A week of pain in the emergency department.

BACKGROUND: Pain is a common complaint in patients attending the emergency department (ED), and historically, it is under-assessed and undertreated. Previous research is heterogeneous and does not well describe pain in EDs over time. Our aim was to describe pain in a UK ED using a sample that included every adult attendance over the course of 1 week. METHODS: We retrospectively reviewed every adult attendance (N = 1872) over 1 week to the ED of a large English NHS District General Hospital. We noted the initial pain score and, if the initial score was ≥5, the final recorded pain score. We categorised attendances as 'illness' or 'injury'. RESULTS: In all, 62.1% of patients had a pain score recorded, of whom 50.7% had a pain score of zero. Median pain score was 6/10 in patients with pain; 58% had a second score recorded. More patients with illness than injury had a second score recorded. Most patients had an improvement in their pain; however, around one-third had no change or worse pain at the end of their ED stay. CONCLUSION: We have defined the incidence, severity and change in pain in an ED over 1 week. This information will underpin the design of future studies aimed at improving patient care in this important area of emergency medicine practice.

Valsalva using a syringe: pressure and variation.

BACKGROUND: The Valsalva manoeuvre is commonly used in EDs to terminate supraventricular tachycardia by the patient blowing into a syringe. AIM: To identify whether a specific syringe size can be recommended for use in the ED. RESULTS: 20% of syringes 'stuck' and required high pressures to move. In the remaining 80% of syringes, a 20 mL syringe was the most appropriate size to achieve the recommended 40 mm Hg. Once 'released' plunger position did not make a difference. CONCLUSIONS: Use of a syringe of any size cannot be recommended if a consistent pressure is required.

Good's syndrome: Is thymectomy the solution? Case report and literature review.

Good's syndrome is thymoma accompanied by immunodeficiency. A 69-year-old woman presented with recurrent chest infections, hypogammaglobulinemia, and radiological features of a thymoma. Immunoglobulin replacement therapy was not tolerated prior to surgery. Postoperative recovery was uneventful, and a Masaoka stage II type AB thymoma was confirmed on histology. One-year follow-up revealed no recurrence of the thymoma but the patient remained hypogammaglobulinemic and developed collagenous colitis. She declined immunoglobulin replacement therapy but remains under follow-up. Awareness of Good's syndrome to avoid overwhelming infection is emphasized. The finding of thymoma should prompt the thoracic surgeon to test for immunodeficiency.

Disinfection of water using Pt- and Ag-doped TiO2 photocatalysts.

In this article we have reported heterogeneous photocatalytic disinfection using pristine and Ag- and Pt-doped nano TiO2 under near-UV light and solar light irradiation. Disinfection experiments were conducted in slurry reactors with Escherichia coli, artificial light and sunlight. The influence of various amounts of Pt and Ag loading (0.5% to 5%) on the E. coli inactivation was examined and results indicated that 5% Pt-TiO2 and 0.5% Ag-TiO2 showed the highest photocatalytic E. coli inactivation. The Pt- and Ag-doped photocatalysts were characterized using XPS and TEM analysis. The influence of experimental parameters such as various photocatalysts, photocatalyst concentration, reactor geometry effect, pH and temperature on the photocatalytic disinfection was studied. The experimental results show that sunlight or near-UV light with TiO2 photocatalyst strongly inactivates E. coli. The Ag-TiO2 photocatalyst was the most efficient photocatalyst tested for bactericidal activity. A plausible mechanism ofphotocatalysed E. coli inactivation is discussed. In conclusion, the doped nano TiO2 photocatalysts is a potential candidate for E. coli inactivation.