Abstracts for the 2008 NAEMSP Scientific Assembly

Abstract

Objectives. To date, most patient safety studies have been conducted in relation to the hospital rather than the prehospital setting and data regarding emergency medical services (EMS)-related errors are limited. To address this gap, a study was conducted to gain an in-depth understanding of the views of highly experienced EMS practitioners, educators, administrators, and physicians on major issues pertaining to EMS patient safety. The intent of the study was to identify key issues to give direction to the development of best practices in education, policy, and fieldwork. Methods. A qualitative study was conducted using processes described by Lincoln and Guba (1985) to enhance the quality and credibility of data and analysis. Purposive sampling was used to identify informants with knowledge and expertise regarding policy, practice, and research who could speak to the issue of patient safety. Sixteen participants, the majority of whom were Canadian, participated in in-depth interviews. Results. Two major themes were identified under the category of key issues: clinical decision making and EMS's focus and relationship with health care. An education gap has developed in EMS, and there is tension between the traditional stabilize-and-transport role and the increasingly complex role that has come about through “scope creep.” If, as expected, EMS aligns increasingly with the health sector, then change is needed in the EMS educational structure and process to develop stronger clinical decision-making skills. Conclusion. The results of this study indicate that many individual organizations and health regions are addressing issues related to patient safety in EMS, and there are important lessons to be learned from these groups. The broader issues identified, however, are system-wide and best addressed through policy change from health regions and government.     

Intentional ingestion of cyanoacrylate

Abstract

Background. Diphenidine (1-(1,2-diphenylethyl)piperidine) and its 2-methoxylated derivative methoxphenidine (MXP, 2-MeO-diphenidine) are substances with dissociative effects that were recently introduced for “recreational” purpose through the online-based sale of new psychoactive substances (NPS). A number of analytically confirmed non-fatal intoxications associated with diphenidine or MXP have occurred in Sweden and were included in the STRIDA project. Study design. Observational case series of consecutive patients with admitted or suspected intake of NPS and requiring intensive treatment in an emergency room and hospitalization in Sweden. Patients and methods. Blood and urine samples were collected from intoxicated patients presenting at emergency departments all over the country. NPS analysis was performed by multi-component liquid chromatography–mass spectrometry methods. Data on clinical features were collected during telephone consultations with the Poisons Information Centre and retrieved from medical records. Information was also obtained from online drug discussion forums. Case series. Over a 12-month period from January to December 2014, 750 cases of suspected NPS intoxication originating from emergency departments were enrolled in the STRIDA project of which 14 (1.9%) tested positive for diphenidine and 3 (0.4%) tested positive for MXP. Co-exposure to several other NPS (e.g., 5-/6-(2-aminopropyl)benzofuran, 2-4-bromomethcathinone, butylone, 3,4-dichloromethylphenidate, 5-methoxy-N-isopropyltryptamine, methiopropamine, and α-pyrrolidinopentiothiophenone), also including other dissociative substances (3-/4-methoxyphencyclidine), and classical drugs of abuse (e.g., cannabis and ethanol) was documented in 87% of these cases. The 17 patients were aged 20–48 (median: 32) years, and 13 (76%) were men. They commonly presented with hypertension (76%), tachycardia (47%), anxiety (65%), and altered mental status (65%) including confusion, disorientation, dissociation, and/or hallucinations. Eight patients (47%) displayed severe intoxication (Poisoning Severity Score 3). The diphenidine- or MXP-positive patients required hospitalization for 1–3 (median: 2) days. In addition to standard supportive therapy, half of the cases were treated with benzodiazepines and/or propofol. Conclusion. The adverse effects noted in analytically confirmed cases of NPS intoxication involving diphenidine or MXP were similar to those reported for other dissociative substances such as ketamine and methoxetamine. However, the high proportion of polysubstance use might have played a role in the intoxication and clinical features in some cases.     

Non-invasive measurement of coronary plaque from coronary CT angiography and its clinical implications

Coronary CT angiography (CTA) is increasingly used worldwide for direct, non-invasive evaluation of the coronary arteries. Advances in computed tomography (CT) technology over the last decade have enabled such reliable imaging of the coronary arteries. Beyond arterial stenosis, coronary CTA also permits assessment of atherosclerotic plaque (including plaque burden) and coronary artery remodeling, previously only achievable through invasive means. It has been shown that coronary plaque volumes for non-calcified and mixed plaques and the arterial remodeling index, correlate closely with invasive intravascular ultrasound. Several studies have also shown a strong relationship of adverse plaque features imaged by coronary CTA with acute coronary syndrome, all-cause death, major adverse cardiovascular events and myocardial ischemia. The aim of this review is to summarize current methods for quantitative measurement of atherosclerotic plaque features from coronary CTA and to discuss their clinical implications.     

Psychosocial and Spiritual Care in Hospice: Differences Between Nursing,Social Work,and Clergy

A chart review of the most recent home visits from nursing, social work, and clergy to 37 home hospice patients indicated that all but two psychosocial and spiritual issues examined were addressed by hospice staff on home visits. Spirituality and, secondly, death anxiety were the most frequently discussed variables. Clergy addressed more spiritual issues than the other two professions, and social work addressed more psychosocial issues than the other two professions. These findings underscore the important roles that clergy and social work play on the hospice team, and imply that hospice should make a renewed commitment to psychosocial and spiritual care. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworth.com]     

哌拉西林/他唑巴坦致血细胞减少的回顾性研究

目的:比较儿童及成人使用哌拉西林/他唑巴坦致血液系统不良反应(ADR)的发生情况及其影响因素,为儿童安全用药提供参考。方法:回顾性分析某三甲医院2017 年4 月至2018 年3 月使用哌拉西林/ 他唑巴坦的5 176 例患者的病例资料,根据年龄分为0 ~28 d,1 ~12 月,>1 ~12 岁,>12 ~18 岁,>18 ~65 岁,>65 岁6 组,分析不同年龄组患者血细胞减少的发生率、发生时间、严重程度及转归等,并对患者血细胞减少相关危险因素进行Logistic 回归分析,探讨儿童与成人使用该药的安全性差异。结果:血液系统ADR 总发生率为2.99%,1 ~ 12 月龄婴幼儿ADR 发生率最高,达14.48%,>65 岁的老年人最低,仅1.38%。898 例儿童中有88 例(9.80%)血细胞(NEU、WBC、PLT)减少,15 例(1.67%)3 ~ 4 级严重中性粒细胞减少。Logistic 多因素分析结果显示,年龄<1 岁(OR =5.399)是用药后血细胞(NEU、WBC、PLT)严重减少的独立危险因素。结论:哌拉西林/ 他唑巴坦在各年龄段儿童患者中血液系统ADR 发生率均明显高于成人和药品说明书的报道,尤其是新生儿及1 ~ 12 月龄的婴幼儿,应高度关注其血液系统ADR,加强监测血常规。     

大剂量甲氨蝶呤治疗儿童急性淋巴细胞白血病的不良反应临床观察

目的:探讨大剂量甲氨蝶呤(HD-MTX)治疗儿童急性淋巴细胞白血病(ALL)的不良反应。方法:对40例ALL患儿采用HD-MTX 2.0～5.0 g/m2治疗,观察治疗后患儿的临床症状和体征,并统计不良反应发生率。结果:经过3个疗程的临床治疗后,患儿出现了骨髓抑制、胃肠道反应、感染、肝损害、黏膜损害、心脏损害、神经系统症状、皮疹及脱发等不良反应。其中,骨髓抑制发生率为61.3%,胃肠道反应发生率为51.9%,感染发生率为38.1%,肝损害发生率为41.3%,黏膜损害发生率为15.6%,心脏损害发生率为10.0%,神经系统症状发生率为15.0%,皮疹发生率为6.9%,脱发发生率为5.0%;未见明显的肾功能损害。结论:HD-MTX治疗ALL患儿的不良反应较多,要积极对症治疗,加强对MTX血药浓度的监测以及个体化治疗,以提高患儿的长期无病生存率。     

静脉用β-七叶皂甙钠局部不良反应防治的临床研究

目的：探讨临床静脉应用β-七叶皂甙钠的不同药物浓度、合并用药对局部皮肤、血管不良反应的影响，为临床应用该药时减少药物不良反应的发生、提高患者依从性提供依据。方法：对248例静脉输入β-七叶皂甙钠出现局部不良反应进行临床分析研究，总结局部并发症的临床特点及防治措施。结果：本组248例中，191例出现了不同程度的局部不良反应。结果表明，随着β-七叶皂甙钠液体药物浓度的增高，局部不良反应发生率越高，各组之间有显著性差异；在与血塞通、丹参等活血化淤类药物及甘露醇合并使用时，局部不良反应的发生率明显增加，与未合并用药组有显著差异；β-七叶皂甙钠液体浓度相同，配制液体量越多，局部不良反应发生率也越高，但统计学上无显著性差异。结论：严格的无菌技术操作，保护性静脉穿刺，合理的给药方法，强调给药剂量、浓度、持续用药时间等，是减少静脉用药后局部不良反应发生，增加临床治疗中用药依从性的关键。     

Extracellular Gd-CA: differences in prevalence of NSF

Until recently it was believed that extracellular gadolinium-based contrast agents were safe for both the kidneys and all other organs within the dose range up to 0.3 mmol/kg body weight. However, in 2006, it was demonstrated that some gadolinium-based contrast agents may trig the development of nephrogenic systemic fibrosis, a generalized fibrotic disorder, in renal failure patients. As no prospective studies can be performed we must rely on retrospective data. From those data it is obvious that the prevalence of NSF is significantly higher after the unstable agent gadodiamide than after any other gadolinium-based agent (3–7% versus 0–1% per injection) in patients with reduced renal function. Prevalence after exposure to two gadodiamide injections is as high as 36% in patients with chronic kidney disease (CKD) stage 5. No report of NSF after the most stable agents has been reported in the peer-reviewed literature documenting that there is a difference between the various agents regarding triggering NSF.     

2000~2014年中医药干预化疗所致消化道毒性反应临床试验的方法学质量评价?

目的：评价2000~2014年中国中医药干预化疗致消化道毒性反应临床试验的方法学质量。方法计算机检索知网、万方、维普、中国生物医学文献数据库及中国中医药数据库(2000年1月至2014年12月),并辅以手工检索。采用 Cochrane偏倚风险评估表对纳入的随机对照试验、半随机对照试验进行方法学质量评价。结果最终筛选研究291篇,符合 Cochrane 偏倚风险评估表“低风险”标准至少一条的随机对照试验及半随机对照试验仅76个,总体方法学质量欠佳。结论近14年来,中医药疗法干预化疗致消化道毒性反应的临床试验发表呈逐年上升趋势,但总体研究设计存在缺陷。