Evaluating the performance of the National Early Warning Score in different diagnostic groups.

BACKGROUND: The National Early Warning Score (NEWS) is used in hospitals across the UK to detect deterioration of patients within care pathways. It is used for most patients, but there are relatively few studies validating its performance in groups of patients with specific conditions. METHODS: The performance of NEWS was evaluated against 36 other Early Warning Scores, in 123 patient groups, through use of the area under the receiver operating characteristic (AUROC) curve technique, to compare the abilities of each Early Warning Score to discriminate an outcome within 24hrs of vital sign recording. Outcomes evaluated were death, ICU admission, or a combined outcome of either death or ICU admission within 24 hours of an observation set. RESULTS: The National Early Warning Score 2 performs either best or joint best within 120 of the 123 patient groups evaluated and is only outperformed in prediction of unanticipated ICU admission. When outperformed by other Early Warning Scores in the remaining 3 patient groups, the performance difference was marginal. CONCLUSIONS: Consistently high performance indicates that NEWS is a suitable early warning score to use for all diagnostic groups considered by this analysis, and patients are not disadvantaged through use of NEWS in comparison to any of the other evaluated Early Warning Scores.

Solvent Effect on Electrochemical CO2 Reduction Reaction on Nanostructured Copper Electrodes.

The electrochemical reduction of CO2 (CO2RR) is a sustainable alternative for producing fuels and chemicals, although the production of highly desired hydrocarbons is still a challenge due to the higher overpotential requirement in combination with the competitive hydrogen evolution reaction (HER). Tailoring the electrolyte composition is a possible strategy to favor the CO2RR over the HER. In this work we studied the solvent effect on the CO2RR on a nanostructured Cu electrode in acetonitrile solvent with different amounts of water. Similar to what has been observed for aqueous media, our online gas chromatography results showed that CO2RR in acetonitrile solvent is also structure-dependent, since nanocube-covered copper (CuNC) was the only surface (in comparison to polycrystalline Cu) capable of producing a detectable amount of ethylene (10% FE), provided there is enough water present in the electrolyte (>500 mM). In situ Fourier Transform Infrared (FTIR) spectroscopy showed that in acetonitrile solvent the presence of CO2 strongly inhibits HER by driving away water from the interface. CO is by far the main product of CO2RR in acetonitrile (>85% Faradaic efficiency), but adsorbed CO is not detected. This suggests that in acetonitrile media CO adsorption is inhibited compared to aqueous media. Remarkably, the addition of water to acetonitrile has little quantitative and almost no qualitative effect on the activity and selectivity of the CO2RR. This indicates that water is not strongly involved in the rate-determining step of the CO2RR in acetonitrile. Only at the highest water concentrations and at the CuNC surface, the CO coverage becomes high enough that a small amount of C2+ product is formed.

Impact of the coronavirus pandemic on the patterns of vital signs recording and staff compliance with expected monitoring schedules on general wards.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) placed increased burdens on National Health Service hospitals and necessitated significant adjustments to their structures and processes. This research investigated if and how these changes affected the patterns of vital sign recording and staff compliance with expected monitoring schedules on general wards. METHODS: We compared the pattern of vital signs and early warning score (EWS) data collected from admissions to a single hospital during the initial phase of the COVID-19 pandemic with those in three control periods from 2018, 2019 and 2020. Main outcome measures were weekly and monthly hospital admissions; daily and hourly patterns of recorded vital signs and EWS values; time to next observation and; proportions of 'on time', 'late' and 'missed' vital signs observations sets. RESULTS: There were large falls in admissions at the beginning of the COVID-19 era. Admissions were older, more unwell on admission and throughout their stay, more often required supplementary oxygen, spent longer in hospital and had a higher in-hospital mortality compared to one or more of the control periods. More daily observation sets were performed during the COVID-19 era than in the control periods. However, there was no clear evidence that COVID-19 affected the pattern of vital signs collection across the 24-h period or the week. CONCLUSIONS: The increased burdens of the COVID-19 pandemic, and the alterations in healthcare structures and processes necessary to respond to it, did not adversely affect the hospitals' ability to monitor patients under its care and to comply with expected monitoring schedules.

The performance of the National Early Warning Score and National Early Warning Score 2 in hospitalised patients infected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

INTRODUCTION: Since the introduction of the UK's National Early Warning Score (NEWS) and its modification, NEWS2, coronavirus disease 2019 (COVID-19), has caused a worldwide pandemic. NEWS and NEWS2 have good predictive abilities in patients with other infections and sepsis, however there is little evidence of their performance in COVID-19. METHODS: Using receiver-operating characteristics analyses, we used the area under the receiver operating characteristic (AUROC) curve to evaluate the performance of NEWS or NEWS2 to discriminate the combined outcome of either death or intensive care unit (ICU) admission within 24 h of a vital sign set in five cohorts (COVID-19 POSITIVE, n = 405; COVID-19 NOT DETECTED, n = 1716; COVID-19 NOT TESTED, n = 2686; CONTROL 2018, n = 6273; CONTROL 2019, n = 6523). RESULTS: The AUROC values for NEWS or NEWS2 for the combined outcome were: COVID-19 POSITIVE, 0.882 (0.868-0.895); COVID-19 NOT DETECTED, 0.875 (0.861-0.89); COVID-19 NOT TESTED, 0.876 (0.85-0.902); CONTROL 2018, 0.894 (0.884-0.904); CONTROL 2019, 0.842 (0.829-0.855). CONCLUSIONS: The finding that NEWS or NEWS2 performance was good and similar in all five cohorts (range = 0.842-0.894) suggests that amendments to NEWS or NEWS2, such as the addition of new covariates or the need to change the weighting of existing parameters, are unnecessary when evaluating patients with COVID-19. Our results support the national and international recommendations for the use of NEWS or NEWS2 for the assessment of acute-illness severity in patients with COVID-19.