Severe depression and all-cause and cause-specific mortality in Scotland: 20 year national cohort study.

BACKGROUND: Understanding cause of death in people with depression could inform approaches to reducing premature mortality. AIM: To describe all-cause and cause-specific mortality for people with severe depression in Scotland, by sex, relative to the general population. METHOD: We performed a retrospective cohort study, using psychiatric hospital admission data linked to death data, to identify adults (≥18 years old) with severe depression and ascertain cause-specific deaths, during 2000-2019. We estimated relative all-cause and cause-specific mortality for people with severe depression using standardised mortality ratios (SMRs), stratified by sex using the whole Scottish population as the standard. RESULTS: Of 28 808 people with severe depression, 7903 (27.4%) died during a median follow-up of 8.7 years. All-cause relative mortality was over three times higher than expected (SMR, both sexes combined: 3.26, 95% CI 3.19-3.34). Circulatory disease was the leading cause of death, and, among natural causes of death, excess relative mortality was highest for circulatory diseases (SMR 2.51, 2.40-2.66), respiratory diseases (SMR 3.79, 3.56-4.01) and 'other' causes (SMR 4.10, 3.89-4.30). Among circulatory disease subtypes, excess death was highest for cerebrovascular disease. Both males and females with severe depression had higher all-cause and cause-specific mortality than the general population. Suicide had the highest SMR among both males (SMR 12.44, 95% CI 11.33-13.54) and females (22.86, 95% CI 20.35-25.36). CONCLUSION: People with severe depression have markedly higher all-cause mortality than the general population in Scotland, with relative mortality varying by cause of death. Effective interventions are needed to reduce premature mortality for people with severe depression.

Association between sex and survival after out-of-hospital cardiac arrest: A systematic review and meta-analysis.

The current literature on sex differences in 30-day survival following out-of-hospital cardiac arrest (OHCA) is conflicting, with 3 recent systematic reviews reporting opposing results. To address these contradictions, this systematic literature review and meta-analysis aimed to synthesize the literature on sex differences in survival after OHCA by including only population-based studies and through separate meta-analyses of crude and adjusted effect estimates. MEDLINE and Embase databases were systematically searched from inception to March 23, 2022 to identify observational studies reporting sex-specific 30-day survival or survival until hospital discharge after OHCA. Two meta-analyses were conducted. The first included unadjusted effect estimates of the association between sex and survival (comparing males vs females), whereas the second included effect estimates adjusted for possible mediating and/or confounding variables. The PROSPERO registration number was CRD42021237887, and the search identified 6712 articles. After the screening, 164 potentially relevant articles were identified, of which 26 were included. The pooled estimate for crude effect estimates (odds ratio [OR], 1.42; 95% confidence interval [CI], 1.22-1.66) indicated that males have a higher chance of survival after OHCA than females. However, the pooled estimate for adjusted effect estimates shows no difference in survival after OHCA between males and females (OR, 0.93; 95% CI, 0.84-1.03). Both meta-analyses involved high statistical heterogeneity between studies: crude pooled estimate I2 = 95.7%, adjusted pooled estimate I2 = 91.3%. There does not appear to be a difference in survival between males and females when effect estimates are adjusted for possible confounding and/or mediating variables in non-selected populations.

Incidence, characteristics and outcomes of out-of-hospital cardiac arrests in patients with psychiatric illness: A systematic review.

AIM: To conduct a systematic literature review of the existing evidence on incidence, characteristics and outcomes after out-of-hospital cardiac arrest (OHCA) in patients with psychiatric illness. METHODS: We searched Embase, Medline, PsycINFO and Web of Science using a comprehensive electronic search strategy to identify observational studies reporting on OHCA incidence, characteristics or outcomes by psychiatric illness status. One reviewer screened all titles and abstracts, and a second reviewer screened a random 10%. Two reviewers independently performed data extraction and quality assessment. RESULTS: Our search retrieved 11,380 studies, 10 of which met our inclusion criteria (8 retrospective cohort studies and two nested case-control studies). Three studies focused on depression, whilst seven included various psychiatric conditions. Among patients with an OHCA, those with psychiatric illness (compared to those without) were more likely to have: an arrest in a private location; an unwitnessed arrest; more comorbidities; less bystander cardiopulmonary resuscitation; and an initial non-shockable rhythm. Two studies reported on OHCA incidence proportion and two reported on survival, showing higher risk, but lower survival, in patients with psychiatric illness. CONCLUSION: Psychiatric illness in relation to OHCA incidence and outcomes has rarely been studied and only a handful of studies have reported on OHCA characteristics, highlighting the need for further research in this area. The scant existing literature suggests that psychiatric illness may be associated with higher risks of OHCA, unfavourable characteristics and poorer survival. Future studies should further investigate these links and the role of potential contributory factors such as socioeconomic status and comorbidities.

Perception and Attitude of Medical Staff in the Saudi Red Crescent Authority Toward their Preparedness for Disaster Management and Response.

OBJECTIVE: The Saudi Red Crescent Authority (SRCA) plays a major role in the event of disasters and crisis, as it is the main pre-hospital health-care provider. This study reports on the attitude and perceptions of SRCA medical staff concerning their knowledge of disaster management and response. METHOD: This is a descriptive cross-sectional study performed in Riyadh, Saudi Arabia. An Arabic version of the Disaster Preparedness Evaluation Tool (DPET), a self-administered Likert-scale survey, was used to obtain data from SRCA medical staff to evaluate the current status of disaster preparedness. RESULTS: The population surveyed consisted of 302 participants; 20.9% had participated in a drill exercise or practical application of a regular disaster or emergency plan in their workplaces. Most of participants (85.3%) had incentives to extend their education regarding their role, scope of practice, and skills as medical staff in disaster situations. CONCLUSION: Results indicate a lack of regular disaster drills available to prehospital care providers, although most of them are willing to participate in more training and education programs regarding preparedness for disaster management, especially concerning their role in a disaster situation.

The effect of COVID-19 on the characteristics of adult emergency department visits: A retrospective cohort tertiary hospital experience in Riyadh.

BACKGROUND: On March 2, 2020, Saudi Arabia identified the first positive COVID-19 case. Since then, several aspects of the COVID-19 impact on Emergency Departments (EDs) use have been reported. The objective of this study is to describe the pattern and characteristics of Emergency Department visits during the COVID-19 pandemic period, compared with the same period in the previous year, including the patients' demographic information, acuity level, length of stay, and admission rate. METHODS: Data were collected from King Abdulaziz Medical City in Riyadh, Saudi Arabia. The health records of all the patients who presented at the Emergency Department from January 2019 to September 2020 were retrospectively reviewed. The variations in the patient and the visit characteristics were described for the periods before and during COVID-19. RESULTS: The records of 209,954 patients who presented at the Emergency Department were retrieved. In contrast to 2019, the number of visits during the pandemic period reduced by 23%. A dramatic decrease was observed after the announcement of the first COVID-19 diagnosed case in Saudi Arabia, and subsequently the numbers gradually increased. The patients who presented at the Emergency Department during the pandemic period were slightly older (mean age, 43.1 versus 44.0 years), more likely to be older, more urgent and had a higher admission rate compared to the pre-pandemic period. There was a slight increase in visits during the daytime curfew hours and a decrease during the nighttime. CONCLUSION: We report a considerable decrease in the number of Emergency Department visits. The reduction was higher in non-urgent and less urgent cases. Patients presenting at the Emergency Department during the curfew times were more likely to stay longer in the Emergency Department and more likely to be admitted, compared with the pre-pandemic period.

Comparison of the Effectiveness and Comfort Level of Two Commonly Used Mask Ventilation Techniques in a Model.

BACKGROUND: Mask ventilation is an important rescue airway skill for providing oxygenation and ventilation. Maintaining a good face mask seal is a fundamental factor for successful ventilation. Therefore, the aim of this study was to compare the effectiveness and comfortability of 2 commonly used mask ventilation techniques. METHODS: A randomized crossover study was performed to compare the 2-handed C-E and 2-handed V-E techniques on a simulation model. Respiratory therapists were recruited by convenience sampling to hold the mask during mechanical ventilation with a fixed tidal volume (VT) of 500 mL, a rate of 12 breaths/min and a PEEP of zero were provided. Each participant performed a 2-min ventilation session, with a total of 24 breaths for each technique. For each technique, we recorded the median VT and the number of successful breaths (≥300 mL). Provider comfort was assessed by using a 5-point Likert scale at the end of the 2 techniques. Subgroup analyses were conducted for sex, experience, and height of the participants. RESULTS: Of the 75 respiratory therapists recruited, 74 participants were included in the analysis. There was no statistically significant difference in the median VT between the V-E (417 mL [interquartile range, 396-427] mL) and C-E techniques (410 [interquartile range, 391-423] mL) (P = .82). Approximately 74% of breaths delivered by the C-E technique were effective, whereas only 68% of those delivered by the V-E technique were effective (P < .001). Most of the participants reported that using the 2-handed C-E technique was more comfortable. CONCLUSIONS: In our study, the median VT did not differ significantly between the 2 techniques. However, the C-E technique seemed to be superior to the V-E technique in terms of the number of effectively delivered breaths and comfortability. Further studies are recommended for basic airway management techniques.

The impact of emergency antibiotic administration time on patients with sepsis.

OBJECTIVES: To assess the mortality benefits of timely antibiotic treatment of adults present at the emergency department with sepsis and compare one-hour administration and 3-hour administration starting from the time of triage. METHODS: In this retrospective study, we used secondary data analysis to investigate the utility of the National Early Warning Score as a predictor of mortality in sepsis patients between July 2018 and June 2019, at the Emergency Department, King Saud Medical City, Riyadh, Saudi Arabia. The patients were grouped into 2 based on the time interval from triage to the first antibiotic administration: the immediate group received antibiotics within the first hour, and the early group received antibiotics between one and 3 hours. The primary outcome of interest was in-hospital mortality. RESULTS: Out of 495 septic patients, only 292 patients (mean age of 56.3 ± 23.6 years) met the inclusion criteria. Two hundred fifty (85.6%) patients received antibiotics within one hour of triage (immediate), while 42 (14.4%) patients received antibiotics between one and 3 hours (early). Overall, in-hospital mortality was 31.8%. The mortality rates among patients who received early antibiotic was 31.6% and who received immediate antibiotic was 33.3%, with a p-value of 0.823. CONCLUSION: Our findings did not support immediate antibiotic administration over early administration in patients with sepsis. However, further studies are recommended to investigate the effects of antibiotic timing on the outcome of severe sepsis patients.

Using gel for difficult mask ventilation on the bearded patients: a simulation-based study.

The beard is a well-known cause of difficult mask ventilation due to excessive air leaks. Various techniques have been proposed to overcome this difficulty, such as applying a gel on the mask edge. Our objective was to determine whether the gel technique will improve ventilation and to assess the comfort of the provider. A randomized crossover design was conducted to assess the efficacy of gel in a bearded simulation model. Respiratory therapists (RT) were recruited by convenience sampling to hold the mask using a two-handed technique for a two-minute ventilation session. During the session, the ventilator provided a fixed Tidal Volume (TV) of 550 mL and a respiratory rate of 12 per minute, and the simulated model measured the received volumes. We compared the median TV and number of failed ventilation attempts with or without the gel. The comfort level while using the gel was assessed with constructed questions. We recruited 74 respiratory therapists working in Riyadh city. More than half of the participants had more than 5 years experience. The median tidal volume for standard mask ventilation without the gel was 283 mL [interquartile range (IQR) 224, 327], whereas that with the gel was 467 mL [451, 478], respectively (p < 0.01). The number of successful ventilations was recorded out of 24 breaths during the 2-min ventilation period for each technique; the proportion of successful ventilations increased significantly by 65% (95% CI 51-75%, p < 0.01) with the gel. In addition, only nine participants believed the technique was not comfortable, while the remaining individuals found it comfortable or natural. In our bearded simulation model, applying the gel significantly improved ventilation without negatively affecting comfort. Further studies and education are encouraged in the field of basic airway management.

Risk factors associated with worse outcomes in COVID-19: a retrospective study in Saudi Arabia.

BACKGROUND: The rapid emergence of the novel coronavirus disease 2019 (COVID-19) has resulted in millions of infected patients and hundreds of thousands of deaths worldwide. Health care services delivery is being compromised due to the surge in the number of infected patients during this pandemic. AIMS: This study aimed to assess the risk factors associated with poor prognosis among COVID-19 patients in Saudi Arabia. METHODS: This was a multi-centre retrospective cohort study that included all laboratory-confirmed COVID-19 cases with definitive outcomes in Saudi Arabia during March 2020. Demographic, clinical history, comorbidity and outcomes data were retrieved from the National Health Electronic Surveillance Network (HESN) database. We used logistic regression models to calculate crude and adjusted odds ratios (OR) to explore risk factors for critical outcomes (intensive care unit admission or death) among COVID-19 cases. RESULTS: We included 648 COVID-19-positive patients with a median age of 34 years. Of these, 11.9% were in the critical group. Risk factors associated with worse outcomes included males (OR=1.92), age >60 years (OR=3.65), cardiac diseases (OR=3.05), chronic respiratory diseases (OR=2.29), and cases with two or more comorbidities (OR=2.57) after adjusting for age and sex; all had significant P-values <0.05. CONCLUSIONS: Independent risk factors for critical outcomes among COVID-19 cases include old age, males, cardiac patients, chronic respiratory diseases, and the presence of two or more comorbidities. We recommend designing a unique multi-item scale system to prognosticate COVID-19 patients.

Increased Emergency Calls during the COVID-19 Pandemic in Saudi Arabia: A National Retrospective Study.

The impact on the utilization of emergency medical services (EMS) in Saudi Arabia during the COVID-19 pandemic. We studied cumulative data from emergency calls collected from the SRCA. Data were separated into three periods: before COVID-19 (1 January-29 February 2020), during COVID-19 (1 March-23 April 2020), and during the Holy Month of Ramadan (24 April-23 May 2020). A marked increase of cases was handled during the COVID-19 period compared to the number before pandemic. Increases in all types of cases, except for those related to trauma, occurred during COVID-19, with all regions experiencing increased call volumes during COVID-19 compared with before pandemic. Demand for EMS significantly increased throughout Saudi Arabia during the pandemic period. Use of the mobile application ASAFNY to request an ambulance almost doubled during the pandemic but remained a small fraction of total calls. Altered weekly call patterns and increased call volume during the pandemic indicated not only a need for increased staff but an alteration in staffing patterns.