Radiological signs of hypoxic-ischaemic encephalopathy on head computed tomography for prediction of poor functional outcome after cardiac arrest – a prospective observational cohort study

Introduction: Qualitative assessment of hypoxic ischaemic encephalopathy on computed tomography (CT) after cardiac arrest is limited by interrater agreement. We explored how qualitative assessment can be improved. Methods: In-depth analysis of radiological items evaluated in a prospective sub-study within the Targeted Hypothermia versus Targeted Normothermia after out-of-hospital cardiac arrest (TTM2) trial examining unconscious patients with CT &gt; 48 h ≤ 7 days. Prognostic performance to diagnose poor outcome (modified Rankin Scale 4–6 at six months) and interrater agreement were evaluated for: “loss of grey-white matter distinction” and “sulcal effacement” at different anatomical levels, “the Pseudo Subarachnoid Haemorrhage Sign”, “the White Cerebellum Sign”, and “the Reversal Sign”. Results: We included 140 patients examined with CT at median 84 h (IQR 66–109) post-arrest. Median age was 68 years (IQR 59–76), 106 (76%) were male and 105 (75%) had a poor functional outcome. “Loss of grey-white matter distinction” predicted poor functional outcome with 100% specificity and 45–50% sensitivity. The specificity for “sulcal effacement” was 93–99% and the sensitivity 29–49%. “The Pseudo Subarachnoid Haemorrhage Sign”, “the Reversal Sign”, and the ”White Cerebellum Sign“ predicted poor functional outcome with 99–100% specificity and 8–11% sensitivity. The highest interrater agreement was “moderate” (κ = 0.74) for the loss of grey-white matter distinction at high convexity level. Conclusion: Extensive and bilateral loss of grey-white matter distinction on CT is associated with poor functional outcome after cardiac arrest and yielded the highest interrater agreement. Signs of sulcal effacement were less reliable and should thus be used with caution in neuroprognostication. The TTM2 CT substudy is registered at clinicaltrials.gov (NCT03913065).</p

Minimum wages in 2021 : annual review

Aquesta publicació s'elabora a partir de les contribucions de cadascú dels membres nacionals que integren la Network of Eufound Correspondent. Pel cas d'Espanya la contribució ha estat realitzada per l'Oscar MolinaThis report summarises how minimum wage rates for 2021 were set during 2020 - the year marked by the COVID-19 pandemic. It reviews the difficulties faced by national decision-makers and how they reacted to the challenges of the economic and social fall-out of the pandemic when making decisions regarding the minimum wage. It maps the extent to which minimum wages were referred to in COVID-19-related support measures. It discusses advances made on the EU initiative on adequate minimum wages and maps the reactions of the EU-level social partners and national decision-makers. The report is accompanied by two complementary working papers: one providing an analysis of developments for low-paid employees and minimum wage workers over the past decade; the other summarising the most recent research on minimum wages in EU countries, Norway and the UK

Student–senior isolation prevention partnership: a Canada-wide programme to mitigate social exclusion during the COVID-19 pandemic

Summary Amidst the pandemic, Canada has taken critical steps to curb the transmission of the 2019 novel coronavirus disease (COVID-19). A key intervention has been physical distancing. Although physical distancing may protect older adults and other at-risk groups from COVID-19, research suggests quarantine and isolation may worsen mental health. Among older adults, social exclusion and social safety nets are social determinants of health (SDOH) that may be uniquely affected by the COVID-19 physical distancing measures. Health promotion programmes designed to reduce social exclusion and enhance social safety nets are one way to mitigate the potential mental health implications of this pandemic. The Student–Senior Isolation Prevention Partnership (SSIPP) is a student-led, community health promotion initiative that has scaled into a nation-wide effort to improve social connection among older adults. This initiative began with in-person visits and transformed into a tele-intervention guided by health promotion principles due to COVID-19. SSIPP continued to target the SDOH of social exclusion and social safety nets by pairing student volunteers with older adults to engage in weekly phone- and video-based interactions. Informed by the community partnership model by Best et al., SSIPP is built on the three orientations of empowerment, behaviour and organization, which are achieved through cross-disciplinary collaboration. This article reviews the importance of the adaptability of health promotion programmes, such as SSIPP during a pandemic, placing an emphasis on the lessons learned and future steps.</jats:p

Standardised and automated assessment of head computed tomography reliably predicts poor functional outcome after cardiac arrest : a prospective multicentre study

Purpose: Application of standardised and automated assessments of head computed tomography (CT) for neuroprognostication after out-of-hospital cardiac arrest. Methods: Prospective, international, multicentre, observational study within the Targeted Hypothermia versus Targeted Normothermia after out-of-hospital cardiac arrest (TTM2) trial. Routine CTs from adult unconscious patients obtained > 48 h ≤ 7 days post-arrest were assessed qualitatively and quantitatively by seven international raters blinded to clinical information using a pre-published protocol. Grey–white-matter ratio (GWR) was calculated from four (GWR-4) and eight (GWR-8) regions of interest manually placed at the basal ganglia level. Additionally, GWR was obtained using an automated atlas-based approach. Prognostic accuracies for prediction of poor functional outcome (modified Rankin Scale 4–6) for the qualitative assessment and for the pre-defined GWR cutoff < 1.10 were calculated. Results: 140 unconscious patients were included; median age was 68 years (interquartile range [IQR] 59–76), 76% were male, and 75% had poor outcome. Standardised qualitative assessment and all GWR models predicted poor outcome with 100% specificity (95% confidence interval [CI] 90–100). Sensitivity in median was 37% for the standardised qualitative assessment, 39% for GWR-8, 30% for GWR-4 and 41% for automated GWR. GWR-8 was superior to GWR-4 regarding prognostic accuracies, intra- and interrater agreement. Overall prognostic accuracy for automated GWR (area under the curve [AUC] 0.84, 95% CI 0.77–0.91) did not significantly differ from manually obtained GWR. Conclusion: Standardised qualitative and quantitative assessments of CT are reliable and feasible methods to predict poor functional outcome after cardiac arrest. Automated GWR has the potential to make CT quantification for neuroprognostication accessible to all centres treating cardiac arrest patients.Peer reviewe