scholarly journals An Evaluation of the Drone Delivery of Adrenaline Auto-Injectors for Anaphylaxis: Pharmacists’ Perceptions, Acceptance, and Concerns

Drones ◽  
2020 ◽  
Vol 4 (4) ◽  
pp. 66
Author(s):  
September Beck ◽  
Tam T. Bui ◽  
Andrew Davies ◽  
Patrick Courtney ◽  
Alex Brown ◽  
...  
Keyword(s):  
Threatening Condition ◽  
Life Threatening ◽  
Relevant Group ◽  
Chemical Purity ◽  
Vitro Model ◽  
The Stability ◽  
The Uk ◽  
Auto Injector ◽  
Temperature Storage

Anaphylaxis is a life-threatening condition where delays in medical treatment can be fatal. Such situations would benefit from the drone delivery of an adrenaline auto-injector such as EpiPen®. This study evaluates the potential risk, reward, and impact of drone transportation on the stability of adrenaline during episodes of anaphylaxis. Further, this study examines pharmacists’ perceptions on drone delivery—pharmacists approved the use of drones to deliver EpiPen® during emergencies but had concerns with drone safety and supply chain security. Laboratory simulated onboard drone conditions reflected typical missions. In these experiments, in vitro model and pharmaceutical equivalent formulations were subjected independently to 30 min vibrations at 5, 8.43, and 13.33 Hz, and temperature storage at 4, 25, 40, and 65 °C for 0, 0.5, 3, and 24 h. The chiral composition (an indicator of chemical purity that relates to molecular structure) and concentration of these adrenaline formulations were determined using ultraviolet (UV) and circular dichroism spectroscopy (CD). Adrenaline intrinsic stability was also explored by edge-of-failure experimentation to signpost the uppermost limits for safe transportation. During drone flight with EpiPen®, the temperature and vibration g-force were 10.7 °C and 1.8 g, respectively. No adverse impact on adrenaline was observed during drone flight and laboratory-simulated conditions shown by conformation to the British Pharmacopeia standards (p > 0.05 for CD and UV). This study showed that drone delivery of EpiPen® is feasible. There are more than 15,000 community pharmacies and ≈9000 GP surgeries spanning the UK, which are likely to provide achievable ranges and distances for the direct drone delivery of EpiPen®. The authors recommend that when designing future missions, in addition to medicine stability testing that models the stresses imposed by drone flight, one must conduct a perceptions survey on the relevant group of medical professionals, because their insights, acceptance, and concerns are extremely valuable for the design and evaluation of the mission.

Recognising and managing an acute asthma attack

2021 ◽  
Vol 2 (1) ◽  
pp. 12-18
Author(s):  
Richard Elston
Keyword(s):  
Acute Asthma ◽  
Asthma Attack ◽  
Threatening Condition ◽  
Life Threatening ◽  
The Uk ◽  
Inhaled Salbutamol

Asthma is a potentially life-threatening condition, characterised by a reversible narrowing of the airways. It affects 1 in 10 children in the UK. During exacerbations, it is difficult for the child to breathe and get enough oxygen into their blood. There is a huge variance in the severity of an attack. Some can be managed in the community while others are potentially fatal and need urgent transfer to hospital. For that reason, criteria have been created to categorise attacks as mild, moderate, severe or life threatening. Initially, an asthma attack should be treated using inhaled salbutamol; however, if the patient does not respond or has severe or life-threatening asthma, they need urgent transfer to hospital.

scholarly journals A methodological approach for quantifying and characterizing the stability of agitated saline contrast: implications for quantifying intrapulmonary shunt

2016 ◽  
Vol 121 (2) ◽  
pp. 568-576 ◽  
Author(s):  
Heather K. Hackett ◽  
Lindsey M. Boulet ◽  
Paolo B. Dominelli ◽  
Glen E. Foster
Keyword(s):  
Transit Time ◽  
Methodological Approach ◽  
Contrast Echocardiography ◽  
Acoustic Intensity ◽  
Suitable Alternative ◽  
Transit Times ◽  
Flow Through ◽  
Vitro Model ◽  
The Stability

Agitated saline contrast echocardiography is often used to determine blood flow through intrapulmonary arteriovenous anastomoses (Q̇IPAVA). We applied indicator dilution theory to time-acoustic intensity curves obtained from a bolus injection of hand-agitated saline contrast to acquire a quantitative index of contrast mass. Using this methodology and an in vitro model of the pulmonary circulation, the purpose of this study was to determine the effect of transit time and gas composition [air vs. sulphur hexafluoride (SF6)] on contrast conservation between two detection sites separated by a convoluted network of vessels. We hypothesized that the contrast lost between the detection sites would increase with transit times and be reduced by using contrast bubbles composed of SF6. Changing the flow and/or reducing the volume of the circulatory network manipulated transit time. Contrast conservation was measured as the ratio of outflow and inflow contrast masses. For air, 53.2 ± 3.4% (SE) of contrast was conserved at a transit time of 9.25 ± 0.02 s but dropped to 16.0 ± 1.0% at a transit time of 10.17 ± 0.06 s. Compared with air, SF6 contrast conservation was significantly greater ( P < 0.05) with 114.3 ± 2.9% and 73.7 ± 3.3% of contrast conserved at a transit time of 10.39 ± 0.02 s and 13.46 ± 0.04 s, respectively. In summary, time-acoustic intensity curves can quantify agitated saline contrast, but loss of contrast due to bubble dissolution makes measuring Q̇IPAVA across varying transit time difficult. Agitated saline composed of SF6 is stabilized and may be a suitable alternative for Q̇IPAVA measurement.

scholarly journals Epilepsy emergency rescue training

2015 ◽  
Vol 4 (1) ◽  
pp. u208167.w3566 ◽  
Author(s):  
Rohit Shankar ◽  
Caryn Jory ◽  
juliet ashton ◽  
Brendan McLean ◽  
Matthew Walker
Keyword(s):  
Rescue Medication ◽  
Premature Death ◽  
Convulsive Status Epilepticus ◽  
Web Based ◽  
Emergency Rescue ◽  
Prolonged Seizure ◽  
Threatening Condition ◽  
Life Threatening ◽  
The Uk ◽  
Safe Care

AbstractThe NICE audit of epilepsy related deaths revealed that 1200 epilepsy deaths occur every year in the UK, with 42% potentially avoidable.[1] Convulsive status epilepticus (SE) is a life-threatening condition with over 20% mortality rate, especially if early treatment is not initiated .[2] Ten percent of all UK emergency department (ED) admissions are due to epilepsy, usually over represented by cases of SE.[3] Six out of seven epilepsy cases seen in the ED are admitted into medical care.[4]Patients with chronic and/or treatment resistant epilepsy carry a higher risk of premature death. When a seizure lasts for five minutes or more then the patient is at high risk of continuing to SE and this may result in causing brain damage or death.[2]Buccal midazolam is an emergency rescue medication prescribed on a special named patient license to reduce the duration of an epileptic seizure and prevent SE.[2,5] It should be administered by a trained person and is widely used due to its effectiveness and social acceptability. In the UK, epilepsy education and training courses are expected to be conducted by epilepsy professionals in line with the agreed training guidelines of Joint Epilepsy Council (JEC) backed up by evidence from NICE.[6,7] Training should provide an overview of epilepsy to facilitate safe care and appropriate administration of rescue medication for people with epilepsy (PWE) when experiencing a prolonged seizure. The medication is prescribed on specialist advice by the GP or specialists directly.Unfortunately the JEC guidelines are not robust enough to provide assurances of safe care. This problem had a myriad of complexities and an appropriate solution using web based resource was piloted, tested, and applied successfully using quality improvement methodology.

Meningitis in service-age personnel

2015 ◽  
Vol 101 (1) ◽  
pp. 63-68
Author(s):  
R Miller ◽  
K Houlberg
Keyword(s):  
Bacterial Meningitis ◽  
Case Fatality ◽  
Acute Bacterial Meningitis ◽  
Operational Environment ◽  
Bacterial Strains ◽  
Threatening Condition ◽  
Life Threatening ◽  
Classical Triad ◽  
The Uk ◽  
Medical Advances

AbstractThe incidence of meningitis is declining in the UK population largely due to increased availability of vaccinations against the most common bacterial strains. Acute bacterial meningitis, however, is a life-threatening condition and distinguishing it from more benign causes of headache and fever is difficult in an operational environment due to limited access to diagnostic tests. Despite medical advances, the case fatality rate in the United Kingdom in adults with invasive meningococcal disease is 10.5%. Acute bacterial meningitis presents with the classical triad of fever, neck pain and altered mental state in less than half of adults, and in the initial course of the disease it frequently mimics common viral illnesses. The aim of this article is to discuss the recognition and management of meningitis with special emphasis on the deployed military environment.

scholarly journals Dynamic effects of genetic variation on gene expression revealed following hypoxic stress in cardiomyocytes

eLife ◽  
2021 ◽  
Vol 10 ◽  
Author(s):  
Michelle C Ward ◽  
Nicholas E Banovich ◽  
Abhishek Sarkar ◽  
Matthew Stephens ◽  
Yoav Gilad
Keyword(s):  
Gene Expression ◽  
Complex Traits ◽  
Induced Pluripotent Stem Cell ◽  
Chromatin Accessibility ◽  
Regulatory Changes ◽  
Life Threatening ◽  
Vitro Model ◽  
Culturing Conditions ◽  
Induced Pluripotent

One life-threatening outcome of cardiovascular disease is myocardial infarction, where cardiomyocytes are deprived of oxygen. To study inter-individual differences in response to hypoxia, we established an in vitro model of induced pluripotent stem cell-derived cardiomyocytes from 15 individuals. We measured gene expression levels, chromatin accessibility, and methylation levels in four culturing conditions that correspond to normoxia, hypoxia, and short- or long-term re-oxygenation. We characterized thousands of gene regulatory changes as the cells transition between conditions. Using available genotypes, we identified 1,573 genes with a cis expression quantitative locus (eQTL) in at least one condition, as well as 367 dynamic eQTLs, which are classified as eQTLs in at least one, but not in all conditions. A subset of genes with dynamic eQTLs is associated with complex traits and disease. Our data demonstrate how dynamic genetic effects on gene expression, which are likely relevant for disease, can be uncovered under stress.

scholarly journals Aortic flow below and visceral circulation during aortic counterpulsation: Evaluation of an in vitro model

Perfusion ◽  
2020 ◽  
pp. 026765912097864
Author(s):  
Monique MJ de Jong ◽  
Orlando Parise ◽  
Francesco Matteucci ◽  
Marcel Rutten ◽  
Maxime Devos ◽  
...  
Keyword(s):  
Systemic Circulation ◽  
Cardiovascular Model ◽  
Mock Circulation ◽  
Bland Altman Method ◽  
Heart Contraction ◽  
Vitro Model ◽  
The Stability ◽  
Number Of Cycles

Introduction: This study aimed to test a computer-driven cardiovascular model for the evaluation of the visceral flow during intra-aortic balloon pump (IABP) assistance. Methods: The model includes a systemic and pulmonary circulation as well as a heart contraction model. The straight polyurethane tube aorta had a single visceral while four windkessel components mimicked resistance compliance of the brachiocephalic, renal and sub-mesenteric, pulmonary, and systemic circulation. Twelve flow probes were placed in the circuit to measure pressures and flows with the IABP on and off. Results: With the balloon off, the meantime to reach the steady state was 48 ± 16 s; with the balloon on, this figure was 178 ± 20 s. The stability of pressure and flow signals was obtained after 72 ± 11 min. The number of cycles of stability of the system was 93 [86–103]. Measurements were reliable either with samples of 10 or 20 beats. Bland Altman method demonstrated the reliability of measurements. Finally, all measurements were comparable to published in vivo data. Conclusion: The presented mock circulation was reliable and gave values with high accuracy both at baseline and during mechanical assistance. This system allows evaluation of the mesenteric flow during IABP, under different clinical/hemodynamic conditions. Nonetheless, its translational potential needs to be further evaluated

Continuous renal replacement therapy in the treatment of severe hyperkalemia: An in vitro study

2019 ◽  
Vol 43 (2) ◽  
pp. 87-93 ◽  
Author(s):  
Pascal Houzé ◽  
Frédéric Joseph Baud ◽  
Jean-Herlé Raphalen ◽  
Anaïs Winchenne ◽  
Sonia Moreira ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
In Vitro Study ◽  
Central Compartment ◽  
Life Threatening ◽  
Severe Hyperkalemia ◽  
Continuous Filtration ◽  
Vitro Model

Introduction: Continuous renal replacement therapy is not presently recommended in the treatment of life-threatening hyperkalemia. There are no specific recommendations in hemodialysis to treat hyperkalemia. We hypothesized an in vitro model may provide valuable information on the usefulness of continuous renal replacement therapy to treat severe hyperkalemia. Methods: A potassium-free solute was used instead of diluted blood for continuous renal replacement therapy with a simulated blood flowrate set at 200 mL/min. The mode of elimination included continuous filtration, continuous dialysis, and continuous diafiltration using a flowrate of 4000 mL/min for continuous filtration and continuous dialysis modes, and a ratio of 2500/1500 in the continuous diafiltration mode. Results: The mean initial potassium in the central compartment was 10.1 ± 0.4 mmol/L. The clearances in the continuous diafiltration, continuous filtration, and continuous dialysis were 3.4 ± 0.5, 3.6 ± 0.1, and 3.7 ± 0.1 L/h, respectively, not significantly different. Continuous dialysis resulted in the lowest workload for staff. Increasing the continuous dialysis flowrates from 2000 to 8000 mL/h increased clearance from 2.3 ± 0.3 to 6.2 ± 0.8 L/h. The delays in decreasing the potassium concentration to 5.5 mmol/L dropped from 120 to 45 min, respectively. Potassium eliminated in the first hour increased from 18 to 38 mmol that compared favorably with hemodialysis. Decrease in simulated blood flowrate from 200 to 50 mL/min moderately but significantly decreased the clearance from 3.7 to 3.0 L/h. Conclusion: Hyperkalemia is efficiently treated by continuous renal replacement therapy using the dialysis mode. Caution is needed to prevent the onset of severe hypokalemia within 40 min after initiation of the session.

scholarly journals Ovarian Hyperstimulation Syndrome on the Acute Medical Unit: A problem-based review

2015 ◽  
Vol 14 (1) ◽  
pp. 21-27
Author(s):  
Rebeca Carter ◽  
◽  
Kyle Petrie ◽  
Ashkan Sadighi ◽  
Hannah Skene ◽  
...  
Keyword(s):  
Ovarian Hyperstimulation Syndrome ◽  
Signs And Symptoms ◽  
In Vitro Fertilisation ◽  
Ovarian Hyperstimulation ◽  
Care Services ◽  
Acute Medical Unit ◽  
Life Threatening ◽  
Acute Care Services ◽  
The Uk

Ovarian Hyperstimulation Syndrome (OHSS) is a spectrum of clinical features typically resulting from assisted conception techniques. With 2.35% of all live births in the UK resulting from in-vitro fertilisation (IVF), OHSS is on the rise. Moreover, there has been an increase in the presentation of its complications to GP surgeries and unscheduled acute care services nationwide. This review will discuss signs and symptoms of the increasingly common and potentially fatal complications of OHSS, namely pleural effusion, ascites and thromboembolic events. With such propensity toward critical, life-threatening events it is not only prudent to recognise the population at risk, but also to be aware of the signs, symptoms and complications to expedite treatment and ensure optimum outcome.

scholarly journals Barriers and Challenges Affecting Parents Use of Adrenaline Auto-Injector in Children at Risk of Anaphylaxis

2020 ◽  
Author(s):  
Ahmed Elghoudi ◽  
Klithem Al Dhaheri ◽  
Hassib Narchi
Keyword(s):  
United Arab Emirates ◽  
Medical Personnel ◽  
Drug Of Choice ◽  
Effective Interventions ◽  
Al Ain ◽  
Threatening Condition ◽  
Life Threatening ◽  
Barriers And Challenges ◽  
Fear And Anxiety ◽  
Auto Injector

Abstract Background: Anaphylaxis is a life-threatening condition. As accidental exposure to the offending allergens usually happens in the community, in absence of medical personnel, adrenaline auto-injector (AAI), carried by parents, remains the first and only drug of choice. As studies have shown that AAI is commonly underused by parents, this study was undertaken to elucidate the causes of its underutilization in our community.Methods: A cohort of parents attending the paediatric allergy clinic at Al Ain hospital, in the United Arab Emirates (UAE), completed a questionnaire survey aimed to assess their understanding and knowledge of their child’s allergy management, including their aptitude with the use the AAI, as well as their competence and comfort to provide this treatment in an emergency. Results: A total of 47 parents, 83% of whom were Emirati, including 66% of mothers, participated in the study. Food allergy was the main indication for AAI prescription, with tree nuts 62%) and peanuts (38%) being the main culprits. The majority (94%) of parents were trained by a doctor on using the AAI, with most (79%) demonstrating a good knowledge of indications for administering the AAI. Although all parents expressed satisfaction with the training that they had received, they still admitted to a remaining lack of confidence with using an AAI. Conclusions: The continuous education and training of parents on how to use an AAI, still requires supplementary psychological support to overcome their fear and anxiety with using the device in an urgent situation. More research is needed to explore the reasons behind their fear and anxiety to plan effective interventions.

A simple in vitro model to study the stability of acylglucuronides

2007 ◽  
Vol 55 (1) ◽  
pp. 91-95 ◽  
Author(s):  
Zhesheng Chen ◽  
Tom G. Holt ◽  
James V. Pivnichny ◽  
Kwan Leung
Keyword(s):  
In Vitro Model ◽  
Vitro Model ◽  
The Stability
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