Modified Early Warning Score Changes Prior to Cardiac Arrest in General Wards.

PURPOSE: The frequency, extent, time frame, and implications of changes to the modified early warning score (MEWS) in the 24 hours prior to cardiac arrest are not known. Our aim was to determine the prevalence and trends of the MEWS prior to in-hospital cardiac arrest (IHCA) on a ward, and to evaluate the association between changes in the MEWS and in-hospital mortality. METHODS: A total of 501 consecutive adult IHCA patients who were monitored and resuscitated by a medical emergency team on the ward were enrolled in the study between March 2009 and February 2013. The MEWS was calculated at 24 hours (MEWS24), 16 hours (MEWS16), and 8 hours (MEWS8) prior to cardiac arrest. RESULTS: Out of 380 patients, 268 (70.5%) had a return of spontaneous circulation. The survival rate to hospital discharge was 25.8%. When the MEWS was divided into three risk groups (low: ≤2, intermediate: 3-4, high: ≥5), the distribution of the low-risk MEWS group decreased at each time point before cardiac arrest. However, even 8 hours prior to cardiac arrest, 45.3% of patients were still in the low MEWS group. The MEWS was associated with in-hospital mortality at each time point. However, increasing MEWS value from MEWS24 to MEWS8 was not associated with in-hospital mortality [OR 1.24 (0.77-1.97), p = 0.38]. CONCLUSIONS: About half of patients were still in low MEWS group 8 hours prior to cardiac arrest and an increasing MEWS only occurred in 46.8% of patients, suggesting that monitoring the MEWS alone is not enough to predict cardiac arrest.

Phycicola gilvus gen. nov., sp. nov., an actinobacterium isolated from living seaweed.

A Gram-positive, aerobic, non-mycelium-forming actinomycete, designated strain SSWW-21(T), was isolated from a living seaweed sample on the coast of Jeju, Republic of Korea. Cells of the organism were rod-shaped or coccoid depending on culture age. Short rods were observed in young cultures, whereas older cultures predominantly consisted of coccoid cells. Rod-shaped cells were motile by means of flagella, but coccoid cells were non-motile. Budding-like cell division was observed. The temperature and pH for growth were 4-30 degrees C and pH 6.1-10.1. Growth occurred in the presence of up to 2 % NaCl. Phylogenetic analyses showed that the organism formed a distinct clade within the family Microbacteriaceae. Comparative 16S rRNA gene sequence analyses showed that strain SSWW-21(T) was related most closely to the type strains of Okibacterium fritillariae (96.8 % similarity), Leifsonia poae (96.8 %) and Agreia bicolorata (96.6 %). Levels of 16S rRNA gene sequence similarity between the new isolate and members of other genera within the family Microbacteriaceae were in the range 93.1-96.3 %. The cell-wall peptidoglycan of strain SSWW-21(T) was of the B-type (2,4-diaminobutyric acid as the diagnostic diamino acid). The acyl type of the muramic acid was acetyl. The predominant menaquinone was MK-11. The polar lipid profile contained phosphatidylcholine, phosphatidylglycerol, phosphatidylinositol and diphosphatidylglycerol. Mycolic acids were not present. The major cellular fatty acids were saturated branched-chain components (anteiso-C(15 : 0) and anteiso-C(17 : 0)). The G+C content of the DNA was 69.8 mol%. On the basis of the phenotypic and phylogenetic data presented, strain SSWW-21(T) is considered to represent a novel species of a new genus within the family Microbacteriaceae, for which the name Phycicola gilvus gen. nov., sp. nov. is proposed. The type strain of Phycicola gilvus is SSWW-21(T) (=KCTC 19185(T) =DSM 18319(T)).