A pilot study to assess an online training module to quickly identify drugs on resuscitation trays

OBJECTIVE

To measure the median time required for healthcare professionals to identify drugs on resuscitation trays and to assess the usefulness of an online training module used to identify drugs on resuscitation trays.

STUDY DESIGN

This is a descriptive pilot study conducted in a mother-child university hospital center with a convenience sample of physicians, residents, nurses, pharmacists, pharmacy students or pharmacy technicians (10/group).

METHOD

Participants were given a questionnaire before and after using a simulation module to identify drugs on resuscitation drug trays (30 questions on the full trays with 43 drugs and 15 questions on the partial trays with 21 drugs). The identification times were measured for each drug and for each tray.

RESULTS

The median time to identify the drugs varied from 4s (range 2-46) for dextrose to 18s (range 4-78) for epinephrine. The median times to locate a drug on full and partial trays were, respectively: pharmacists 7 (2-103) and 6 (1-31), physicians 10 (3-78) and 7 (2-61) and nurses 10 (3-83) and 7 (2-53). All 60 participants strongly agreed that the online simulation module was a good tool for healthcare staff and that it would allow them to locate drugs more quickly in emergency situations.

CONCLUSION

The online simulation module can be used by various groups of professionals and it can allow them to locate drugs on resuscitation tray more rapidly during an emergency.

Total body bone mineral content and density during weight loss and maintenance on a low- or recommended-dairy weight-maintenance diet in obese men and women

BACKGROUND

Diets high in either dairy or calcium during moderate weight reduction both prevent loss of bone mineral density (BMD) and suppress bone turnover. The purpose of this study was to determine whether recommended dairy and calcium intakes during weight maintenance favorably affect total body BMD (TBBMD) and bone mineral content (TBBMC) in obese adults.

METHODS

Obese men (n=49) and women (n=64), aged 40.8+/-0.6 years, underwent 12 weeks of moderate energy restriction (approximately 1200 kcal/day) followed by 24 weeks on either a low or recommended dairy weight maintenance diet. The TBBMC and TBBMD values were measured using dual energy X-ray absorptiometry at baseline, 12, 24 and 36 weeks. Concentrations of calcium, intact parathyroid hormone (iPTH), 25OH and 1,25 (OH)(2) vitamin D in plasma were also measured. Data were analyzed using a two-factor repeated measures analysis of variance.

RESULTS

After weight loss, women exhibited a small, but statistically significant, increase in TBBMC (1.17+/-0.57%), whereas TBBMD increased in the men (1.34+/-0.28%). The iPTH concentration decreased significantly in all subjects. Despite significantly greater intakes of calcium, vitamin D and protein compared with the recommended dairy diet, there were no treatment-related differences in outcome variables after 24 weeks of weight maintenance. The TBBMC remained unchanged in women during weight stabilization; both TBBMC and TBBMD decreased in men (-1.59+/-0.51% and -0.70+/-0.25%, respectively).

CONCLUSIONS

In summary, results of this study do not provide convincing evidence that moderate weight loss through energy restriction and mild exercise reduces TBBMC in obese men and women. Similarly, a weight-maintenance diet providing the recommended daily servings of dairy does not seem to affect changes in BMC after weight loss.

Unintentional household poisoning in children

Despite the major reduction in fatal paediatric poisonings that has been achieved in industrialised countries over the last few decades, unintentional paediatric poisoning remains a major public health issue worldwide. In this article, we aim to provide clinicians dealing with poisoned children an overview of the problem and specific guidance on the identification and management of significant poisoning. Substances most frequently ingested by children in the developed world include household chemicals, medication, and plants. Although the great majority of such poisonings have no or limited clinical effects, it puts substantial burden on health care systems. Importantly, a few poisons can kill after ingestion of very small amounts. Unintentional poisoning in developing countries can be much more serious, following ingestion of kerosene, caustic agents, herbal remedies, insecticides or herbicides. Management of symptomatic patients involves supportive care, if available the administration of antidotes, and the removal of the offending drug from the body. Recent position papers on gastric decontamination indicate that such interventions are only rarely necessary. To further reduce the number of deaths and disabilities in the industrialised world and to begin to have an effect in the developing world, much more work is required to both identify and implement prevention strategies to reduce the number of cases of paediatric poisoning.

Epidemiology of electrical and lightning related deaths and injuries among Canadian children and youth

Among burn injuries, electrical injuries constitute a small but devastating fraction. To describe the epidemiology of electrical injuries in Canadian children, data on deaths and emergency department visits related to electrical injuries, including lightning strikes, were obtained from provincial coroners' offices and the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) respectively, for the years 1991-96. Twenty one deaths and 606 emergency visits highlight that electrical related deaths, more frequent among school age children, are more likely the result of high voltage and lightning strike, while emergency department visits, more frequent among younger children, are more likely the result of low voltage. While the introduction of legislated standards for child safe outlets and educational programs for parents, children, and youth are recommended strategies toward reducing the frequency of these incidents, these strategies require further evaluation before their effectiveness can be estimated.

Radiofrequency neurotomy for the treatment of third occipital headache

OBJECTIVE

To evaluate the efficacy of a revised technique of percutaneous radiofrequency neurotomy for third occipital headache.

METHODS

The revisions included using a large gauge electrode, ensuring minimum separation between the three electrode placements, and holding the electrode in place by hand. The revised technique was used to treat 51 nerves in 49 patients diagnosed as suffering from third occipital headache on the basis of controlled diagnostic blocks of the third occipital nerve. The criteria for successful outcome were complete relief of pain for at least 90 days associated with restoration of normal activities of daily living, and no use of drug treatment for the headache.

RESULTS

Of the 49 patients, 43 (88%) achieved a successful outcome. The median duration of relief in these patients was 297 days, with eight patients continuing to have ongoing relief. Fourteen patients underwent a repeat neurotomy to reinstate relief, with 12 (86%) achieving a successful outcome. The median duration of relief in these patients was 217 days, with six patients having ongoing relief. Side effects of the procedure were consistent with coagulation of the third occipital nerve and consisted of slight ataxia, numbness, and temporary dysaesthesia. No side effects required intervention, and they were tolerated by the patients in exchange for the relief of headache.

CONCLUSIONS

Use of the revised procedure greatly improved the rather low success rate previously encountered with third occipital neurotomy. Although the relief of headache is limited in duration, it is profound and can be reinstated by repeat neurotomy. No other form of treatment has been validated for this common form of headache.