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BackgroundCardiovascular disease is the leading cause of death worldwide. Early recognition, diagnosis, and reperfusion are the key elements of treatment for ST-segment elevation myocardial infarction. The absence of a prehospital 12-lead electrocardiogram (P12ECG) can cause definitive treatment delay and repeated transfer. Although guidelines highly recommend the measurement and transmission of P12ECG data, P12ECG use has not been widely established. ObjectiveThe aim of this study was to verify the time-efficiency and feasibility of the use of a patchy-type 12-lead ECG measuring and transmitting device (P-ECG) by an emergency medical technician (EMT) in an ambulance during patient transport. MethodsThis was a simulation-based prospective randomized crossover-controlled study that included EMTs. The participants were randomly assigned to one of two groups. Group A began the experiment with a conventional 12-lead ECG (C-ECG) device and then switched to the intervention device (P-ECG), whereas group B began the experiment with the P-ECG and then switched to the C-ECG. All simulations were performed inside an ambulance driving at 30 km/h. The time interval was measured from the beginning of ECG application to completion of sending the results. After the simulation, participants were administered the System Usability Scale questionnaire about usability of the P-ECG. ResultsA total of 18 EMTs were recruited for this study with a median age of 35 years. The overall interval time for the C-ECG was 254 seconds (IQR 247-270), whereas the overall interval time for the P-ECG was 130 seconds (IQR 112-150), with a significant difference (P

BackgroundThe task of monitoring and managing the entire emergency department (ED) is becoming more important due to increasing pressure on the ED. Recently, dashboards have received the spotlight as health information technology to support these tasks. ObjectiveThis study aimed to describe the development of a real-time autonomous dashboard for the ED and to evaluate perspectives of clinical staff on its usability. MethodsWe developed a dashboard based on three principles—“anytime, anywhere, at a glance;” “minimal interruption to workflow;” and “protect patient privacy”—and 3 design features—“geographical layout,” “patient-level alert,” and “real-time summary data.” Items to evaluate the dashboard were selected based on the throughput factor of the conceptual model of ED crowding. Moreover, ED physicians and nurses were surveyed using the system usability scale (SUS) and situation awareness index as well as a questionnaire we created on the basis of the construct of the Situation Awareness Rating Technique. ResultsThe first version of the ED dashboard was successfully launched in 2013, and it has undergone 3 major revisions since then because of geographical changes in ED and modifications to improve usability. A total of 52 ED staff members participated in the survey. The average SUS score of the dashboard was 67.6 points, which indicates “OK-to-Good” usability. The participants also reported that the dashboard provided efficient “concentration support” (4.15 points), “complexity representation” (4.02 points), “variability representation” (3.96 points), “information quality” (3.94 points), and “familiarity” (3.94 points). However, the “division of attention” was rated at 2.25 points. ConclusionsWe developed a real-time autonomous ED dashboard and successfully used it for 5 years with good evaluation from users.

Introduction: In this study we aimed to investigate the prognostic accuracy for predicting in-hospital mortality using respiratory Sequential Organ Failure Assessment (SOFA) scores by the conventional method of missing-value imputation with normal partial pressure of oxygen (PaO2)- and oxygen saturation (SpO2)-based estimation methods.Methods: This was a single-center, retrospective cohort study of patients with suspected infection in the emergency department. The primary outcome was in-hospital mortality. We compared the area under the receiver operating characteristics curve (AUROC) and calibration results of the conventional method (normal value imputation for missing PaO2) and six SpO2-based methods: using methods A, B, PaO2 is estimated by dividing SpO2 by a scale; with methods C and D, PaO2 was estimated by a mathematical model from a previous study; with methods E, F, respiratory SOFA scores was estimated by SpO2 thresholds and respiratory support use; with methods A, C, E are SpO2-based estimation for all PaO2 values, while methods B, D, F use such estimation only for missing PaO2 values.Results: Among the 15,119 patients included in the study, the in-hospital mortality rate was 4.9%. The missing PaO2was 56.0%. The calibration plots were similar among all methods. Each method yielded AUROCs that ranged from 0.735–0.772. The AUROC for the conventional method was 0.755 (95%confidence interval [CI] 0.736–0.773). The AUROC for method C (0.772; 95% CI 0.754–0.790) was higher than that of the conventional method, which was an SpO2-based estimation for all PaO2 values. The AUROC for total SOFA score from method E (0.815; 95% CI 0.800–0.831) was higher than that from the conventional method (0.806; 95% CI 0.790–0.822), in which respiratory SOFA was calculated by the predefined SpO2 cut-offs and oxygen support.Conclusion: In non-ICU settings, respiratory SOFA scores estimated by SpO2 might have acceptable prognostic accuracy for predicting in-hospital mortality. Our results suggest that SpO2-based respiratory SOFA score calculation might be an alternative for evaluating respiratory organ failure in the ED and clinical research settings.

We developed a modified cardiovascular (CV) Sequential Organ Failure Assessment (SOFA) score using an emergency department-based cohort data, incorporating norepinephrine equivalent dose and lactate to represent current clinical practice patterns for vasopressor utilization and the diagnostic significance of lactate, respectively. In this study, we sought to validate this modified CV-SOFA score in intensive care unit patients with suspected infection using the Marketplace for Medical Information in Intensive Care (MIMIC)-IV database. This was a retrospective study that utilized data from the MIMIC-IV database. Modified CV/total SOFA score and original CV/total SOFA score were compared for predicting in-hospital mortality. Area under the receiver operating characteristic curve (AUROC) and the calibration curve were employed to evaluate discrimination and calibration, respectively. A total of 29,618 ICU patients with suspected infections was analyzed. The in-hospital mortality rate was 12.4% (n = 3,675). Modified CV-SOFA score (AUROC 0.667; 95% confidence interval [CI] 0.657–0.677 vs. 0.663; 95% CI 0.654–0.673; p = 0.283) and modified total SOFA score (0.784 [95% CI 0.776–0.793] vs. 0.785 [95% CI 0.777–0.793], p = 0.490) did not differ significantly from the original CV-SOFA score and original total SOFA score, respectively. The calibration curve of the original CV-SOFA score was inferior to that of the modified CV-SOFA score. The modified CV- and total SOFA scores were better calibrated than the original CV- and total SOFA scores, but their discriminative performance was not significantly different. Further studies of the modified CV-SOFA score in different settings and populations are required to assess the generalizability of this score. [ABSTRACT FROM AUTHOR]

Background: Effective communication between patients and healthcare providers in the emergency department (ED) is challenging due to the dynamic nature of the ED environment. This study aimed to trial a chat service enabling patients in the ED and their family members to ask questions freely, exploring the service's feasibility and user experience. Objectives: To identify the types of needs and inquiries from patients and family members in the ED that could be addressed through the chat service and to assess the user experience of the service. Methods: We enrolled patients and family members aged over 19 years in the ED, providing the chat service for up to 4 h per ED visit. Trained research nurses followed specific guidelines to respond to messages from the participants. After participation, participants were required to complete a survey. Those who agreed also participated in interviews to provide insights on their experiences with the ED chat service. Results: A total of 40 participants (20 patients and 20 family members) sent 305 messages (72 by patients and 233 by family members), with patients sending an average of 3.6 messages and family members 11.7. Research nurses resolved 41.4% of patient inquiries and 70.9% of family member inquiries without further healthcare provider involvement. High usability was reported, with positive feedback on communication with healthcare workers, information accessibility, and emotional support. Conclusions: The ED chat service was found to be feasible and led to positive user experiences for both patients and their family members. [ABSTRACT FROM AUTHOR]

Microplastics (MPs) are contaminants of global concern, especially considering their widespread use. However, a systematic and comprehensive analytical procedure is not yet standardized for MPs in soils. Most of the methods have primarily been modified from existing marine research without acknowledging the inherent complexities of sampling and analyzing MPs in soil ecosystems. This review critically evaluates existing sampling, separation, identification, and quantification methods for MPs in soils and proposes a comprehensive methodology comprising eight phases for analyzing MPs in soils. We emphasize the importance of the soil sampling planning phase before conducting soil MP analyses and the necessity to assess physicochemical properties. Novel methods should be developed, and existing analytical approaches must be adequately modified and refined, given the heterogeneity of soils. Soil MP analyses should be coordinated globally by utilizing existing networks and infrastructure for soils, crops, and food security research and biomonitoring in conjunction with environmental and material sciences. This critical review may be an effective model for developing global standards for MP analysis in soils, focusing on the new regulations initiated by the UNEP to develop a legally binding agreement on plastic pollution. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the effects of early combination therapy with intravenous vitamin C and thiamine on recovery from organ failure in patients with septic shock. Methods The ascorbic acid and thiamine effect in septic shock (ATESS) trial was a multi-centre, double-blind, randomized, controlled trial conducted in four academic emergency departments, enrolling adult patients with septic shock from December 2018 through January 2020. Patients were randomly assigned in a 1:1 ratio to either the treatment group [intravenous vitamin C (50 mg/kg, maximum single dose 3 g) and thiamine (200 mg) administration every 12 h for a total of 48 h] or the placebo group (identical volume of 0.9% saline with the same protocol). The primary outcome was [DELTA] Sequential Organ Failure Assessment (SOFA) score (SOFA score at enrolment-SOFA score after 72 h). Eighteen secondary outcomes were predefined, including shock reversal and 28-day mortality. Results A total of 111 patients were enrolled, of which 53 were assigned to the treatment group and 58 were assigned to the placebo group. There was no significant difference in [DELTA]SOFA scores between the treatment group and the placebo group [3, interquartile range (IQR) - 1 to 5 vs. 3, IQR 0-4, respectively, p = 0.96]. Predefined secondary outcomes were also not significantly different between the groups. Conclusion In this study, vitamin C and thiamine administration in the early phase of septic shock did not improve organ function compared with placebo, despite improvements in vitamin C and thiamine levels., Author(s): Sung Yeon Hwang [sup.1], Seung Mok Ryoo [sup.2], Jong Eun Park [sup.1], You Hwan Jo [sup.3] [sup.4], Dong-Hyun Jang [sup.3] [sup.4], Gil Joon Suh [sup.4], Taegyun Kim [sup.4], Youn-Jung [...]

Despite that biodegradable plastics are perceived as environmentally friendly, there is a lack of comprehensive understanding of their fate in soil. Current Environmental, Social, and Governance (ESG) frameworks, along with new UNEP regulations on plastic pollution, necessitate scientific information on plastic degradation in soils for developing sustainable biodegradable plastics. In this study, we examined the degradation rates of two biodegradable plastics, poly(butylene adipate‐co‐terephthalate) (PBAT) and poly(lactic acid) (PLA), in a laboratory microcosm experiment using uncontaminated soil, with PBAT or PLA added at 8.3% (w/w). Our aim was to further understand the impact of these plastic types on soil properties and microbial communities under different incubation temperatures. Both PBAT and PLA treatments elevated cumulative CO2 efflux compared with the control soil incubated at 25 and 58°C. After 33 weeks, 9.2% and 6.1% of the added PBAT and PLA degraded, respectively, at 58°C, while only 2.3% of PBAT and 1.7% of PLA degraded at 25°C, implying slower degradation rates of PBAT and PLA under the lower temperature. Degradation at 58°C increased total soil carbon by 0.6%, 1.9%, and 4.3% for Control, PBAT, and PLA, respectively, and soil electrical conductivity by 0.17, 0.33, and 2.38 dS m−1, respectively, but decreased soil pH. Microbial diversity and richness decreased under thermophilic conditions at 58°C compared with that at 25°C. We conclude that the degradation of PBAT and PLA varies with environmental condition, and influences soil properties. [ABSTRACT FROM AUTHOR]