Patients with Altered Mental Status May Benefit from Medical Toxicology Consultation.

BACKGROUND: Presentation of intoxicated patients to hospitals is frequent, varied, and increasing. Medical toxicology expertise could lead to important changes in diagnosis and treatment, especially in patients presenting with altered mental status. OBJECTIVES: To describe and analyze clinical scenarios during a 1-year period after the establishment of a medical toxicology consultation service (MTCS). METHODS: Cases of 10 patients with altered mental status at presentation were evaluated. Medical toxicology consultation suggested major and significant changes in diagnosis and management. RESULTS: Of 973 toxicology consultations performed during the study period, bedside consultation was provided for 413 (42%) patients. Of these 413, 88 (21%) presented with some level of altered mental status. We described 10 patients in whom medical toxicology consultation brought about major and significant changes in diagnosis and management. CONCLUSIONS: Benefits may be derived from medical toxicology consultations, especially in patients with altered mental status. Medical toxicology specialists are well positioned to provide high value and expedited patient care.

Emergency medicine physician burnout before and during the COVID-19 pandemic.

BACKGROUND: Burnout is a common issue among physicians, and the rate among emergency medicine physicians (EPs) appears to be higher than those of other medical specialties. The COVID-19 pandemic presents unprecedented challenges to the medical community worldwide, but its effects on EP burnout has not yet been determined. METHODS: We conducted a three-stage nationwide study between July 2019 and June 2021. First, we evaluated the responses to burnout questionnaires that had been filled in by EP before the COVID-19 pandemic. We then re-sent the same questionnaires, with an addition of pandemic-specific questions. The third step involved a small group of EPs who participated in a burnout reduction workshop and re-took the questionnaires after a 3-month interval. The Maslach Burnout Inventory measured three burnout scales and a Work and Meaning Inventory predicts job satisfaction. Descriptive, univariate, and multivariate statistical tests were used to analyze the data. RESULTS: In the first stage, 240 questionnaires were sent by email to all Israeli EPs listed in emergency departments nationwide, and 84 out of 88 submitted questionnaires were completed in full before the pandemic. 393 questionnaires were sent in the second stage during the pandemic and 93 out of 101 submitted questionnaires were completed in full. Twenty EPs participated in the workshop and 13 out of 20 submitted questionnaires were completed in full. Burnout levels were high (Maslach) among EPs before the pandemic and increased during the pandemic. The feelings of personal accomplishment and work meaning-both protective factors from burnout-were significantly higher in the second (pandemic) stage. The pandemic-specific burnout factors were fear of infecting family members, lack of care centers for the physician's children, increased workload, and insufficient logistic support. The physician-oriented intervention had no significant impact on burnout levels (p < 0.412, Friedman test). CONCLUSIONS: Physician burnout is a major global problem, and it is now being aggravated by the challenges of the COVID-19 pandemic. Healthcare administrators should be alerted to pandemic-specific stress factors in order to help teams cope better and to prevent further worsening of the burnout. Further research is warranted to determine the lasting effect of the pandemic on EM physician burnout and the best means for reducing it.

Publication outcomes of abstracts presented at 2013 North American Congress of Clinical Toxicology (NACCT) conference.

Introduction: Scientific conferences are useful in disseminating medical research and advancing the medical and scientific fields. An important measure of the success of such conferences is the proportion of research that is published in peer-reviewed journals. The conversion rates for toxicology abstracts to full-text publications at previous North American toxicology meetings were low. No study has assessed the publication rate from the 2013 North American Congress of Clinical Toxicology (NACCT) conference.Methods: We reviewed 316 abstracts presented at the 2013 NACCT Conference. We searched the PubMed, EMBASE, and Medline databases using the authors' names and keywords, through September 2019. We then identified and excluded cases and case reports to reanalyze the data.Results: Thirty-three of 316 abstracts (10.4%) subsequently appeared in 17 different peer-reviewed journals, led by Clinical Toxicology (13 out of 33, 3%). Leading countries of origin for abstract submission were the USA (285), Canada (9), and the UK (8). Excluding case reports, 25 out of 207 abstracts (12.0%) achieved publication in peer-reviewed journals.Conclusions: Fewer than one in eight abstracts reached publication within six years of the 2013 NACCT meeting, even after accounting for and excluding case reports. This rate is lower than in other specialty medical societies.