A Statistical Model for Early Recognition of Patients Requiring Transfer to Palliative Care (ERPAC).

OBJECTIVE: To develop a scoring system to identify patients at an early stage who will need palliative care during intensive care follow-up. STUDY DESIGN: Analytical study. PLACE AND DURATION OF STUDY: Ankara City Hospital, Neurology and Orthopaedics Hospital, General Intensive Care Unit, Ankara, Turkiye, from June 2019 to March 2020. METHODOLOGY: Intensive care patients were enrolled and divided into palliative care transfer (p1) and nontransfer groups (p2). The predicted logit value / probality score was calculated and a scoring system was developed, using the formula value, [logit= -3.275 + 0.194 (days of hospitalisation) - 0.345 (SOFAmax) +1.659 (ward admission) + 2.08 (cancer)]. RESULTS: One hundred and thirty five patients were analysed. Sixty-eight (50.4%) were males. The mean age was 67.2 ± 17.2 years. Length of hospital stay (p<0.001), highest sequential organ failure score (SOFAmax, p<0.001), previous hospitalisation (p=0.015), and cancer history (p=0.009) affect the need for palliative care significantly.  Predicted probability = epredicted togit / 1+epredicted logit If predicted probabilty >0.5, patient was candidate for palliative care transfer. CONCLUSION:  Every intensive care unit can calculate its own logit value and represent ERPAC score. ERPAC scores can predict which patients will be transferred to palliative care. Predictedlogit value will help to recognise which patients will need palliative care at an early stage. KEY WORDS: Palliative care, Scoring, Intensive care.

An investigation of clinical characteristics and antimicrobial agent susceptibility patterns in clinical Comamonas testosteroni isolates: An increasingly prevalent nosocomial pathogen.

BACKGROUND: Comamonas testosteroni is a gram-negative bacillus, known before 1987 as Pseudomonas testosteroni. Although considered as a rare pathogen, its frequency has been increasing. Data regarding its antibiotic susceptibility are insufficient. To date, forty-four cases have been reported in the literature. In this study, we identified the C. testosteroni infections observed in our hospital and evaluated their antimicrobial agent susceptibility patterns compared with cases reported in the literature. METHODS: For the purposes of the present study, patients admitted to hospital between November 2019 and December 2020 were screened. Those with clinical and laboratory signs of infection with positive C. testosteroni growth in culture were enrolled. Clinical isolates obtained from the samples processed in accordance with standard microbiological examination procedures in our laboratory were defined by MALDI-TOF mass spectrometry with 99.9% probability as C. testosteroni. RESULTS: C testosteroni infection was detected between November 2019 and December 2020 in eight patients in our hospital. Six of them had a bloodstream infection (BSI), one had pneumonia, and one had urinary tract infection due to C. testosteroni. Coexistence of COVID-19 was detected in four patients. Six out of the eight cases with BSI had hospital-acquired infection and all of the infections were healthcare-associated. When antimicrobial agent susceptibility results reported in the literature were evaluated in combination with the current results, ceftazidime and meropenem were found to be the most susceptible agents (96.1% and 80%, respectively). CONCLUSIONS: The frequency of nosocomial C. testosteroni infections and resistance to antimicrobial agents are gradually increasing. While resistance to carbapenems is on the upswing, third-generation cephalosporins are still seen as suitable treatment options.

Do not invade, just support.

BACKGROUND: Since the first attempts for ventilation, there have been significant changes in terms of the size of devices, ventilation techniques, and technology. In time, invasive methods and huge devices were replaced by non-invasive methods and small and portable devices. Increased use of non-invasive methods was followed by enrichment of literature on the topic. This study aimed to determine the evolution of non-invasive ventilation (NIV) literature and predict future trends. MATERIALS AND METHODS: We used the Web of Science database for search. To include all papers, we searched multiple keywords, including "non-invasive ventilation, non-invasive positive pressure, continuous positive airway pressure, CPAP, NIV." All articles that meet the criteria published in the respiratory system, critical care medicine, anesthesiology, and emergency medicine fields during 1975-2020 were determined. RESULTS: We made bibliometric analyses of 2847 original articles. However, the limited number of articles in the first years, published by year, exceeded a hundred with the new millennium and continues to increase. We predict that 233 and 334 papers will be published in 2021-2025, respectively. Most active countries were United States of America (576, 20.2 %), France (395, 13.8 %), Italy (293, 10.2 %). The most used keywords in NIV papers are non-invasive ventilation, continuous positive airway pressure and obstructive sleep apnea. CONCLUSION: NIV technology and new devices are developing day by day. In addition, new areas of use have been defined by doctors. All these bring about new and different studies on NIV. We believe the present study that summarized the history and development of NIV literature will guide the authors who want to study this area (Tab. 4, Fig. 8, Ref. 19).