ORCID Profile
0000-0002-2956-2432
Current Organisation
Deakin University
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: BMJ
Date: 2008
Abstract: Evidence suggests that the rate of recurrent headache after treatment of migraine in the emergency department (ED) is high. The mechanisms for this are unclear, but neurogenic inflammation may play a role. There is conflicting evidence about whether adjuvant dexamethasone reduces the rate of recurrent headache. The aim of this study was to compare the rate of recurrent headache in patients with migraine randomised to receive a single dose of oral dexamethasone or placebo at discharge after treatment in the ED with intravenous phenothiazine. A double-blind, randomised, placebo-controlled trial was conducted in the ED of three community teaching hospitals. Adult patients with physician-diagnosed migraine were treated with intravenous phenothiazine and at discharge were randomised to receive either 8 mg oral dexamethasone or placebo as a single dose. Follow-up was by telephone at 48-72 h and the proportion of patients with recurrent headache overall and in the subgroup with headache duration <24 h was recorded. 63 patients (76% women) of median age 39 years were enrolled, 61 of whom (97%) completed follow-up. The pooled rate of recurrent headache was 33%. 32 were randomised to placebo and 31 to dexamethasone. The rate of recurrent headache in the dexamethasone and control groups was 27% (8/30) vs 39% (12/31) (relative risk (RR) 0.69, 95% CI 0.33 to 1.45, p = 0.47). For 40 patients with headache lasting <24 h the rate of recurrent headache in the dexamethasone and control groups was 15% (3/20) vs 45% (9/20), a reduction in absolute risk of 30% (RR 0.33, 95% CI 0.11 to 1.05, p = 0.08). A single oral dose of dexamethasone following phenothiazine treatment for migraine in the ED did not reduce the rate of recurrent headache. There is weak evidence for a possible benefit in the subgroup who present within <24 h of symptom onset. A multicentre trial to confirm this finding is warranted.
Publisher: Wiley
Date: 04-07-2023
DOI: 10.1111/JAN.15765
Abstract: To examine healthcare professional's knowledge about assessment and management of sleep disorders for cardiac patients and to describe the barriers to screening and management in cardiac rehabilitation settings. A qualitative descriptive study. Data were collected via semi‐structured interviews. In March 2022, a total of seven focus groups and two interviews were conducted with healthcare professionals who currently work in cardiac rehabilitation settings. Participants included 17 healthcare professionals who had undertaken cardiac rehabilitation training within the past 5 years. The study adheres to the consolidated criteria for reporting qualitative research guidelines. An inductive thematic analysis approach was utilized. Six themes and 20 sub‐themes were identified. Non‐validated approaches to identify sleep disorders (such as asking questions) were often used in preference to validated instruments. However, participants reported positive attitudes regarding screening tools provided they did not adversely affect the therapeutic relationship with patients and benefit to patients could be demonstrated. Participants indicated minimal training in sleep issues, and limited knowledge of professional guidelines and recommended that more patient educational materials are needed. Introduction of screening for sleep disorders in cardiac rehabilitation settings requires consideration of resources, the therapeutic relationship with patients and the demonstrated clinical benefit of extra screening. Awareness and familiarity of professional guidelines may improve confidence for nurses in the management of sleep disorders for patients with cardiac illness. The findings from this study address healthcare professionals' concerns regarding introduction of screening for sleep disorders for patients with cardiovascular disease. The results indicate concern for therapeutic relationships and patient management and have implications for nursing in settings such as cardiac rehabilitation and post‐cardiac event counselling. Adherence to COREQ guidelines was maintained. No Patient or Public Contribution as this study explored health professionals' experiences only.
Publisher: Hindawi Limited
Date: 10-2012
DOI: 10.1111/J.1744-6198.2012.00281.X
Abstract: This study examined the opinions of nurses about the introduction of enrolled nurse medication administration and analyzed its impact on the medication error rate. Data were collected using a survey and examination of incident reports regarding nursing medication errors. Nurses (registered nurse, enrolled nurse with medication endorsement, enrolled nurse) responded to survey items regarding the introduction of enrolled nurse medication administration. Data analysis included descriptive statistics, Fischer's exact test, and chi-square analysis where appropriate. The majority of nurses (75.2%) supported enrolled nurse medication administration. However, differences in opinion were observed between registered nurse (RN) and enrolled nurse with medication endorsement (ENME) regarding clear understanding of responsibility and accountability (RN: 47.2% vs. ENME: 77.8% p =.033), and whether suitable education was provided (RN: 34.7% vs. ENME: 73.7% p =.012). Moreover, less than one-third of RNs agreed that the assessment process for EN medication endorsement clearly identified the competence of the ENME to administer medications. Nonetheless, nursing medication errors did not increase in the 12-month period after the introduction of enrolled nurse medication administration (pre: 314, post: 302). The findings of this study suggest areas that should be addressed in the future, including assessment of competence and focused education about accountability and responsibility.
Publisher: Wiley
Date: 05-07-2013
DOI: 10.1111/JOCN.12274
Abstract: To explore emergency department (ED) nurses' perceptions of current practices and essential components of effective change of shift nursing handover. Ineffective nursing handover can negatively impact on patient outcomes. Evidence suggests that nursing handover in ED is highly variable. Proposed handover models in the literature are structured for inpatient settings and may not be suitable for ED settings. A mixed methods study (survey and group interviews) was conducted in a metropolitan ED in Melbourne, Australia. During February-June 2011, a survey (n = 63) investigated perceptions of current practices and preferences for handover structure. Analyses are descriptive. In the same period, group interviews (n = 41) explored nurses' opinions about essential features and information of an effective nursing handover in the ED environment. A modified nominal group technique generated data that were analysed using content analysis. Most nurses (96%) perceived receiving adequate information during handover however, gaps were identified, including omission of important information regarding medications, vital signs and nursing care needs. Group interviews identified five essential features of effective handover: systematic approach, treatment, appropriate environment, reference to documentation/charts and efficient communication. Essential information included patient details, presenting problem, future care/disposition plan, treatment and nursing observations. Handover structures in the ED may not provide essential information to ensure adequate continuity of nursing care. ED nurses consider optimal handover to be specific for patients for whom they are caring, conducted at the bedside, structured and containing key elements (patient details, presenting problem, treatment, nursing observations, plan). Provision of a handover framework incorporating key features and essential information has the potential to improve the efficiency of handover. Use of this framework may enhance the transfer of accurate and essential information to enable safe and high standards of nursing care in the ED.
Publisher: BMJ
Date: 2006
Publisher: Wiley
Date: 05-2009
DOI: 10.1111/J.1465-3362.2009.00029.X
Abstract: In response to concerns about the prevalence of heroin-related morbidity and mortality, overdose response training programs have been implemented in Victoria, with the aim of improving outcomes after heroin overdose. The aim of this study was to examine reported overdose response by current injecting drug users (IDU) during overdose events, in comparison with previous studies. A total of 99 IDU (median age 35 years, 72% male) were administered a questionnaire that collected information on knowledge and experience regarding recognition of heroin overdose and response. The primary outcome measure was the rate of ambulance notification and expired air resuscitation during witnessed heroin overdose. Data were analysed using descriptive statistics and univariate analysis. Sixty participants had overdosed at least once, and 84% had witnessed an overdose. 78% recognised altered consciousness as a sign of heroin overdose, but less were aware of depressed breathing (42%) or cyanosis (61%). Reported overdose interventions included correct positioning (39%), expired air resuscitation (32%), ambulance notification (76%) and staying with the victim (87%). Our study has found improved responses to heroin overdose during witnessed heroin overdose among current IDU, compared with earlier work. However, a lack of knowledge regarding appropriate first-aid response persists, which might improve with the development and implementation of training initiatives in this area, ranging from identification of overdose to the administration of life-saving measures.
Publisher: Wiley
Date: 05-01-2023
DOI: 10.1111/JOCN.16598
Abstract: The aim of this systematic review was to examine the methodological quality of dignity‐related patient reported outcome measures (PROMs) used to measure patients' dignity during acute hospitalisation using the Consensus‐based Standards for the selection of health Measurement Instruments (COSMIN) methodology for systematic review of PROMs. Previous scoping review studies on the methodological quality of dignity‐related PROMs lack specificity for dignity during acute hospital admission. They included PROMs that were developed to measure constructs of care other than patient dignity or designed to measure dignity in contexts outside of the acute hospital setting. A systematic review based on COSMIN methodology. A systematic search was undertaken using five databases (CINAHL Complete, Medline Complete, EMBASE, PsycINFo and AgeLine) for articles published between 2000 and 2022. Relevant papers were identified using strict adherence to eligibility criteria, and studies that included development of dignity‐related PROMs for use in acute hospital settings were selected. Two reviewers independently screened the identified papers, extracted data and examined the quality of studies. Six papers met the inclusion criteria. Two PROMs, the 25‐item Patient Dignity Inventory and the 34‐item Inpatient Dignity Scale, met the COSMIN quality criteria because of their sufficient quality of evidence for content validity and reliable internal consistency. None of the PROMs met the quality criteria for assessment of measurement error, criterion validity, cross‐cultural validity and responsiveness. We recommend the Patient Dignity Inventory and the Inpatient Dignity Scale as the PROMs of choice for evaluating patients' dignity and/or dignified care during acute hospital admissions. These PROMs were developed using robust procedures with sufficient overall quality for content validity, internal consistency reliability and other measurement properties, and with moderate to high quality of evidence for these measurement properties. Researchers and clinicians who wish to use other dignity‐related PROMs identified in this review should consider the methodological limitations of these PROMs, as highlighted in the present systematic review. The review findings will guide healthcare professionals about their choice of patient reported outcome measures for evaluating patients' dignity or dignified care during acute hospitalisation.
Publisher: Wiley
Date: 23-08-2013
DOI: 10.1111/IJN.12158
Abstract: Within the context of contemporary nursing practice, bedside handover has been advocated as a potentially more suitable mode for achieving patient-centred care. Given that patients can play an important role in the process, better understanding of patients' perspectives of bedside handover could be a critical determinate for successful implementation of the practice. Using a phenomenological approach, this study attempted to explore patients' perceptions of bedside nursing handover. Four key themes emerged from the patient interviews: 'a more effective and personalised approach', 'being empowered and contributing to error minimization', 'privacy, confidentiality and sensitive topics', and 'training need and avoidance of using technical jargon'. Patients welcome bedside handover as they can be empowered through participation in the process. Nevertheless, attention is needed to ensure that adequate training is provided to nurses and to minimize the use of technical jargon so that handover is delivered with a professional and consistent approach.
Publisher: Elsevier BV
Date: 05-2015
DOI: 10.1016/J.IJOA.2014.11.006
Abstract: Intranasal administration of fentanyl is a non-invasive method of analgesic delivery which has been shown to be effective. This pilot study aimed to assess the practicality and tolerability of patient-controlled intranasal fentanyl for relieving pain during childbirth. This prospective, non-randomised, clinical trial recruited women with a singleton pregnancy during November 2009 to October 2011. Exclusion criteria included respiratory disease, gestation <37 weeks and pregnancy complications. The device administered fentanyl 54 μg per spray, incorporating a 3-min lock-out. Data collected included demographics, dose, additional analgesia, adverse events, pain relief and delivery outcomes. Follow-up data were obtained within 48 h regarding tolerability of the device. The final s le included 32 women: mean age was 28.7 years and gestation 39.8 weeks. Mean fentanyl dose was 734 μg and duration of use was 3.5 h. Most women (78.2%) reported satisfactory to excellent pain relief using the nasal device. Four neonates (12.5%) required bag-mask ventilation at birth: three had adequate respiration within 5 min and one required short-term observation in the special-care nursery. For all items, there was a trend towards an adverse outcome, including neonatal respiratory support, as the dose of fentanyl increased. On follow-up, 84.4% reported they would use intranasal fentanyl for their next childbirth experience. Patient-controlled intranasal fentanyl provides an acceptable level of analgesia during childbirth. It may, however, increase the risk of neonatal respiratory depression. Future, randomised studies should evaluate the safety and efficacy of patient-controlled intranasal fentanyl compared with existing analgesia options.
Publisher: Wiley
Date: 11-2004
DOI: 10.1111/J.1445-5994.2004.00650.X
Abstract: Standard practice for patients requiring hospital admission with suspected acute coronary syndromes (ACS) is admission to a monitored cardiology bed. The Western Hospital Chest Pain Protocol was developed to identify a subset of these patients who could be safely managed in an unmonitored bed. The objective of this prospective study of chest pain patients classified as 'high' or 'intermediate' risk by the Agency for Health Care Policy and Research/National Health and Medical Research Council guidelines was to further evaluate the safety of this protocol. This study was a prospective, observational, cohort study investigating the outcomes of patients admitted to hospital with suspected ACS. The primary outcome of interest was death or life-threatening arrhythmia within 24 h of hospital admission. If the Western Hospital Chest Pain Protocol had been strictly applied, there would have been one death in the group assigned to unmonitored beds (1/750 0.13%, 95% confidence interval 0.01-0.85%) and no other life-threatening arrhythmias. There is a subgroup of patients with suspected ACS who require hospital admission who can, based on clinical and biochemical features in the emergency department, be safely assigned to unmonitored beds.
Publisher: Wiley
Date: 09-11-2009
DOI: 10.1111/J.1360-0443.2009.02724.X
Abstract: Traditionally, the opiate antagonist naloxone has been administered parenterally however, intranasal (i.n.) administration has the potential to reduce the risk of needlestick injury. This is important when working with populations known to have a high prevalence of blood-borne viruses. Preliminary research suggests that i.n. administration might be effective, but suboptimal naloxone solutions were used. This study compared the effectiveness of concentrated (2 mg/ml) i.n. naloxone to intramuscular (i.m.) naloxone for suspected opiate overdose. This randomized controlled trial included patients treated for suspected opiate overdose in the pre-hospital setting. Patients received 2 mg of either i.n. or i.m. naloxone. The primary outcome was the proportion of patients who responded within 10 minutes of naloxone treatment. Secondary outcomes included time to adequate response and requirement for supplementary naloxone. Data were analysed using multivariate statistical techniques. A total of 172 patients were enrolled into the study. Median age was 29 years and 74% were male. Rates of response within 10 minutes were similar: i.n. naloxone (60/83, 72.3%) compared with i.m. naloxone (69/89, 77.5%) [difference: -5.2%, 95% confidence interval (CI) -18.2 to 7.7]. No difference was observed in mean response time (i.n.: 8.0, i.m.: 7.9 minutes difference 0.1, 95% CI -1.3 to 1.5). Supplementary naloxone was administered to fewer patients who received i.m. naloxone (i.n.: 18.1% i.m.: 4.5%) (difference: 13.6%, 95% CI 4.2-22.9). Concentrated intranasal naloxone reversed heroin overdose successfully in 82% of patients. Time to adequate response was the same for both routes, suggesting that the i.n. route of administration is of similar effectiveness to the i.m. route as a first-line treatment for heroin overdose.
Publisher: Wiley
Date: 19-07-2004
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2010
Publisher: Elsevier BV
Date: 06-2006
DOI: 10.1016/J.ANNEMERGMED.2006.01.022
Abstract: We determine the rate of adverse effects associated with the use of intravenous (IV) epinephrine by infusion for the treatment of severe asthma in the emergency department (ED). This retrospective, structured, medical record review included adult patients who presented to the ED of Western Hospital between 1998 and 2003 and who were triaged as category 1, 2, or 3, had a discharge diagnosis of asthma, and were administered IV epinephrine in the ED. Patients were excluded if they were older than 55 years or if a diagnosis of asthma was not confirmed. The primary outcome measures were occurrence of cardiac arrhythmia or ischemia, local tissue ischemia, hypotension or hypertension, neurologic injury, or death related to epinephrine infusion. Two hundred twenty episodes of care met the inclusion criteria. Adverse events occurred in 67 episodes (30.5% 95% confidence interval [CI] 24.5% to 37.1%) however, most were minor and self-limiting. There were no deaths. Major adverse events occurred in 3.6% of cases (8/220 95% CI 1.7% to 7.3%), including 2 cases of supraventricular tachycardia, 1 case of chest pain with ECG changes, 1 case of incidental elevated troponin, and 4 cases of hypotension requiring intervention. IV epinephrine is associated with a low rate of major and a moderate rate of minor adverse events in patients with severe asthma however, a causal relationship has not been established. Further research investigating effectiveness, as well as safety, is warranted.
Publisher: Elsevier BV
Date: 04-2005
DOI: 10.1016/J.ANNEMERGMED.2004.11.011
Abstract: We assess the methodologic quality of studies using medical record review methodology in 4 international emergency medicine journals. A secondary aim was to compare methodology quality among these journals and across years. This was an observational study of articles whose main methodology was medical record review published in Academic Emergency Medicine (AEM) , Annals of Emergency Medicine (Annals) , Emergency Medicine Journal (EMJ) , and Emergency Medicine Australasia (EMA) between January 2002 and May 2004. Eligible articles were reviewed for reporting of a clear hypothesis or objective, training of abstractors, defined inclusion and exclusion criteria, use of a standard abstraction form, definition of important variables, monitoring of abstractor performance, blinding of abstractors to study hypothesis, reporting of interrater reliability, s le size or power calculation, reporting of ethics approval or waiver, and disclosure of funding source. The primary outcome was the proportion of articles meeting each criterion. Secondary outcomes were comparison of the proportions of articles meeting each criterion among journals and by years. One hundred seven articles were analyzed 31 were published in AEM, 29 in Annals, 29 in EMJ, and 18 in EMA . A clear aim was reported in 93% of articles, standardized abstraction forms were reported in 51%, interrater reliability was reported in 25%, ethics approval or waiver was reported in 68%, and s le size or power calculation was reported in 10%. Adherence to the quality criteria for medical record reviews was suboptimal, and there were significant differences among journals in overall methodologic quality.
Publisher: Wiley
Date: 24-11-2009
DOI: 10.1111/J.1742-6723.2009.01241.X
Abstract: Access block is the inability of ED patients requiring admission to access appropriate inpatient beds in a timely fashion, defined in Australasia as more than 8 h in the ED. The present study describes changes in prevalence of access block in Australia over a 4 year period. Email, telephone and fax survey of ED on six Mondays at 10.00 hours (31 May, 30 August 2004, 18 June, 3 September 2007, 2 June, 2 September 2008). Data collected included point data on the status of patients in the ED at the index time and of recent ED attendance numbers. Results were collated and analysed by state and hospital role delineation. Forty-eight (60%) of 80 eligible ED answered all six surveys. Presentations to the ED the day before rose 15% (P < 0.0001, paired t-test) in 4 years, and nationally access block patients in the ED rose an average of 27%, and patients waiting to be seen by a doctor 31%. There were differences between states, with hospitals in New South Wales reporting a significant reduction in access block patients (-51%, P= 0.0002), but all other states a significant increase (+45%, P= 0.001). There were differences by role delineation, with non-paediatric major referral hospitals experiencing the greatest access block, but smaller hospitals experiencing the greatest increase in patients waiting. Around one-third of all patients receiving care in these ED surveys were experiencing access block. There is evidence that flow through New South Wales ED has improved. The data suggest that most hospitals have passed the point of efficiency.
Publisher: Wiley
Date: 24-05-2023
DOI: 10.1111/JAN.15714
Abstract: To develop and validate a culturally appropriate patient‐reported outcome measure for measuring dignity for older adults during acute hospitalization. A three‐phased exploratory sequential mixed‐method design was used. Domains were identified and items were generated from findings of a recent qualitative study, two systematic reviews and grey literature. Content validity evaluation and pre‐testing were undertaken using standard instrument development techniques. Two‐hundred and seventy hospitalized older adults were surveyed to test construct and convergent validity, internal consistency reliability and test–retest reliability of the measure. Analysis was performed using Statistical Package for the Social Sciences, version 25. The STROBE checklist was used to document reporting of the study. We established the 15‐item Hospitalized Older Adults' Dignity Scale (HOADS) that has a 5‐factor structure: shared decision‐making (3 items) healthcare professional‐patient communication (3 items) patient autonomy (4 items) patient privacy (2 items) respectful care (3 items). Excellent content validity, adequate construct and convergent validity, acceptable internal consistency reliability and good test–retest reliability were demonstrated. We established the HOADS is a valid and reliable scale to measure dignity for older adults during acute hospitalization. Future studies using confirmatory factor analysis are needed to corroborate the dimensionality of the factor structure and external validity of the scale. Routine use of the scale may inform the development of strategies to improve dignity‐related care in the future. The development and validation of the HOADS will provide nurses and other healthcare professionals with a feasible and reliable scale for measuring older adults' dignity during acute hospitalization. The HOADS advances the conceptual understanding of dignity in hospitalized older adults by including additional constructs that have not been captured in previous dignity‐related measures for older adults (i.e. shared decision‐making and respectful care). The factor structure of the HOADS, therefore, includes five domains of dignity and offers a new opportunity for nurses and other healthcare professionals to better understand the nuances of dignity for older adults during acute hospitalization. For ex le, the HOADS enables nurses to identify differences in levels of dignity based on contextual factors and to use this information to guide the implementation of strategies that promote dignified care. Patients were involved in the generation of items for the scale. Their perspectives and the perspectives of experts were sought in determining the relevance of each item of the scale to patients' dignity.
Publisher: Wiley
Date: 12-2002
DOI: 10.1046/J.1442-2026.2002.00380.X
Abstract: To externally validate a chest pain protocol that triages low risk patients with chest pain to an unmonitored bed. Retrospective study of all patients admitted from the emergency department of a tertiary referral public teaching hospital with an admission diagnosis of 'unstable angina' or suspected ischemic chest pain. Data was collected on adverse outcomes and analysed on the basis of intention-to-treat according to the chest pain protocol. There were no life-threatening arrhythmias, cardiac arrests or deaths within the first 72 h of admission in the group assigned to an unmonitored bed by the chest pain protocol ([0/244] 0.0%: 95% confidence interval 0.0-1.5%). Four patients had an uncomplicated myocardial infarction, two patients had recurrent ischemic chest pain and one patient developed acute pulmonary oedema ([7/244] 2.9%: 95% confidence interval 1.2-5.8%). This retrospective study externally validated the chest pain protocol. Care in a monitored bed would not have altered outcomes for patients triaged to an unmonitored bed by the chest pain protocol. Compared to current guidelines, application of the chest pain protocol could increase the availability of monitored beds.
Publisher: Wiley
Date: 28-06-2014
DOI: 10.1111/JOCN.12308
Abstract: To explore patients' perspectives of bedside handover by nurses in the emergency department (ED). International guidelines promote standardisation in clinical handover. Poor handover can lead to adverse incidents and expose patients to harm. Studies have shown that nurses and patients have favourable opinions about handover that is conducted at the bedside in hospital wards however, there is a lack of evidence for patients' perspective of nursing handover in the ED environment. Qualitative descriptive study. Semi-structured interviews with 30 ED patients occurred within one hour of bedside handover. Data were analysed using thematic content analysis. Two main themes were identified in the data. First, patients perceive that participating in bedside handover enhances in idual care. It provides the opportunity for patients to clarify discrepancies and to contribute further information during the handover process, and is valued by patients. Patients are reassured about the competence of nurses and continuum of care after hearing handover conversations. Second, maintaining privacy and confidentiality during bedside handover is important for patients. Preference was expressed for handover to be conducted in the ED cubicle area to protect privacy of patient information and for discretion to be used with sensitive or new information. Bedside handover is an acceptable method of performing handover for patients in the ED who value the opportunity to contribute and clarify information, and are reassured that their information is communicated in a private location. From the patients' perspective, nursing handover that is performed at the bedside enhances the quality and continuum of care and maintains privacy and confidentiality of information. Nurses should use discretion when dealing with sensitive or new patient information.
Publisher: Wiley
Date: 23-12-2023
DOI: 10.1111/INM.13108
Abstract: Emergency departments are often the first point of contact for in iduals presenting to healthcare services for assistance and treatment for mental ill health. Emergency departments, particularly those in regional areas, can experience high staff turnover and rely on novice nurses for workforce sustainability. The aim of this paper is to explore the experiences of novice nurses (nurses with years of experience) in providing care to in iduals presenting with mental ill health in the emergency department. Semi‐structured interviews were conducted with novice nurses ( N = 13) in a regional emergency department, using qualitative description as the guiding framework. The following three main themes were identified: (i) confidence in providing quality and safe nursing care, (ii) perceived barriers to providing quality and safe nursing care, and (iii) factors that increase confidence. Our findings indicate that proving safe and appropriate nursing care is affected in novice nurses by factors that lead to a perceived lack of confidence, such as how in iduals present to the emergency department (e.g. intoxicated or violent), an inability to conduct conversations to assess accurately and perceived shortfalls in the emergency department environment itself. Future research should examine the curriculum for relevance of undergraduate education regarding acute mental health presentations and develop training strategies that enhance communication with in iduals who present to the emergency department with mental ill health.
Publisher: Elsevier BV
Date: 02-2005
DOI: 10.1016/J.JEMERMED.2004.08.016
Abstract: The objectives of this before-and-after study of alert, stable adult patients presenting to the Emergency Department of Western Hospital with potential neck injuries who were immobilized in hard cervical collars were to determine the impact of implementation of the Canadian C-spine rule on x-ray ordering rates and whether implementation of the rule reduced time in hard collars for patients with potential neck injury. Data collected included demographics, mechanism of injury, x-ray rate, and time in hard collar. Data analysis was by chi-square test for proportions and Mann-Whitney U test for continuous variables. There were 211 patients studied. The x-ray ordering rate decreased from 67% to 50% (25% relative reduction, p = 0.0187). Time in hard collar was also reduced from a median of 128 min to a median of 103 min (effect size 25.5 min), but this did not reach statistical significance. Implementation of the Canadian C-spine rule reduced x-ray ordering by 25%.
Publisher: Wiley
Date: 29-10-2014
DOI: 10.1111/IJN.12365
Abstract: The aim of this study was to evaluate whether implementation of a new nursing handover model led to improved completion of nursing care activities and documentation. A pre- and post-implementation study, using a survey and document audit, was conducted in a hospital ED in Melbourne. A convenience s le of nurses completed the survey at baseline (n = 67) and post-intervention (n = 59), and the audit was completed at both time points. Results showed significant improvements in several processes: handover in front of the patient (P < 0.001), patients contributed and/or listened to handover discussions (P < 0.001), and provision of adequate information about all patients in the department (P < 0.001). Nurses also reported a reduction in omission of vital signs (P = 0.022) during handover. Three hundred sixty-eight medical records were audited in the two study periods: 173 (pre-intervention) and 195 (post-intervention). Statistically significant improvements in the completion of two nursing care tasks and three documentation items were identified. The findings suggest that implementation of a new handover model improved completion of nursing care activities and documentation, and transfer of important information to nurses on oncoming shifts.
Publisher: Wiley
Date: 07-2010
DOI: 10.1111/J.1445-5994.2010.02263.X
Abstract: Previous studies show that identification and treatment of osteoporosis in patients with minimal trauma fractures treated as outpatients are poor. Our aim was to test two interventions designed to increase rates of identification and treatment. This prospective, action research study, using explicit medical record review and scripted telephone interview, was conducted at emergency departments (ED) of three hospitals from April 2007 to February 2008. Participants were patients aged over 50 years who were treated as outpatients with a minimal trauma wrist fracture. Data collected included demographic and fracture details, bone density testing and osteoporosis-related medication change. There were two interventions staff education in ED and fracture clinic and information provided to patients by telephone by a research nurse. These interventions were applied to all patients sequentially. The outcome measure of interest was the proportion of patients who underwent bone density testing (DEXA scans) in the follow-up period, analysed by intervention (clinic or phone). One hundred and seventeen patients were studied. Eighty-six per cent were female median age 64 years. Ten per cent (12/117) of the ED/clinic intervention group had undergone testing at follow up. At follow up after the telephone intervention 55% (65/117) had undergone testing (P < 0.001, chi(2)). Patients undergoing testing were significantly more likely to have an osteoporosis-related medication change (relative risk 6.8, 95% CI 2.8-17.9). A brief telephone intervention and provision of information pack significantly improved testing rates for osteoporosis after minimal trauma wrist fracture. An ED/clinic-based intervention resulted in low rates of testing. Treatment of clinical osteoporosis remains suboptimal.
Publisher: Wiley
Date: 18-07-2023
DOI: 10.1111/JOCN.16824
Abstract: To evaluate evidence that examined nurses' work experiences in hospital wards with single rooms. The research question was ‘What does the research tell us about nurses’ work experiences in hospital wards with single rooms?’ In the last decades, new hospital builds have moved towards including a high proportion of single rooms. Yet, single rooms create ‘complex environments’ that impact the nurses. A structured integrative review was undertaken of empirical evidence. Original, peer‐reviewed articles, written in English, were sourced from four databases: CINAHL, PubMed, Embase and Web of Science. The initial searches were performed in April 2021 and repeated in December 2022. Quality appraisal was undertaken using the Mixed Methods Appraisal Tool. A narrative synthesis approach was used to analyse the data. Reporting was guided by the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement. Twelve studies, published between 2006 and 2022, with an international origin, and representing n = 826 nurses, were included in this review. The synthesis revealed mixed perspectives about nurses' work experiences in wards with single rooms. Whilst single rooms are ‘all good in theory (and) a good idea’, the reality was quite different. Synthesised findings are presented in four categories: (i) aesthetics and the physical space, (ii) privacy vs. isolation, (iii) safety, which includes situational awareness and (iv) communication and collaboration. This review describes how single rooms affects nurses' work experience. Whilst nurses shared multiple concerns about single rooms and the challenges they also acknowledged patient preference for the privacy and space afforded by single rooms. Findings from this review highlight the need for careful planning to maintain and strengthen teamwork, prevent nurses' sense of working in isolation, as well as creating opportunities for mentorship, and collaboration among nurses when working in single‐room settings.
Publisher: Wiley
Date: 04-2002
DOI: 10.1046/J.1444-0903.2001.00197.X
Abstract: Thrombolysis for patients with acute myocardial infarction (AMI) is of greatest benefit when treatment is commenced as soon as possible after symptom onset. The British Heart Foundation (BHF) recently set a benchmark recommending that eligible patients with AMI receive thrombolytic therapy less than 90 min after calling for medical assistance. The purpose of this study was to compare the performance of an urban emergency service to this benchmark. A secondary objective was to determine whether patients treated outside this time were at a greater risk of mortality. This study consisted of an explicit retrospective analysis of medical records for all patients who presented by ambulance to the Emergency Department (ED) of Western Hospital and received thrombolysis for AMI within 12 h of symptom onset. The study was conducted for the 18-month period between 1 January 1999 and 30 June 2000. Information collected included times of: (i) symptom onset, (ii) call for ambulance, (iii) ambulance response, (iv) transport to hospital and (v) thrombolysis, as well as final diagnosis and in-hospital mortality. For the purposes of this study, call-to-needle time (CTN) was defined as the time between calling the ambulance and commencement of thrombolytic therapy. One hundred and twenty-seven patients met the inclusion criteria. Median CTN was 81 min (range 42-279 min). Sixty-four per cent of patients were treated within the 90-min benchmark. The relative risk of mortality for patients treated outside the 90-min benchmark was 2.6 (95% CI 0.98-6.72). This study showed that the BHF benchmark for CTN was not being met for over one-third of patients in the study region, with potential impact on mortality after AMI. Further research is needed to establish: (i) whether there is relationship between longer transportation times and mortality, (ii) whether the findings of this study may be applied to other regions and (iii) what strategies might be employed to reduce CTN.
Publisher: MDPI AG
Date: 09-05-2023
Abstract: People with Type 2 diabetes mellitus (T2DM) are reported to have a high prevalence of metabolic syndrome (MetS), which increases their risk of cardiovascular events. Our aim was to determine the effect of physical activity (PA) on metabolic syndrome markers in people with T2DM. The study design was a systematic review and meta-analysis of randomised controlled trials evaluating the effect of PA on MetS in adults with T2DM. Relevant databases including SPORTdiscus, Cochrane Central Register of Controlled Trials, CINAHL, MEDLINE, PsycINFO, EMBASE, SocINDEX were searched up to August 2022. Primary endpoints were changes in MetS markers (blood pressure, triglyceride, high-density lipoprotein, fasting blood sugar, and waist circumference) after an exercise intervention. Using a random effect model with 95% confidence interval (CI), the mean difference between intervention groups and control groups were calculated. Twenty-six articles were included in the review. Overall, aerobic exercise had a significant effect on waist circumference (Mean Difference: −0.34 cm, 95% CI: −0.84, −0.05 effect size: 2.29, I2 = 10.78%). The effect sizes on blood pressure, triglyceride, high-density lipoprotein, fasting blood sugar were not statistically significant. No significant differences were found between exercise and control group following resistance training. Our findings suggest that aerobic exercise can improve waist circumference in people with T2DM and MetS. However, both aerobic and resistance exercise produced no significant difference in the remaining MetS markers. Larger and higher-quality studies are required to determine the full effects of PA on MetS markers in this population.
Publisher: Wiley
Date: 28-11-2019
DOI: 10.1111/JOCN.15099
Abstract: The proposed study aimed to answer the following question: What communication issues do nurses find challenging when caring for people with life-limiting illness? Evidence suggests that attitudes, skills and knowledge about how nurses communicate effectively with patients and their families could be improved. However, the literature predominantly focuses on nurses working in oncology and the medical profession. A qualitative descriptive design was used. Focus groups were conducted with 39 nurses from three wards within a regional healthcare organisation in Victoria, Australia. Data were analysed using thematic content analysis. The COREQ checklist was used to document reporting of the study. In their view, nurses have the potential to develop a strong bond with patients and their families. Three key themes were identified: (a) feeling unskilled to have difficult conversations with patients who have life-limiting illness (b) interacting with family members adds complexity to care of patients who have life-limiting illness and (c) organisational factors impede nurses' capacity to have meaningful conversations with patients and their families. Caring for in iduals with life-limiting illness is complex and often occurs in an emotionally charged environment. However, nurses report being h ered by time restraints and lack of information about the patient's condition and goals of care. Limitations in conversation structure and a comprehensive range of core communication skills affect their ability to confidently engage in conversations, particularly when they are responding to prognostic questions. Whilst nurses are responsible for performing technical skills, they can maximise care by developing a trusting relationship with patients and their relatives. Increased acuity limits the time nurses have to talk with patients. In addition, they lack confidence to deal with difficult questions. Specific training may increase nurses' confidence and efficiency when communicating with patients and their families.
Publisher: Springer Science and Business Media LLC
Date: 18-03-2008
Publisher: Wiley
Date: 06-03-2000
Publisher: BMJ
Date: 11-2007
Publisher: Elsevier BV
Date: 05-2010
DOI: 10.1016/J.AJEM.2009.03.005
Abstract: Serial electrocardiographic and biomarker data are used to rule out acute coronary syndrome (ACS) in emergency department (ED) patients with chest pain. These do not identify coronary artery disease (CAD). Functional tests are often used but have limitations. Multislice computed tomography coronary angiography (MSCT-CA) is evolving rapidly, raising the possibility of fast, accurate, and relatively noninvasive anatomical testing for CAD. We aimed to quantify the proportion of ED rule-out ACS patients suitable for MSCT-CA. This retrospective cohort study (by explicit record review) included adult patients who underwent a rule-out ACS process in ED-associated short-stay units. Data collected included demographics, electrocardiographic and biomarker data, contraindications/factors likely to make MSCT-CA unsuccessful or difficult to interpret including irregular heart rhythm, high pulse rate (with rate control contraindicated), renal or thyroid disease, contrast allergy, metformin use, pregnancy, and already confirmed CAD. Outcome of interest was the proportion of patients suitable for MSCT-CA. Data analysis is by descriptive statistics. Four hundred sixty patients were studied (63% male median age, 63 years). Forty-nine percent (224/460 95% confidence interval, 44%-53%) were suitable for MSCT-CA. One hundred eighty-one (39%) already had known CAD. Reasons for unsuitability of the remainder were metformin use 18 (6%), irregular heart rhythm 15 (5%), renal dysfunction 12 (4%), high pulse rate with contraindications to rate control 8 (3%), thyroid disease 7 (3%), and contrast allergy 2 (0.7%). Approximately half of ED patients with chest pain who have underwent ACS rule-out were potentially suitable for MSCT-CA to identify CAD. The best use of MSCT-CA in the investigation of patients with chest pain requires further clarification.
Publisher: BMJ
Date: 04-2010
Abstract: 'Normal' range for cardiac troponin I (TnI) has changed with more sensitive tests, but the validity of low-level elevations is contentious. We aimed to describe the characteristics and outcome of patients with an initial TnI level 1-5 times the upper limit of normal. Retrospective study of patients assessed for ACS with initial TnI level between 0.05-0.19 ng/ml. Data collected included demographics, clinical data, TnI levels and outcome. Primary outcome was the proportion of patients who had a serial TnI rise consistent with ACS. 72 patients were studied median age 71, median TIMI score 3, 66.7% male. 35 patients (48.6%) had a TnI rise consistent with ACS. Approximately half of patients with initial TnI between 0.05-0.19 ng/ml had a TnI rise consistent with ACS. An initial TnI in this range is not, of itself, indicative of ACS. Clinical decision-making should be guided by clinical features and serial TnI measurement.
Publisher: Wiley
Date: 31-10-2003
Publisher: Wiley
Date: 06-2002
DOI: 10.1046/J.1442-2026.2002.00308.X
Abstract: To determine whether, for patients with moderate or severe asthma presenting to emergency departments, there is a difference in need for hospitalization between those with a duration of symptoms less than 6 h and those with a longer duration of symptoms. This prospective, observational study investigated a s le of patients presenting with acute asthma between 21 August and the 3 September 2000, attending study emergency departments and classified as having moderate or severe asthma according to the National Asthma Guidelines. Data collected included duration of symptoms (less than 6 h or greater than 6 h) and disposition following emergency department treatment (home, ward, intensive care unit, high dependency unit, transfer). Data analysis was by Chi square analysis. Of 381 eligible patients, 348 had sufficient data for entry into this study (33 had missing data). Patients with duration of symptoms more than 6 h were more likely to require hospital admission (P < 0.0001). The relative risk for hospital admission or transfer as opposed to discharge from the emergency department for the group with a duration of symptoms of more than 6 h was 2.2. Patients presenting with moderate or severe asthma and a duration of symptoms of more than 6 h are more likely to require hospital admission or transfer for further treatment than patients with a shorter duration of symptoms. This has implications for decision making regarding asthma management and disposition in the emergency department.
Publisher: MDPI AG
Date: 05-09-2023
DOI: 10.3390/JFMK8030127
Publisher: Wiley
Date: 06-05-2015
DOI: 10.1111/JPM.12195
Abstract: No research has been conducted into the experience of peer support in improving adherence with oral antipsychotic medication for consumers with schizophrenia. Altruism influences peers to participate in peer support. Engagement in peer support can be challenging and rewarding for peers, and helps improve their own confidence and well-being. Many consumers with schizophrenia are reluctant to take their prescribed antipsychotic medications however, non-adherence can lead to relapse. The aim of this study was to evaluate peers' perspectives of their participation in a problem-solving peer support programme to enhance adherence in consumers who are reluctant to take antipsychotic medication. Peers contacted consumers by a weekly telephone call for 8 weeks, and used a problem-solving approach to inform their discussion about medication adherence. Semi-structured qualitative interviews were used to evaluate peers' perspectives of their involvement in the programme. Three main themes were abstracted from the data: motivation to participate in the study, experience of peer support programme, and rewards and challenges of the peer experience. Helping others was an important motivator for peers in agreeing to participate in the study. Telephone delivery was a convenient way to deliver the peer support programme. However, at times, it was difficult to contact consumers by telephone and this caused some frustration. Despite these difficulties, peers recognized that being involved in the programme increased their confidence and made them feel worthwhile. The findings have implications for the use of peer support as an adjunct intervention to promote medication adherence in consumers with schizophrenia.
Publisher: Elsevier BV
Date: 10-2001
DOI: 10.1016/S0736-4679(01)00374-2
Abstract: This prospective, observational study evaluated the safety of the Western Hospital admission protocol for patients with suspected acute coronary syndromes. The study included all patients admitted from the Emergency Department with an admission diagnosis of unstable angina, post infarct angina, atypical chest pain, or chest pain for evaluation. Data collected included demographic data, admission diagnosis, location of admission (bed with or without cardiac monitoring), past medical history and presenting chest pain history to determine Agency for Health Care Policy (AHCPR) and Western Hospital (WH) protocol classifications, cardiac enzyme assays, electrocardiogram analysis, adverse outcomes [death, myocardial infarction (MI), dysrhythmia, acute pulmonary edema, recurrent pain], diagnosis at hospital discharge, and length of stay-(LOS). There were 508 patients with a mean age of 63.7 years enrolled in the study. Three hundred nineteen (62.8%) were admitted to beds without any cardiac monitoring. There was one unexpected death in the unmonitored group, an 85 year-old patient who suffered a presumed dysrhythmia and whom the treating physician had decided was not for resuscitation. Twelve patients suffered nonfatal MI, and none suffered pulmonary edema. All MI patients made an uneventful recovery, and none required thrombolysis. If all patients had been admitted to an area of care based on AHCPR guidelines, an additional 310 admissions to monitored beds would have been required. The results of this study suggest that selected patients with suspected acute coronary syndromes can be safely managed in beds without continuous cardiac monitoring.
Publisher: MDPI AG
Date: 21-06-2023
Abstract: Most adults with type 2 diabetes mellitus (T2DM) do not meet their physical activity (PA) goals despite its importance in improving their health outcomes. Our study aim was to explore the opinions of healthcare professionals regarding barriers and facilitators to PA participation in Ghanaian adults with T2DM. Using qualitative descriptive design, data were collected through semi-structured interviews with 13 healthcare professionals experienced in diabetes management in Ghana. Three main themes relating to PA barriers and facilitators were identified in a thematic analysis: health system-related factors, healthcare practitioner factors, and patient factors. Inadequate accessibility to physical therapists and therapy centres hindered the provision of PA programs. Nurses and doctors lacked sufficient knowledge and training on effective PA interventions for in iduals with T2DM. Time constraints during patient consultations limited discussions on PA, while the cost associated with accessing physical therapy posed a significant challenge. Patients often disregarded PA advice from physical therapists due to their reliance on doctors, and some perceived PA as irrelevant for diabetes treatment. Despite these barriers, healthcare professionals expressed belief in PA facilitators, including integrating physical therapists and diabetes educators into diabetes care, providing structured exercise resources, improving curriculum planning to emphasise PA in health science education, and addressing knowledge gaps and misconceptions. Overall, this study highlights patient-related and healthcare system-related factors that influence PA behaviour in Ghanaian adults with T2DM. Findings from this study should inform the development of tailored PA programs for this population.
Publisher: Wiley
Date: 21-08-2023
DOI: 10.1111/JOCN.16850
Abstract: This study examined levels of self‐reported dignity and explored factors expected to influence dignity experienced by older adults during acute hospitalisation in Ghana. Dignified care has been recognised as inseparable from quality nursing care and maintaining patients' dignity has been highlighted in professional codes of conduct for nurses. However, there is a lack of research on self‐reported dignity and the factors that influence the dignity of older adults during acute hospitalisation in Africa. A large teaching hospital in the northern region of Ghana. Hospitalised older adults. A cross‐sectional survey was used to gather data from a convenience s le of 270 older inpatients, using the Hospitalized Older Adults’ Dignity Scale. Data were analysed using descriptive statistics and stepwise ordinal logistic regression to investigate stratified dignity outcomes. The study was reported following the STROBE checklist. More than half of the older adults surveyed reported low to moderate levels of dignity. Demographic characteristics such as age, marital status, religious status, occupation, level of education and type of hospital ward did not show any significant associations with dignity levels. However, there was a significant association found between dignity levels and sex and the number of hospitalisations. Most older adults in a Ghanian hospital experienced loss of dignity during their acute hospitalisation. Male older adults reported higher dignity levels during acute hospitalisation than their female counterparts. Further, older adults who were admitted to hospital for the second time reported less dignity compared to those admitted three or more times. The results emphasise the importance of healthcare professionals having the necessary knowledge and skills to provide gender‐sensitive care, which ultimately promotes the dignity of all patients. Additionally, the results underscore the urgency of implementing measures that guarantee patients' dignity during all hospital admissions. Survey questionnaires were completed by hospitalised older adults at the study setting.
Publisher: Wiley
Date: 26-03-2018
DOI: 10.1111/IJN.12657
Abstract: The aim of this pilot randomized study was to investigate the feasibility of early motivational interviewing, for reducing mood after acute stroke. Depression is a frequent consequence of stroke that can adversely affect recovery. DESIGN: Pilot randomized study. Intervention group patients received 3, in idual motivational interviewing sessions by nurses or social workers prior to hospital discharge. Adult patients with acute stroke during 2013 to 2014. Research assistant who collected data was blind to group assignment. Data were collected at 3 time points: baseline, 1-month, and 3-month follow-up. Outcome measures (anxiety, depression, quality of life) were analysed by descriptive statistics. Forty-eight patients were enrolled, and 79% retention was achieved at 3 months. Eight participants withdrew (16.7%), and 2 were unable to participate (death: 2.1% and new onset aphasia: 2.1%), leaving 38 participants in the final cohort (Intervention: N = 18, Control: N = 20). Anxiety, depression, and quality of life measures did not alter significantly in the study period. Carefully designed studies are required to investigate the effectiveness of early motivational interviewing for improving mood after stroke. The therapy can be administered by nurses, but significant resources are required in terms of training and fidelity.
Publisher: BMJ
Date: 12-2006
Publisher: Elsevier BV
Date: 2008
DOI: 10.1016/J.AJEM.2007.06.026
Abstract: Capillary refill time (CRT) has been taught as a rapid indicator of circulatory status. The aim of this study was to define normal CRT in the Australian context and the environmental, patient, and drug factors that influence it. This prospective observational study included healthy adults at hospital clinics, workplaces, universities, and community groups. Volunteer participants provided their age, sex, ethnic group, and use of hypertensive or cardiac medications. Capillary refill time, ambient temperature, and patient temperature were recorded in a standard manner. Data were analyzed using descriptive statistics and regression analyses. The 95th percentile was used to define the upper limit of normal. One thousand participants were included 57% were women, 90% were white, and 21% were taking cardiac medications. The median CRT was 1.9 seconds (95th percentile, 3.5 seconds). The CRT increased 3.3% for each additional decade of age. The CRT was also on average 7% lower in men than in women. The CRT decreased by 1.2% per degree-Celsius rise of ambient temperature, independently of patient's temperature, and decreased by 5% for each degree-Celsius rise in patient temperature, independently of ambient temperature. On multivariant analysis, age, sex, ambient temperature, and patient temperature were statistically significant predictors of CRT, but together explain only 8% of the observed variability. Capillary refill time varies with environmental and patient factors, but these account for only a small proportion of the variability observed. Its suitability as a reliable clinical test is doubtful.
Publisher: Wiley
Date: 05-08-2013
DOI: 10.1111/IJN.12138
Abstract: The aim of this descriptive qualitative study was to explore perspectives of nurses and midwives towards the introduction of shift-to-shift bedside handover. Semistructured interviews with nurses (n = 20) and midwives (n = 10) occurred 12 months after the introduction of bedside handover. Data were analyzed using thematic content analysis. Two main themes were identified: enhanced in idual patient care and documentation, along with improved patient-clinician partnerships and protection of confidentiality and privacy. The newly introduced bedside handover model improved efficiency and accuracy of the handover process and led to the provision of safe, high-quality care. Development of ward-specific tools and relevant educational resources, along with clinical support, are identified as the facilitators to ensure the new model can be successfully integrated into normal clinical practice.
Publisher: Wiley
Date: 14-11-2007
DOI: 10.1111/J.1742-6723.2007.01025.X
Abstract: A new method for estimation of weight in children based on their age has been proposed. The present study aims to validate the Best Guess formulae in a new population of children. This was a secondary analysis of a database collected for a prospective, observational, cohort study conducted in the Paediatric ED of Sunshine Hospital. Children aged 1-11 years who presented to the ED between 18 August 2005 and 25 February 2006 were included. Actual weight, height, age and ethnicity were obtained. Agreement between estimated weight using the Best Guess formulae and measured weight is reported using mean bias, 95% limits of agreement and proportion within 20% of actual weight. A total of 410 cases were included in the present study. Forty-six per cent were female and median age was 4 years. The mean bias in the 1-5 year group was 0.9 kg, with 95% limits of agreement -3.5 to +5.3 kg. Seventy-six per cent of estimations were within 20% of measured weight. The mean bias in the 5-11 year group was 0.4 kg, with 95% limits of agreement -14.4 to +15.2 kg. In this group, 64% of estimations were within 20% of measured weight. The Best Guess formulae performed moderately well in estimating children's weight, but had a tendency to overestimate weight, particularly in children with lower body mass index.
Publisher: Elsevier BV
Date: 08-2004
DOI: 10.1016/J.RMED.2004.01.008
Abstract: To determine if severity assessment after 1 h of treatment is better than assessment at presentation for predicting the requirement for hospital admission for emergency department (ED) patients with acute asthma. Prospective, observational study conducted in 36 Australian ED for a 2-week period in 2001 involving patients aged 1-55 years presenting with asthma. Data collected included severity assessment according to the National Asthma Guidelines (Australia) at presentation and 1 h, and disposition. Descriptive analysis was applied. 720 cases were analysed. Patients with 'mild' asthma at either assessment time had a greater than 80% chance of discharge home. Patients assessed as 'severe' at either assessment had a greater than 85% chance of requiring hospital admission, but the 1 h assessment was better at predicting the need for Intensive Care Unit (ICU) admission. For the 'moderate' group, the initial assessment was a poor predictor of the need for admission however those who met the criteria for 'moderate' severity at 1 h had an 84% chance of requiring admission. Assessment of asthma severity after 1 h of treatment is better than initial severity assessment for determining the need for hospital admission for patients initially assessed as having 'moderate' asthma and for predicting the need for ICU in patients initially assessed as 'severe'.
Publisher: Elsevier BV
Date: 05-2005
DOI: 10.1016/J.JEMERMED.2004.10.017
Abstract: To validate a previously derived venous pCO2 (pvCO2) cut-off for ruling out arterial hypercarbia in patients with chronic obstructive pulmonary disease (COPD), matched arterial and venous blood gas s les were taken from a convenience s le of patients who presented to the Emergency Department (ED) with COPD deemed by their treating doctor to require arterial blood gas (ABG) analysis as part of their care. The screening cut-off was defined as pvCO2 of > 45 mm Hg and arterial hypercarbia was defined as arterial pCO2 (paCO2) of > 50 mm Hg. Descriptive statistics were employed. Sensitivity, specificity and negative predictive value were calculated. There were 112 patients enrolled in the study, of whom 107 had complete data for analysis. Forty-three patients had arterial hypercarbia (range of 51 to 90 mm Hg, median 60 mm Hg). All cases of arterial hypercarbia were detected by the screening cut-off (sensitivity 100% 43/43 95% CI 91-100% specificity 47%, 95% CI 35-59%). The negative predictive value of pvCO2 < 45 mm Hg was 100% (30/30, 95% CI 89-100%). Assuming the ABG was performed to assess hypercarbia, 29% of ABGs potentially could have been avoided if a venous screening test was employed. In conclusion, pvCO2 can be used as a screening test for arterial hypercarbia, and if employed, can potentially reduce the requirement for ABG s ling.
Publisher: Wiley
Date: 18-05-2006
DOI: 10.1111/J.1742-6723.2006.00846.X
Abstract: Several guidelines have been developed to direct the ordering of head computed tomography (CT) for patients, but most are clinical presentation-specific. Recently, an integrated guideline for ordering emergent head CT for patients who present to the ED of Western Hospital, Footscray, Victoria, Australia, was developed in response to concerns raised regarding perceived over-utilization of head CT for ED patients. Our aim was to determine compliance with the guideline. This was an explicit retrospective medical record review of patients who presented to the ED of Western Hospital between 1/04/2004 and 17/6/2004 and had a head CT as part of their assessment. Clinical information for these cases was compared with guideline recommendations. Data are described by descriptive statistics. Of the 231 cases that were included in the study, 65 (28.1%, 95% confidence interval 23-35%) had abnormal CT findings. Guidelines were adhered to in 217 (93.9%, 95% confidence interval 91-97%) cases. For the cases where the guidelines were not adhered to (14 [6.1%]), there was only one abnormal scan the clinical significance of which is not clear. The study found that compliance with head CT guideline was high. This suggests that the guideline is both clinically relevant and supported by ED doctors or conversely that the guideline is concordant with existing ordering practices of the ED.
Publisher: Wiley
Date: 22-07-2011
Publisher: Elsevier BV
Date: 08-2013
DOI: 10.1016/J.AENJ.2013.05.007
Abstract: Nurse practitioners (NPs) in the Emergency Department (ED) have been trained to assess a range of clinical problems and minor complaints such as acute ankle injury. This study compared assessment of suspected ankle and foot injuries using the Ottawa Ankle Rules (OAR) by NPs and ED medical doctors (ED-Drs). A prospective, comparative, observational study was undertaken in an Australian acute adult and paediatric urban district ED. NPs and ED-Drs recorded information for patients with acute ankle and/or mid-foot injuries on demographic characteristics, OAR features, use of X-ray and patient management. Outcome measures included X-ray rates and identification of fracture. 174 patients were included in this study: 51 received NP and 123 received ED-Dr care. Assessed as requiring X-ray assessment (NP: 78.4%, ED-Dr: 88.6% p=0.081), and detection of significant fracture (NP: 17.6%, ED-Dr: 22.8% p=0.453) were similar. ED-based medical registrars were more likely to miss a fracture compared with NP (NP: 0%, ED-based Registrar: 28.6%, p=0.013). There were no significant differences in rates of OAR features for patients seen by NPs or ED-Drs. This study suggests that NPs are less likely to miss significant fractures of the ankle and/or foot compared with ED-based medical registrars. Future research should focus on actual use of the OAR and accuracy of X-ray assessment by NPs.
Publisher: Elsevier BV
Date: 10-2006
DOI: 10.1016/J.RESUSCITATION.2006.02.007
Abstract: To determine emergency department (ED) staff preference for one- or two-handed paediatric chest compressions and to determine if there was a difference in compression rates delivered and fatigability between the techniques. This was a randomised, cross-over observational study of paediatric CPR performed on a standard paediatric manikin by ED staff. Consenting, eligible staff [ED doctors and nurses] performed CPR in pairs with chest compressions delivered using a one- and two-handed technique. The outcomes of interest were compression rates for one- and two-handed CPR, decrease in compression rate over time for each technique and staff preference for technique. Data was analysed using descriptive statistics, Chi Square test and Mann-Whitney U-test as appropriate. Sixty-two ED staff participated in the study. Compression rates with both techniques were similar and higher than guidelines recommend (133.6 min(-1) for one-handed and 135.7 min(-1) for two-handed respectively). The compression rate slowed by 6.9 compressions/min over 1 min in one-handed compressions compared with 2.6 compressions/min in two-handed compressions (p = 0.0264). 65.6% of participants reported that they preferred the two-handed compression technique. This study showed that CPR compression rate is similar with one- and two-handed compression techniques, but compression rate decreased more quickly with the one-handed technique. The majority of staff preferred the two-handed compression technique for reasons of ease, control and uniformity with other CPR techniques.
Publisher: Elsevier BV
Date: 11-2008
Abstract: International guidelines for the management of primary spontaneous pneumothorax (PSP) vary, and there is growing opinion that more patients could be successfully managed with observation alone. There is little published evidence detailing the outcomes of emergency department (ED) patients who have been treated for PSP. The aim of this study was to describe the clinical outcomes for patients with PSP. This was a retrospective cohort study that was conducted by explicit medical record review that investigated adult patients with PSP who had been treated at two urban teaching hospital EDs from 1996 to 2005. The data collected included demographics, clinical data at presentation, and outcome data. The outcome of interest was the proportion of patients who were successfully treated with the initial management strategy (ie, conservative, aspiration, and tube thoracostomy). Data analysis was performed using descriptive statistics. A total of 203 episodes of PSP in 154 patients (70% male median age, 24 years) was identified. PSP size ranged from 5 to 100%. Ninety-one PSP patients (45%) were treated with outpatient observation, 48 patients (24%) were treated with aspiration, and 64 patients (31%) were treated with tube thoracostomy. In total, the conditions of 79% of patients (82 of 91 patients) who were treated with observation resolved without additional intervention. Aspiration was successful in 50% of cases (24 of 48 cases) where it was attempted the conditions of 73% of PSP patients who were treated with tube thoracostomy (47 of 64) resolved without additional intervention. These data suggest that observation alone is an effective initial treatment strategy for selected patients with PSP. They support the inclusion of an observation arm in planned prospective studies comparing different management approaches.
Publisher: MDPI AG
Date: 14-04-2023
Abstract: There is a high prevalence of metabolic syndrome (MetS) among people with type 2 diabetes mellitus (T2DM). Physical activity has the potential to improve health outcomes for in iduals with type 2 diabetes. Our study aim was to determine the effect of a 12-week culturally appropriate home-based physical activity program on metabolic syndrome markers and quality of life in Ghanaian adults with T2DM. A secondary objective was to examine the feasibility of implementing the PA program. A feasibility randomised controlled trial (RCT) was conducted. A purposive s le of 87 adults with T2DM at the Korle-Bu Teaching Hospital, Ghana, were randomized into either the control group (CG) (n = 43) or the intervention group (IG) (n = 44). Participants in the IG received the physical activity program in addition to their usual diabetes care those in the CG received their usual diabetes care. Measurements for feasibility, MetS markers, and quality of life (SF-12) were performed at baseline and 12-week follow-up. Following the 12-week program, participants in the IG showed a significant improvement in fasting blood glucose (2.4% vs. 0.4%, p 0.05), waist circumference (5.4% vs. 0.4%, p 0.05), and systolic blood pressure (9.8% vs. 1.5%, p 0.05). There were no statistical differences between the IG and CG regarding high-density lipoprotein, triglycerides, and diastolic blood pressure at the 12-week follow-up. Classification of MetS were reduced in the IG compared to the CG (51.2% vs. 83.3%, p 0.05). The MetS severity score improved in the IG compared to the CG (8.8% vs. 0.5%, p 0.05). The IG improved in two of the eight SF-12 dimensions (physical function and vitality, p 0.05) compared to the CG. Thirty-two (72.7%) participants completed all 36 exercise sessions. Another 11 (25%) participants completed 80% of the exercise sessions. No adverse events were reported. In conclusion, a 12-week home-based physical activity program is feasible and safe. The intervention has the potential to improve MetS and quality of life in Ghanaian adults with T2DM. The preliminary findings of this study need to be confirmed in a large-scale multi-centre RCT.
Publisher: Elsevier BV
Date: 03-2021
DOI: 10.51893/2021.1.OA7
Abstract: Objective: Examine values, preferences and goals elicited by doctors following goals-of-care (GOC) discussions with critically ill patients who had life-limiting illnesses. Design: Descriptive qualitative study using four-stage latent content analysis. Setting: Tertiary intensive care unit (ICU) in South Western Victoria. Participants: Adults who had life-limiting illnesses and were admitted to the ICU with documented GOC, between October 2016 and July 2018. Intervention: The iValidate program, a shared decision-making clinical communication education and clinical support program, for all ICU registrars in August 2015. Main outcome measures: Matrix of themes and subthemes categorised into values, preferences and goals. Results: A total of 354 GOC forms were analysed from 218 patients who had life-limiting illnesses and were admitted to the ICU. In the categories of values, preferences and goals, four themes were identified: connectedness and relational autonomy, autonomy of decision maker, balancing quality and quantity of life, and physical comfort. The subthemes — relationships, sense of place, enjoyment of activities, independence, dignity, cognitive function, quality of life, longevity and physical comfort — provided a matrix of issues identified as important to patients. Relationship, place, independence and physical comfort statements were most frequently identified longevity was least frequently identified. Conclusion: Our analysis of GOC discussions between medical staff and patients who had life-limiting illnesses and were admitted to the ICU, using a shared decision-making training and support program, revealed a framework of values, preferences and goals that could provide a structure to assist clinicians to engage in shared decision making.
Publisher: BMJ
Date: 09-2004
Publisher: Wiley
Date: 13-05-2007
DOI: 10.1111/J.1742-6723.2007.00966.X
Abstract: Incidence of life threatening arrhythmia for patients who present to the ED with low-risk chest pain (CP) (non-ischaemic electrocardiograms and normal cardiac marker profiles) is rare. These patients are often transported with cardiac monitoring by nurse escort from the ED. We aimed to show that this group of patients are at low risk of experiencing life-threatening arrhythmia disturbances. This was a prospective, observational study of ED low-risk CP patients who presented in the period September 2005 and March 2006 and were transported with cardiac monitoring. Data were collected via chart review, and nurse escorts prospectively documented transport details. The primary study outcome was the development of a life threatening arrhythmia requiring treatment during transport from the ED. Data analysis included descriptive statistics and interrater agreement. During the study period there were 231 patients admitted to monitored beds from the ED, of whom 170 (74%) were low risk and enrolled in the study. No patient sustained an adverse event during transport from the ED (0% 95% confidence interval 0-2.2%). Mean (+/-SD) time required for nurse escort to and from the radiology department and coronary care unit was 9.0 (+/-3.1) and 16 (+/-6.5) min, respectively. CP patients who present to the ED with normal electrocardiograms and cardiac marker profiles are at low risk (<1%) of experiencing an adverse event during transport from the ED. This subset of patients might not require cardiac monitoring or nurse escort during transportation from the ED.
Publisher: Hindawi Limited
Date: 19-01-2021
DOI: 10.1111/NUF.12548
Publisher: Elsevier BV
Date: 11-2015
Publisher: Wiley
Date: 16-07-2022
DOI: 10.1111/JAN.15370
Abstract: To synthesize quantitative evidence on levels of dignity during acute hospital admission and identify barriers and facilitators to patients' dignity or dignified care from the perspective of hospitalized patients. The secondary aim was to examine the relationship between dignity and demographic, clinical and psychological characteristics of patients. A systematic review based on the protocol of the Preferred Reporting Items for Systematic reviews and Meta‐Analyses guideline for reporting systematic reviews. Five electronic databases (PubMed, CINAHL, Embase, PsycINFO, AgeLine) were searched in February 2021, followed by backward‐forward searching using Web of Science and Scopus databases. Potentially eligible articles were scrutinized by two reviewers. Articles that met the eligibility criteria were appraised for quality using the Critical Appraisal Tool for Cross‐Sectional Studies. Two reviewers extracted data for the review and resolved differences by consensus. Out of 3052 potentially eligible studies, 25 met the inclusion criteria. Levels of dignity for hospitalized patients vary widely across geographic locations. Patients' dignity is upheld when healthcare professionals communicate effectively, maintain their privacy, and provide dignity therapy. Patients' perceptions of dignity were, in some studies, reported to be associated with demographic (e.g. age, marital status, gender, employment, educational status), clinical (e.g. hospitalization, functional impairment, physical symptoms) and psychological (e.g. depression, anxiety, demoralization, coping mechanisms) variables whilst other studies did not observe such associations. Patients in acute care settings experience mild to a severe loss of dignity across different geographic locations. Patients' dignity is influenced by several demographic, clinical and psychological characteristics of patients. The findings of the review support impetus for improvement in dignified care for hospitalized patients, addressing factors that facilitate or impede patients' dignity. Measures aimed at alleviating suffering, fostering functional independence and addressing patients' psychosocial needs can be used to promote dignity.
Publisher: Wiley
Date: 09-2003
DOI: 10.1046/J.1445-5994.2003.00469.X
Abstract: Abstract Aims: To characterize presentations due to acute asthma at Australian emergency departments (ED), including their severity, treatment and disposition. Methods: This prospective, observational study involved 38 departments of emergency medicine throughout Australia participating in the Snapshot of Asthma Study Group project 2000 and 2001. Data were collected for patients presenting with acute asthma between 21 August 2000 and 3 September 2000, and 20 August 2001 and 2 September 2001 and included demographics, severity classification, treatment and disposition. Results: There were 1340 acute asthma presentations in the study periods. Of these presentations, 67% were for children aged years. Asthma severity (according to the Australian National Asthma Guidelines classification) was ‘mild’ in 49% of cases ‘moderate’ in 45% of cases and ‘severe’ in 6% of cases. Treatment administered included: (i) salbutamol to 90%, (ii) ipratropium bromide to 59% and (iii) corticosteroids to 71%. Only six patients received aminophylline. Spacer use for salbutamol was rare (1%) in adults and only moderate (43%) in children. Sixty‐five percent of patients were discharged home from the ED. Less than 1% of patients required ventilatory assistance, of which half was provided non‐invasively. One percent of patients were admitted to the intensive‐care unit or high‐dependency unit. Conclusion: Overall adherence to treatment guidelines was good. There appears to be underuse of spacers and corticosteroids in some groups and overuse of ipratropium bromide. The majority of patients are treated and discharged from the ED. (Intern Med J 2003 33: 406−413)
Publisher: Wiley
Date: 16-03-2014
DOI: 10.1111/JAN.12382
Abstract: To assess if consumers with schizophrenia who were non-adherent to their oral antipsychotic medication had improved adherence and mental state, after participating in a problem-solving based peer support programme. Many people with schizophrenia are reluctant to take their antipsychotic medications. Peer support, combined with a problem-solving approach, could be used as a strategy to improve adherence outcomes. A peer is an in idual with mental illness who offers support to others. A quasi-experimental time-series design was used to measure the effect of the problem-solving based peer support programme on adherence and mental state. Consumers who were non-adherent to oral antipsychotic medication were recruited from February 2009-June 2010. Peers contacted consumers by a weekly 20-minute telephone call for 8 weeks. Mental state was measured using the Brief Psychiatric Rating Scale-E and medication adherence was measured by self-report at baseline, postintervention (week 8) and follow-up (week 14). Data were analysed using the Friedman's test and Wilcoxon Signed Rank test for pair-wise comparisons. The study included 22 consumers and six peers: 19 males, mean age 35·1 years. Improvements were identified in medication adherence, negative symptoms and overall mental state between baseline and week 8. These improvements were maintained at week 14. Medication adherence may be enhanced with the addition of a peer support intervention. A problem-solving based peer support programme could be implemented in the community setting for patients who are non-adherent with oral antipsychotic medication.
Publisher: Wiley
Date: 02-2003
DOI: 10.1046/J.1442-2026.2003.00408.X
Abstract: To determine the level of agreement in classification of the severity of acute asthma at presentation to the emergency department, between emergency physician global assessment and severity classification according to the National Asthma Council Guidelines, Australia 1998 (NACG). Prospective observational study in emergency departments throughout Australia, participating in the Asthma Snapshot 2000 project. Patients between the ages of one and 60 years presenting to participating emergency departments with acute asthma between 21 August and 3 September 2000 were included. Data collected were emergency physician global assessment of asthma severity and severity classification according to the National Asthma Council Guidelines and disposition. Five hundred and five subjects had completed data for emergency physician assessment of severity and for calculation of severity classification according to the National Asthma Council Guidelines. Weighted kappa for agreement in classification was 0.48 (95% confidence interval: 0.40, 0.56). Emergency physicians assess asthma as less severe compared to the National Asthma Council Guidelines assessment. Agreement between physician assessment of severity of acute asthma and severity classification according to National Asthma Council Guidelines is only moderate. This may have implications in treatment and disposition. This also suggests that emergency physicians may be using other methods to classify acute asthma than the National Asthma Council Guidelines classification.
Publisher: Wiley
Date: 19-08-2020
DOI: 10.1111/JOCN.15438
Publisher: Wiley
Date: 02-2009
DOI: 10.1111/J.1742-6723.2008.01145.X
Abstract: The impact of ED overcrowding on delay to analgesia has not been well studied. Our objective was to determine if ED workload influenced time to analgesia (TTA). An observational, retrospective study (May 2006 to March 2007) was conducted. Adult patients with diagnoses of acute biliary pain, renal colic, wrist and femoral neck fractures were identified and assigned to an ED workload group based on total patient care time--a validated measure of ED workload. The groups were defined by low, middle and high quartiles of total patient care time. The high quartile was defined as overcrowded--equating to average ED occupancy/24 h of 85-140%. Data collected included demographics, pain score and analgesia data. The primary outcome was comparison of TTA between workload groups. Data were analysed using Cox regression and multivariate analyses. S le size required was 50 per group. A total of 254 patients were studied (52% male median age 57 years). Demographics were similar between groups. Ninety-three per cent received analgesia with median TTA of 53 min (interquartile range 30.5-114.5). No significant association was found between workload and TTA (hazard ratio [HR] 1.02, 95% CI 0.99-1.02). On multivariate analysis, factors associated with delay to analgesia included advanced age (HR 0.35, P= 0.006), language other than English (HR 0.55, P= 0.010), lower triage acuity (HR 0.20, P= 0.000) and delay to pain assessment (HR 0.16, P= 0.000). Those with higher pain scores received analgesia more quickly (HR 1.12, P= 0.003). No relationship between workload and TTA was observed however, there were delays to analgesia associated with age, non-English-speaking background and delay to pain assessment.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2013
Publisher: Wiley
Date: 05-02-2008
DOI: 10.1111/J.1360-0443.2007.02097.X
Abstract: This paper reviews available literature regarding the effectiveness, safety and utility of intranasal (i.n.) naloxone for the treatment of heroin overdose. Scientific literature in the form of published articles during the period January 1984 to August 2007 were identified by searching several databases including Medline, Cinahl and Embase for the following terms: naloxone, narcan, intranasal, nose. The data extracted included study design, patient selection, numbers, outcomes and adverse events. Reports of the pharmacological investigation and administration of i.n. naloxone for heroin overdose are included in this review. Treatment of heroin overdose by administration of i.n. naloxone has been introduced as first-line treatment in some jurisdictions in North America, and is currently under investigation in Australia. Currently there is not enough evidence to support i.n. naloxone as first-line intervention by paramedics for treatment of heroin overdose in the pre-hospital setting. Further research is required to confirm its clinical effectiveness, safety and utility. If proved effective, the i.n. route may be useful for drug administration in community settings (including peer-based administration), as it reduces risk of needlestick injury in a population at higher risk of blood-borne viruses. Problematically, naloxone is not manufactured currently in an ideal form for i.n. administration.
Publisher: Wiley
Date: 23-03-2023
DOI: 10.1111/JOCN.16286
Abstract: The aim of this study was to explore older adults’ perspectives about dignity and dignified nursing care during acute hospitalisation in Ghana. Maintaining hospitalised older adults’ dignity is an essential component of nursing care and one of the most important determinants of wellbeing. To date, no study has been published on older adults’ perspectives of dignified nursing care in the African context. A qualitative descriptive research design. Twenty hospitalised older adults were purposively selected from the medical and surgical wards of a teaching hospital in Ghana. Data were gathered through semi‐structured interviews between April and August, 2021, and analysed using reflexive thematic analysis techniques. The SRQR checklist was used to document reporting of the study. The following four themes were identified: Effective nurse – patient communication , Maintaining patients’ privacy , Respectful and compassionate care provision and Providing quality and safe care . Dignity was preserved when patients were treated with respect and compassion, provided privacy, and had close family members involved in physical care. Identified barriers to dignity included inadequate information about their health condition, poor communication by the nurses, lack of autonomy, poorly designed healthcare infrastructure and inadequate privacy. Several enablers and barriers to dignified nursing care have been identified that have been discussed in previous studies. The unique factors identified in the Ghanaian context were family members’ involvement in physical care influenced by cultural and religious beliefs, environmental barriers to privacy and dignity and inadequate involvement in decision making. Nurses must treat older patients with respect, educate them about the health condition, involve them in care decisions, and identify their preferences regarding provision of hygiene needs, particularly in consideration of religious and cultural beliefs, including involvement of family members. Future planning of healthcare infrastructure needs to consider the importance of private cubicles with disability‐accessible ensuite bathrooms for patients’ comfort and privacy.
Publisher: BMJ
Date: 21-10-2005
Publisher: Wiley
Date: 26-03-2007
DOI: 10.1197/J.AEM.2006.12.009
Abstract: An estimate of a child's weight is required for critical interventions, particularly pharmacotherapy. Weight measurement is not always practical, so weight estimation methods are used. Recently, a new weight estimation formula was suggested. The Argall formula estimates weight in kilograms as follows: (age in years + 2) x 3. To validate the Argall weight formula. This was a prospective, observational, cohort study conducted in the pediatric emergency department (ED) of Sunshine Hospital. Children aged up to 11 years who presented to the ED during August 18, 2005, to February 25, 2006, were included. Actual weight, height, age, and ethnicity were obtained. Data were analyzed by descriptive statistics (proportion, mean, median, and SD). Agreement between estimated weight using the Argall formula and measured weight is reported by using mean bias, SD, and root mean square error (RMSE) analysis. Four hundred ten cases were included, 46% were female, and the median age was 4 years. The Argall formula had a mean bias of -1.66 kg and RMSE of 5.65. Only 37% of Argall estimates were within 10% of the child's actual weight. The formula performed less well in children weighing more than 35 kg but performed better in Asian children than white children. The Argall weight estimation formula has poor accuracy for weight estimation in Australian children, in particular those weighing more than 35 kg.
Publisher: Elsevier BV
Date: 2021
No related grants have been discovered for Debra Kerr.