BACKGROUND: The initial rhythm is a known predictor of survival in extracorporeal cardiopulmonary resuscitation (ECPR) patients. However, the effect of the rhythm at hospital admission on outcomes in these patients is less clear. METHODS: This observational, single-center study assessed the influence of the rhythm at hospital admission on 30-day survival and neurological outcomes at discharge in patients who underwent ECPR for out-of-hospital cardiac arrest (OHCA). RESULTS: Between January 2012 and December 2023, 1,219 OHCA patients were admitted, and 210 received ECPR. Of these, 196 patients were analyzed. The average age was 52.9 years (±13), with 80.6 % male. The median time to ECPR initiation was 61 min (IQR 54-72). Patients with ventricular fibrillation as both the initial and admission rhythm had the highest 30-day survival rate (52 %: 35/67), while those with asystole in both instances had the lowest (6 %: 1/17, log-rank p < 0.00001). After adjusting for age, sex, initial rhythm, resuscitation time, location, bystander, and witnessed status, asystole at admission was linked to higher 30-day mortality (OR 4.03, 95 % CI 1.49-12.38, p = 0.009) and worse neurological outcomes (Cerebral Performance Category 3-5) at discharge (OR 4.61, 95 % CI 1.49-17.62, p = 0.013). CONCLUSIONS: The rhythm at hospital admission affects ECPR outcomes. Patients presenting with and maintaining ventricular fibrillation have a higher chance of favorable neurological survival, whereas those presenting with or converting to asystole have poor outcomes. The rhythm at hospital admission appears to be a valuable criterion for deciding on ECPR initiation.

• Keywords
• Cardiac arrest, Cardiac rhythm, Cardiopulmonary resuscitation, Extracorporeal cardiopulmonary resuscitation, Extracorporeal membrane oxygenation, Heart arrest, Heart rhythm, Rhythm conversion,
• MeSH
• Adult MeSH
• Ventricular Fibrillation therapy   mortality   complications   MeSH
• Hospitalization * statistics & numerical data   MeSH
• Cardiopulmonary Resuscitation methods   statistics & numerical data   MeSH
• Middle Aged MeSH
• Humans MeSH
• Extracorporeal Membrane Oxygenation * methods   statistics & numerical data   MeSH
• Survival Rate trends   MeSH
• Brain * physiopathology   MeSH
• Patient Admission * statistics & numerical data   MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Heart Rate * physiology   MeSH
• Out-of-Hospital Cardiac Arrest therapy   mortality   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Observational Study MeSH

PURPOSE: To describe temporal trends in inpatient care use for adult mental disorders in Czechia from 1994 until 2015. METHODS: Data from the nationwide register of inpatient care use and yearly census data were used to calculate (a) yearly admissions rates, (b) median length of stay, and (c) standardized inpatient-years for adult mental disorders (ICD-10 codes F0-F6] or G30). Segmented regressions were used to analyze age- and sex-specific temporal trends. RESULTS: Admission rates were increasing in adults (average annual percent change = 0.51; 95% confidence interval = 0.16 to 0.86 for females and 1.01; 0.63 to 1.40 for males) and adolescents and emerging adults (3.27; 2.57 to 3.97 for females and 2.98; 2.08 to 3.88 for males), whereas in seniors, the trend was stable (1.22; -0.31 to 2.73 for females and 1.35; -0.30 to 2.98 for males). The median length of stay for studied mental disorders decreased across all age and sex strata except for a stable trend in male adolescents and emerging adults (-0.96; -2.02 to 0.10). Standardized inpatient-years were decreasing in adults of both sexes (-0.85; -1.42 to -0.28 for females and -0.87; -1.19 to -0.56 for males), increasing in female adolescents and emerging adults (0.95; 0.42 to 1.47), and stable in the remaining strata. CONCLUSION: Psychiatric hospital admissions were increasing or stable coupled with considerable reductions in median length of stay, suggesting that inpatient episodes for adult mental disorders have become more frequent and shorter over time. The overall psychiatric inpatient care use was decreasing or stable in adults and seniors, potentially implying a gradual shift away from hospital-based care.

• Keywords
• Central and Eastern Europe, Common mental disorders, Healthcare services, Hospital-based care, National data, Psychiatric hospitalization, Schizophrenia, Substance use disorders, Temporal trends,
• MeSH
• Length of Stay * statistics & numerical data   MeSH
• Adult MeSH
• Mental Disorders * therapy   epidemiology   MeSH
• Hospitalization * statistics & numerical data   trends   MeSH
• Inpatients * statistics & numerical data   MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Patient Admission statistics & numerical data   trends   MeSH
• Registries * MeSH
• Aged MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic epidemiology   MeSH

BACKGROUND: The present survey aims to describe the intensive cardiac care unit organization and admission policies in Europe. METHODS: A total of 228 hospitals (61% academic) from 27 countries participated in this survey. In addition to the organizational aspects of the intensive cardiac care units, including classification of the intensive cardiac care unit levels, data on the admission diagnoses were gathered from consecutive patients who were admitted during a two-day period. Admission policies were evaluated by comparing illness severity with the intensive cardiac care unit level. Gross national income was used to differentiate high-income countries (n=13) from middle-income countries (n=14). RESULTS: A total of 98% of the hospitals had an intensive cardiac care unit: 70% had a level 1 intensive cardiac care unit, 76% had a level 2 intensive cardiac care unit, 51% had a level 3 intensive cardiac care unit, and 60% of the hospitals had more than one intensive cardiac care unit level. High-income countries tended to have more level 3 intensive cardiac care units than middle-income countries (55% versus 41%, p=0.07). A total of 5159 admissions were scored on illness severity: 63% were low severity, 24% were intermediate severity, and 12% were high severity. Patients with low illness severity were predominantly admitted to level 1 intensive cardiac care units, whereas patients with high illness severity were predominantly admitted to level 2 and 3 intensive cardiac care units. A policy mismatch was observed in 12% of the patients; some patients with high illness severity were admitted to level 1 intensive cardiac care units, which occurred more often in middle-income countries, whereas some patients with low illness severity were admitted to level 3 intensive cardiac care units, which occurred more frequently in high-income countries. CONCLUSION: More than one-third of the admitted patients were considered intermediate or high risk. Although patients with higher illness severity were mostly admitted to high-level intensive cardiac care units, an admission policy mismatch was observed in 12% of the patients; this mismatch was partly related to insufficient logistic intensive cardiac care unit capacity.

• Keywords
• Intensive cardiac care unit, acute cardiovascular care, admission policy, organization,
• MeSH
• Intensive Care Units organization & administration   MeSH
• Humans MeSH
• Morbidity trends   MeSH
• Heart Diseases epidemiology   therapy   MeSH
• Patient Admission statistics & numerical data   MeSH
• Surveys and Questionnaires MeSH
• Risk Factors MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Geographicals
• Europe epidemiology   MeSH

The World Health Organization declared COVID-19, the infectious disease caused by the coronavirus SARS-CoV-2, a pandemic on March 12, 2020. COVID-19 is causing massive health problems and economic suffering around the world. The European Association for the Study of Obesity (EASO) promptly recognised the impact that the outbreak could have on people with obesity. On one side, emerging data suggest that obesity represents a risk factor for a more serious and complicated course of COVID-19 in adults. On the other side, the health emergency caused by the outbreak diverts attention from the prevention and care of non-communicable chronic diseases to communicable diseases. This might be particularly true for obesity, a chronic and relapsing disease frequently neglected and linked to significant bias and stigmatization. The Obesity Management Task Force (OMTF) of EASO contributes in this paper to highlighting the key aspects of these two sides of the coin and suggests some specific actions.

• Keywords
• Barrier to treatment, COVID-19, Obesity, Pandemic, SARS-CoV-2,
• MeSH
• Betacoronavirus * MeSH
• COVID-19 MeSH
• Adult MeSH
• Coronavirus Infections epidemiology   transmission   MeSH
• Middle Aged MeSH
• Humans MeSH
• Disease Susceptibility MeSH
• Obesity complications   epidemiology   MeSH
• Pandemics statistics & numerical data   MeSH
• Patient Admission statistics & numerical data   MeSH
• Risk Factors MeSH
• SARS-CoV-2 MeSH
• Aged MeSH
• Severity of Illness Index MeSH
• World Health Organization MeSH
• Vaccination MeSH
• Viral Load MeSH
• Pneumonia, Viral epidemiology   transmission   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Aged MeSH
• Publication type
• Journal Article MeSH

Despite the increase in awareness of chronic disease, little is known about whether multimorbidity-defined as two or more coexisting chronic conditions-has had a diminished impact on health in Europe in the past decade. We used multiple cross-sectional data from the Survey of Health, Ageing and Retirement in Europe to estimate changes in the prevalence of multimorbidity and in its association with health outcomes in ten European countries between 2006-07 and 2015. We found that the prevalence of multimorbidity rose from 38.2 percent in 2006-07 to 41.5 percent in 2015. Over the ten-year study period we also found a marginal reduction of the impact of multimorbidity on primary care visits and functional capacity. We did not find a reduction of its impact on hospital admissions and quality of life. Austria, the Czech Republic, Germany, and Spain were the countries that showed the largest reduction in the impact of multimorbidity on health outcomes. Multimorbidity continues to pose challenges for European health care systems, with only marginal improvement on health care use and health outcomes since 2006-07.

• Keywords
• Chronic disease management models, Elderly, Europe, Functional capacity, Healthcare utilisation, Quality of life, multimorbidity,
• MeSH
• Chronic Disease MeSH
• Databases, Factual MeSH
• Geriatric Assessment methods   MeSH
• Risk Assessment MeSH
• Outcome Assessment, Health Care * MeSH
• Quality of Life MeSH
• Medical Assistance economics   statistics & numerical data   MeSH
• Humans MeSH
• Multimorbidity trends   MeSH
• Delivery of Health Care organization & administration   MeSH
• Prevalence MeSH
• Patient Admission statistics & numerical data   MeSH
• Cross-Sectional Studies MeSH
• Retrospective Studies MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Government Programs economics   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Research Support, Non-U.S. Gov't MeSH
• Research Support, N.I.H., Extramural MeSH
• Geographicals
• Czech Republic MeSH
• Europe MeSH
• Germany MeSH
• Spain MeSH

BACKGROUND: Providing the correct level of care for patients with intracerebral hemorrhage (ICH) is crucial, but the level of care needed at initial presentation may not be clear. This study evaluated factors associated with admission to intensive care unit (ICU) level of care. METHODS: This is an observational study of all adult patients admitted to our institution with non-traumatic supratentorial ICH presenting within 72 h of symptom onset between 2009-2012 (derivation cohort) and 2005-2008 (validation cohort). Factors associated with neuroscience ICU admission were identified via logistic regression analysis, from which a triage model was derived, refined, and retrospectively validated. RESULTS: For the derivation cohort, 229 patients were included, of whom 70 patients (31 %) required ICU care. Predictors of neuroscience ICU admission were: younger age [odds ratio (OR) 0.94, 95 % CI 0.91-0.97; p = 0.0004], lower Full Outline of UnResponsiveness (FOUR) score (0.39, 0.28-0.54; p < 0.0001) or Glasgow Coma Scale (GCS) score (0.55, 0.45-0.67; p < 0.0001), and larger ICH volume (1.04, 1.03-1.06; p < 0.0001). The model was further refined with clinician input and the addition of intraventricular hemorrhage (IVH). GCS was chosen for the model rather than the FOUR score as it is more widely used. The proposed triage ICH model utilizes three variables: ICH volume ≥30 cc, GCS score <13, and IVH. The triage ICH model predicted the need for ICU admission with a sensitivity of 94.3 % in the derivation cohort [area under the curve (AUC) = 0.88; p < 0.001] and 97.8 % (AUC = 0.88) in the validation cohort. CONCLUSIONS: Presented are the derivation, refinement, and validation of the triage ICH model. This model requires prospective validation, but may be a useful tool to aid clinicians in determining the appropriate level of care at the time of initial presentation for a patient with a supratentorial ICH.

• Keywords
• Intensive care, Intracerebral hemorrhage, Triage,
• MeSH
• Cerebral Hemorrhage diagnosis   diagnostic imaging   therapy   MeSH
• Glasgow Outcome Scale * MeSH
• Cerebral Intraventricular Hemorrhage diagnosis   therapy   MeSH
• Intensive Care Units statistics & numerical data   MeSH
• Middle Aged MeSH
• Humans MeSH
• Models, Neurological MeSH
• Patient Admission statistics & numerical data   MeSH
• Retrospective Studies MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Triage methods   standards   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Observational Study MeSH

BACKGROUND/OBJECTIVES: After the creation of the moderately severe acute pancreatitis (MSAP) category in the Revised Atlanta Classification in 2012, predictors to identify these patients early have not been identified. The MSAP category includes patients with (peri)pancreatic necrosis, fluid collections, and transient organ failure in the same category. However, these outcomes have not been studied to determine whether they result in similar outcomes to merit inclusion in the same severity. METHODS: Retrospective, review of 514 consecutive, direct admissions for acute pancreatitis from 2010 to 2013. Multivariate logistic regression identified predictors of MSAP. RESULTS: Persistent SIRS was the best prognostic marker of MSAP with AUC 0.72. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for persistent SIRS to predict MSAP are: 55%, 88%, 40%, 93%, and 84%. Patients with necrosis had significantly longer length of stay (LOS) (p = 0.0001) and higher rates of ICU admission (p = 0.02) compared with patients with transient organ failure. Compared to those with acute fluid collections, patients with necrosis had longer LOS (p < 0.0001), higher rates of ICU admission (p = 0.0005), required more interventions (p = 0.001), and demonstrated higher mortality (0.003). DISCUSSION: Moderately severe pancreatitis can be distinguished from mild pancreatitis on the basis of persistent SIRS but cannot be accurately distinguished from severe pancreatitis in the first 48 h (Peri)pancreatic necrosis demonstrates significantly more morbidity compared to the other components of MSAP of fluid collections and transient organ failure.

• Keywords
• Fluid collection, Moderate, Necrotizing pancreatitis, Organ failure,
• MeSH
• Pancreatitis, Acute Necrotizing classification   diagnosis   therapy   MeSH
• Length of Stay MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Multiple Organ Failure etiology   MeSH
• Critical Care statistics & numerical data   MeSH
• Area Under Curve MeSH
• Predictive Value of Tests MeSH
• Patient Admission statistics & numerical data   MeSH
• Prognosis MeSH
• Reproducibility of Results MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Systemic Inflammatory Response Syndrome MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Aim To verify and compare the accuracies of mortality predictions in the Intensive Care Unit (ICU) of the Internal Clinic of Central Military Hospital in Prague, Czech Republic, using model APACHE II and the newer systems of the APACHE IV, SAPS 3 and MPMo III. Methods The data were collected retrospectively between 2011 and 2012, 1000 patients were evaluated. The assessment of the overall accuracy of the mortality predictions was performed using the standardized mortality ratio (SMR), and the calibration was assessed using the Lemeshow-Hosmer "goodness-of-fit" C statistic. Discrimination was evaluated using ROC curves based on calculations of the areas under the curve (AUCs). Results The APACHE II, SAPS 3, and MPMo III systems significantly overestimated the expected mortality, whereas the APACHE IV model led to correct estimations of the overall mortality. The discrimination capabilities of the models assessed according to the constructions of the ROC curves were evaluated as good, only the APACHE II was evaluated as satisfactory. The calibrations of all models were evaluated as unsatisfactory. Conclusion The best mortality estimation for the investigated population sample was provided by the APACHE IV system. The discrimination capabilities of all models for the studied population were satisfactory, but the calibration of all of the systems was unsatisfactory. The conclusions of our study are limited by the relatively small size of the investigated sample and the fact that this study was conducted at only a single site.

• Keywords
• Czech Republic, ROC curve, calibration, health status indicators, humans, intensive care units, models, mortality, prognosis, retrospective studies,
• MeSH
• Intensive Care Units statistics & numerical data   MeSH
• Middle Aged MeSH
• Humans MeSH
• Hospital Mortality * MeSH
• Patient Admission statistics & numerical data   MeSH
• Retrospective Studies MeSH
• ROC Curve MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Severity of Illness Index MeSH
• Models, Theoretical MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Comparative Study MeSH
• Geographicals
• Czech Republic epidemiology   MeSH

OBJECTIVES: The aim of our study was to elucidate the current pattern of acute poisoning among children admitted to a regional University Hospital in the prefecture of Evros in Northern Greece. We also compared the obtained findings with those of two previous studies performed in the same region. METHODS: Demographic and clinical data, management, and outcome of children with acute poisoning were recorded in our region, during the past 5-years (2005-2009, period C) and compared to similar studies carried out in the periods 1985-1989 (period A) and 1995-1999 (period B). RESULTS: Comparison between the three periods showed that in period Athe lower incidence of children's acute poisoning (CAP) was observed. Also this revealed a 20%-reduction in the frequency of poisoning over the past 5-years (period C) compared to period B (p = 0.219), a significant increase in tobacco intoxication over the years (in the order A-C; p < 0.001 for comparisons of periods A and B, and periods B and C), while poisoning from insecticides-pesticides decreased (p < 0.001). The incidence of poisoning via salicylates significantly reduced from 9.7% in period A to 6.2% in period B, and further to 4.7% in period C (p = 0.016), whereas during the same periods poisoning via paracetamol increased from 2.3% to 5.1% and then to 10.4%, respectively (p < 0.001). Atrend toward a higher incidence of suicide attempt via poisoning was found during the three periods (from 3.0% in period A to 4.7% and 6.6%, in periods B and C, respectively; p = 0.049). CONCLUSIONS: The frequency of acute poisoning among children has decreased over the past 5 years. The incidences of poisoning via paracetamol and tobacco, and attempted suicide have increased in recent years. Targeted and continuous educational preventive programs are mandatory.

• MeSH
• Child MeSH
• Incidence MeSH
• Infant MeSH
• Humans MeSH
• Hospitals, University MeSH
• Poisoning epidemiology   MeSH
• Child, Preschool MeSH
• Patient Admission statistics & numerical data   trends   MeSH
• Socioeconomic Factors MeSH
• Outcome and Process Assessment, Health Care statistics & numerical data   trends   MeSH
• Check Tag
• Child MeSH
• Infant MeSH
• Humans MeSH
• Male MeSH
• Child, Preschool MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Greece epidemiology   MeSH

Little information is available on the predicting factors for hospitalisation and mortality in heart failure. The aim of this study was to determine the symptoms and clinical signs at the time of the diagnosis of heart failure that predict hospitalisation within the first month after diagnosis and mortality within the first six months after diagnosis. Data were prospectively collected during a two-year period by a nationwide network of sentinel family practices. All adult patients for whom the first time the diagnosis of heart failure was clinically suspected were registered. One, six and twelve months after the initial diagnosis, the family physicians completed a follow-up form with questions about the final diagnosis, evolution and outcome. In total 557 patients with confirmed heart failure were recorded (median age = 78 years). Hospitalisation within the first month after the diagnosis was best predicted by peripheral oedema (p = 0.001), nocturnal dyspnoea (p = 0.022) and pleural effusion (p = 0.032) at the time of the diagnosis. Six months after the initial diagnosis the mortality was 19% and after 12 months it was 26%. Mortality within the first six months after the diagnosis was best predicted by age (p < 0.001) and pulmonary rales (p = 0.001). Peripheral oedema appeared more among the survivors (p = 0.035). Peripheral oedema, nocturnal dyspnoea and pleural effusion are highly associated with hospitalisation within the first month after diagnosis.

• MeSH
• Time Factors MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Hospitals statistics & numerical data   MeSH
• Prevalence MeSH
• Patient Admission statistics & numerical data   MeSH
• Prospective Studies MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Sentinel Surveillance MeSH
• Heart Failure diagnosis   epidemiology   mortality   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH