3M™ Defib-Pads as a Reusable Alternative to Commercial Ultrasound Gel in Resource-Limited Settings.

INTRODUCTION: With point-of-care ultrasound (POCUS) use in austere environments comes the challenge of having an ever-available coupling medium for image generation. Commercial gel has numerous drawbacks that can limit its utility in these settings, and no studies have evaluated the potential for a reusable coupling medium. This study aimed to determine whether 3M™ Defib-Pads could be utilized as a reusable alternative to commercial gel for image generation in resource-limited settings. METHODS: A descriptive, cross-sectional survey of Canadian physicians with POCUS interest was conducted to evaluate the interpretability of various POCUS images in a blinded fashion. Three anatomic regions (cardiac, abdominal, and nerve) were utilized, and image generation from the commercial gel and 7 Defib-Pad conditions were evaluated. These included pads that were 1) newly opened, 2) dirtied then rinsed, 3) air dried, 4) rinsed after being air dried, 5) frozen then thawed, 6) used in double thickness, and 7) used with a probe cover. RESULTS: Compared to commercial gel, 3M™ Defib-Pads performed similarly, with adequate image interpretability of up to 100% in some conditions. The exception was pads that had prolonged air exposure, which produced images that were never interpretable. However, subsequent rinsing of these pads with water resulted in restored image generation. CONCLUSION: 3M™ Defib-Pads were found to produce interpretable POCUS images under multiple environmental stressors and with different modalities of use, suggesting that 3M™ Defib-Pads can perform as a reusable gel alternative in resource-limited settings.

Predictors of 30-day recurrent emergency department visits for hyperglycemia in patients with types 1 and 2 diabetes: a population-based cohort study.

OBJECTIVES: This study's aims were to describe the outcomes of patients with diabetes presenting with their first ED visit for hyperglycemia, and to identify predictors of recurrent ED visits for hyperglycemia. METHODS: Using linked databases, we conducted a population-based cohort study of adult and pediatric patients with types 1 and 2 diabetes presenting with a first ED visit for hyperglycemia from April 2010 to March 2020 in Ontario, Canada. We determined the proportion of patients with a recurrent ED visit for hyperglycemia within 30 days of the index visit. Using multivariable regression analysis, we examined clinical and socioeconomic predictors for recurrent visits. RESULTS: There were 779,632 patients with a first ED visit for hyperglycemia. Mean (SD) age was 64.3 (15.2) years; 47.7% were female. 11.0% had a recurrent visit for hyperglycemia within 30 days. Statistically significant predictors of a recurrent visit included: male sex, type 1 diabetes, regions with fewer visible minority groups and with less education or employment, higher hemoglobin A1C, more family physician or internist visits within the past year, being rostered to a family physician, previous ED visits in the past year, ED or hospitalization within the previous 14 days, access to homecare services, and previous hyperglycemia encounters in the past 5 years. Alcoholism and depression or anxiety were positive predictors for the 18-65 age group. CONCLUSIONS: This population-level study identifies predictors of recurrent ED visits for hyperglycemia, including male sex, type 1 diabetes, regions with fewer visible minority groups and with less education or employment, higher hemoglobin A1C, higher previous healthcare system utilization (ED visits and hospitalization) for hyperglycemia, being rostered to a family physician, and access to homecare services. Knowledge of these predictors may be used to develop targeted interventions to improve patient outcomes and reduce healthcare system costs.

ABSTRAIT: OBJECTIFS: Les objectifs de cette étude étaient de décrire les résultats des patients diabétiques présentant leur première visite aux urgences pour hyperglycémie, et d'identifier les prédicteurs des visites récurrentes aux urgences pour hyperglycémie. MéTHODES: À l'aide de bases de données couplées, nous avons mené une étude de cohorte basée sur la population de patients adultes et pédiatriques atteints de diabète de type 1 et 2 présentant une première visite aux urgences pour l'hyperglycémie d'avril 2010 à mars 2020 en Ontario, au Canada. Nous avons déterminé la proportion de patients présentant une visite récurrente à l'urgence pour hyperglycémie dans les 30 jours suivant la visite d'index. À l'aide d'une analyse de régression multivariée, nous avons examiné les prédicteurs cliniques et socioéconomiques des visites récurrentes. RéSULTATS: Il y avait 779 632 patients avec une première visite à l'urgence pour hyperglycémie. L'âge moyen (ET) était de 64,3 (15,2) ans; 47,7% étaient des femmes. 11,0 % avaient une visite récurrente pour hyperglycémie dans les 30 jours. Les prédicteurs statistiquement significatifs d'une visite récurrente comprenaient le sexe masculin, le diabète de type 1, les régions comptant moins de groupes de minorités visibles et ayant moins d'études ou d'emploi, une hémoglobine A1C plus élevée, plus de visites chez un médecin de famille ou un interniste au cours de la dernière année, être inscrit auprès d'un médecin de famille, consulter le service d'urgence au cours de la dernière année, être hospitalisé au cours des 14 derniers jours, avoir accès à des services de soins à domicile et avoir été confronté à une hyperglycémie au cours des 5 dernières années. L'alcoolisme et la dépression ou l'anxiété étaient des prédicteurs positifs pour le groupe des 18-65 ans. CONCLUSIONS: Cette étude au niveau de la population identifie des prédicteurs de visites récurrentes aux urgences pour l'hyperglycémie, y compris le sexe masculin, le diabète de type 1, les régions avec moins de groupes de minorités visibles et avec moins d'études ou d'emploi, plus d'hémoglobine A1C, l'utilisation antérieure plus élevée du système de soins de santé (visites aux urgences et hospitalisation) pour l'hyperglycémie, le fait d'être inscrit auprès d'un médecin de famille et l'accès aux services de soins à domicile. La connaissance de ces prédicteurs peut être utilisée pour élaborer des interventions ciblées afin d'améliorer les résultats pour les patients et de réduire les coûts du système de santé.

Physician wellbeing and burnout in emergency medicine in Switzerland.

Emergency physicians are the most at-risk medical specialist group for burnout. Given its consequences for patient care and physician health and its resulting increased attrition rates, ensuring the wellbeing of emergency physicians is vital for preserving the integrity of the safety net for the healthcare system that is emergency medicine. In an effort to understand the current state of practicing physicians, this study reviews the results of the first national e-survey on physician wellbeing and burnout in emergency medicine in Switzerland. Addressed to all emergency physicians between March and April 2023, it received 611 complete responses. More than half of respondents met at least one criterion for burnout according to the Maslach Burnout Inventory - Human Services Survey (59.2%) and the Copenhagen Burnout Inventory (54.1%). In addition, more than half reported symptoms suggestive of mild to severe depression, with close to 20% screening positively for moderate to severe depression, nearly 4 times the incidence in the general population, according to the Patient Health Questionnaire-9. We found that 10.8% of respondents reported having considered suicide at some point in their career, with nearly half having considered this in the previous 12 months. The resulting high attrition rates (40.6% of respondents had considered leaving emergency medicine because of their working conditions) call into question the sustainability of the system. Coinciding with trends observed in other international studies on burnout in emergency medicine, this study reinforces the fact that certain factors associated with wellbeing are intrinsic to emergency medicine working conditions.