829 (59%) patients, whereas the hand-knot tying technique was used in 576 (41%) patients. The multivariable proportional competing risk regression analysis showed a significantly lower risk of infective endocarditis during follow-up in the automated titanium fastener group (adjusted sub-hazard ratio 0.44, 95% confidence interval 0.20–0.94, P  = 0.035). The automated titanium fastener group was not associated with an increased risk of mortality or attaining the composite outcome, respectively (adjusted hazard ratio 0.81, 95% confidence interval 0.60–1.09, P  = 0.169; adjusted hazard ratio 0.82, 95% confidence interval 0.63–1.07, P  = 0.152). This group was not associated with an increased risk of stroke (adjusted sub-hazard ratio 0.82, 95% confidence interval 0.47–1.45, P  = 0.504). Also, a significantly lower rate of early-onset infective endocarditis was observed in the automated titanium fastener group, (0.4% vs 1.4%, P  = 0.032). CONCLUSIONS Suture-securing with an automated titanium fastener device appears to be superior compared to the hand-knot tying technique in terms of lower risk of infective endocarditis. [ABSTRACT FROM AUTHOR]

Phase 3 trials are the mainstay of drug development across medicine but have often not met expectations set by preceding phase 2 studies. A systematic meta-analysis evaluated all randomized controlled, double-blind trials investigating targeted disease-modifying anti-rheumatic drugs in rheumatoid and psoriatic arthritis. Primary outcomes of American College of Rheumatology (ACR) 20 responses were compared by mixed-model logistic regression, including exploration of potential determinants of efficacy overestimation. In rheumatoid arthritis, phase 2 trial outcomes systematically overestimated subsequent phase 3 results (odds ratio comparing ACR20 in phase 2 versus phase 3: 1.39, 95% confidence interval: 1.25-1.57, P < 0.001). Data for psoriatic arthritis trials were similar, but not statistically significant (odds ratio comparing ACR20 in phase 2 versus phase 3: 1.35, 95% confidence interval: 0.94-1.94, P = 0.09). Differences in inclusion criteria largely explained the observed differences in efficacy findings. Our findings have implications for all stakeholders in new therapeutic development and testing, as well as potential ethical implications. A meta-analysis comparing primary efficacy outcomes of phase 2 and phase 3 randomized controlled trials in rheumatoid arthritis and psoriatic arthritis shows that phase 2 studies consistently overestimate the effect sizes anticipated in subsequent phase 3 trials., Author(s): Andreas Kerschbaumer [sup.1] , Josef S. Smolen [sup.1] , Harald Herkner [sup.2] , Tijen Stefanova [sup.1] , Eva Chwala [sup.3] , Daniel Aletaha [sup.1] Author Affiliations: (1) Division of [...]

Purpose: A systematic review and meta-analysis to evaluate the impact of extracorporeal carbon dioxide removal (ECCO2R) on gas exchange and respiratory settings in critically ill adults with respiratory failure. Methods: We conducted a comprehensive database search, including observational studies and randomized controlled trials (RCTs) from January 2000 to March 2022, targeting adult ICU patients undergoing ECCO2R. Primary outcomes were changes in gas exchange and ventilator settings 24 h after ECCO2R initiation, estimated as mean of differences, or proportions for adverse events (AEs); with subgroup analyses for disease indication and technology. Across RCTs, we assessed mortality, length of stay, ventilation days, and AEs as mean differences or odds ratios. Results: A total of 49 studies encompassing 1672 patients were included. ECCO2R was associated with a significant decrease in PaCO2, plateau pressure, and tidal volume and an increase in pH across all patient groups, at an overall 19% adverse event rate. In ARDS and lung transplant patients, the PaO2/FiO2 ratio increased significantly while ventilator settings were variable. "Higher extraction" systems reduced PaCO2 and respiratory rate more efficiently. The three available RCTs did not demonstrate an effect on mortality, but a significantly longer ICU and hospital stay associated with ECCO2R. Conclusions: ECCO2R effectively reduces PaCO2 and acidosis allowing for less invasive ventilation. "Higher extraction" systems may be more efficient to achieve this goal. However, as RCTs have not shown a mortality benefit but increase AEs, ECCO2R's effects on clinical outcome remain unclear. Future studies should target patient groups that may benefit from ECCO2R. PROSPERO Registration No: CRD 42020154110 (on January 24, 2021). [ABSTRACT FROM AUTHOR]