Prevalence of occupational heat stress across the seasons and its management amongst healthcare professionals in the UK.

Occupational heat stress (OHS) is an issue in healthcare facilities (HCFs) in the United Kingdom (UK). The aims of this study were to evaluate perceived levels of OHS during two seasons and its perceived consequences on healthcare professionals (HCPs) and to assess the efficacy of heat stress management (HSM) policies. An anonymous online survey was distributed to HCPs working in HCFs in the UK. The survey returned 1014 responses (87% women). Descriptive statistics and content analysis of survey data identified that OHS in HCFs is frequently experienced throughout the year and concerned most HCPs. Over 90% perceived OHS impairs their performance and 20% reported heat-related absenteeism. Awareness of HSM policies was poor and 73% deemed them not adequate. To help reduce the financial loss and impact on staff performance, health and well-being and patient safety, it is recommended that revisions and widespread dissemination of HSM policies are made.

A survey study investigating perceptions and acceptance of the whole-body imaging techniques used for the diagnosis of myeloma.

INTRODUCTION: The purpose of this study was to investigate patient perceptions and acceptance of the three whole-body imaging (WBI) modalities used for diagnosing myeloma; radiographic skeletal survey (RSS), low-dose whole-body computed tomography (LD-WBCT) and whole-body magnetic resonance imaging (WB-MRI). The secondary aim was to explore the factors affecting the acceptance of whole-body imaging for myeloma. METHODS: 60 participants (median age = 58.5 years old) recruited from three NHS trusts and social media completed a survey in which they scored their experiences of each WBI modality on nine 5-point rating scales. Spearman's correlation coefficient, Kruskal-Wallis, Mann-Whitney and Wilcoxon signed-rank tests were used to compare scores between different WBI techniques. Participants were invited to provide additional open text responses for interpretation using thematic analysis. RESULTS: All modalities demonstrated high levels of acceptability (median score = 4). WB-MRI was perceived as more stressful (p=<0.01) and claustrophobic (p=<0.01) than RSS and LD-WBCT. Thematic analysis showed patients understood the importance of imaging but had concerns about exacerbated pain and the results. WB-MRI was difficult to tolerate due to its duration. Respondents were averse to the physical manipulation required for RSS while remaining stationary was perceived as a benefit of LD-WBCT and WB-MRI. Staff interactions had both positive and negative effects on acceptance. CONCLUSIONS: Despite the psychological and physical burdens of WBI, patients accepted its role in facilitating diagnosis. Staff support is vital for facilitating a positive whole-body imaging experience. Healthcare practitioners can improve WBI acceptance by understanding the burdens imposed by WBI and adopting the personalised care model. IMPLICATIONS FOR PRACTICE: Patient experience can be improved by tailoring examinations to individual needs. RSS can be as burdensome as other WBI techniques and could be superseded by LD-WBCT or WB-MRI.

Heat stress and PPE during COVID-19: impact on healthcare workers' performance, safety and well-being in NHS settings.

Personal protective equipment (PPE) can potentiate heat stress, which may have a negative impact on the wearer's performance, safety and well-being. In view of this, a survey was distributed to healthcare workers (HCWs) required to wear PPE during the coronavirus disease 2019 pandemic in the UK to evaluate perceived levels of heat stress and its consequences. Respondents reported experiencing several heat-related illness symptoms, and heat stress impaired both cognitive and physical performance. The majority of respondents stated that wearing PPE made their job more difficult. These, and additional, responses suggest that modification to current working practices is required urgently to improve the resilience of HCWs to wearing PPE during pandemics.

A comparison of two commercially available ELISA methods for the quantification of human plasma heat shock protein 70 during rest and exercise stress.

This study compared resting and exercise heat/hypoxic stress-induced levels of plasma extracellular heat shock protein 70 (eHSP70) in humans using two commercially available enzyme-linked immunosorbent assay (ELIS)A kits. EDTA plasma samples were collected from 21 males during two separate investigations. Participants in part A completed a 60-min treadmill run in the heat (HOT70; 33.0 ± 0.1 °C, 28.7 ± 0.8 %, n = 6) at 70 % V̇O2max. Participants in part B completed 60 min of cycling exercise at 50 % V̇O2max in either hot (HOT50; 40.5 °C, 25.4 relative humidity (RH)%, n = 7) or hypoxic (HYP50; fraction of inspired oxygen (FIO2) = 0.14, 21 °C, 35 % RH, n = 8) conditions. Samples were collected prior to and immediately upon termination of exercise and analysed for eHSP70 using EKS-715 high-sensitivity HSP70 ELISA and new ENZ-KIT-101 Amp'd(™) HSP70 high-sensitivity ELISA. ENZ-KIT was superior in detecting resting eHSP70 (1.54 ± 3.27 ng · mL(-1); range 0.08 to 14.01 ng · mL(-1)), with concentrations obtained from 100 % of samples compared to 19 % with EKS-715 assay. The ENZ-KIT requires optimisation prior to running samples in order to ensure participants fall within the standard curve, a step not required with EKS-715. Using ENZ-KIT, a 1:4 dilution allowed for quantification of resting HSP70 in 26/32 samples, with a 1:8 (n = 3) and 1:16 (n = 3) dilution required to determine the remaining samples. After exercise, eHSP70 was detected in 6/21 and 21/21 samples using EKS-715 and ENZ-KIT, respectively. eHSP70 was increased from rest after HOT70 (p < 0.05), but not HOT50 (p > 0.05) or HYP50 (p > 0.05) when analysed using ENZ-KIT. It is recommended that future studies requiring the precise determination of resting plasma eHSP70 use the ENZ-KIT (i.e. HSP70 Amp'd(®) ELISA) instead of the EKS-715 assay, despite additional assay development time and cost required.

Effect of inspiration of 12% O2 (balance N2) on cardiac output, respiration, oxygen saturation, and oxygen delivery.

Low arterial oxygen saturation (SaO(2)) will result in a reduced rate of arterial oxygen delivery to the tissues (DO(2)), unless there is a compensatory increase in cardiac output (CO) or haemoglobin concentration (Hb). An adequate DO(2) can therefore be maintained by increasing ventilation, CO, or both. Sustaining a tissue specific oxygen extraction is thought to play an important part in overall compensation. The present study has examined responses to acute hypoxic exposure in 8 volunteers (breathing 12% oxygen, balance nitrogen) and describes changes in CO, ventilation and the SaO(2). Aims included: examination of the extent of intersubject variations and seeing whether DO(2) was maintained. SaO(2), PCO(2), respiration (via stethograph) and Finapress (non-invasive) arterial blood pressure (BP) were recorded, firstly on air and then on 12% oxygen. CO was derived, off-line, from the BP record. CO was increased in 5 subjects (22%-45%) but was virtually unchanged in 3, and yet comparison for all 8 subjects showed that DO(2) on 12% oxygen was not significantly different from DO(2) on air (mean on air 1017 ml. min(-1); hypoxia 1080 ml. min(-1), p = 0.27). SaO(2) on 12% oxygen ranged between 85% and 93%. In conclusion, exposure to the same hypoxic gas mixture resulted in differing individual ventilatory and CO responses. However, DO(2) was well maintained.

Human erythrocyte and plasma amino acid concentrations during exercise.

PURPOSE: This investigation examined the effects of exercise and maltodextrin (Md) or placebo (Pl) ingestion on plasma and erythrocyte concentrations of amino acids. METHODS: The erythrocyte and plasma concentrations of 17 amino acids, as well as plasma glucose and insulin, were analyzed in eight healthy trained male subjects before, during, and 25 min after 90-min cycle ergometer exercise at 65% peak oxygen uptake. The two treatments involved ingestion of orange-flavored water (Pl) or orange-flavored 10% maltodextrin solution (Md). RESULTS: Two-way ANOVA revealed 1) that plasma concentrations of alanine and tyrosine changed significantly during the treatments, 2) that the plasma concentrations were significantly different between treatments for glycine and threonine, 3) that all erythrocyte concentrations increased significantly throughout the treatments except for arginine and tyrosine, and 4) that there were no significant differences in erythrocyte concentrations between the treatments. Three-way ANOVA highlighted the significant differences in the time responses between plasma and erythrocyte concentrations; the changes in erythrocyte levels from rest being significantly different from plasma for all amino acids except aspartic acid, glycine, and ornithine. Plasma glucose concentrations became elevated and remained above rest values in Md but fell below rest values in Pl: the differences in concentration between treatments were significant. Correspondingly, plasma insulin was significantly higher in Md during exercise. CONCLUSION: These results highlight that far from being slow in the uptake of amino acids, the erythrocyte in fact sequesters amino acids at an appreciable rate during exercise without a corresponding elevation in the plasma amino acids. For a greater understanding of amino acid changes during exercise, the analysis of both plasma and erythrocytes is recommended.