Development and validation of a novel poisoning agitation-sedation score for predicting the need for endotracheal intubation and mechanical ventilation in acutely poisoned patients with disturbed consciousness.

BACKGROUND: Accurate assessment of disturbed consciousness level (DCL) is crucial for predicting acutely poisoned patients' outcomes. AIM: Development of a novel Poisoning Agitation-Sedation Score (PASS) to predict the need for endotracheal intubation (ETI) and mechanical ventilation (MV) in acutely poisoned patients with DCL. Validation of the proposed score on a new set of acutely poisoned patients with DCL. METHODS: This study was conducted on 187 acutely poisoned patients with DCL admitted to hospital from June 2020 to November 2021 (Derivation cohort). Patients' demographics, toxicological data, neurological examination, calculation of the Glasgow Coma Scale (GCS), Full Outline of Unresponsiveness (FOUR) score, Richmond Agitation-Sedation Scale (RASS), and outcomes were gathered for developing a new score. The proposed score was externally validated on 100 acutely poisoned patients with DCL (Validation cohort). RESULTS: The PASS assessing sedation consists of FOUR (reflexes and respiration) and GCS (motor) and provides a significantly excellent predictive power (AUC = 0.975) at a cutoff ≤9 with 100% sensitivity and 92.11% specificity for predicting the need for ETI and MV in sedated patients. Additionally, adding RASS (agitation) to the previous model exhibits significantly good predictive power (AUC = 0.893), 90.32% sensitivity, and 73.68% specificity at a cutoff ≤14 for predicting the need for ETI and MV in disturbed consciousness patients with agitation. CONCLUSION: The proposed PASS could be an excellent, valid and feasible tool to predict the need for ETI and MV in acutely poisoned disturbed consciousness patients with or without agitation.

Factors Affecting Sense of Presence in a Virtual Reality Social Environment: A Qualitative Study.

Sense of presence is an important factor influencing the quality of the virtual reality (VR) experience. However, there is limited understanding of what factors affect presence in virtual environments. This study uses a qualitative methodology, specifically thematic analysis, to investigate factors affecting sense of presence in a VR social environment that has been designed for psychological assessment. After experiencing a virtual bar-room that contained interactions with multiple avatars, participants (n = 76) took part in a semistructured interview. Eight key themes and associated subthemes were identified: emotions about self (anxiety, paranoid ideation, and detachment), emotions about others (loneliness, retrospective emotions, and recognition of self), thoughts about self (memories and social judgment), thoughts about others (paranoid ideation and narrative), physiological reactions (anxiety and cybersickness), behavior of avatars (narrative, duration of interaction, and characteristics), interactivity with environment (movement and familiarity), and environmental characteristics (restrictions). Sense of presence was facilitated when the VR elicited genuine cognitive, emotional, and behavioral responses, and when participants created their own narrative about events. Presence decreased when participants experienced diminished agency and experienced physical impediments, such as cybersickness and awareness of apparatus and body movement. Strengths of the study include rich data generated by the qualitative approach and the large sample size. Limitations include lack of follow-up measuring longer-term effects.