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Purpose: Healthcare workers (HCWs) wearing personal protective equipment (PPE) experience physiological strain that can impair motor and psychological functions, potentially affecting patient care. We assessed the effects of heat exposure on maximal strength and risk-taking behavior among PPE-wearing HCWs and the efficacy of ice slurry to alleviate adverse effects. Methods: Seventeen HCWS completed two experimental trials in a crossover design, consuming 5 g·kg−1 of body mass of ambient drink (AMB) or ice slurry (ICE) before donning PPE and undergoing 2 h of simulated decontamination exercise (wet-bulb globe temperature (WBGT): 25.9° C ± 0.8°C, PPE microenvironment WBGT: 29.1°C ± 2.1°C). Body core temperature (Tc), heart rate (HR), chest skin temperature (Tsk), ratings of perceived exertion (RPE), thermal sensation (RTS), maximal voluntary contraction (MVC), risk-taking behavior (balloon analogue risk-taking task (BART)), and salivary cortisol were assessed. Results: Predrinking to postdrinking ΔTc was greater in ICE (−0.2°C ± 0.1°C) than AMB (−0.0°C ± 0.1°C, P = 0.003). Post-drinking RTS was lower in ICE (2.7 ± 1.2) than AMB (4.1 ± 0.4, P < 0.001). ICE and AMB had similar Tc and HR (both P > 0.05), but Tsk was lower in ICE than AMB (P = 0.049). A lower MVC (30.3 ± 6.7 vs 27.4 ± 4.9 kg, P = 0.001) and higher BART-adjusted total pump count (472 ± 170 vs 615 ± 174 pumps, P = 0.017) was observed pretrial to posttrial in AMB but absent in ICE (both P > 0.05). Salivary cortisol was similar between trials (P = 0.42). Conclusions: Heat-exposed PPE-wearing HCWs had impaired maximal strength and elevated risk-taking behavior. This may increase the risk of avoidable workplace accidents that can jeopardize HCWs and patient care. Ice slurry ingestion alleviated these heat-related impairments, suggesting its potential as an ergogenic aid. [ABSTRACT FROM AUTHOR]

BackgroundThe benefits of telemedicine include cost savings and decentralized care. Video consultation is one form that enables early detection of deteriorating patients and promotion of self-efficacy in patients who are well but anxious. Abdominal pain is a common symptom presented by patients in emergency departments. These patients could benefit from video consultation, as it enables remote follow-up of patients who do not require admission and facilitates early discharge of patients from overcrowded hospitals. ObjectiveThe study aimed to evaluate the safety and efficacy of the use of digital telereview in patients presenting with undifferentiated acute abdominal pain. MethodsThe SAVED study was a prospective randomized controlled trial in which follow-up using existing telephone-based telereview (control) was compared with digital telereview (intervention). Patients with undifferentiated acute abdominal pain discharged from the emergency department observation ward were studied based on intention-to-treat. The control arm received routine, provider-scheduled telereview with missed reviews actively coordinated and rescheduled by emergency department staff. The intervention arm received access to a platform for digital telereview (asynchronous and synchronous format) that enabled patient-led appointment rescheduling. Patients were followed-up for 2 weeks for outcomes of service utilization, efficacy (compliance with their disposition plan), and safety (re-presentation for the same condition). ResultsA total of 70 patients participated, with patients randomly assigned to each arm (1:1 ratio). Patients were a mean age of 40.0 (SD 13.8; range 22-71) years, predominantly female (47/70, 67%), and predominantly of Chinese ethnicity (39/70, 56%). The telereview service was used by 32 patients in the control arm (32/35, 91%) and 18 patients in the intervention arm (18/35, 51%). Most patients in control (33/35, 94%; 95% CI 79.5%-99.0%) and intervention (34/35, 97%; 95% CI 83.4%-99.9%) arms were compliant with their final disposition. There was a low rate of re-presentation at 72 hours and 2 weeks for both control (72 hours: 2/35, 6%; 95% CI 1.0%-20.5%; 2 weeks: 2/35, 6%, 95% CI 1.0%-20.5%) and intervention (72 hours: 2/35, 6%; 95% CI 1.0%-20.5%; 2 weeks: 3/35, 9%, 95% CI 2.2%-24.2%) arms. There were no significant differences in safety (P>.99) and efficacy (P>.99) between the two groups. ConclusionsThe application of digital telereview for the follow-up of patients with abdominal pain may be safe and effective. Future studies are needed to evaluate its cost-effectiveness and usefulness for broader clinical application. Trial RegistrationISRCTN Registry ISRCTN28468556; http://www.isrctn.com/ISRCTN28468556.

The article discusses a case of carbon monoxide poisoning among restaurant workers in Singapore, highlighting the challenges in diagnosing and managing such incidents. It emphasizes the importance of prompt recognition, proper communication among emergency response teams, and the necessity for CO detectors to prevent future occurrences of CO poisoning in both occupational and residential settings.

This article presents a case report of a patient who developed hemorrhagic pancreatitis as a result of taking the medications fenofibrate and metformin. The report emphasizes the limited knowledge about the toxicity of fibrates in overdose and the highly toxic nature of metformin, even at therapeutic doses. The patient experienced symptoms such as weakness, vomiting, and poor oral intake, and was found to have excessive levels of fenofibrate and metformin in her blood. The article stresses the importance of considering acute poisoning as a potential cause in critically ill patients taking these medications. It also explores treatment options for this condition, including lipid rescue and plasmapheresis. The article highlights the significance of considering drug-induced acute pancreatitis in patients who are on diabetic and dyslipidemia medications, and the value of timely blood toxicology results in guiding diagnosis and management. [Extracted from the article]

Risk stratification in paracetamol (acetaminophen) poisoning is crucial because hepatotoxicity is common and can be mitigated with treatment. However, current risk stratification tools have limitations. We evaluated the diagnostic performance of the paracetamol concentration × aminotransferase multiplication product, for predicting hepatotoxicity after paracetamol overdose. Medline, Cochrane Library and Embase were searched for eligible papers. We used random effects models to obtain pooled estimates of the likelihood ratios and diagnostic odds ratios, from which sensitivity and specificity were computed. We assessed two commonly used cut-off values of paracetamol × aminotransferase, 1500 mg/L × IU/L and 10,000 mg/L × IU/L. Using the confusion matrices of these two cut-offs, area under the summary receiver operator characteristic curve and optimal cut-off values in different clinical scenarios were established. Six studies comprising 5036 participants were included. In 4051 patients, using the cut-off of 1500 mg/L × IU/L, a diagnostic odds ratio of 31.90 (95%CI: 9.52–106.90), sensitivity of 0.98 (95%CI: 0.94–1.00) and specificity of 0.66 (95%CI: 0.49–0.89) were obtained. In 3983 patients, using the cut-off of 10,000 mg/L × IU/L, a diagnostic odds ratio of 99.34 (95%CI: 12.26–804.87), sensitivity of 0.65 (95%CI: 0.51–0.82) and specificity of 0.97 (95%CI: 0.95–1.00) were obtained. For staggered ingestions, the 1500 mg/L × IU/L cut-off yielded a diagnostic odds ratio of 69.53 (95%CI: 4.03–1199.75), sensitivity of 1.00 (95%CI: 0.87–1.00) and specificity of 0.74 (95%CI: 0.43–1.00). Next, using the 10,000 mg/L × IU/L cut-off in this scenario yielded a diagnostic odds ratio of 254.58 (95%CI: 11.12–5827.60), sensitivity of 0.79 (95%CI: 0.59–1.00) and specificity of 0.98 (95%CI: 0.94–1.00). The overall summary receiver operator characteristic curve was 0.91 (95%CI: 0.75–0.97), and the optimal cut-off value was 3840 mg/L × IU/L. The summary receiver operator characteristic curve in patients with staggered ingestions was 0.96 (95%CI: 0.85–0.99). The summary receiver operator characteristic curve in patients with staggered ingestions and whose paracetamol concentration was below the detectable limit of 10 mg/L at presentation was 0.97 (95%CI: 0.94–0.99). In this first meta-analysis, paracetamol × aminotransferase demonstrates its use in prognosticating hepatotoxicity in patients with paracetamol poisoning. It complements the Rumack-Matthew nomogram as it has shown promise in addressing two key limitations of the nomogram: it is usable after more than 24 h between overdose and acetylcysteine treatment, and it is applicable in staggered ingestions. [ABSTRACT FROM AUTHOR]

BACKGROUND: Developments in information technology (IT) have driven a push in healthcare innovation in the emergency department (ED). Many of these applications rely on mobile technology (MT) such as smartphones but not everyone is comfortable with MT usage. Our study aims to characterize the technology usage behavior of users in the ED so as to guide the implementation of IT interventions in the ED. METHODS: A cross-sectional survey was conducted in the emergency department of a tertiary hospital. Patients and their caregivers aged 21 and above were recruited. The survey collected demographic information, technology usage patterns, and participant reported comfort level in the usage of MT. We performed descriptive statistics and multivariate logistic regression to identify factors differentially associated with comfort in usage of MT. RESULTS: A total of 498 participants were recruited, and 299 (60%) were patients. English was the most commonly written and read language (66.9%) and 64.2% reported a comfort level of 3/5 or more in using MT. Factors that were associated with being comfortable in using MT include having a tertiary education, being able to read and write English, as well as being a frequent user of IT. Caregivers were more likely to display these characteristics. CONCLUSION: A large proportion of ED patients are not comfortable in the usage of MT. Factors that predicted comfort level in the usage of MT were common amongst caregivers. Future interventions should take this into consideration in the design of MT interventions. [ABSTRACT FROM AUTHOR]