PP20 A retrospective service evaluation of the presentation of anaphylaxis to a UK ambulance service

2019 ◽  
Vol 36 (10) ◽  
pp. e9.2-e9
Author(s):  
Nicholas Groom ◽  
Sarah Taylor ◽  
Ed England ◽  
Helen Pocock ◽  
Charles D Deakin
Keyword(s):  
Service Evaluation ◽  
Ambulance Service ◽  
Small Scale ◽  
Patient Records ◽  
Electronic Patient Records ◽  
Self Administration ◽  
Patient Demographics ◽  
The Mean ◽  
The Impact ◽  
To Receive

BackgroundThere is a lack of data relating to frequency and presentation of anaphylaxis to the ambulance service in England. Little research exists relating to the patients’ self-treatment of anaphylaxis and there is an absence of evidence to evaluate the impact of self-administered adrenaline, there is a need to describe this patient group to evaluate any potential to develop their care.MethodsRetrospective data were collected from the electronic patient records of a single NHS ambulance service serving a population of approximately four million. Records between 1stApril 2017 and 31st March 2018 were included where a diagnosis of anaphylaxis was recorded. Gender, age, incident location, allergy history, were summarised to identify any trends in presentation. The frequency of patient self-administration, as well as ambulance administration, of adrenaline was also included for analysis to determine any correlation.Results326 records were included in the analysis. The mean, median and modal patient ages were 34, 29 and 20 respectively. Patient ages ranged from six months to 95 years. Patients were 65% female, 35% male and 59% of incidents occurred at home. 76% of patients reported having a known allergy with food being the most common allergen (44%). Peak times for calling 999 were midday and 6pm. 35% of patients had self-administered adrenaline. 52% received ambulance-administered adrenaline. The doses of self-administered adrenaline ranged from 0–3 doses and ambulance administered adrenaline ranged from 0–8 doses. Patients who self-administered adrenaline were less likely to receive further adrenaline from the ambulance service. No correlation was found between the number of self-administered doses and ambulance administered doses.ConclusionPatient demographics such as age, gender and allergies were consistent with two previous small-scale studies. This study suggests that early self-administration of adrenaline is beneficial. Opportunities for improvements in data recording as well as patient education were identified.

PP38 Rates of recording different aspects of patients’ social history on ambulance electronic patient records – a service evaluation

2021 ◽  
Vol 38 (9) ◽  
pp. A16.1-A16
Author(s):  
Chloé R Barley ◽  
Imogen M Gunson
Keyword(s):  
Social History ◽  
Median Number ◽  
Service Evaluation ◽  
Patient Records ◽  
Completion Rates ◽  
Electronic Patient Records ◽  
Minimal Impact ◽  
History Data ◽  
Qualitative Work ◽  
The Impact

BackgroundUnderstanding the impact of a patient’s social history forms part of medical assessments and wider NHS data collection. To date, there has been little work examining the extent of social history recording by ambulance clinicians. The aim of this service evaluation is to examine how frequently staff complete social history fields on electronic patient records and to identify patterns in completion rate when comparing categories of call, localities of crew, conveyance or non-conveyance, and individual fields of social history data.MethodA retrospective review of one NHS ambulance trust’s electronic patient records (attended 01/01/2019 – 31/12/2019) was conducted. 10% of the records were analysed due to software limitations (n = 134434 adult cases).ResultsVery few cases (<0.05%) had every field completed, with 28.6% of all cases having no fields completed at all. In 45% of cases, between 8 and 11 fields were completed. The mean number of fields completed per case was 5.79 and the median number was 7.‘Mobility’ and ‘Home circumstances’ were the most frequently completed and ‘Sexual Orientation’ and ‘Language’ were the least.Category of call appears to have minimal impact on completion rates. Localities and specialists had more variation, ranging from 21.3% to 49.9% with no fields completed at all.ConclusionSocial history documentation is very infrequently fully completed by frontline ambulance crews within this service. The majority of cases have a partially complete social history however, due to software limitations, it is unknown whether the same fields are consistently completed throughout these cases.Further research, including qualitative work, is recommended to understand the low rate of recording of social history data and how this information is used by ambulance staff.

The Impact of Medical Comorbidities on Patient Satisfaction in Chronic Rhinosinusitis

2021 ◽  
pp. 000348942110157
Author(s):  
Amarbir S. Gill ◽  
Joshua Hwang ◽  
Angela M. Beliveau ◽  
Jeremiah A. Alt ◽  
Edward Bradley Strong ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Hearing Impairment ◽  
Chronic Rhinosinusitis ◽  
Medical Comorbidities ◽  
Patient Demographics ◽  
Significant Difference ◽  
Comorbidity Index ◽  
The Mean ◽  
Therapy Compliance ◽  
The Impact

Background: Patient satisfaction has a significant bearing on medical therapy compliance and patient outcomes. The purpose of this study was to (1) describe patient satisfaction, as characterized by the Patient Satisfaction Questionnaire-18 (PSQ-18), in the care of patients with chronic rhinosinusitis (CRS) and (2) analyze the impact of comorbidities on satisfaction using the functional comorbidity index (FCI). Methods: Patient demographics, disease severity measures, and PSQ-18 scores for patients with CRS presenting to a tertiary rhinology clinic between November 2019 and April 2020 were collected and analyzed. FCI was calculated retrospectively using the electronic medical record; individual comorbidities were tabulated. Spearman’s correlations followed by multivariate regression was used to assess the relationship between medical comorbidities and PSQ-18. Results: Sixty-nine patients met criteria for analysis. There were no significant differences in age, gender, and Sinonasal Outcomes Test-22 scores between CRS patients with (CRSwNP) and without (CRSsNP) nasal polyps. There was no significant difference in the mean FCI for patients with CRSwNP versus CRSsNP (5.1 and 4.3, respectively) ( P = .843). Similarly, there was no significant difference in the mean sum PSQ-18 score (78/100 in both) between these cohorts ( P = .148). The mean sum PSQ-18 score was not significantly associated with anxiety ( P = .728), depression ( P = .624), or FCI ( P = .282), but was significantly associated with hearing impairment ( P < .001). Conclusion: Patient satisfaction in the care of CRS is generally high with a diagnosis of comorbid hearing impairment demonstrating a negative association with satisfaction in this cohort.

The impact of electronic patient records on workflow in general practice

2007 ◽  
Vol 13 (2) ◽  
pp. 155-160 ◽  
Author(s):  
Matthew R. Cauldwell ◽  
Caroline E. Beattie ◽  
Benita M. Cox ◽  
William J. Denby ◽  
Jessica A. Ede-Golightly ◽  
...  
Keyword(s):  
General Practice ◽  
Patient Records ◽  
Electronic Patient Records ◽  
The Impact

scholarly journals End-Of-Life Discussions Reduce The Utilization of Life-Sustaining Treatments During The Last Three Months of Life in Cancer Patients : A Nationwide Population-Based Cohort Study

2021 ◽  
Author(s):  
Shang-Yih Chan ◽  
Yun-Ju Lai ◽  
Yu-Yen Hsin Chen ◽  
Shuo-Ju Chiang ◽  
Yi-Fan Tsai ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cardiopulmonary Resuscitation ◽  
End Of Life ◽  
Cancer Patients ◽  
Medical Records ◽  
Population Based ◽  
Lower Likelihood ◽  
The Mean ◽  
The Impact ◽  
To Receive

Abstract Purpose Studies to examine the impact of end-of-life (EOL) discussions on the utilization of life-sustaining treatments near death were limited and had inconsistent findings. This nationwide population-based cohort study determined the impact of EOL discussions on the utilization of life-sustaining treatments in the last three months of life in Taiwanese cancer patients. Methods This cohort study included adult cancer patients from 2012–2018, which were confirmed by pathohistological reports. Life-sustaining treatments during the last three months of life included cardiopulmonary resuscitation, intubation, and defibrillation. EOL discussions in cancer patients were confirmed by their medical records. Association of EOL discussions with utilization of life-sustaining treatments were assessed using multiple logistic regression. Results Of 381,207 patients, the mean age was 70.5 years and 19.4% of the subjects utilized life-sustaining treatments during the last three months of life. After adjusting for other covariates, those who underwent EOL discussions were less likely to receive life-sustaining treatments during the last three months of life compared to those who did not (Adjusted odds ratio [AOR]: 0.82; 95% confidence interval [CI]: 0.80–0.84). Considering the type of treatments, EOL discussions correlated with a lower likelihood of receiving cardiopulmonary resuscitation (AOR = 0.43, 95% CI: 0.41–0.45), endotracheal intubation (AOR = 0.87, 95%CI: 0.85–0.89), and defibrillation (AOR = 0.52, 95%CI: 0.48–0.57). Conclusion EOL discussions correlated with a lower utilization of life-sustaining treatments during the last three months of life among cancer patients. Our study supports the importance of providing these discussions to cancer patients to better align care with preferences during the EOL treatment.

scholarly journals Depression, Suicidal Ideation, and Resilience among Rural Farmers in a Drought-Affected Area of Trichy District, Tamil Nadu

2019 ◽  
Vol 10 (02) ◽  
pp. 238-244 ◽  
Author(s):  
Deepak Justine Viswanathan ◽  
Veerakumar A. M ◽  
Hemalatha Kumarasamy
Keyword(s):  
Suicidal Ideation ◽  
Tamil Nadu ◽  
Pearson Correlation ◽  
Small Scale ◽  
Cluster Sampling ◽  
Years Of Experience ◽  
Affected Area ◽  
Prevalence Of Depression ◽  
The Mean ◽  
The Impact

ABSTRACTBackground: Changes in climatic conditions and other factors including trade and commerce have influenced agriculture worldwide. These factors have created a crisis among farmers. Objectives: The objective of this study was to find out the prevalence of depression and suicidal ideation, to measure the resilience, and to find out the factors that influence depression and resilience among farmers. Materials and Methods: A community-based cross-sectional analytical study was performed among farmers residing in a drought-affected area of Tiruchirappalli district of Tamil Nadu. The sample size was 191 and cluster sampling was used to select the participants. Structured, pretested questionnaires were used to find the prevalence of depression, suicidal ideation, and resilience among farmers. Pearson Correlation, Student’s t-test, analysis of variance, and Pearson Chi-square test were used to identify the factors influencing depression and resilience. Results: A total of 194 farmers participated in the study. The mean age of the farmers was 46.68 ± 12.6 years, majority 64% were males and 89% were literates. Among the participants, 97.4% had some form of depression, and 67% had severe depression. About 60% of the farmers had suicidal ideation. Male farmers, farmers with few years of farming experience, and severe reduction in yield had a higher level of depression. Suicidal ideation was influenced by gender, small-scale farming, fewer years of experience in farming, and the impact of drought on yield. The mean resilience score was 49.4 ± 10. Gender and years of experience in farming had a significant association with resilience. Conclusion: High prevalence of depression and suicidal ideation and low level of resilience has been observed among the farmers. Interventions need to be provided for marginal and small-scale farmers, male farmers in the affected area to reduce the impact of drought in these farmers.

The Effect of Microsite Variation on Seed-Germination and Seedling Survival of Eucalyptus delegatensis

1993 ◽  
Vol 41 (2) ◽  
pp. 169 ◽  
Author(s):  
M Battaglia ◽  
JB Reid
Keyword(s):  
Seed Germination ◽  
Seedling Survival ◽  
Soil Conditions ◽  
Small Scale ◽  
Root Penetration ◽  
Mean Survival Time ◽  
The Mean ◽  
Developmental Characteristics ◽  
The Impact ◽  
Eucalyptus Delegatensis

The correlation between microsite and seedling numbers was determined in field sowings, and the impact of microsites on germination and seedling survival tested in artificial seedbeds in the glasshouse. Small scale variation in soil conditions, at the scale of tens of centimetres, markedly affected the germination and establishment of Eucalyptus delegatensis R.T.Baker seeds and seedlings. Under conditions of limiting soil moisture, microsites that afforded protection, and probably resulted in increased humidity, caused a marked increase in germination number and rate. The mean survival time was significantly higher on these protected microsites than on less protected microsites, or on microsites that restricted root penetration. The importance of this variability in microtopography was strongly influenced by season and the level of environmental stress, and was diminished as seedlings aged. Due to the different requirements for seed germination and seedling growth, a favourable microsite for germination was not necessarily a favourable site for seedling survival. A comparison of seed and seedling responses to water stress indicated that for E. delegatensis, at least, selection due to microsite differences at the time of germination may not have an impact on the developmental characteristics of the seedlings.

Xenon Provides Faster Emergence from Anesthesia than Does Nitrous Oxide-sevoflurane or Nitrous Oxide-isoflurane 

1997 ◽  
Vol 86 (6) ◽  
pp. 1273-1278 ◽  
Author(s):  
Takahisa Goto ◽  
Hayato Saito ◽  
Masahiro Shinkai ◽  
Yoshinori Nakata ◽  
Fumito Ichinose ◽  
...  
Keyword(s):  
Nitrous Oxide ◽  
Minimum Alveolar Concentration ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Patient Demographics ◽  
The Mean ◽  
American Society ◽  
End Tidal ◽  
To Receive ◽  
Rapid Emergence

Background Xenon, an inert gas with anesthetic properties (minimum alveolar concentration [MAC] = 71%), has an extremely low blood:gas partition coefficient (0.14). Therefore, we predicted that xenon would provide more rapid emergence from anesthesia than does N2O+isoflurane or N2O+sevoflurane of equivalent MAC. Methods Thirty American Society of Anesthsiologists class I or II patients undergoing total abdominal hysterectomy were randomly assigned to receive 60% xenon, 60% N2O + 0.5% isoflurane, or 60% N2O + 0.70% sevoflurane (all concentrations are end-tidal: n = 10 per group). After placement of an epidural catheter, anesthesia was induced with standardized doses of midazolam, thiopental, and fentanyl. Thirty minutes later, xenon, N2O+isoflurane, or N2O+sevoflurane was started as previously assigned. These regimens were supplemented with epidural anesthesia with mepivacaine so that the mean arterial pressure and heart rate were controlled within 20% of the preoperative values. At the end of operation lasting approximately 2 h, all inhalational anesthetics were discontinued, and the patients were allowed to awaken while breathing spontaneously on an 8 l/min inflow of oxygen. A blinded investigator recorded the time until the patient opened her eyes on command (T1), was judged ready for extubation (T2), could correctly state her name, her date of birth, and the name of the hospital (T3), and could count backward from 10 to 1 in less than 15 s (T4). Results Emergence times from xenon anesthesia were: T1, 3.4 +/- 0.9 min; T2, 3.6 +/- 1 min; T3, 5.2 +/- 1.4 min; and T4, 6.0 +/- 1.6 min (mean +/- SD). These were one half to one third of those from N2O+sevoflurane (T1, 6.0 +/- 1.7 min; T4, 10.5 +/- 2.5 min) or N2O+isoflurane (T1, 7.0 +/- 1.9 min; T4, 14.3 +/- 2.8 min) anesthesia. The three groups did not differ in terms of patient demographics, the duration of anesthesia, the amount of epidural mepivacaine administered, or the postoperative pain rating. No patient could recalls intraoperative events. Conclusions Emergence from xenon anesthesia is two or three times faster than that from equal-MAC N2O+isoflurane or N2O+sevoflurane anesthesia.

scholarly journals Analgesia for extremity fractures in the paediatric emergency department

2020 ◽  
Vol 29 (2) ◽  
pp. 108-112
Author(s):  
Siew Ming Tan ◽  
Yong-Kwang Gene Ong ◽  
Jen Heng Pek
Keyword(s):  
Emergency Department ◽  
Pain Score ◽  
Lower Limb ◽  
Key Management ◽  
Current Practice ◽  
Paediatric Emergency Department ◽  
Patient Demographics ◽  
Paediatric Emergency ◽  
The Mean ◽  
The Impact

Background: Extremity fractures are an important and common presentation at the Paediatric Emergency Department (PED). Provision of analgesia is a key management principle, but it is often suboptimal. Although there is an increase in awareness of this issue, the impact on current practice is not known. We aimed to review the current practice of providing analgesia for extremity fractures in the PED. Objective: Our objective was to determine the utilisation, adequacy and timeliness of analgesia provided for these patients. Methods: A retrospective study was carried out from November to December 2017. Patients with a diagnosis of extremity fracture involving the upper or lower limb were included. Information about patient demographics, diagnosis, pain score, analgesia use and clinical progress were collected for analysis. Results: There were 101 cases. The mean age was 8.5±4.2 years old, and 62 (61.4%) patients were male. There were 76 (75.3%) cases of fractures involving the upper limb, and 25 (24.7%) cases of fractures involving the lower limb. The mean pain score at presentation was 3.3±2.3. Analgesia was administered to only 10 (9.9%) patients, with oral paracetamol ( n=5; 5.0%) being the most common medication administered. The median time between arrival in the PED to analgesia administration was 69 minutes (range 25–328 minutes). Conclusions: Despite the increase in awareness, analgesia for these patients remains underutilised, inadequate and delayed. Further efforts at pain assessment, analgesia selection and administration are necessary to improve the provision of analgesia for these patients.

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