Evaluation of cut-off values in acute paracetamol overdose following the United Kingdom guidelines

Abstract Background The United Kingdom guideline for acute paracetamol overdose has recommended the use of ‘100-treatment line’. Emergency medical centers in some developing countries lack the resources for timely reporting of paracetamol concentrations, hence treatment depends on reported dose. This study aimed to examine whether using an reported dose is safe to predict concentration above the 100-line. Methods Data were retrieved from two emergency medical centers retrospectively, between 2010 and 2017. The inclusion criteria were single acute paracetamol overdose, presentation within 15 h, and age ≥ 14 years. Multiple linear regression was performed to determine the effect of ingested dose on paracetamol concentration. Subgroups were created based on ingested dose, rate of concentration above 100-line were investigated. Results One hundred and seventy-two patients were enrolled in the primary analysis; median dose was 133.3 mg/kg and 46 (37.8%) had concentration above 100-line in the first test. Only dose per weight was moderately correlated with the first concentration (R2 = 0.410, p < 0.001). In the ≤200 mg/kg ingestion group, 18 patients showed concentration above 100-line and 8 showed acute liver injury. The cut-off value of 150 mg/kg showed 82.6% sensitivity and 73.8% specificity to predict concentration above 100-line. Conclusion Where paracetamol concentration is not available and activated charcoal is readily used, following United Kingdom guideline, it is safe to use an ingested dose of > 150 mg/kg as the cut-off value for N-acetylcysteine treatment with risk stratification for hepatotoxicity if the patient is ≥14 years and visit the ED within 15 h after an acute paracetamol overdose.

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Utilisation of a Helicopter Emergency Medical Service (HEMS) for equestrian accidents in a regional major trauma network in the United Kingdom

Injury ◽

10.1016/j.injury.2014.10.067 ◽

2015 ◽

Vol 46 (5) ◽

pp. 781-786 ◽

Cited By ~ 4

Author(s):

Carl McQueen ◽

Nick Crombie ◽

Stef Cormack ◽

Arun George ◽

Steve Wheaton

Keyword(s):

United Kingdom ◽

Emergency Medical Service ◽

Major Trauma ◽

Medical Service ◽

Helicopter Emergency Medical Service ◽

Trauma Network ◽

The United Kingdom ◽

Emergency Medical

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Non-medical prescribing in primary care in the United Kingdom: an overview of the current literature

Journal of Prescribing Practice ◽

10.12968/jprp.2021.3.9.352 ◽

2021 ◽

Vol 3 (9) ◽

pp. 352-361

Author(s):

Amanda Armstrong ◽

Andrea Manfrin ◽

Josephine Gibson

Keyword(s):

Primary Care ◽

United Kingdom ◽

English Language ◽

Inclusion Criteria ◽

Exclusion Criteria ◽

The United Kingdom ◽

Organisational Support ◽

Primary Care Patients ◽

Negative Perceptions ◽

The Uk

Background: Non-medical prescribers (NMPs) are perceived as a complement to busy general practice in primary care. Aim: To conduct an overview of the literature available on the role and impact of non-medical prescribing (NMP) on primary care patients. Method: The search was conducted using multiple databases to find articles published between January 2015-January 2021. Inclusion criteria: NMPs in primary care in the United Kingdom, written in English language. Exclusion criteria: research conducted in secondary care or outside the UK. Findings: 285 studies were identified; 15 were eligible for critical appraisal. Key themes were: NMP's positive perceptions were autonomy, job satisfaction and colleague support; negative perceptions included risk, lack of continuous professional development (CPD), organisational support. Conclusion: By reviewing the perceptions of NMPs in primary care, organisations can ensure when employing new NMPs that the adequate CPD and support is in place. Thereby reducing NMPs concerns about the ligation risk of prescribing.

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Access to personal protective equipment in healthcare workers during the COVID-19 pandemic in the United Kingdom: results from a nationwide cohort study (UK-REACH)

10.1101/2021.09.16.21263629 ◽

2021 ◽

Author(s):

Christopher A Martin ◽

Daniel Pan ◽

Joshua Nazareth ◽

Avinash Aujayeb ◽

Luke Bryant ◽

...

Keyword(s):

Cohort Study ◽

United Kingdom ◽

Personal Protective Equipment ◽

Healthcare Workers ◽

Secondary Analysis ◽

Protective Equipment ◽

Primary Analysis ◽

Questionnaire Response ◽

The United Kingdom ◽

The Uk

Abstract Objectives: To determine the prevalence and predictors of self-reported access to appropriate personal protective equipment (aPPE) for healthcare workers (HCWs) in the United Kingdom (UK) during the first UK national COVID-19 lockdown (March 2020) and at the time of questionnaire response (December 2020 - February 2021). Design: Two cross sectional analyses using data from a questionnaire-based cohort study. Setting: Nationwide questionnaire from 4th December 2020 to 28th February 2021. Participants: A representative sample of HCWs or ancillary workers in a UK healthcare setting aged 16 or over, registered with one of seven main UK healthcare regulatory bodies. Main outcome measure: Binary measure of self-reported aPPE (access all of the time vs access most of the time or less frequently) at two timepoints: the first national lockdown in the UK (primary analysis) and at the time of questionnaire response (secondary analysis). Results: 10,508 HCWs were included in the primary analysis, and 12,252 in the secondary analysis. 3702 (35.2%) of HCWs reported aPPE at all times in the primary analysis; 6806 (83.9%) reported aPPE at all times in the secondary analysis. After adjustment (for age, sex, ethnicity, migration status, occupation, aerosol generating procedure exposure, work sector, work region, working hours, night shift frequency and trust in employing organisation), older HCWs (per decade increase in age: aOR 1.2, 95% CI 1.16 - 1.26, p<0.001) and those working in Intensive Care Units (1.61, 1.38 - 1.89, p<0.001) were more likely to report aPPE at all times. Those from Asian ethnic groups compared to White (0.77, 0.67 - 0.89, p<0.001), those in allied health professional (AHPs) and dental roles (vs those in medical roles; AHPs: 0.77, 0.68 - 0.87, p<0.001; dental: 0.63, 0.49 - 0.81, p<0.001), and those who saw a higher number of COVID-19 patients compared to those who saw none (≥21 patients 0.74, 0.61 - 0.90, p=0.003) were less likely to report aPPE at all times in the primary analysis. aPPE at all times was also not uniform across UK regions (reported access being better in South West and North East England than London). Those who trusted their employing organisation to deal with concerns about unsafe clinical practice, compared to those who did not, were twice as likely to report aPPE at all times (2.18, 1.97 - 2.40, p<0.001). With the exception of occupation, these factors were also significantly associated with aPPE at all times in the secondary analysis. Conclusions: We found that only a third of HCWs in the UK reported aPPE at all times during the period of the first lockdown and that aPPE had improved later in the pandemic. We also identified key sociodemographic and occupational determinants of aPPE during the first UK lockdown, the majority of which have persisted since lockdown was eased. These findings have important public health implications for HCWs, particularly as cases of infection and long-COVID continue to rise in the UK.

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The helicopter emergency medical service

BMJ ◽

10.1136/bmj.328.7443.s133-a ◽

2004 ◽

Vol 328 (7443) ◽

pp. s133.2-s134

Author(s):

Alastair Newton

Keyword(s):

United Kingdom ◽

Emergency Medical Service ◽

Medical Service ◽

Helicopter Emergency Medical Service ◽

The United Kingdom ◽

Emergency Medical ◽

London Hospital ◽

Royal London Hospital

The helicopter emergency medical service based at the Royal London Hospital is the only medical helicopter in the United Kingdom that carries a doctor. Stephen Hearns and Alastair Newton describe life as the doctor on board and what it takes to get the job

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Influence of the SARS-CoV-2 Outbreak on the Uptake of a Popular Smoking Cessation App in UK Smokers: Interrupted Time Series Analysis

JMIR mhealth and uhealth ◽

10.2196/19494 ◽

2020 ◽

Vol 8 (6) ◽

pp. e19494 ◽

Cited By ~ 3

Author(s):

Olga Perski ◽

Aleksandra Herbeć ◽

Lion Shahab ◽

Jamie Brown

Keyword(s):

Time Series ◽

Smoking Cessation ◽

United Kingdom ◽

Secondary Analysis ◽

Interrupted Time Series ◽

Step Change ◽

Outcome Variable ◽

Primary Analysis ◽

The United Kingdom ◽

Increasing Trend

Background The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak may motivate smokers to attempt to stop in greater numbers. However, given the temporary closure of UK stop smoking services and vape shops, smokers attempting to quit may instead seek out mobile health support, such as smartphone apps. Objective We examined, using an interrupted time series approach, whether the SARS-CoV-2 outbreak has been associated with a step change or increasing trend in UK downloads of an otherwise popular smoking cessation app, Smoke Free. Methods Data were from daily and nondaily adult smokers in the United Kingdom who had downloaded the Smoke Free app between January 1, 2020, and March 31, 2020 (primary analysis), and January 1, 2019, and March 31, 2020 (secondary analysis). The outcome variable was the number of downloads aggregated at the 12-hourly (primary analysis) or daily level (secondary analysis). The explanatory variable was the start of the SARS-CoV-2 outbreak, operationalized as March 1, 2020 (primary analysis), and January 15, 2020 (secondary analysis). Generalized additive mixed models adjusted for relevant covariates were fitted. Results Data were collected on 45,105 (primary analysis) and 119,881 (secondary analysis) users. In both analyses, there was no evidence for a step change or increasing trend in downloads attributable to the start of the SARS-CoV-2 outbreak. Calculation of Bayes factors (BFs) indicated that the data for the primary analysis favored the null hypothesis compared with large associations (for level, BF=0.25; for slope, BF=0.26) but were insensitive to the detection of small associations (for level, BF=0.78; for slope, BF=1.35). Conclusions In the United Kingdom, between January 1, 2020, and March 31, 2020, and between January 1, 2019, and March 31, 2020, there was no evidence that the SARS-CoV-2 outbreak has been associated with a large step change or increasing trend in downloads of a popular smoking cessation app. Findings on the association of the SARS-CoV-2 outbreak with a small step change or increasing trend were inconclusive.

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Influence of the SARS-CoV-2 Outbreak on the Uptake of a Popular Smoking Cessation App in UK Smokers: Interrupted Time Series Analysis (Preprint)

10.2196/preprints.19494 ◽

2020 ◽

Author(s):

Olga Perski ◽

Aleksandra Herbeć ◽

Lion Shahab ◽

Jamie Brown

Keyword(s):

Time Series ◽

Smoking Cessation ◽

United Kingdom ◽

Secondary Analysis ◽

Interrupted Time Series ◽

Step Change ◽

Outcome Variable ◽

Primary Analysis ◽

The United Kingdom ◽

Increasing Trend

BACKGROUND The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak may motivate smokers to attempt to stop in greater numbers. However, given the temporary closure of UK stop smoking services and vape shops, smokers attempting to quit may instead seek out mobile health support, such as smartphone apps. OBJECTIVE We examined, using an interrupted time series approach, whether the SARS-CoV-2 outbreak has been associated with a step change or increasing trend in UK downloads of an otherwise popular smoking cessation app, Smoke Free. METHODS Data were from daily and nondaily adult smokers in the United Kingdom who had downloaded the Smoke Free app between January 1, 2020, and March 31, 2020 (primary analysis), and January 1, 2019, and March 31, 2020 (secondary analysis). The outcome variable was the number of downloads aggregated at the 12-hourly (primary analysis) or daily level (secondary analysis). The explanatory variable was the start of the SARS-CoV-2 outbreak, operationalized as March 1, 2020 (primary analysis), and January 15, 2020 (secondary analysis). Generalized additive mixed models adjusted for relevant covariates were fitted. RESULTS Data were collected on 45,105 (primary analysis) and 119,881 (secondary analysis) users. In both analyses, there was no evidence for a step change or increasing trend in downloads attributable to the start of the SARS-CoV-2 outbreak. Calculation of Bayes factors (BFs) indicated that the data for the primary analysis favored the null hypothesis compared with large associations (for level, BF=0.25; for slope, BF=0.26) but were insensitive to the detection of small associations (for level, BF=0.78; for slope, BF=1.35). CONCLUSIONS In the United Kingdom, between January 1, 2020, and March 31, 2020, and between January 1, 2019, and March 31, 2020, there was no evidence that the SARS-CoV-2 outbreak has been associated with a large step change or increasing trend in downloads of a popular smoking cessation app. Findings on the association of the SARS-CoV-2 outbreak with a small step change or increasing trend were inconclusive.

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