Introduction: In this study, we sought to determine whether laboratory and physiological parameters can be useful in predicting mortality in patients with sepsis-induced hypotension and septic shock. Methodology: This prospective cohort study was carried out in the emergency department at an academic medical center. A total of 51 patients met enrollment criteria during the study period and 41 of them were included in the study. Inclusion criteria were patients 18 years old or older, diagnosed to have either sepsis-induced hypotension or septic shock and investigated sepsis marker (blood lactate and leukocytes) measured. Other physiological variables were also measured in this study. The main outcome measure was 30-day mortality. Kaplan-Meier, Log-rank and Cox's methods were used for statistical analysis using SPSS version 12.0.1. Results: 61% were diagnosed to have sepsis-induced hypotension and 39% were diagnosed with septic shock. Twenty two (54%) deaths occurred within the 30 day follow up. The overall mean blood lactate level and leukocyte counts were 3.52 mmol/L (SD=2.29) and 11.37 x 109 (SD=6.38) respectively. A Cox Proportional Hazard Analysis revealed an increase in blood lactate levels in the ED was associated with an increased risk of death (B=0.35, HR=1.45, 95% CI 1.22,1.73, p<0.001). However no significant correlation between the physiological parameters and the 30-day mortality. Patients with septic shock state prior to initial presentation has a lower 30 day survival compared to any other septic conditions. Conclusion: Our results support blood lactate level as a promising risk stratification tool when compared with leukocytes counts and other physiological parameters. The multivariate analysis showed that for every increment of lactate value of 1 mmol/L, the hazards of dying are expected to increase by 1.5 times (p<0.001).

According to the class of hypovolaemic shock, a blood loss less than 750 ml is not associated with the physiological changes. As a result it may cause a delay in fluid resuscitation. We postulate inferior vena cava (IVC) diameter reduction in inspiration and expiration may resemble the significant volume of blood loss in a healthy adult. We conducted a study to examine the changes of the IVC diameter pre and post blood donation.The inferior vena cava diameter during inspiration (IVCi) and expiration (IVCe) were measured using ultrasound (GE HEALTH) in supine position before and after blood donation of 450 ml. Paired t-test and Wilcoxin rank test were used to analyse the data. Forty two blood donors enrolled during the study period. The mean age of blood donors was 32.3 +/- 8.9 and mainly male blood donors. The mean IVCe of pre and post blood donation was 18.5 +/- 6.2 mm (95%CI 18.23, 18.74) and 16.6 +/- 6.6 mm (95%CI 16.35, 16.76) respectively. Meanwhile, the mean IVCi of pre and post blood donation was 17.1 +/- 8.6 mm (95%CI 16.89,17.30) and 15.6 +/- 6.6 mm (95%CI 15.43,15.81) respectively. The mean difference of IVCe pre and post blood donation was 1.9 +/- 0.5 mm (95%CI 1.75, 2.13) (p<0.001). In contrast, the mean difference of IVCi pre and post blood donation was 1.5 +/- 0.5 mm (95%CI 1.34, 1.68) (p<0.001). As a conclusion, the measurement of IVC diameter by ultrasound can predict the volume of blood loss in simulated type 1 hypovolaemia patient.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has had an unprecedented impact in Asia and has placed significant burden on already stretched healthcare systems. We examined the impact of COVID-19 on the safety attitudes among healthcare workers (HCWs), as well as their associated demographic and occupational factors, and measures of burnout, depression and anxiety. METHODS: A cross-sectional survey study utilising snowball sampling was performed involving doctors, nurses and allied health professions from 23 hospitals in Singapore, Malaysia, India and Indonesia between 29 May 2020 and 13 July 2020. This survey collated demographic data and workplace conditions and included three validated questionnaires: the Safety Attitudes Questionnaire (SAQ), Oldenburg Burnout Inventory and Hospital Anxiety and Depression Scale. We performed multivariate mixed-model regression to assess independent associations with the SAQ total percentage agree rate (PAR). RESULTS: We obtained 3,163 responses. The SAQ total PARs were found to be 35.7%, 15.0%, 51.0% and 3.3% among the respondents from Singapore, Malaysia, India and Indonesia, respectively. Burnout scores were highest among respondents from Indonesia and lowest among respondents from India (70.9%-85.4% vs. 56.3%-63.6%, respectively). Multivariate analyses revealed that meeting burnout and depression thresholds and shifts lasting ≥12 h were significantly associated with lower SAQ total PAR. CONCLUSION Addressing the factors contributing to high burnout and depression and placing strict limits on work hours per shift may contribute significantly towards improving safety culture among HCWs and should remain priorities during the pandemic.
Humans ; Cross-Sectional Studies ; Pandemics ; COVID-19/epidemiology* ; Burnout, Psychological ; Health Personnel