National early warning score at Emergency Department triage may allow earlier identification of patients with severe sepsis and septic shock: a retrospective observational study.

INTRODUCTION: Severe sepsis and septic shock (SS) are time-critical medical emergencies that affect millions of people in the world. Earlier administration of antibiotics has been shown to reduce mortality from SS; however, the initiation of early resuscitation requires recognition that a patient may have sepsis. Early warning scores (EWS) are broadly used to detect patient deterioration, but to date have not been evaluated to detect patients at risk for SS. The purpose of our study was to look at the relationship between the initial national EWS (NEWS) in the emergency department (ED) and the diagnosis of SS. METHODS: We performed a retrospective, single-centre, observational study in the ED of an urban university hospital with an annual attendance of 140,000 patients. We aimed to include 500 consecutive non-trauma adult patients presenting to the ED with Manchester Triage System (MTS) category 1-3. The final diagnosis was taken from either the ED medical records or the hospital discharge summary. For all NEWS, the sensitivity and specificity to detect patients with SS was calculated. RESULTS: A total of 500 patients were included, 27 patients (5.4%) met the criteria for SS. The area under the curve (AUC) for NEWS to identify patient at risk for SS is 0.89 (95% CI 0.84 to 0.94). A NEWS of 3 or more at ED triage has a sensitivity of 92.6% (95% CI 74.2% to 98.7%) and a specificity of 77% (95% CI 72.8% to 80.6%) to detect patients at risk for SS at ED triage. CONCLUSIONS: A NEWS of 3 or more at ED triage may be the trigger to systematically screen the patient for SS, which may ultimately lead to early recognition and treatment.

Effect of once weekly pulmonary rehabilitation on exercise tolerance in patients with chronic lung disease.

BACKGROUND: Pulmonary rehabilitation (PR) programmes improve exercise tolerance and reduce breathlessness in patients with chronic obstructive pulmonary disease. AIM: A retrospective audit was undertaken to assess the effectiveness of the pulmonary rehabilitation programme at Belfast City Hospital (BCH). METHODS: Data from 74 patients who completed a six-week PR programme were reviewed. Exercise tolerance was assessed by the shuttle walk test (SWT), and breathlessness by the BORG scale. Paired t-tests were used for within group analysis. RESULTS: The mean (SD) exercise tolerance assessed by the SWT improved significantly as did duration of individual exercises. Patients were able to exercise more without increasing their breathlessness or heart rate. CONCLUSIONS: This paper highlights the effect of PR on exercise tolerance and breathlessness in patients with chronic lung disease. The results compare favourably with published literature where more frequently supervised exercise sessions were provided.

Comparing the impact of homosexual and heterosexual parents on children: meta-analysis of existing research.

Courts determine custody and visitation on the basis of the "best interests of the child." Current judicial rulings in some jurisdictions reflect a bias against awarding custody or granting visitation rights to homosexual parents, favoring the heterosexual parent or heterosexual relative of the child(ren). Should the sexual orientation of the parent play a part in the determination of custody or visitation in order to protect the child? This meta-analysis summarizes the available quantitative literature comparing the impact of heterosexual and homosexual parents, using a variety of measures, on the child(ren). The analyses examine parenting practices, the emotional well-being of the child, and the sexual orientation of the child. The results demonstrate no differences on any measures between the heterosexual and homosexual parents regarding parenting styles, emotional adjustment, and sexual orientation of the child(ren). In other words, the data fail to support the continuation of a bias against homosexual parents by any court.