ORCID Profile
0000-0002-5313-5852
Current Organisations
Cabrini
,
Monash Health
,
Monash University
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Publisher: Wiley
Date: 07-2016
Publisher: Wiley
Date: 12-01-2018
Publisher: SAGE Publications
Date: 20-04-2015
Abstract: Feline gastrointestinal eosinophilic sclerosing fibroplasia (FGESF) is a recently described inflammatory disease of cats affecting stomach or intestines and draining regional lymph nodes. This study presents clinical and laboratory data on 13 newly described cases from Australia (11) and the UK (two). The disease was most often observed in middle-aged cats (median 7 years of age interquartile range 5–9 years). Ragdolls (7/13) and males (9/13) were overrepresented. Cats generally had a long history of vomiting and/or diarrhoea. Lesions were typically large, hard, non-painful, easily palpable and most commonly situated near the pylorus or ileocaecocolic junction. Lesions were heterogeneous ultrasonographically and on sectioning at celiotomy or necropsy. Masses were hard and ‘gritty’ on fine-needle aspiration due to internal trabeculae made up of mature collagen bundles. Bacteria were commonly detected within masses (9/13 cases) using either culture or conventional light microscopy and a panel of special stains, and/or fluorescence in situ hybridisation (FISH), although detection often required a diligent search of multiple tissue sections. A consistent bacterial morphology could not be appreciated among the different cases. Patients were treated with a variable combination of cytoreduction (debulking and biopsy, to complete surgical resection), immunosuppressive therapy and antimicrobial agents. Many cats had a poor outcome, which was attributable to late diagnosis combined with suboptimal management. It is hoped that suggestions outlined in the discussion may improve clinical outcomes and long-term survival in future cases.
Publisher: Wiley
Date: 06-2007
Publisher: BMJ
Date: 16-03-2021
Publisher: Wiley
Date: 05-2019
Abstract: Goals-of-care discussions at end-of-life are associated with increased patient satisfaction and reduced treatment burdens, reduced family and healthcare worker distress and healthcare costs, while achieving equal life-expectancy. It is unclear how goals-of-care discussions should occur. The objective of the study was to determine which patients could benefit, requirements, content, documentation, and harms and benefits of emergency medicine goals-of-care discussions. We sought primary evidence on goals-of-care discussions in EDs with adult patients nearing end-of-life, published in English after 1989. Data sources included Medline, Embase, PsycINFO, CINAHL, Web of Science and reference lists of included articles. One thousand nine hundred and twenty abstracts were screened, five articles selected. There was no consensus on the meaning of goals-of-care, which is often confused with advanced care planning and treatment limitation. Emergency clinicians can identify most patients needing discussions following training. There was no evidence for how to involve stakeholders, nor how to adapt conversations to meet cultural and linguistically erse needs. Expert panels have suggested requirements and content for conversations with little supporting evidence. There was no evidence for how emergency conversations differ to those in other settings, nor for harms or benefits for holding goals-of-care conversations in EDs. Increased ED goals-of-care conversations increased hospice referral and reduced in-patient admissions. Most studies were of moderate quality only, outcomes were not standardised and s le sizes were small. 'Goals-of-care' is used inconsistently across the literature. This is the first systematic review regarding goals-of-care discussions in EDs. Further research is needed on all aspects of these conversations.
Publisher: Cold Spring Harbor Laboratory
Date: 21-12-2022
DOI: 10.1101/2022.12.20.22283735
Abstract: Millions of patients attend emergency departments (EDs) around the world every year. Patients are triaged on arrival by a trained nurse who collects structured data and an unstructured free-text history of presenting complaint. Natural language processing (NLP) uses various computational methods to analyse and understand human language, and has been applied to data acquired at ED triage to predict various outcomes. The objective of this systematic review is to evaluate how NLP has been applied to ED triage, assess if NLP based models outperform humans or current risk stratification techniques, and assess if incorporating free-text improve predictive performance of models when compared to predictive models that use only structured data. All English language peer-reviewed research that applied an NLP technique to free-text obtained at ED triage was eligible for inclusion. We excluded studies focusing solely on disease surveillance, and studies that used information obtained after triage. We searched the electronic databases MEDLINE, Embase, Cochrane Database of Systematic Reviews, Web of Science, and Scopus for medical subject headings and text keywords related to NLP and triage. Databases were last searched on 01/01/2022. Risk of bias in studies was assessed using the Prediction model Risk of Bias Assessment Tool (PROBAST). Due to the high level of heterogeneity between studies, a metanalysis was not conducted. Instead, a narrative synthesis is provided. In total, 3584 studies were screened, and 19 studies were included. The population size varied greatly between studies ranging from 1.8 million patients to 762 simulated encounters. The most common primary outcomes assessed were prediction of triage score, prediction of admission, and prediction of critical illness. NLP models achieved high accuracy in predicting need for admission, critical illness, and mapping free-text chief complaints to structured fields. Overall, NLP models predicted admission with greater accuracy than emergency physicians, outperformed abnormal vital sign trigger and triage score at predicting critical illness, and were more accurate than nurses at assigning triage scores in two out of three papers. Incorporating both structured data and free-text data improved results when compared to models that used only structured data. The majority of studies were (79%) were assessed to have a high risk of bias, and only one study reported the deployment of an NLP model into clinical practice. Unstructured free-text triage notes contain valuable information that can be used by NLP models to predict clinically relevant outcomes. The use of NLP at ED triage appears feasible and could allow for early and accurate prediction of multiple important patient-oriented outcomes. However, there are few ex les of implementation of into clinical practice, most research in retrospective, and the potential benefits of NLP at triage are yet to be realised.
Publisher: Wiley
Date: 10-02-2020
Publisher: Wiley
Date: 06-06-2017
Abstract: We aimed to evaluate patient perceptions of medical scribes in the ED and to test for scribe impacts on ED Net Promoter Scores, Press Ganey Surveys and other patient-centred topics. Exploratory semi-structured interviews were conducted in the ED during wait times after scribed consultations. Interview results were used to derive topics relating to scribes. Items addressing these topics from validated surveys were combined with items from widely used patient satisfaction questionnaires. Questionnaires were administered in the ED by face-to-face approach while patients were waiting for admission/discharge or test results. Patients and doctors were blinded to the purpose of the questionnaire. The survey evaluated for non-inferiority of scribed consultations, using Net Promoter Scores, Press Ganey questions and questions specific to the presence of the scribe. Patient interviews did not identify any negative views regarding the presence of scribes during consultations. Thematic saturation was achieved after seven interviews. Two hundred and fifty-eight patients were approached to complete the questionnaire, and 215 participated (83%) 95 and 118 participants in the scribed and non-scribed groups, respectively. There was no difference between scribed and non-scribed consultations on the following measures of satisfaction: the Net Promoter Score, Press Ganey questions, quality of information received from doctors, communication, privacy concerns or inhibition about revealing private information and room crowding. We found no evidence that scribes reduce patient satisfaction during emergency consultations, nor prompt discomfort that might cause a patient to withhold information.
Publisher: Springer Science and Business Media LLC
Date: 08-11-2019
DOI: 10.1038/S41598-019-52710-8
Abstract: The pulse arrival time (PAT), pre-ejection period (PEP) and pulse transit time (PTT) are calculated using on-body continuous wave radar (CWR), Photoplethysmogram (PPG) and Electrocardiogram (ECG) sensors for wearable continuous systolic blood pressure (SBP) measurements. The CWR and PPG sensors are placed on the sternum and left earlobe respectively. This paper presents a signal processing method based on wavelet transform and adaptive filtering to remove noise from CWR signals. Experimental data are collected from 43 subjects in various static postures and 26 subjects doing 6 different exercise tasks. Two mathematical models are used to calculate SBPs from PTTs/PATs. For 38 subjects participating in posture tasks, the best cumulative error percentage (CEP) is 92.28% and for 21 subjects participating in exercise tasks, the best CEP is 82.61%. The results show the proposed method is promising in estimating SBP using PTT. Additionally, removing PEP from PAT leads to improving results by around 9%. The CWR sensors present a low-power, continuous and potentially wearable system with minimal body contact to monitor aortic valve mechanical activities directly. Results of this study, of wearable radar sensors, demonstrate the potential superiority of CWR-based PEP extraction for various medical monitoring applications, including BP measurement.
Publisher: Wiley
Date: 02-2006
DOI: 10.1111/J.1742-6723.2006.00801.X
Abstract: To determine whether the 'Timed Up and Go' (TUG) test is a useful test for predicting re-attendance at an ED, emergency hospital admission or death within 90 days in elderly patients discharged from the ED. This was a prospective blinded cohort study at a tertiary referral ED. Patients completed a TUG test during their Allied Health assessment prior to discharge from the department. After 90 days, patient ED attendances, emergency admissions to hospital or deaths were recorded and confirmed by phone. Data were analysed using logistic regression and reported as odds ratios (OR) or log-transformation and Pearson analysis. One hundred patients were enrolled: 78 (78%, 95% confidence interval [CI] 70-86%) patients remained event free, 22 (22%, 95% CI 14-30%) patients re-attended an ED and 15 (15%, 95% CI 8-22%) were admitted to hospital as an emergency admission. There was no significant difference between TUG test times and whether patients re-attended an ED (OR 1.0 [0.93-1.06] P = 0.9) or were admitted to hospital (OR 0.99 [0.91-1.07] P = 0.74). There was no significant correlation between a patient's TUG test time and the number of days to ED re-attendance (Pearson correlation coefficient 0.38 [-0.04 to 0.69] P = 0.08) or admission (Pearson correlation coefficient 0.32 [-0.23 to 0.71] P = 0.25). This study did not detect any predictive value of the TUG test for ED re-attendance or hospital admission within 90 days of discharge among aged ED patients.
Publisher: Wiley
Date: 23-02-2021
Abstract: Time‐based targets for ED length of stay were introduced in England in 2000, followed by the rest of the UK, Canada, Ireland, New Zealand, and Australia after ED crowding was associated with poor quality of care and increased mortality. This systematic review evaluates qualitative literature to see if ED time‐based targets have influenced patient care quality. We included 13 studies from four countries, incorporating 617 interviews. We conclude that time‐based targets have impacted on the quality of emergency patient care, both positively and negatively. Successful implementation depends on whole hospital resourcing and engagement with targets.
Publisher: Georg Thieme Verlag KG
Date: 07-2017
Abstract: Background: Scribes are assisting Emergency Physicians by writing their electronic clinical notes at the bedside during consultations. They increase physician productivity and improve their working conditions. The quality of Emergency scribe notes is unevaluated and important to determine. Objective: The primary objective of the study was to determine if the quality of Emergency Department scribe notes was equivalent to physician only notes, using the Physician Documentation Quality Instrument, Nine-item tool (PDQI-9). Methods: This was a retrospective, observational study comparing 110 scribed to 110 non-scribed Emergency Physician notes written at Cabrini Emergency Department, Australia. Consultations during a randomised controlled trial of scribe/doctor productivity in 2016 were used. Emergency physicians and nurses rated randomly selected, blinded and de-identified notes, 2 raters per note. Comparisons were made between paired scribed and unscribed notes and between raters of each note. Characteristics of in idual raters were examined. The ability of the tool to discriminate between good and poor notes was tested. Results: The PDQI-9 tool has significant issues. In idual items had good internal consistency (Cronbach’s alpha=0.93), but there was very poor agreement between raters (Pearson’s r=0.07, p=0.270). There were substantial differences in PDQI-9 scores allocated by each rater, with some giving typically lower scores than others, F(25,206)=1.93, p=0.007. The tool was unable to distinguish good from poor notes, F(3,34)=1.15, p=0.342. There was no difference in PDQI-9 score between scribed and non-scribed notes. Conclusions: The PDQI-9 documentation quality tool did not demonstrate reliability or validity in evaluating Emergency Medicine consultation notes. We found no evidence that scribed notes were of poorer quality than non-scribed notes, however Emergency scribe note quality has not yet been determined. Citation: Walker KJ, Wang A, Dunlop W, Rodda H, Ben-Meir M, Staples M. The 9-Item Physician Documentation Quality Instrument (PDQI-9) score is not useful in evaluating EMR (scribe) note quality in Emergency Medicine. Appl Clin Inform 2017 8: 981–993 0.4338/ACI2017052017050080
Publisher: Wiley
Date: 18-07-2021
Publisher: Wiley
Date: 06-12-2020
Publisher: Elsevier BV
Date: 07-2021
Publisher: SAGE Publications
Date: 08-2007
DOI: 10.1016/J.JFMS.2007.01.007
Abstract: Serum s les from 340 pet cats presented to three inner city clinics in Sydney Australia, 68 feral cats from two separate colonies in Sydney, and 329 cattery-confined pedigree and domestic cats in eastern Australia, were collected over a 2-year period and tested for antibodies directed against feline immunodeficiency virus (FIV) using immunomigration (Agen FIV Rapid Immunomigration test) and enzyme-linked immunosorbent assay methods (Snap Combo feline leukaemia virus antigen/FIV antibody test kit, IDEXX Laboratories). Western blot analysis was performed on s les in which there was discrepancy between the results. Information regarding breed, age, gender, housing arrangement and health status were recorded for all pet and cattery-confined cats, while the estimated age and current physical condition were recorded for feral cats. The FIV prevalence in the two feral cat populations was 21% and 25%. The majority of FIV-positive cats were male (60–80%). The FIV prevalence in cattery-confined cats was nil. The prevalence of FIV in the pet cat s le population was 8% (27/340) with almost equal prevalence in ‘healthy’ (13/170) and ‘systemically unwell’ (14/170) cats. The age of FIV-positive pet cats ranged from 3 to 19 years all FIV-positive cats were domestic shorthairs with outside access. The median age of FIV-positive pet cats (11 years) was significantly greater than the median age of FIV-negative pet cats (7.5 years: P .05). The prevalence of FIV infection in male pet cats (21/172 12%) was three times that in female pet cats (6/168 4% P .05). With over 80% of this pet cat population given outside access and continued FIV infection present in the feral population, this study highlights the need to develop rapid, accurate and cost-effective diagnostic methods that are not subject to false positives created by concurrent vaccination against FIV. This is especially important in re-homing stray cats within animal shelters and monitoring the efficacy of the new vaccine, which has not been challenged against Australian strains. The absence of FIV within cattery-confined cats highlights the value in routine screening and indoor lifestyles. This study provides cogent baseline FIV prevalences in three cat subpopulations which can be used for appraising potential disease associations with FIV in Australia.
Publisher: Wiley
Date: 06-2006
Publisher: Cold Spring Harbor Laboratory
Date: 02-04-2022
DOI: 10.1101/2022.03.30.22273211
Abstract: Visualising patient wait times in emergency departments for patients and families is increasingly common, following the development of prediction models using routinely collected patient demographic, urgency and flow data. Consumers of an emergency department wait time display will have culturally and linguistically erse backgrounds, are more likely to be from under-served populations and will have varied data literacy skills. The wait times are uncertain, the information is presented when people are emotionally and physically challenged, and the predictions may inform high stakes decisions. In such a stressful environment, simplicity is crucial and the visual language must cater to the erse audience. When wait times are conveyed well, patient experience improves. Designers must ensure the visualisation is patient-centred and that data are consistently and correctly interpreted. In this article, we present the results of a design study at three hospitals in Melbourne, Australia, undertaken in 2021. We used rapid iterative testing and evaluation methodology, with patients and families from erse backgrounds as participants, to develop and validate a wait time display. We present the design process and the results of this project. Patients, families and staff were eligible to participate if they were awaiting care in the emergency department, or worked in patient reception and waiting areas. The patient-centred approach taken in our design process varies greatly from past work led by hospital administrations, and the resulting visualisations are very distinct. Most currently displayed wait time visualisations could be adapted to better meet end-user needs. Also of note, we found that techniques developed by visualisation researchers for conveying temporal uncertainty tended to overwhelm the erse audience rather than inform. There is a need to balance precise and comprehensive information presentation against the strong need for simplicity in such a stressful environment.
Publisher: Elsevier BV
Date: 06-2011
Publisher: SAGE Publications
Date: 11-12-2012
Abstract: Routine urine cultures were performed in cats with chronic kidney disease (CKD) to assess the overall prevalence and clinical signs associated with a positive urine culture (PUC). An occult urinary tract infection (UTI) was defined as a PUC not associated with clinical signs of lower urinary tract disease or pyelonephritis. Multivariate logistic and Cox proportional hazard regression models were used to evaluate the risk factors for an occult UTI and its relationship with survival. There were 31 PUCs from 25 cats. Eighty-seven percent of PUCs had active urine sediments. The most common infectious agent was Escherichia coli and most bacteria were sensitive to amoxicillin-clavulanate. Eighteen of 25 cats had occult UTIs. Among cats with occult UTI, increasing age in female cats was significantly associated with PUC no significant association between occult UTI and survival was found and serum creatinine was predictive of survival in the short term (200 days) only. In conclusion, among cats with CKD, those with occult UTI were more likely to be older and female, but there was no association with severity of azotaemia. The presence of an occult UTI, when treated, did not influence survival.
Publisher: Wiley
Date: 04-2007
DOI: 10.1111/J.1742-6723.2007.00946.X
Abstract: To assess whether electrocardiogram (ECG) interpretation accuracy improves with advancing years of emergency medicine training. A prospective cross-sectional double-blinded study of emergency medicine trainees attending teaching sessions in ACEM accredited Victorian hospitals. Subjects completed a survey about level of training, rotations completed and ECG training. They were then asked for the 'main diagnosis' on 10 clinically significant ECG. Those in their fourth year of advanced training onwards, or in active preparation for fellowship examination (senior trainees) were compared with trainees in earlier years (other trainees). There were 122 trainees surveyed in total. In the present study, 48/122 were senior trainees and 74/122 were other trainees. The overall accuracy of ECG interpretation was 67.5% (95% confidence interval [CI] 63.2-71.8%) for the senior trainees and 49.6% (95% CI 45.2-53.9%) for the others. Results for some of the in idual ECG were: left bundle branch block: 81.3% (95% CI 69.9-92.6%) seniors and 58.1% (95% CI 46.6-69.7%) others ventricular tachycardia: 43.8% (95% CI 29.3-58.2%) seniors and 37.8% (95% CI 26.5-49.2%) others and ventricular fibrillation: 70.8% (95% CI 57.6-84.1%) seniors and 63.5% (95% CI 52.2-74.9%) others. There is an improvement in ECG interpretation accuracy with advancing years of emergency medicine training in Victoria. There exists, however, a low level of accuracy for some critical ECG diagnoses. There is a call by trainees for more formalized and regular ECG education to begin earlier in their training.
Publisher: SAGE Publications
Date: 02-2010
DOI: 10.1016/J.JFMS.2009.12.013
Abstract: This study used immunohistochemistry (IHC) and histopathology to evaluate the presence of feline herpesvirus-1 (FHV-1) in feline cases of ‘eosinophilic granuloma complex’ (EGC) or other eosinophilic dermatoses or stomatitis, diagnosed at the Veterinary Pathology Diagnostic Service, University of Sydney between January 1996 and June 2008. Two of the 30 cases (6.6%) examined showed positive immunoreactivity to FHV-1 using IHC. Intranuclear inclusion bodies were also detected on histopathological examination of haematoxylin and eosin stained sections of both cases but were very difficult to find. Therefore, FHV-1 is uncommonly associated with EGC or other eosinophilic dermatoses or stomatitis in Sydney. However, misdiagnosis as an EGC lesion or other eosinophilic dermatoses may occur if inclusion bodies are overlooked or absent on histopathology and this may significantly decrease the chance of a favourable treatment outcome. FHV-1 should be considered in cats with severe ulcerative cutaneous or oral lesions, unresponsive to corticosteroid treatment, with or without concurrent or historical signs of upper respiratory tract or ocular disease more typical of FHV-1. IHC may be helpful in differentiating FHV-1 dermatitis or stomatitis from other eosinophilic lesions, which is of vital clinical and therapeutic importance.
Publisher: Wiley
Date: 02-2013
Publisher: Wiley
Date: 16-04-2018
Abstract: There is limited literature to inform the content and format of Goals-of-Care forms, for use by doctors when they are undertaking these important conversations. This was a prospective, qualitative and quantitative study evaluating the utility of a new 'Goals-of-Care' form to doctors in a private, tertiary ED, used from December 2016 to February 2017 at Cabrini, Melbourne. A Goals-of-Care form was designed, incorporating medical aims of therapy and patient values and preferences. Doctors wishing to complete a Not-for-CPR form were also supplied with the trial Goals-of-Care form. Form use, content and patient progress were followed. Doctors completing a form were invited to interview. Forms were used in 3% of attendances, 120 forms were taken for use and 108 were analysed. The median patient age was 91, 81% were Supportive and Palliative Care Indicators Tool (SPICT) positive and patients had a 48% 6-month mortality. A total of 34 doctors completed the forms, 16 were interviewed (two ED trainees, 11 senior ED doctors and three others). Theme saturation was only achieved for the senior doctors interviewed. Having a Goals-of-Care form was valued by 88% of doctors. The frequency of section use was: Aims-of-Care 91% Quality-of-Life 75% (the term was polarising) Functional Impairments 35% and Outcomes of Value 29%. Opinions regarding the ideal content and format varied. Some doctors liked free-text space and others tick-boxes. The median duration of the conversation and documentation was 10 min (interquartile range 6-20 min). Having a Goals-of-Care form in emergency medicine is supported the ideal contents of the form was not determined.
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/AH16188
Abstract: Objective Medical scribes have an emerging and expanding role in health, particularly in Emergency Medicine in the US. Scribes assist physicians with documentation and clerical tasks at the bedside while the physician consults with his or her patient. Scribes increase medical productivity. The aim of the present study was to examine the feasibility of a pilot hospital-administered scribe-training program in Australia and to evaluate the ability of an American training course (Medical Scribe Training Systems) to prepare trainee scribes for clinical training in an emergency department in Australia. Methods The present study was a pilot, prospective, observational cohort study from September 2015 to February 2016 at Cabrini Emergency Department, Melbourne. Scribe trainees were enrolled in the pre-work course and then trained clinically. Feasibility of training scribes and limited efficacy testing of the course was undertaken. Results The course was acceptable to users and demand for training exists. There were many implementation tasks and issues experienced and resources were required to prepare the site for scribe implementation. Ten trainees were enrolled for preclinical training. Six candidates undertook clinical training, five achieved competency (required seven to 16 clinical shifts after the preclinical course). The training course was helpful and provided a good introduction to the scribe role. The course required adaptation to a non-US setting and the specific hospital setting. In addition, it needed more detail in some common emergency department topics. Conclusion Training scribes at a hospital in Australia is feasible. The US training course used can assist with preclinical training. Course modification is required. What is known about the topic? Scribes increase emergency physician productivity in Australia. There is no previous work on how to train scribes in Australia. What does this paper add? We show that implementing a scribe-training program is feasible and that a training package can be purchased from the US to train scribes in Australia and that it is useful. We also show the adaptation that the course may require to meet Australian emergency department needs. What are the implications for practitioners? Scribes could become an additional member of the emergency department team in Australia and can be trained locally.
Publisher: Wiley
Date: 27-09-2021
DOI: 10.1111/AJAG.12999
Abstract: To describe the characteristics, assessment and management of older emergency department (ED) patients with non‐traumatic headache. Planned sub‐study of a prospective, multicentre, international, observational study, which included adult patients presenting to ED with non‐traumatic headache. Patients aged ≥75 years were compared to those aged years. Outcomes of interest were epidemiology, investigations, serious headache diagnosis and outcome. A total of 298 patients (7%) in the parent study were aged ≥75 years. Older patients were less likely to report severe headache pain or subjective fever (both P 0.001 ). On examination, older patients were more likely to be confused, have lower Glasgow Coma Scores and to have new neurological deficits (all P 0.001). Serious secondary headache disorder (composite of headache due to subarachnoid haemorrhage (SAH), intracranial haemorrhage, meningitis, encephalitis, cerebral abscess, neoplasm, hydrocephalus, vascular dissection, stroke, hypertensive crisis, temporal arteritis, idiopathic intracranial hypertension or ventriculoperitoneal shunt complications) was diagnosed in 18% of older patients compared to 6% of younger patients ( P 0.001). Computed tomography brain imaging was performed in 66% of patients ≥75 years compared to 35% of younger patients ( P 0.001). Older patients were less likely to be discharged (43% vs 63%, P 0.001). Older patients with headache had different clinical features to the younger cohort and were more likely to have a serious secondary cause of headache than younger adults. There should be a low threshold for investigation in older patients attending ED with non‐traumatic headache.
Publisher: Elsevier BV
Date: 02-2021
Publisher: Cold Spring Harbor Laboratory
Date: 14-08-2020
DOI: 10.1101/2020.08.11.20173153
Abstract: Emergency Departments have the potential ability to predict patient wait times and to display this to patients and other stakeholders. Little is known about whether consumers and stakeholders would want this information and how wait time predictions might be used. The aim of this study was to gain perspectives from consumer, referrer and health services personnel regarding the concept of emergency wait time visibility. In 2019, 103 semi-structured interviews and one focus group were conducted with emergency medicine patients/families, paramedics, well community members and hospital aramedic administrators. Nine emergency departments and multiple organisations in Victoria, Australia, contributed data. Transcripts were coded and themes are presented. Consumers and paramedics face physical and psychological difficulties when wait times aren’t visible. Consumers believe about a 2-hour wait is tolerable, beyond this most begin to consider alternative strategies for seeking care. Consumers want to see triage to doctor times paramedics want door to off-stretcher times (for all possible transport destinations) with 47/50 consumers and 30/31 paramedics potentially using this information. Twenty-eight of 50 consumers would use times to inform facility or provider choice, 19/50 want information once in the waiting room. During prolonged waits, 1/52 consumers would consider not seeking care. Visibility of approximate waits would better inform decision-making, improve load-spreading, allow planning and access to basic needs and might reduce anxiety. Consumers and paramedics want wait time information visibility. They would use the information in a variety of ways, both pre-hospital and whilst waiting for care.
Publisher: Wiley
Date: 14-05-2022
Abstract: To estimate the total economic impact of peripheral intravenous catheter (PIVC) or cannula insertion and use in adult Australian EDs, including those cannulas that remain unused for therapeutic purposes. Searches on Australian government websites were conducted to find rates of insertion, complications and cost of cannula following this, gaps in national data sets were filled with MEDLINE and PubMed searches to estimate the total cost of cannula use in Australian EDs. Once the data were collected, totals were combined to establish an estimated cost for the listed categories. The estimated cost of cannulation in Australia may be up to A$594 million per year, including the cost of insertion (equipment and staff), cost of complications such as Staphylococcus aureus bacteraemia and phlebitis, and patient‐centred costs (lost patient productivity, infiltration, occlusion and dislodgement). Approximately A$305.9 million is attributed to unused cannulas and approximately 11 790 days of clinician time is spent annually inserting cannula that remains idle. The figures developed in the present study represent an important educational opportunity to encourage thoughtful consideration of all interventions, no matter how small. ED cannula insertion represents a large economic and health cost to Australia's health system, many of which remain unused. There are no national data sets that record complications associated with PIVCs and we highlight the urgent need for improved data.
Publisher: Microbiology Society
Date: 09-2014
Abstract: Meticillin-resistant Staphylococcus pseudintermedius (MRSP) has recently emerged as a worldwide cause of canine pyoderma. In this study, we characterized 22 S. pseudintermedius isolates cultured from 19 dogs with pyoderma that attended a veterinary dermatology referral clinic in Australia in 2011 and 2012. Twelve isolates were identified as MRSP by mecA real-time PCR and phenotypic resistance to oxacillin. In addition to β-lactam resistance, MRSP isolates were resistant to erythromycin (91.6 %), gentamicin (83.3 %), ciprofloxacin (83.3 %), chlor henicol (75 %), clindamycin (66 %), oxytetracycline (66 %) and tetracycline (50 %), as shown by disc-diffusion susceptibility testing. Meticillin-susceptible S. pseudintermedius isolates only showed resistance to penicillin/ icillin (90 %) and tetracycline (10 %). PFGE using the Sma I restriction enzyme was unable to type nine of the 12 MRSP isolates. However the nine isolates provided the same PFGE pulsotype using the Cfr 91 restriction enzyme. Application of the mec -associated direct repeat unit ( dru ) typing method identified the nine Sma I PFGE-untypable isolates as dt11cb, a dru type that has only previously been associated with MRSP sequence type (ST)45 isolates that possess a unique SCC mec element. The dt11cb isolates shared a similar multidrug-resistant antibiogram phenotype profile, whereas the other MRSP isolates, dt11a, dt11af (dt11a-associated) and dt10h, were resistant to fewer antibiotic classes and had distinct PFGE profiles. This is the first report of MRSP causing pyoderma in dogs from Australia. The rapid intercontinental emergence and spread of multidrug-resistant MRSP strains confirms the urgent need for new treatment modalities for recurrent canine pyoderma in veterinary practice.
Publisher: Elsevier BV
Date: 11-2011
DOI: 10.1016/J.CVSM.2011.07.003
Abstract: Feline immunodeficiency virus (FIV) is an important infection in both domestic and nondomestic cats. Although many studies have provided insight into FIV pathophysiology and immunologic responses to infection in cats, questions remain regarding the association of FIV with specific disease syndromes. For many diseases, both association and causation of disease with FIV remain to be confirmed and clarified. The use of experimental infection models is unlikely to yield answers about naturally infected domestic cats and is not feasible in nondomestic felids, many of which are endangered species. Researches might consider further study of naturally occurring disease with an emphasis on confirming which diseases have a likely association with FIV.
Publisher: BMJ
Date: 28-06-2016
DOI: 10.1136/EMERMED-2016-205934
Abstract: To undertake a cost analysis of training medical scribes in an ED. This was a pilot, observational, single-centre study at Cabrini ED, Melbourne, Australia, studying the costs of initiating a scribe programme from the perspective of the hospital and Australian Health sector. Recruitment and training occurred between August 2015 and February 2016 and comprised of a prework course (1 month), prework training sessions and clinical training shifts for scribe trainees (2-4 months, one shift per week) who were trained by emergency physicians. Costs of start-up, recruitment, administration, preclinical training, clinical training shifts and productivity changes for trainers were calculated. 10 trainees were recruited to the prework course, 9 finished, 6 were offered clinical training after simulation assessment, 5 achieved competency. Scribes required clinical training ranging from 68 to 118 hours to become competent after initial classroom training. Medical students (2) required 7 shifts to become competent, premedical students (3) 8-16 shifts, while a trainee from an alternative background did not achieve competency. Based on a scribe salary of US$15.91/hour (including 25% on-costs) plus shift loadings, costs were: recruitment and start-up US$3111, education US$1257, administration US$866 and clinical shift costs US$1137 (overall cost US$6317 per competent scribe). Physicians who trained the clinical trainee scribes during shifts did not lose productivity. Training scribes outside the USA is feasible using an on-line training course and local physicians. It makes economic sense to hire in iduals who can work over a long period of time to recoup training costs. ACTRN12615000607572.
Publisher: Informa UK Limited
Date: 29-03-2019
DOI: 10.1080/13548506.2019.1595683
Abstract: Goals-of-care discussions aim to establish patient values for shared medical decision-making. These discussions are relevant towards end-of-life as patients may receive non-beneficial treatments if they have never discussed preferences for care. End-of-life care is provided in Emergency Departments (EDs) but little is known regarding ED-led goals-of-care discussions. We aimed to explore practitioner perspectives on goals-of-care discussions for adult ED patients nearing end-of-life. We report the qualitative component of a mixed methods study regarding a 'Goals-of-Care' form in an Australian ED. Eighteen out of 34 doctors who completed the form were interviewed. We characterised ED-led goals-of-care consultations for the first time. Emergency doctors perceive goals-of-care discussions to be relevant to their practice and occurring frequently. They aim to ensure appropriate care is provided prior to review by the admitting team, focusing on limitations of treatment and clarity in the care process. ED doctors felt they could recognise end-of-life and that ED visits often prompt consideration of end-of-life care planning. They wanted long-term practitioners to initiate discussions prior to patient deterioration. There were numerous interpretations of palliative care concepts. Standardisation of language, education, collaboration and further research is required to ensure Emergency practitioners are equipped to facilitate these challenging conversations.
Publisher: BMJ
Date: 03-2021
DOI: 10.1136/BMJOPEN-2020-043223
Abstract: The population is ageing, with increasing health and supportive care needs. For older people, complex chronic health conditions and frailty can lead to a cascade of repeated hospitalisations and further decline. Existing solutions are fragmented and not person centred. The proposed Being Your Best programme integrates care across hospital and community settings to address symptoms of frailty. A multicentre pragmatic mixed methods study aiming to recruit 80 community-dwelling patients aged ≥65 years recently discharged from hospital. Being Your Best is a codesigned 6-month programme that provides referral and linkage with existing services comprising four modules to prevent or mitigate symptoms of physical, nutritional, cognitive and social frailty. Feasibility will be assessed in terms of recruitment, acceptability of the intervention to participants and level of retention in the programme. Changes in frailty (Modified Reported Edmonton Frail Scale), cognition (Mini-Mental State Examination), functional ability (Barthel and Lawton), loneliness (University of California Los Angeles Loneliness Scale-3 items) and nutrition (Malnutrition Screening Tool) will also be measured at 6 and 12 months. The study has received approval from Monash Health Human Research Ethics Committee (RES-19-0000904L). Results will be disseminated through peer-reviewed journals, conference and seminar presentations. ACTRN12620000533998 Pre-results.
Publisher: Wiley
Date: 30-05-2017
DOI: 10.1111/CEO.12972
Publisher: Wiley
Date: 18-12-2020
Publisher: Research Square Platform LLC
Date: 14-02-2020
Abstract: Background Large, multicentre studies are required in emergency medicine to advance clinical care and improve patient outcomes. The Australasian College for Emergency Medicine clinical trials network is available to researchers to assist with facilitating large, multicentre research. However, there is no current information about the research capacity of emergency departments (EDs) in Australia and New Zealand. Methods All EDs accredited for emergency medicine training in Australia and New Zealand were eligible to participate. Research leads or ED directors were invited via email and telephone to complete a survey. Data were collected regarding the presence of a research lead, their research experience available research resources including colleagues, funding, departmental paid research time publications and research culture. Results One hundred and twelve responses were received on behalf of 122 (84%) sites (10 satellite plus main) from a possible 143 sites with all types of hospitals and regions represented. Research leads were identified at 66 (59%) sites, 32 (29%) had a director of emergency medicine research. A wide range of research was underway. Ninety-six sites (66%) contributed data to multicentre projects. Twenty-one centres (17%), were highly productive with multiple resources (skilled colleagues, funding, staffing), a positive research culture and high volume output. Sixty to seventy centres (50-58%) had limited resources, experienced an unsupportive research culture and authored manuscripts infrequently. Paid time for research directors was associated with increased research outputs. Discussion ACEM sites have capacity to undertake large multicentre studies with a varied network of sites and researchers. While some sites are well equipped for research, the majority of EDs had minimal research output.
Publisher: Wiley
Date: 26-10-2017
Abstract: Emergency medicine was once exclusively provided in public hospitals in Australia, but now over half a million consultations per annum are in private (7% total emergency consultations). Private EDs have excess capacity and are staffed by senior doctors (majority FACEM) with open access to investigations and broad specialist inpatient services. Public EDs struggle with rising attendances and overcapacity. Private hospitals have high levels of patient satisfaction and aim to optimise service provision. A major barrier to private ED attendances is out-of-pocket costs. Insurers deem private EDs outpatient services and therefore do not contribute any funding to these attendances. Additionally state governments provide no funding while Medicare items cover only 10-15% of costs. Out-of-pocket consultation costs to patients vary nationally ($110-$480) but never cover the full cost of providing services. Patients may also pay out-of-pocket costs for investigations. Private EDs can provide many benefits to patients and the community. Patients can see senior doctors immediately (at less cost per patient than public EDs). Demand can be directed away from resource-poor public EDs. Private EDs could also provide extra surge capacity during disasters. There is a need for further strong advocacy for private emergency medicine at many levels, particularly regarding the lack of funding. Stakeholder relationships should be strengthened. Research and education about decision-making in the choice between public and private ED attendance should be encouraged, particularly regarding paramedic advice to patients. Finally, patients who have purchased private insurance should be able to utilise it during evaluation of an acute illness.
Publisher: Elsevier BV
Date: 03-2015
Publisher: Wiley
Date: 20-10-2014
Abstract: The study aims to determine if trained scribes in an Australian ED can assist emergency physicians (EPs) to work with increased productivity. This was a pilot, prospective, observational study conducted at a private ED in Melbourne. A scribe is a trained assistant who works with an EP and performs non-clinical tasks that reduce the time spent providing clinical care for patients. Shifts with and without a scribe were compared. The primary outcomes were patients per hour per doctor and billings per patient. Additional analyses included total patient time in ED in idual doctor productivity time to see a doctor time on ambulance bypass and complaints/issues identified with scribes. There was an overall increase in doctor consultations per hour of 0.32 patients (95% confidence interval (CI) 0.17, 0.47). This varied between doctors from an increase in patients per hour of 0.16 (95% CI -0.09, 0.40) to 0.65 (95% CI 0.41, 0.89). Billings per patient were increased (AUD15.24 95% CI -AUD18.51, AUD48.99), but the increase was not statistically significant time to see a doctor reduced by 22 min (95% CI 11, 33) bypass episodes reduced by 66 min per shift (95% CI 11, 122), total patient ED stay remained constant. In this pilot study, scribe usage was feasible, and overall improvements in consultations per hour were seen. Overall income improved by AUD104.86 (95% CI AUD38.52, AUD171.21) per scribed hour. Further study is recommended to determine if results are sustained or improved over a longer period.
Publisher: Wiley
Date: 24-02-2016
Publisher: Cold Spring Harbor Laboratory
Date: 24-03-2021
DOI: 10.1101/2021.03.19.21253921
Abstract: Patients, families and community members would like emergency department wait time visibility. This would improve patient journeys through emergency medicine. The study objective was to derive, internally and externally validate machine learning models to predict emergency patient wait times that are applicable to a wide variety of emergency departments. Twelve emergency departments provided three years of retrospective administrative data from Australia (2017-19). Descriptive and exploratory analyses were undertaken on the datasets. Statistical and machine learning models were developed to predict wait times at each site and were internally and externally validated. Model performance was tested on COVID-19 period data (January to June 2020). There were 1,930,609 patient episodes analysed and median site wait times varied from 24 to 54 minutes. In idual site model prediction median absolute errors varied from +/−22.6 minutes (95%CI 22.4,22.9) to +/− 44.0 minutes (95%CI 43.4,44.4). Global model prediction median absolute errors varied from +/−33.9 minutes (95%CI 33.4, 34.0) to +/−43.8 minutes (95%CI 43.7, 43.9). Random forest and linear regression models performed the best, rolling average models under-estimated wait times. Important variables were triage category, last-k patient average wait time, and arrival time. Wait time prediction models are not transferable across hospitals. Models performed well during the COVID-19 lockdown period. Electronic emergency demographic and flow information can be used to approximate emergency patient wait times. A general model is less accurate if applied without site specific factors. ⍰ Patients and families want to know approximate emergency wait times, which will improve their ability to manage their logistical, physical and emotional needs whilst waiting ⍰ There are a few small studies from a limited number of jurisdictions, reporting model methods, important predictor variables and accuracy of derived models ⍰ Our study demonstrates that predicting wait times from simple, readily available data is complex and provides estimates that aren’t as accurate as patients would like, however rough estimates may still be better than no information ⍰ We present the most influential variables regarding wait times and advise against using rolling average models, preferring random forest or linear regression techniques ⍰ Emergency medicine machine learning models may be less generalisable to other sites than we hope for when we read manuscripts or buy commercial off-the-shelf models or algorithms. Models developed for one site lose accuracy at another site and global models built for whole systems may need customisation to each in idual site. This may apply to data science clinical decision instruments as well as operational machine learning models.
Publisher: BMJ
Date: 30-01-2019
DOI: 10.1136/BMJ.L121
Abstract: To evaluate the changes in productivity when scribes were used by emergency physicians in emergency departments in Australia and assess the effect of scribes on throughput. Randomised, multicentre clinical trial. Five emergency departments in Victoria used Australian trained scribes during their respective trial periods. Sites were broadly representative of Australian emergency departments: public (urban, tertiary, regional referral, paediatric) and private, not for profit. 88 physicians who were permanent, salaried employees working more than one shift a week and were either emergency consultants or senior registrars in their final year of training 12 scribes trained at one site and rotated to each study site. Physicians worked their routine shifts and were randomly allocated a scribe for the duration of their shift. Each site required a minimum of 100 scribed and non-scribed shifts, from November 2015 to January 2018. Physicians’ productivity (total patients, primary patients) patient throughput (door-to-doctor time, length of stay) physicians’ productivity in emergency department regions. Self reported harms of scribes were analysed, and a cost-benefit analysis was done. Data were collected from 589 scribed shifts (5098 patients) and 3296 non-scribed shifts (23 838 patients). Scribes increased physicians’ productivity from 1.13 (95% confidence interval 1.11 to 1.17) to 1.31 (1.25 to 1.38) patients per hour per doctor, representing a 15.9% gain. Primary consultations increased from 0.83 (0.81 to 0.85) to 1.04 (0.98 to 1.11) patients per hour per doctor, representing a 25.6% gain. No change was seen in door-to-doctor time. Median length of stay reduced from 192 (interquartile range 108-311) minutes to 173 (96-208) minutes, representing a 19 minute reduction (P .001). The greatest gains were achieved by placing scribes with senior doctors at triage, the least by using them in sub-acute/fast track regions. No significant harm involving scribes was reported. The cost-benefit analysis based on productivity and throughput gains showed a favourable financial position with use of scribes. Scribes improved emergency physicians’ productivity, particularly during primary consultations, and decreased patients’ length of stay. Further work should evaluate the role of the scribe in countries with health systems similar to Australia’s. ACTRN12615000607572 (pilot site) ACTRN12616000618459.
Publisher: Wiley
Date: 02-06-2019
Abstract: We describe a novel ambulance ersion programme, piloted in Victoria. This article discusses creating increased emergency capacity during surge or disasters by utilising private EDs, tested during a recent thunderstorm asthma disaster and an influenza epidemic. Public hospitals and EDs often run at or over capacity during normal operations. This leaves limited ability to manage surges in demand, resulting in suboptimal outcomes for patients, public ED staff and ambulance services. It is feasible to create surge capacity in private EDs for public ambulance patients. Other states could consider this option to help manage health disasters.
Publisher: Cold Spring Harbor Laboratory
Date: 04-01-2021
DOI: 10.1101/2021.01.03.21249171
Abstract: Time-based-targets for emergency department length-of-stay were introduced in England in 2000 followed by Canada, Ireland, New Zealand, and Australia after emergency department crowding was associated with poor quality of care and increased mortality. The aim of the systematic review was to evaluate qualitative literature to investigate how implementing time-based-targets for emergency department length-of-stay has influenced the quality of care of patients. Systematic review of qualitative studies that described knowledge, attitudes to or experiences regarding a time-based-target for emergency department length-of-stay. Searches were conducted in Cochrane library, Medline, Embase, CInAHL, Emerald, ABI/Inform, and Informit. In idual studies were evaluated using the Critical Appraisal Skills Programme tool. In idual study findings underwent thematic analysis. Confidence in findings was assessed using the Confidence in the Evidence from Reviews of Qualitative research approach. The review included thirteen studies from four countries, incorporating 617 interviews. Themes identified were: quality of care, access block and overcrowding, patient experience, staff morale and workload, intrahospital and interdepartmental relationships, clinical education and training, gaming, and enablers and barriers to achieving targets. The confidence in findings is moderate or high for most themes. More patient and junior doctor perspectives are needed. Emergency time-based-targets have impacted on the quality of emergency patient care. The impact can be both positive and negative and successful implementation depends on whole hospital resourcing and engagement with targets. The Australasian College for Emergency Medicine provided administrative support for the study, no funding was received. PROSPERO CRD42019107755 (prospective)
Publisher: BMJ
Date: 25-08-2021
DOI: 10.1136/EMERMED-2020-211000
Abstract: Patients, families and community members would like emergency department wait time visibility. This would improve patient journeys through emergency medicine. The study objective was to derive, internally and externally validate machine learning models to predict emergency patient wait times that are applicable to a wide variety of emergency departments. Twelve emergency departments provided 3 years of retrospective administrative data from Australia (2017–2019). Descriptive and exploratory analyses were undertaken on the datasets. Statistical and machine learning models were developed to predict wait times at each site and were internally and externally validated. Model performance was tested on COVID-19 period data (January to June 2020). There were 1 930 609 patient episodes analysed and median site wait times varied from 24 to 54 min. In idual site model prediction median absolute errors varied from±22.6 min (95% CI 22.4 to 22.9) to ±44.0 min (95% CI 43.4 to 44.4). Global model prediction median absolute errors varied from ±33.9 min (95% CI 33.4 to 34.0) to ±43.8 min (95% CI 43.7 to 43.9). Random forest and linear regression models performed the best, rolling average models underestimated wait times. Important variables were triage category, last-k patient average wait time and arrival time. Wait time prediction models are not transferable across hospitals. Models performed well during the COVID-19 lockdown period. Electronic emergency demographic and flow information can be used to approximate emergency patient wait times. A general model is less accurate if applied without site-specific factors.
Publisher: BMJ
Date: 29-09-2018
DOI: 10.1136/EMERMED-2017-206637
Abstract: The utilisation of medical scribes in the USA has enabled productivity gains for emergency consultants, though their personal experiences have not been widely documented. We aimed to evaluate the consultant experience of working with scribes in an Australian ED. Emergency consultants working with scribes and those who declined to work with scribes were invited to participate in in idual interviews (structured and semistructured questions) about scribes, scribe work and the scribe program in October 2016. Of 16 consultants, 13 participated in interviews, that is, 11 worked with scribes and 2 did not and 3 left Cabrini prior to the interviews. Consultants working with scribes found them most useful for capturing initial patient encounters, for finding information and completing discharge tasks. Scribes captured more details than consultants usually did. Editing was required for omissions, misunderstandings and rearranging information order, but this improved with increasing scribe experience. Consultants described changing their style to give more information to the patient in the room. Consultants felt more productive and able to meet demands. They also described enjoyment, less stress, less cognitive loading, improved ability to multitask, see complex patients and less fatigue. In interviews with the two consultants declining scribes, theme saturation was not achieved. Consultants declining scribes preferred to work independently. They did not like templated notes and felt that consultation nuances were lost. They valued their notes write-up time as time for cognitive processing of the presentation. They thought the scribe and computer impacted negatively on communication with the patient. Medical scribes were seen to improve physician productivity, enjoyment at work, ability to multitask and to lower stress levels. Those who declined scribes were concerned about losing important nuances and cognitive processing time for the case.
Publisher: Wiley
Date: 16-03-2021
Publisher: Wiley
Date: 28-09-2020
Publisher: SAGE Publications
Date: 06-2003
DOI: 10.1016/S1098-612X(02)00069-4
Abstract: A seven-year-old castrated British shorthair cross cat was presented for coughing of five-weeks duration. Thoracic radiographs and an unguided bronchoalveolar lavage showed changes consistent with inflammatory airway disease. In addition, a soft tissue density was evident in the thoracic films between the heart and the diaphragm. Exploratory thoracotomy demonstrated a diaphragmatic hernia, probably congenital in origin, with incarceration of a portion of the hepatic parenchyma. The herniated portion of liver was resected surgically and the defect in the diaphragm closed. The cat was given a 10-day course of doxycycline post-operatively and the cough did not recur subsequently. In retrospect, the hernia was potentially an incidental problem, the cat's coughing being attributable to inflammatory airway disease.
Publisher: Wiley
Date: 30-10-2021
Publisher: Wiley
Date: 27-04-2014
DOI: 10.1111/AVJ.12176
Abstract: To evaluate three easily performed methods of skin surface s ling for bacterial culture of Staphylococcus isolates obtained from dogs with superficial bacterial pyoderma (SBP) presenting to two veterinary teaching hospitals in Sydney, Australia, and to determine the antimicrobial susceptibility of isolates. Prospective study of 27 dogs with SBP. Cytologically confirmed SBP lesions were s led for bacterial culture using a dry cotton swab, a saline-moistened cotton swab and a skin surface scraping. Isolates were identified by standard discriminatory phenotypic and biochemical analyses, and confirmed using matrix-assisted laser desorption ionisation time of flight mass spectrometry (MALDI-TOF MS). Susceptibilities to 14 antimicrobials were determined by disk diffusion and by detection of the mecA gene using PCR. S ling methods were compared according to bacterial yield, antibiograms and bacterial phenotypic analysis. Location of causative bacteria was evaluated via 8-mm punch skin biopsies using haematoxylin and eosin, Gram-Twort and Giemsa staining, and fluorescence in situ hybridisation (FISH). Staphylococcus sp. were isolated from lesions in all dogs, either S. pseudintermedius (24 dogs) or S. schleiferi (3 dogs). Susceptibility was highest to cephalexin (96%) and amoxycillin clavulanate (96%). Methicillin resistance assessed by mecA real-time PCR and phenotypic oxacillin resistance was found in one dog (4.3%). Routine histology and FISH revealed bacteria within superficial stratum corneum. Staphylococcal isolates from canine SBP demonstrated high susceptibility to common empirical antimicrobials. Histological techniques confirmed presence of bacteria at superficial sites, likely to be accessed by the s ling techniques. The three techniques afforded similar results and may be equally suitable for obtaining s les for culture.
Publisher: Oxford University Press (OUP)
Date: 23-02-2021
Abstract: Advance care planning is intended to support residents’ preferences regarding health decisions, even when they can no longer participate. Little is known about the power discourses influencing how residents, family members, and health care workers engage in advance care planning and how advance care directives are used if a conflict arises. A large critical ethnographic study was conducted exploring decision making when a resident’s health deteriorates in the nursing home setting. Advance care planning practices were not the focus of the original study, but the richness of the data warranted further exploration. A new research question was developed to inform a secondary analysis: How does advance care planning influence the relationship between resident values and clinical expertise when determining a direction of care at the time of a resident deterioration? A secondary analysis of data from an ethnographic study involving 184 h of participatory observation, 40 semistructured interviews and advance care planning policies, and document review undertaken in two nursing homes in Melbourne, Australia. Advance care planning may result in inaccurate documentation of residents’ preferences and devalue clinical decision making and communication with residents and family members at the time of deterioration. Advance care planning may contribute toward a reductionist approach to decision making. There is an urgent need for the development of evidence-based policy and legislation to support residents, families, and health care workers to make appropriate decisions, including withholding invasive treatment when a resident deteriorates.
Publisher: Wiley
Date: 10-2006
Publisher: Elsevier
Date: 2006
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/AH20180
Abstract: ObjectiveA pilot study to: (1) describe the ability of emergency physicians to provide primary consults at an Australian, major metropolitan, adult emergency department (ED) during the COVID-19 pandemic when compared with historical performance and (2) to identify the effect of system and process factors on productivity. MethodsA retrospective cross-sectional description of shifts worked between 1 and 29 February 2020, while physicians were carrying out their usual supervision, flow and problem-solving duties, as well as undertaking additional COVID-19 preparation, was documented. Effect of supervisory load, years of Australian registration and departmental flow factors were evaluated. Descriptive statistical methods were used and regression analyses were performed. ResultsA total of 188 shifts were analysed. Productivity was 4.07 patients per 9.5-h shift (95% CI 3.56–4.58) or 0.43 patients per h, representing a 48.5% reduction from previously published data (P& .0001). Working in a shift outside of the resuscitation area or working a day shift was associated with a reduction in in idual patient load. There was a 2.2% (95% CI: 1.1–3.4, P& .001) decrease in productivity with each year after obtaining Australian medical registration. There was a 10.6% (95% CI: 5.4–15.6, P& .001) decrease in productivity for each junior physician supervised. Bed access had no statistically significant effect on productivity. ConclusionsEmergency physicians undertake multiple duties. Their ability to manage their own patients varies depending on multiple ED operational factors, particularly their supervisory load. COVID-19 preparations reduced their ability to see their own patients by half. What is known about the topic?An understanding of emergency physician productivity is essential in planning clinical operations. Medical productivity, however, is challenging to define, and is controversial to measure. Although baseline data exist, few studies examine the effect of patient flow and supervision requirements on the emergency physician’s ability to perform primary consults. No studies describe these metrics during COVID-19. What does this paper add?This pilot study provides a novel cross-sectional description of the effect of COVID-19 preparations on the ability of emergency physicians to provide direct patient care. It also examines the effect of selected system and process factors in a physician’s ability to complete primary consults. What are the implications for practitioners?When managing an emergency medical workforce, the contribution of emergency physicians to the number of patients requiring consults should take into account the high volume of alternative duties required. Increasing alternative duties can decrease primary provider tasks that can be completed. COVID-19 pandemic preparation has significantly reduced the ability of emergency physicians to manage their own patients.
Publisher: SAGE Publications
Date: 04-2006
DOI: 10.1016/J.JFMS.2005.10.001
Abstract: ‘Wound man’ refers to a stylised diagram used in early medical textbooks to illustrate the various injuries that the human body can sustain in battle. We have adapted this concept to create ‘Wound cat’, as a way to emphasise the type and location of injuries cats may inflict on one another during combat. We have further extended this concept to include wounds that may result from interactions with rodents and snakes. It is hoped that our ‘Wound cat’ concept will assist less experienced clinicians locate sites of cat bites and scratches, and to recognise why certain infections arise in particular stereotyped locations. In addition, this approach should assist veterinarians in determining which pathogens are most likely to be involved in wounds located in a given anatomical region.
Publisher: Wiley
Date: 04-2018
Publisher: Wiley
Date: 18-07-2021
Publisher: Wiley
Date: 02-06-2020
DOI: 10.1002/MDS3.10091
Publisher: Wiley
Date: 23-06-2022
Abstract: Recent studies suggest many patients with non‐specific low back pain presenting to public hospital EDs receive low‐value care. The primary aim was to describe management of patients presenting with low back pain to the ED of a private hospital in Melbourne, Australia, and received a final ED diagnosis of non‐specific low back pain. We also determined predictors of hospital admission. Retrospective review of patients who presented with low back pain and received a final ED diagnosis of non‐specific low back pain to Cabrini Malvern ED in 2015. Demographics, lumbar spinal imaging, pathology tests and medications were extracted from hospital records. Multivariate logistic regression was used to determine independent predictors of hospital admission. Four hundred and fifty presentations were included (60% female) 238 (52.9%) were admitted to hospital. One hundred and seventy‐seven (39.3%) patients received lumbar spine imaging. Two hundred and eighty (62.2%) patients had pathology tests and 391 (86.9%) received medications, which included opioids ( n = 298, 66.2%), paracetamol ( n = 219, 48.7%), NSAIDs ( n = 161, 35.8%), benzodiazepines ( n = 118, 26.2%) and pregabalin ( n = 26, 5.8%). Predictors of hospital admission included older age (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.02–1.05), arrival by ambulance (OR 2.03, 95% CI 1.06–3.90) and receipt of pathology tests (OR 3.32, 95% CI 2.01–5.49) or computed tomography scans (OR 1.86, 95% CI 1.12–3.11). We observed high rates of imaging, pathology tests and hospital admissions compared with previous public hospital studies, while medication use was similar. Implementation of strategies to optimise evidence‐based ED care is needed to reduce low‐value care and improve patient outcomes.
Publisher: Elsevier BV
Date: 12-2009
DOI: 10.1016/J.VETPAR.2009.07.032
Abstract: We have investigated the diagnostic utility of culture methods for Tritrichomonas foetus from cat faeces and the influence of faecal storage on the sensitivity of two different culture systems, InPouch TF-Feline (Bio-Med Diagnostics) and Modified Diamond's Medium. Normally formed cat faeces were spiked using a 10-fold serial dilution of 2 x 10(2) to 2 x 10(5)T. foetus per gram of faeces prior to storage at either room temperature or under refrigeration. At different time points a 20mg s le of spiked faeces was inoculated into each of the culture systems which were evaluated daily for up to 7 days and on day 11. Successfully cultured T. foetus 24h following faecal spiking and storage at room temperature demonstrates that the environmental resilience of the organism is greater than previously anticipated. At a conservative detection limit of 2 x 10(3) organisms per gram of faeces the accumulative sensitivity of each culture method was found to be 83% and 100% for the InPouch TF-Feline and Modified Diamond's Medium respectively over a 6h period. This research demonstrates that voided faeces kept at room temperature for up to 6h represent suitable material for diagnostic investigation. The resilience of T. foetus suggests that transmission is not limited to close contact between cats.
Publisher: Springer Science and Business Media LLC
Date: 15-04-2020
DOI: 10.1186/S12245-020-00275-Z
Abstract: Large, multicentre studies are required in emergency medicine to advance clinical care and improve patient outcomes. The Australasian College for Emergency Medicine clinical trials network is available to researchers to assist with facilitating large, multicentre research. However, there is no current information about the research capacity of emergency departments (EDs) in Australia and New Zealand. All EDs accredited for emergency medicine training in Australia and New Zealand were eligible to participate. Research leads or ED directors were invited via email and telephone to complete a survey. Data were collected regarding the presence of a research lead their research experience available research resources including colleagues, funding, departmental paid research time publications and research culture. One hundred and twelve responses were received on behalf of 122 (84%) sites (10 satellite plus main) from a possible 143 sites with all types of hospitals and regions represented. Research leads were identified at 66 (59%) sites 32 (29%) had a director of emergency medicine research. A wide range of research was underway. Ninety-six sites (66%) contributed data to multicentre projects. Twenty-one centres (17%) were highly productive with multiple resources (skilled colleagues, funding, staffing), a positive research culture and high-volume output. Sixty to seventy centres (50–58%) had limited resources, experienced an unsupportive research culture and authored manuscripts infrequently. Paid time for research directors was associated with increased research outputs. ACEM sites have the capacity to undertake large multicentre studies with a varied network of sites and researchers. While some sites are well equipped for research, the majority of EDs had minimal research output.
Publisher: Elsevier BV
Date: 02-2020
Publisher: Wiley
Date: 07-12-2020
Publisher: Elsevier BV
Date: 05-2002
DOI: 10.1016/S0378-1135(01)00433-3
Abstract: Recent evidence suggests that feline members of the genus Porphyromonas are of consequence in periodontal disease in cats. Several possible virulence factors from feline strains of Porphyromonas gingivalis have been described that have similarities to those of human P. gingivalis. Both human and feline strains of P. gingivalis produce superoxide dismutase (SOD) which has been proposed as modulator of the inflammatory response during infection. The objective of this study was to clone the superoxide dismutase gene of feline P. gingivalis, to compare the characteristics of its product with that of the native enzyme and to determine its immunoreactivity in cats with periodontal disease. The sod gene of the feline strain Veterinary Pathology and Bacteriology (VPB) 3457 of P. gingivalis was lified by PCR and cloned in frame with the alpha-peptide of the LacZ gene of E. coli in plasmid pUC19. This construct expressed SOD activity in E. coli with characteristics similar to those of the native SOD enzyme of P. gingivalis human strain 381 and the parent feline strain VPB 3457. The recombinant SOD had an apparent molecular weight of 54,700+/-1300 (S.E.M.) and was inactivated by 5mM hydrogen peroxide but not by 2mM KCN. There was a significant association (P=0.005) between the immunoreactivity of cats to P. gingivalis VPB 3457 soluble whole cell proteins on immunoblots and their responsiveness to the SOD protein. This suggests that cats showing a marked serum responsiveness to P. gingivalis itself, react to the SOD enzyme and further supports the role of feline P. gingivalis in periodontal disease.
Publisher: Wiley
Date: 08-03-2016
Abstract: The present study aims to determine if a scribe in an Australian ED can assist emergency physicians to work with increased productivity and to investigate when and where to allocate a scribe and to whom. This was a prospective observational single-centre study conducted at a private ED in Melbourne. It evaluated one American scribe and five doctors over 6 months. A scribe is a trained assistant who performs non-clinical tasks usually performed by the doctor. The primary outcomes were patients/hour/doctor and billings atient. Additional analyses included in idual doctor productivity, productivity by ED region, shift time, day of the week and physician learning curves. Door-to-doctor time, time spent on ambulance bypass and door-to-discharge time were examined, also complaints or issues with the scribe. There was an overall increase in doctor consultations of 0.11 (95%CI 0.07-0.15) primary consultations per hour (13%). There was variation seen between in idual doctors (lowest increase 0.06 [6%] to highest increase 0.12 [15%]). Billings per patients, door-to-doctor, door-to-discharge and ambulance bypass times remained the same. There was no advantage to allocating a scribe to a specific time of day, day of week or region of the ED. There was no learning period found. In the present study, scribe usage was associated with overall improvements in primary consultations per hour of 13% per scribed hour, and this varied depending on the physician. There is an economic argument for allocating scribes to some emergency physicians on days, evenings and weekends, not to trainees.
Publisher: Elsevier BV
Date: 08-2012
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Katherine Walker.