1
|
Miró Ò, Waring WS, Dargan PI, Wood DM, Dines AM, Yates C, Giraudon I, Moughty A, O'Connor N, Heyerdahl F, Hovda KE, Vallersnes OM, Paasma R, Pold K, Jürgens G, Megarbane B, Anand JS, Liakoni E, Liechti M, Eyer F, Zacharov S, Caganova B, Bonnici J, Radenkova-Saeva J, Galicia M. Variation of drugs involved in acute drug toxicity presentations based on age and sex: an epidemiological approach based on European emergency departments. Clin Toxicol (Phila) 2021; 59:896-904. [PMID: 33724118 DOI: 10.1080/15563650.2021.1884693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To analyse the relative percentage of acute recreational drug toxicity emergency department (ED) presentations involving the main drug groups according to age and sex and investigate different patterns based on sex and age strata. METHODS We analysed all patients with acute recreational drug toxicity included by the Euro-DEN Plus dataset (22 EDs in 14 European countries) between October 2013 and December 2016 (39 months). Drugs were grouped as: opioids, cocaine, cannabis, amphetamines, gamma-hydroxybutyrate (GHB), hallucinogens, new psychoactive substances (NPS), benzodiazepines and ketamine. Descriptive data by age and sex are presented and compared among age/sex categories and among drug families. RESULTS Of 17,371 patients were included during the 39-month period, 17,198 (99.0%) had taken at least one of the investigated drugs (median age: 31 years; 23.9% female; ethanol co-ingestion recorded in 41.5%, unknown in 31.2%; multiple drug use in 37.9%). Opioids (in 31.4% of patients) and amphetamines (23.3%) were the most frequently involved and hallucinogens (1.9%) and ketamine (1.7%) the least. Overall, female patients were younger than males, both in the whole cohort (median age 29 vs. 32 years; p < 0.001) and in all drug groups except benzodiazepines (median age 36 vs. 36 years; p = 0.83). The relative proportion of each drug group was different at every age strata and some patterns could be clearly described: cannabis, NPS and hallucinogens were the most common in patients <20 years; amphetamines, ketamine and cocaine in the 20- to 39-year group; GHB/GBL in the 30- to 39-year group; and opioids and benzodiazepines in patients ≥40 years. Ethanol and other drug co-ingestion was more frequent at middle-ages, and multidrug co-ingestion was more common in females than males. CONCLUSION Differences in the drugs involved in acute drug toxicity presentations according to age and sex may be relevant for developing drug-prevention and education programs for some particular subgroups of the population based on the increased risk of adverse events in specific sex and/or age strata.
Collapse
Affiliation(s)
- Òscar Miró
- Emergency Department, Hospital Clínic, IDIBAPS, Barcelona, Spain.,Medical School, Universitat de Barcelona, Barcelona, Spain
| | - William S Waring
- Acute Medical Unit York Teaching Hospitals NHS Foundation Trust, York, UK
| | - Paul I Dargan
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.,Clinical Toxicology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - David M Wood
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.,Clinical Toxicology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Alison M Dines
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - Christopher Yates
- Emergency Department, Hospital Son Espases, Palma de Mallorca, Spain
| | - Isabelle Giraudon
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Adrian Moughty
- Emergency Department Mater, Misericordiae University Hospital, Dublin, Republic of Ireland
| | - Niall O'Connor
- Department of Emergency Medicine, Our Lady of Lourdes Hospital, Drogheda, Republic of Ireland
| | - Fridtjof Heyerdahl
- Department of Prehospital Medicine, Oslo University Hospital, Oslo, Norway
| | - Knut E Hovda
- The National CBRNe Centre of Medicine, Department of Acute Medicine, Medical Division, Oslo University Hospital, Oslo, Norway
| | - Odd M Vallersnes
- Department of General Practice, University of Oslo, Oslo Accident and Emergency Outpatient Clinic, City of Oslo Health Agency, Oslo, Norway
| | | | | | - Gesche Jürgens
- Clinical Pharmacology Unit, Zealand University Hospital Roskilde, Roskilde, Denmark.,Department and Clinical Pharmacology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Bruno Megarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS-1144, Paris-Diderot University, Paris, France
| | - Jacek S Anand
- Department of Clinical Toxicology, Medical University of Gdansk, Gdansk, Poland.,Pomeranian Centre of Toxicology, Gdansk, Poland
| | - Evangelia Liakoni
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Liechti
- Division of Clinical Pharmacology and Toxicology, Basel University Hospital and University of Basel, Basel, Switzerland
| | - Florian Eyer
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sergej Zacharov
- Department of Occupational Medicine, Toxicological Information Centre, Charles Universtity and General Hospital University, Prague, Czech Republic
| | - Blazena Caganova
- National Toxicological Information Center, University Hospital, Bratislava, Slovakia
| | | | | | - Miguel Galicia
- Emergency Department, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | | |
Collapse
|
2
|
Quirke M, Mitchell N, Varley J, Kelly S, Boland F, Moughty A, McKeever J, Fahey T, Wakai A. Prevalence and predictors of oral to intravenous antibiotic switch among adult emergency department patients with acute bacterial skin and skin structure infections: a pilot, prospective cohort study. BMJ Open 2020; 10:e034057. [PMID: 32868346 PMCID: PMC7462158 DOI: 10.1136/bmjopen-2019-034057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To determine the prevalence and predictors of oral to intravenous antibiotic switch among adult emergency department (ED) patients with acute bacterial skin and skin structure infections (ABSSSIs). DESIGN Multicentre, pilot cohort study. SETTING Three urban EDs in Dublin, Ireland. PARTICIPANTS Consecutive ED patients aged >16 years old with ABSSSIs between March 2015 and September 2016. INTERVENTION Oral flucloxacillin 500 mg-1 g four times a day (alternative in penicillin allergy). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was to determine the prevalence and predictors of oral to intravenous antibiotic switch. Secondary outcomes were to determine the prevalence and predictors of receiving an extended course of oral antibiotic treatment and measurement of interobserver reliability for clinical predictors at enrolment. RESULTS Overall, 159 patients were enrolled of which eight were lost to follow-up and five were excluded. The majority of patients were male (65.1%) and <50 years of age (58.2%). Oral to intravenous antibiotic switch occurred in 13 patients (8.9%; 95% CI 4.8% to 14.7%). Increased lesion size (OR 1.74; 95% CI 1.09 to 2.79), white cell count (OR 1.32; 95% CI 1.05 to 1.67), athlete's foot (OR 8.00; 95% CI 2.31 to 27.71) and fungal nail infections (OR 7.25; 95% CI 1.99 to 26.35) were associated with oral to intravenous antibiotic switch. 24.8% (95% CI 18.1% to 33.0%) of patients received an extended course of oral antibiotic treatment. CONCLUSION The prevalence of oral to intravenous antibiotic switch in this pilot study is 8.9% (95% CI 4.8% to 14.7%). We identify the predictors of oral to intravenous switch worthy of future investigation. TRIAL REGISTRATION NUMBER NCT02230813.
Collapse
Affiliation(s)
- Michael Quirke
- Emergency Care Research Unit, Royal College of Surgeons Ireland, Dublin, Ireland
- Department of Emergency Medicine, Beaumont Hospital, Dublin, Ireland
| | - Niamh Mitchell
- Department of Emergency Medicine, Connolly Hospital Blanchardstown, Blanchardstown, Dublin, Ireland
| | - Jarlath Varley
- Department of Emergency Medicine, Connolly Hospital Blanchardstown, Blanchardstown, Dublin, Ireland
| | - Stephen Kelly
- Department of Emergency Medicine, Beaumont Hospital, Dublin, Ireland
| | - Fiona Boland
- HRB Centre For Primary Care Research, Department of General Practice, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Adrian Moughty
- Department of Emergency Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Joseph McKeever
- Department of Emergency Medicine, Connolly Hospital Blanchardstown, Blanchardstown, Dublin, Ireland
| | - Tom Fahey
- HRB Centre For Primary Care Research, Department of General Practice, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Abel Wakai
- Emergency Care Research Unit, Royal College of Surgeons Ireland, Dublin, Ireland
- Department of Emergency Medicine, Beaumont Hospital, Dublin, Ireland
| |
Collapse
|
3
|
Noseda R, Schmid Y, Scholz I, Liakoni E, Liechti ME, Dargan PI, Wood DM, Dines AM, Yates C, Heyerdahl F, Hovda KE, Giraudon I, Ceschi A, Anand L, Anseeuw K, Badaras R, Bonnici J, Brvar M, Burke R, Caganova B, Eyer F, Galicia M, Geith S, Gillebeert J, Grenc D, Gorozia K, Jaffal K, Jürgens G, Konstari J, Kutubidze S, Laubner G, Liguts V, Lyphout C, Mégarbane B, Miró Ò, Moughty A, O'Connor N, Paasma R, Perez JO, Perminas M, Persett PS, Põld K, Puiguriguer J, Radenkova-Saeva J, Rulisek J, Sopirala R, Stašinskis R, Surkus J, Toth I, Vallersnes OM, Vigorita F, Waldman W, Waring WS, Zacharov S. MDMA-related presentations to the emergency departments of the European Drug Emergencies Network plus (Euro-DEN Plus) over the four-year period 2014–2017. Clin Toxicol (Phila) 2020; 59:131-137. [DOI: 10.1080/15563650.2020.1784914] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Roberta Noseda
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Yasmin Schmid
- Division of Clinical Pharmacology and Toxicology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Irene Scholz
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Pharmacology, University of Bern, Bern, Switzerland
| | - Evangelia Liakoni
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Pharmacology, University of Bern, Bern, Switzerland
| | - Matthias E. Liechti
- Division of Clinical Pharmacology and Toxicology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Paul I. Dargan
- Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust and King’s Health Partners, London, UK
- Clinical Toxicology, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - David M. Wood
- Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust and King’s Health Partners, London, UK
- Clinical Toxicology, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Alison M. Dines
- Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust and King’s Health Partners, London, UK
| | - Christopher Yates
- Emergency Department and Clinical Toxicology Unit, Hospital Universitari Son Espases, Mallorca, Spain
| | - Fridtjof Heyerdahl
- Prehospital Division, Oslo University Hospital, Oslo, Norway
- The Norwegian Air Ambulance Foundation, Bodo, Norway
| | - Knut E. Hovda
- The Norwegian CBRNE Centre of Medicine, Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
| | - Isabelle Giraudon
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - Alessandro Ceschi
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland
| | - Lukasz Anand
- Department of Clinical Toxicology, Medical University of Gdansk, Poland
| | - Kurt Anseeuw
- Department of Emergency Medicine, ZNA Stuivenberg, Antwerp, Belgium
| | | | | | - Miran Brvar
- Centre for Clinical Toxicology and Pharmacology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Rachel Burke
- Emergency Department, Mater Misericordiae University Hospital, Dublin 7, Republic of Ireland
| | - Blazena Caganova
- National Toxicological Information Centre, University Hospital, Bratislava, Slovakia
| | - Florian Eyer
- Department of Clinical Toxicology, Klinikum Rechts der Isar, Technical University of Munich, Germany
| | | | - Stefanie Geith
- Department of Clinical Toxicology, Klinikum Rechts der Isar, Technical University of Munich, Germany
| | - Johan Gillebeert
- Department of Emergency Medicine, ZNA Stuivenberg, Antwerp, Belgium
| | - Damjan Grenc
- Centre for Clinical Toxicology and Pharmacology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Ketevan Gorozia
- Archangel St. Michael Multiprofile Clinical Hospital, Tbilisi, Georgia
| | - Karim Jaffal
- Department of Medical and Toxicological Critical Care, Lariboisiere Hospital, INSERM UMRS-1144, Paris-Diderot University, Paris, France
| | - Gesche Jürgens
- Zealand University Hospital Roskilde, Clinical Pharmacology Unit, Roskilde, Denmark
| | | | - Soso Kutubidze
- Archangel St. Michael Multiprofile Clinical Hospital, Tbilisi, Georgia
| | - Gabija Laubner
- Republic Vilnius University Hospital, Vilnius, Lithuania
| | | | | | - Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, Lariboisiere Hospital, INSERM UMRS-1144, Paris-Diderot University, Paris, France
| | - Òscar Miró
- Emergency Department, Hospital Clınic, University of Barcelona, Catalonia, Spain
| | - Adrian Moughty
- Emergency Department, Mater Misericordiae University Hospital, Dublin 7, Republic of Ireland
| | - Niall O'Connor
- Department of Emergency Medicine, Our Lady of Lourdes Hospital, Drogheda, County Louth, Republic of Ireland
| | | | - Juan Ortega Perez
- Clinical Toxicology Unit, Emergency Department, Hospital Son Espases, Palma de Mallorca, Balearic Island, Spain
| | - Marius Perminas
- Hospital of Lithuanian University of Health Sciences (LSMU), Kauno klinikos, Kaunus, Lithuania
| | - Per Sverre Persett
- Department of Acute Medicine, Medical Division, Oslo University Hospital, Norway
| | - Kristiina Põld
- Emergency Medicine Department, North-Estonia Medical Centre, Tallinn, Estonia
| | - Jordi Puiguriguer
- Clinical Toxicology Unit, Emergency Department, Hospital Son Espases, Palma de Mallorca, Balearic Island, Spain
| | | | - Jan Rulisek
- Department of Anesthesia and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital, U Nemocnice 2, 120 00 Prague 2, Czech Republic
| | - Radhika Sopirala
- Department of Emergency Medicine, Our Lady of Lourdes Hospital, Drogheda, County Louth, Republic of Ireland
| | | | - Jonas Surkus
- Hospital of Lithuanian University of Health Sciences (LSMU), Kauno klinikos, Kaunus, Lithuania
| | | | - Odd Martin Vallersnes
- Department of General Practice, University of Oslo, Oslo, Norway
- Oslo Accident and Emergency Outpatient Clinic, City of Oslo Health Agency, Oslo, Norway
| | | | - Wojciech Waldman
- Department of Clinical Toxicology, Medical University of Gdansk, Poland
- Pomeranian Centre of Toxicology, Gdansk, Poland
| | - W. Stephen Waring
- Acute Medical Unit, York Teaching Hospitals NHS Foundation Trust, York, UK
| | - Sergej Zacharov
- Toxicological Information Centre, Department of Occupational Medicine, 1st Faculty of Medicine, Charles University and General University Hospital, Na Bojisti 1, 120 00 Prague 2, Czech Republic
| | | |
Collapse
|
4
|
Miró Ò, Yates C, Dines AM, Wood DM, Dargan PI, Galán I, Jerez A, Puiguriguer J, Waring WS, Moughty A, O'Connor N, Heyerdahl F, Hovda KE, Vallersnes OM, Paasma R, Põld K, Jürgens G, Megarbane B, Anand JS, Liakoni E, Liechti M, Eyer F, Zacharov S, Caganova B, Giraudon I, Galicia M. Emergencies related to recreational drug abuse in Spain compared to emergencies attended in 3 European areas. Emergencias 2019; 30:385-394. [PMID: 30638341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To analyze epidemiologic, clinical, and care characteristics in cases in which patients came to 2 Spanish emergency departments (EDs) with symptoms caused by recreational drug abuse. To compare the characteristics with those reported for other areas of Europe. MATERIAL AND METHODS Secondary analysis of the registry of the European Drug Emergencies Network (Euro-DEN Plus), which collects cases in 14 European countries and 20 EDs. The registry included all patients attending EDs with symptoms of recreational drug abuse (excepting cases involving alcohol alone) over a period of 39 consecutive months (October 2013 to December 2016). We compared the cases from the 2 Spanish EDs (in Barcelona and Palma de Mallorca) to those from the 5 EDs in Ireland and the UK, 6 in northern Europe, and 7 in central Europe. RESULTS A total of 17 104 patients' cases were included: Spain, 1186; UK and Ireland, 6653; northern Europe, 6097; and central Europe, 3168. Spain saw more emergencies related to cocaine (48.4%) and fewer related to opioids (12.4%) than the other areas. The Spanish patients were younger (32.2 years) on average than those in northern Europe and older than those in the UK and Ireland and central Europe. Fewer patients were women in Spain (21.9%) than in northern or central Europe. Fewer arrived in ambulances in Spain (70.0%) than in the UK and Ireland or northern Europe. The Spanish EDs recorded the temperature and respiratory frequency of fewer patients (29.8% and 30.3%, respectively). Clinical signs differed between geographical areas attributable to differences in drug-use patterns. In Spain, naloxone was used by fewer patients (9.6%) than in the UK and Ireland and northern Europe, and flumazenil was used by more patients (5.6%) than in other areas. Spain saw lower percentages of admissions (4.6%) and patients who left without an ED discharge (6.2%) in comparison with other areas. Mortality rates in the Spanish EDs (0.4%) and after discharge from them (0.7%) were higher than in northern Europe. CONCLUSION The characteristics of emergencies related to recreational drug abuse registered by the Spanish EDs were differed from those registered in other parts of Europe due to different patterns of drug use. We also detected differences between the Spanish and other European EDs with respect to examinations or tests performed, treatment given, and discharge disposition.
Collapse
Affiliation(s)
- Òscar Miró
- Área de Urgencias, Hospital Clínic, Barcelona; Grupo de Investigación "Urgencias: Procesos y Patologías", IDIBAPS, Barcelona, España. Facultad de Medicina, Universitat de Barcelona, España
| | - Christopher Yates
- Servicio de Urgencias, Hospital Son Espases, Palma de Mallorca, España
| | - Alison M Dines
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, Londres, Reino Unido
| | - David M Wood
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, Londres, Reino Unido. Clinical Toxicology, Faculty of Life Sciences and Medicine, King's College London, Londres, Reino Unido
| | - Paul I Dargan
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, Londres, Reino Unido. Clinical Toxicology, Faculty of Life Sciences and Medicine, King's College London, Londres, Reino Unido
| | - Itxaso Galán
- Área de Urgencias, Hospital Clínic, Barcelona; Grupo de Investigación "Urgencias: Procesos y Patologías", IDIBAPS, Barcelona, España
| | - Alba Jerez
- Área de Urgencias, Hospital Clínic, Barcelona; Grupo de Investigación "Urgencias: Procesos y Patologías", IDIBAPS, Barcelona, España
| | - Jordi Puiguriguer
- Servicio de Urgencias, Hospital Son Espases, Palma de Mallorca, España
| | - W Stephen Waring
- Acute Medical Unit York Teaching Hospitals NHS Foundation Trust York, Reino Unido
| | - Adrian Moughty
- Emergency Department Mater Misericordiae University Hospital, Dublin, República de Irlanda
| | - Niall O'Connor
- Department of Emergency Medicine, Our Lady of Lourdes Hospital, Drogheda, County Louth, República de Irlanda
| | - Fridtjof Heyerdahl
- The National CBRNe Centre of Medicine, Department of Acute Medicine, Medical Division, Oslo University Hospital, Oslo, Noruega
| | - Knut E Hovda
- The National CBRNe Centre of Medicine, Department of Acute Medicine, Medical Division, Oslo University Hospital, Oslo, Noruega
| | - Odd M Vallersnes
- Oslo Accident and Emergency Outpatient Clinic, City of Oslo Health Agency, Oslo, Noruega
| | | | | | - Gesche Jürgens
- Zealand University Hospital Roskilde Clinical Pharmacology Unit Roskilde, Dinamarca. Bispebjerg Hospital, Copenague, Dinamarca
| | - Bruno Megarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS-1144, Paris-Diderot University, Paris, Francia
| | - Jacek S Anand
- Department of Clinical Toxicology Medical University of Gdansk, Gdansk, Poland; Pomeranian Centre of Toxicology, Gdansk, Polonia
| | - Evangelia Liakoni
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Berna, Suiza
| | - Matthias Liechti
- Division of Clinical Pharmacology and Toxicology, Basel University Hospital and University of Basel, Basilea, Suiza
| | - Florian Eyer
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Alemania
| | - Sergej Zacharov
- Department of Occupational Medicine, Toxicological Information Centre, Charles Universtity and General Hospital University, Praga, República Checa
| | - Blazena Caganova
- Natonal Toxicological Information Center, University Hospital, Bratislava, Eslovaquia
| | - Isabelle Giraudon
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisboa, Portugal
| | - Miguel Galicia
- Área de Urgencias, Hospital Clínic, Barcelona; Grupo de Investigación "Urgencias: Procesos y Patologías", IDIBAPS, Barcelona, España
| |
Collapse
|
5
|
Wolfe CE, Wood DM, Dines A, Whatley BP, Yates C, Heyerdahl F, Hovda KE, Giraudon I, Dargan PI, Anseeuw K, Badaras R, Bonnici J, Brvar M, Caganova B, Ceschi A, Eyer F, Galicia M, Geith S, Gillebeert J, Grenc D, Gorozia K, Jaffal K, Jürgens G, Kabata PM, Kennedy I, Konstari J, Kutubidze S, Laubner G, Liakoni E, Liechti ME, Lyphout C, Mégarbane B, Miró Ò, Moughty A, Müller L, O'Connor N, Paasma R, Perez JO, Perminas M, Persett PS, Põld K, Puiguriguer J, Radenkova-Saeva J, Rulisek J, Schmid Y, Scholz I, Sopirala R, Surkus J, Toth I, Vallersnes OM, Vigorita F, Waldman W, Waring WS, Zacharov S. Seizures as a complication of recreational drug use: Analysis of the Euro-DEN Plus data-set. Neurotoxicology 2019; 73:183-187. [DOI: 10.1016/j.neuro.2019.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/04/2019] [Accepted: 04/04/2019] [Indexed: 10/27/2022]
|
6
|
Borhan N, Borhan F, Ni Cheallaigh C, Dinesh B, O'Reilly K, Moughty A. Bacteraemia in the ED: Are We Meeting Targets? Ir Med J 2018; 111:720. [PMID: 30376237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM An audit was performed in an Irish Emergency department (ED) to evaluate adherence to established antimicrobial guidelines and to determine the most common presentations of sepsis. METHODS Data on ED patients with clinically significant bacteraemia on blood cultures were recorded for three months . The antimicrobial given to the patient was compared to that which the hospital guidelines would recommend for the ED diagnosis. RESULTS Eleven patients out of 53 had no antimicrobial guidelines for diagnosis. Of the 42/53 patients, non-adherence to antimicrobial guidelines by physicians was observed in 81% (n=34/42) patients and adherence was observed in 19% (n=8/42) patients. Escherichia coli 35.70% (n=18), was the most frequent organism isolated. CONCLUSIONS Non-adherence to antimicrobial guidelines resulted in 68% (n=23/34) of organisms covered by the antibiotic. Adherence to antimicrobial guidelines resulted in 87% (n=7/8) of organisms covered by the antibiotic.
Collapse
Affiliation(s)
- N Borhan
- Emergency Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - F Borhan
- Emergency Department, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - C Ni Cheallaigh
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - B Dinesh
- Microbiology Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - K O'Reilly
- Department of Respiratory Medicine, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - A Moughty
- Emergency Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
| |
Collapse
|
7
|
Power D, Brazil E, Cogan L, Ramiah V, Moughty A, O’Connor G, Breslin T. 137The Impact of Access Block in the Emergency Department on the Functional Status of the Admitted Older Patient. Age Ageing 2017. [DOI: 10.1093/ageing/afx144.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
8
|
Monks D, Neill A, Barton D, Moughty A, McFeely A, Timmons A, Hatton S, McMorrow D. Age Adjusted D-Dimer for exclusion of Pulmonary Embolism: a retrospective cohort study. Ir Med J 2017; 110:599. [PMID: 29341511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
D-Dimer (DD) will increase with age and recent studies have shown the upper limit of normal can be raised in those who are low risk and over 50. We studied age adjusted D-dimer (AADD) levels to assess whether pulmonary embolism (PE) could be safely excluded. This study analysed the Emergency Department (ED) Computed Tomographic Pulmonary Angiography (CTPA) requests. There were 756 requests. The parameters studied were; age, DD value, calculated AADD, CT result and Simplified Geneva Score (SGS). The primary outcome was the diagnostic performance of AADD. One hundred and eighty-five patients were included in the final cohort. Twenty-one patients had a negative DD after age adjustment. Of these one had a PE, corresponding to a failure rate of 4.76% (1 in 22). The sensitivity of AADD was 0.96 (95% CI 0.76 to 0.99) and its specificity was 0.12 (95% CI 0.08- 0.19). AADD demonstrated a reduction in false positives with one false negative, giving rise to a failure rate higher than that of other larger studies. Further study is indicated to accurately define the diagnostic characteristics for the Irish context.
Collapse
Affiliation(s)
- D Monks
- St. Vincent's University Hospital, Elm Park, Donnybrook, D4, Ireland
| | - A Neill
- St. Vincent's University Hospital, Elm Park, Donnybrook, D4, Ireland
| | - D Barton
- St. Vincent's University Hospital, Elm Park, Donnybrook, D4, Ireland
| | - A Moughty
- St. Vincent's University Hospital, Elm Park, Donnybrook, D4, Ireland
| | - A McFeely
- St. Vincent's University Hospital, Elm Park, Donnybrook, D4, Ireland
| | - A Timmons
- St. Vincent's University Hospital, Elm Park, Donnybrook, D4, Ireland
| | - S Hatton
- St. Vincent's University Hospital, Elm Park, Donnybrook, D4, Ireland
| | - D McMorrow
- St. Vincent's University Hospital, Elm Park, Donnybrook, D4, Ireland
| |
Collapse
|
9
|
Ryan J, Shields G, Finegan E, Moughty A. Post Traumatic Tension Pneumocephalus: The Mount Fuji Sign. Ir Med J 2017; 110:550. [PMID: 28665089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Pneumocephalus is defined as the presence of intracranial air. This is most commonly secondary to a traumatic head injury. Tension pneumocephalus presents radiologically with compression of the frontal lobes and widening of the interhemispheric space between the frontal lobes. It is often termed the Mount Fuji sign due to a perceived similarity with an iconic mountain peak in Japan. We present the case of a 52-year-old gentleman who presented to the emergency department shortly before 8am on a Saturday morning following an assault. He was alert and ambulatory with no clinical evidence of raised intracranial pressure. A plain radiograph of the facial bones showed significant pneumocephalus. A later CT was consistent with a tension pneumocephalus which usually necessitates urgent decompression.The patient showed no clinical signs or symptoms of raised intracranial pressure and was managed conservatively. He was discharged home 16 days later with no neurological deficit.
Collapse
Affiliation(s)
- J Ryan
- Department of Emergency Medicine, Mater Misericordiae University Hospital, Dublin
| | - G Shields
- Department of Emergency Medicine, Mater Misericordiae University Hospital, Dublin
| | - E Finegan
- Department of Emergency Medicine, Mater Misericordiae University Hospital, Dublin
| | - A Moughty
- Department of Emergency Medicine, Mater Misericordiae University Hospital, Dublin
| |
Collapse
|
10
|
Ramasubbu B, Donnelly A, Moughty A. Profile of Frequent Attenders to a Dublin Inner City Emergency Department. Ir Med J 2016; 109:389. [PMID: 27685483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A retrospective review of the demographics, co-morbidities and substance misuse of the 20 most frequent presenters to the Mater Misericordiae University Hospital emergency department during 2014 was carried out in an attempt to better understand the epidemiology of their presentations. Eighty-five percent were male and 15% female (p<0.001). The average age was 40.6 years with a median 38.5 years. All were unemployed and 7 (35%) had no fixed abode. Thirteen patients (65%) lived an average of 4.5 kilometres from the ED. In this study the presence of a mental illness, homelessness, alcohol or drug misuse were associated with significantly higher attendance rates (p=0.001, p<0.001, p<0.05, p<0.001 respectively). Early identification of these patients and targeting them for effective case-based community-led treatment strategies could improve their quality of life, decrease their cost of care and ultimately lead to more effective utilisation of our already overburdened emergency departments.
Collapse
Affiliation(s)
- B Ramasubbu
- Emergency Department, Mater Misericordiae University Hospital, Eccles St, Dublin 7
| | - A Donnelly
- Emergency Department, Mater Misericordiae University Hospital, Eccles St, Dublin 7
| | - A Moughty
- Emergency Department, Mater Misericordiae University Hospital, Eccles St, Dublin 7
| |
Collapse
|
11
|
Hyde A, Coughlan B, Naughton C, Hegarty J, Savage E, Grehan J, Kavanagh E, Moughty A, Drennan J. Nurses', physicians' and radiographers' perceptions of the safety of a nurse prescribing of ionising radiation initiative: A cross-sectional survey. Int J Nurs Stud 2016; 58:21-30. [PMID: 27087295 DOI: 10.1016/j.ijnurstu.2016.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 01/15/2016] [Accepted: 01/19/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND A new initiative was introduced in Ireland following legislative changes that allowed nurses with special training to prescribe ionising radiation (X-ray) for the first time. A small number of studies on nurse prescribing of ionising radiation in other contexts have found it to be broadly as safe as ionising radiation prescribing by physicians. Sociological literature on perceptions of safety indicates that these tend to be shaped by the ideological position of the professional rather than based on objective evidence. OBJECTIVES To describe, compare and analyse perceptions of the safety of a nurse prescribing of ionising radiation initiative across three occupational groups: nursing, radiography and medicine. DESIGN A cross-sectional survey design. SETTINGS Participants were drawn from a range of clinical settings in Ireland. PARTICIPANTS Respondents were 167 health professionals comprised of 49 nurses, 91 radiographers, and 27 physicians out of a total of 300 who were invited to participate. Non-probability sampling was employed and the survey was targeted specifically at health professionals with a specific interest in, or involvement with, the development of the nurse prescribing of ionising radiation initiative in Ireland. METHODS Comparisons of perspectives on the safety of nurse prescribing of ionising radiation across the three occupational groups captured by questionnaire were analysed using the Kruskal-Wallis H test. Pairwise post hoc tests were conducted using the Mann-Whitney U test. RESULTS While the majority of respondents from all three groups perceived nurse prescribing of ionising radiation to be safe, the extent to which this view was held varied. A higher proportion of nurses was found to display confidence in the safety of nurse prescribing of ionising radiation compared to physicians and radiographers with differences between nurses' perceptions and those of the other two groups being statistically significant. CONCLUSION That an occupational patterning emerged suggests that perceptions about safety and risk of nurse prescribing of ionising radiation are socially constructed according to the vantage point of the professional and may not reflect objective measures of safety. These findings need to be considered more broadly in the context of ideological barriers to expanding the role of nurses.
Collapse
Affiliation(s)
- Abbey Hyde
- UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland.
| | - Barbara Coughlan
- UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland.
| | - Corina Naughton
- Florence Nightingale School, King's College, James Clerk Maxwell Building, Waterloo, United Kingdom.
| | | | - Eileen Savage
- School of Nursing and Midwifery, University College Cork, Ireland.
| | - Jennifer Grehan
- UCD School of Medicine and Medical Science, University College Dublin, Ireland.
| | - Eoin Kavanagh
- UCD School of Medicine and Medical Science, University College Dublin, Ireland.
| | - Adrian Moughty
- Mater Misercordiae University Hospital, Dublin, Ireland.
| | | |
Collapse
|
12
|
|
13
|
O'Connor G, Ramiah V, McInerney J, Moughty A. Splenic rupture visualised with focused assessment with sonography for trauma (FAST): heterogeneous echogenicity of acute haemorrhage following blunt trauma. Case Reports 2012; 2012:bcr-2012-007336. [DOI: 10.1136/bcr-2012-007336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|