Owner's Perception of Seizure Detection Devices in Idiopathic Epileptic Dogs

Accurate knowledge of seizure frequency is key to optimising treatment. New methods for detecting epileptic seizures are currently investigated in humans, which rely on changes in biomarkers, also called seizure detection devices. Critical to device development, is understanding user needs and requirements. No information on this subject has been published in veterinary medicine. Many dog health collars are currently on the market, but none has proved to be a promising seizure detector. An online survey was created and consisted of 27 open, closed, and scaled questions divided over two parts: part one focused on general questions related to signalment and seizure semiology, the second part focused specifically on the use of seizure detection devices. Two hundred and thirty-one participants caring for a dog with idiopathic epilepsy, were included in the study. Open questions were coded using descriptive coding by two of the authors independently. Data was analysed using descriptive statistics and binary logistic regression. Our results showed that the unpredictability of seizures plays a major part in the management of canine epilepsy and dog owners have a strong desire to know when a seizure occurs. Nearly all dog owners made changes in their daily life, mainly focusing on intensifying supervision. Owners believed seizure detection devices would improve their dog's seizure management, including a better accuracy of seizure frequency and the ability to administer emergency drugs more readily. Owners that were already keeping track of their dog's seizures were 4.2 times more likely to show confidence in using seizure detection devices to manage their pet's seizures, highlighting the need for better monitoring systems. Our results show that there is a receptive market for wearable technology as a new management strategy in canine epilepsy and this topic should be further explored.

Priapism in a Healthy Male: A Rare Side Effect of Herbal Medicines Containing Withania somnifera

Priapism is an uncommon urological emergency. Drugs are known causes of priapism. Self-medication and use of over-the-counter drugs are very common in India. Withania somnifera is common over the counter herb used in India for anxiety, depression, boosting immunity, infertility, etc. Despite the unprohibited and over-the-counter use of drug, the efficacy and adverse events data are not available. We report a patient of anxiety and depression self-medicating with W. somnifera and multivitamins presenting with ischemic priapism.

Impact of a Mobile App on Paramedics’ Perceived and Physiologic Stress Response During Simulated Prehospital Pediatric Cardiopulmonary Resuscitation: Study Nested Within a Multicenter Randomized Controlled Trial (Preprint)

BACKGROUND Out-of-hospital cardiac arrests (OHCAs) are stressful, high-stake events that are associated with low survival rates. Acute stress experienced in this situation is associated with lower cardiopulmonary resuscitation performance in calculating drug dosages by emergency medical services. Children are particularly vulnerable to such errors. To date, no app has been validated to specifically support emergency drug preparation by paramedics through reducing the stress level of this procedure and medication errors. OBJECTIVE This study aims to determine the effectiveness of an evidence-based mobile app compared with that of the conventional preparation methods in reducing acute stress in paramedics at the psychological and physiological levels while safely preparing emergency drugs during simulated pediatric OHCA scenarios. METHODS In a parent, multicenter, randomized controlled trial of 14 emergency medical services, perceived and physiologic stress of advanced paramedics with drug preparation autonomy was assessed during a 20-minute, standardized, fully video-recorded, and highly realistic pediatric OHCA scenario in an 18-month-old child. The primary outcome was participants’ self-reported psychological stress perceived during sequential preparations of 4 intravenous emergency drugs (epinephrine, midazolam, 10% dextrose, and sodium bicarbonate) with the support of the PedAMINES (Pediatric Accurate Medication in Emergency Situations) app designed to help pediatric drug preparation (intervention) or conventional methods (control). The State-Trait Anxiety Inventory and Visual Analog Scale questionnaires were used to measure perceived stress. The secondary outcome was physiologic stress, measured by a single continuous measurement of the participants’ heart rate with optical photoplethysmography. RESULTS From September 3, 2019, to January 21, 2020, 150 advanced paramedics underwent randomization. A total of 74 participants were assigned to the mobile app (intervention group), and 76 did not use the app (control group). A total of 600 drug doses were prepared. Higher State-Trait Anxiety Inventory–perceived stress increase from baseline was observed during the scenario using the conventional methods (mean 35.4, SD 8.2 to mean 49.8, SD 13.2; a 41.3%, 35.0 increase) than when using the app (mean 36.1, SD 8.1 to mean 39.0, SD 8.4; a 12.3%, 29.0 increase). This revealed a 30.1% (95% CI 20.5%-39.8%; <i>P</i>&lt;.001) lower relative change in stress response in participants who used the app. On the Visual Analog Scale questionnaire, participants in the control group reported a higher increase in stress at the peak of the scenario (mean 7.1, SD 1.8 vs mean 6.4, SD 1.9; difference: −0.8, 95% CI −1.3 to −0.2; <i>P</i>=.005). Increase in heart rate during the scenario and over the 4 drugs was not different between the 2 groups. CONCLUSIONS Compared with the conventional method, dedicated mobile apps can reduce acute perceived stress during the preparation of emergency drugs in the prehospital setting during critical situations. These findings can help advance the development and evaluation of mobile apps for OHCA management and should be encouraged. CLINICALTRIAL ClinicalTrials.gov NCT03921346; https://clinicaltrials.gov/ct2/show/NCT03921346 INTERNATIONAL REGISTERED REPORT RR2-10.1186/s13063-019-3726-4

Mobile Health Apps Related to Emergency Drugs: Systematic Search on App Stores and Content Analysis (Preprint)

BACKGROUND Drug referencing mobile apps are among the most frequently apps used by emergency health professionals. Currently there are no studies about the quantity and quality of apps related to emergency drugs. OBJECTIVE The aim of this study was to identify apps designed to assist emergency healthcare professionals in managing drugs and to analyze their contents. METHODS We performed an observational, cross-sectional, descriptive study of apps about emergency drugs. A search was conducted in February 2021 on the iOS and Android platforms. Apps identified were downloaded and their main characteristics were evaluated by 2 independent researchers. Developer affiliation, cost, updates, user ratings and number of downloads were analyzed. We also evaluated the number of drugs described, the inclusion of bibliographic references and the presence of the following drug information: commercial presentations, usual dosage, dose adjustment for renal failure, mechanism of action, therapeutic indications, contraindications, interaction with other medicinal products, use in pregnancy and lactation, adverse reactions, method of preparation and administration, stability data/incompatibilities, identification of high-alert medications, positioning in treatment algorithms, information about medication reconciliation and cost. RESULTS We identified a total of 49 apps. Of these, 32 (65.3%) were found at both digital platforms, 11 (22.4%) were only available for Android and 6 (12.2%) for iOS. A total of 20 (40.8%) required payment (ranging from 0.59€ to 179.99€) and 11 (22.4%) were developed by non-healthcare professionals. The weighted user rating mean was 4.023 out of 5 (SD 0.71). Overall, 22 apps (44.9%) were focused on emergency drugs and 27 (55.1%) on emergency medicine. More than a half (61.7%) did not include bibliographic references or had not been updated for more than a year (59.2%). The median number of drugs was 66 (range 4 to 5000+). Most apps included information about usual dosage (87.8%) and therapeutic indications (79.2%), while information about contraindications (55.3%) and adverse reactions (51.1%) was only found in about half of apps. Dose adjustment for renal failure (31.9%), interactions (21.3%) and use in pregnancy and lactation (31.9%) were described in less than a half of apps. Furthermore, only 3 (6.4%) identified high-alert medications and 1 (2.1%) included information about medication reconciliation. Health-related developer, main topic of the app (emergency drugs or emergency medicine) and greater amount of drug information were not statistically associated with higher user ratings (P=.99, P=.09 and P=.31, respectively). CONCLUSIONS We provide a comprehensive review of apps related to emergency drugs. Our findings show that information on authorship, drug characteristics and bibliographic references is frequently scarce, so we propose some recommendations to take into account when developing an app of these characteristics. Future efforts should be done to increase regulation of drug referencing apps and to carry out a more frequent and documented review of their clinical content.

Comorbidity of atopic bronchial asthma and food allergy in adults

Adult patients with atopic bronchial asthma are susceptible to food allergy, in more than one third of cases, while asthma is a risk factor for severe life-threatening factors. The aim of the study was to determine the prevalence and relationship of food allergies with atopic bronchial asthma in adults living in Chelyabinsk. Materials and methods. An analysis of 313 outpatient case histories of patients with atopic bronchial asthma over the age of 18 was performed. Results. The presence of food allergy was a factor in the earlier onset of atopic bronchial asthma, which is consistent with the concept of comorbidity of these diseases. Patients with seasonal allergic rhinitis and pollen sensitization have an increased risk of developing food allergies (OR – 2.075 [1.27- 3.39]), p=0,004. The overall incidence of oral allergic syndrome among all patients with atopic asthma and plant sensitization was 33% [28; 37]. Plant products (fruits, honey, nuts) were the cause of food allergic reactions in 87% [80; 92] of adult cases. The main clinical manifestations were: oral allergic syndrome, urticaria, angioedema, shortness of breath. Sensitization to pollen of trees, grasses and weeds approximately equally increases the risk of developing an oral allergic syndrome, upon sensitization to tree pollen (OR – 3.08 [2.32-4.25]), to grass pollen (OR – 3.5 [2.23-5.61]), to weed pollen (OR – 2.86 [2.02-4.03]). The combination of several types of pollen sensitization increases by 4 times the risk of developing oral allergic syndrome to a wide range of foods. Conclusion. Data on the causes and clinical manifestations of food allergies in combination with bronchial asthma have been obtained. The notion of a significant risk of developing dangerous clinical manifestations of food allergy in patients with atopic bronchial asthma will make it possible to reasonably prescribe emergency drugs for independent use.

KESESUAIAN PENGELOLAAN DAN GAMBARAN PENGGUNAAN LOGISTIK FARMASI TROLI DI RUANG ICU RSUD ULIN BANJARMASIN

Emergency medicine is life saving, so emergency management is important to improve emergency services. The implementation of emergency pharmaceutical logistics management must use an effective, coordinated and multidisciplinary process. The purpose of this study was to determine the percentage of suitability of emergency trolley management and the type of emergency pharmacy logistics with the highest frequency percentage of using emergency trolleys in the ICU room of RSUD Ulin Banjarmasin. This research is a non-experimental descriptive study, data were collected prospectively using observation sheets based on SPO and use sheets for emergency pharmacy logistics in the ICU room at RSUD Ulin Banjarmasin. The population and sample of this study were all observation data of emergency trolley management in the ICU Room. The sampling technique used is saturated sampling technique all populations as samples. Data analysis was performed by calculating the percentage of suitability and the data were presented in tabular form. The results showed that the overall percentage of suitability for emergency trolley on SPO was 43.4% and 56.6% unsuitable. The highest frequency of use of emergency drugs was Vascon (norefinephrine) 73.33%, while the highest medical equipment was at Surflo 20,22,24 86.67% and Spuit NGT 50cc / Spuit 50cc 86.67%.

Awareness of Emergency Drugs and Their Usage among Dental Professionals

Effective management of an emergency in the dental office is ultimately the dentist’s responsibility. The lack of training and inability to cope with medical emergencies can lead to tragic consequences and sometimes legal action. Around 126 responses were collected from different dental professionals including graduates and clinicians through questionnaire surveys regarding emergency medications and their usage. The extent of treatment by the dentist requires preparation, prevention, and then management, as necessary. Prevention is accomplished by conducting a thorough medical history with appropriate alterations to dental treatment as required. The most important aspect of nearly all medical emergencies in the dental office is to prevent, or correct, insufficient oxygenation of the brain and heart. For which the dental professionals should be with a thorough understanding of the medical emergencies. Life-threatening emergencies can occur anytime, anywhere, and to anyone. Such situations are somewhat more likely to occur within the confines of the dental office due to the increased level of stress which is so often present. Awareness of emergency drug use among dental professionals needs to be improved and updated.