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 ever...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.展开更多
BACKGROUND:A perennial challenge faced by clinicians and made even more relevant with the global obesity epidemic,difficult intravenous access(DIVA)adversely impacts patient outcomes by causing significant downstream ...BACKGROUND:A perennial challenge faced by clinicians and made even more relevant with the global obesity epidemic,difficult intravenous access(DIVA)adversely impacts patient outcomes by causing significant downstream delays with many aspects of diagnoses and therapy.As most published DIVA strategies are limited to various point-of-care ultrasound techniques while other“tricks-of-the-trade”and pearls for overcoming DIVA are mostly relegated to informal nonpublished material,this article seeks to provide a narrative qualitative review of the iterature on DIVA and consolidate these strategies into a practical algorithm.METHODS:We conducted a literature search on PubMed using the keywords“difficult intravenous access”,“peripheral vascular access”and“peripheral venous access”and searched emergency medicine and anaesthesiology resources for relevant material.These strategies were then categorized and incorporated into a DIVA algorithm.RESULTS:We propose a Vortex approach to DIVA that is modelled after the Difficult Airway Vortex concept:starting off with standard peripheral intravenous cannulation(PIVC)techniques,progressing sequentially on to ultrasound-guided cannulation and central venous cannulation and finally escalating to the most invasive intraosseous access should the patient be in extremis or should best efforts with the other lifelines fail.CONCLUSION:DIVA is a perennial problem that healthcare providers across various disciplines will be increasingly challenged with.It is crucial to have a systematic stepwise approach such as the DIVA Vortex when managing such patients and have at hand a wide repertoire of techniques to draw upon.展开更多
Fibrates have been used for over forty-odd years to manage dyslipidemia and are generally considered safe and well-tolerated.^([1])However,little is known about the toxicity offibrates in overdose,[2]and most of the k...Fibrates have been used for over forty-odd years to manage dyslipidemia and are generally considered safe and well-tolerated.^([1])However,little is known about the toxicity offibrates in overdose,[2]and most of the knowledge about fibrate toxicity comes from extrapolated observations of adverse effects encountered at therapeutic doses instead.展开更多
Dear editor,Studies have revealed a significant prevalence of mixed substance abuse,[1-3]and a focused approach towards polysubstance use has been emphasized.[4]Among recreational drugs,cases of hypoglycemia from ecst...Dear editor,Studies have revealed a significant prevalence of mixed substance abuse,[1-3]and a focused approach towards polysubstance use has been emphasized.[4]Among recreational drugs,cases of hypoglycemia from ecstasy,[5]amphetamine,[6]eutylone,[7]and cannabinoid[8]use have been reported,but none of these cases have had persistent refractory hypoglycemia.展开更多
文摘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.
文摘BACKGROUND:A perennial challenge faced by clinicians and made even more relevant with the global obesity epidemic,difficult intravenous access(DIVA)adversely impacts patient outcomes by causing significant downstream delays with many aspects of diagnoses and therapy.As most published DIVA strategies are limited to various point-of-care ultrasound techniques while other“tricks-of-the-trade”and pearls for overcoming DIVA are mostly relegated to informal nonpublished material,this article seeks to provide a narrative qualitative review of the iterature on DIVA and consolidate these strategies into a practical algorithm.METHODS:We conducted a literature search on PubMed using the keywords“difficult intravenous access”,“peripheral vascular access”and“peripheral venous access”and searched emergency medicine and anaesthesiology resources for relevant material.These strategies were then categorized and incorporated into a DIVA algorithm.RESULTS:We propose a Vortex approach to DIVA that is modelled after the Difficult Airway Vortex concept:starting off with standard peripheral intravenous cannulation(PIVC)techniques,progressing sequentially on to ultrasound-guided cannulation and central venous cannulation and finally escalating to the most invasive intraosseous access should the patient be in extremis or should best efforts with the other lifelines fail.CONCLUSION:DIVA is a perennial problem that healthcare providers across various disciplines will be increasingly challenged with.It is crucial to have a systematic stepwise approach such as the DIVA Vortex when managing such patients and have at hand a wide repertoire of techniques to draw upon.
文摘Fibrates have been used for over forty-odd years to manage dyslipidemia and are generally considered safe and well-tolerated.^([1])However,little is known about the toxicity offibrates in overdose,[2]and most of the knowledge about fibrate toxicity comes from extrapolated observations of adverse effects encountered at therapeutic doses instead.
文摘Dear editor,Studies have revealed a significant prevalence of mixed substance abuse,[1-3]and a focused approach towards polysubstance use has been emphasized.[4]Among recreational drugs,cases of hypoglycemia from ecstasy,[5]amphetamine,[6]eutylone,[7]and cannabinoid[8]use have been reported,but none of these cases have had persistent refractory hypoglycemia.
