ORCID Profile
0000-0003-0262-1305
Current Organisations
Griffith University
,
Australasian Society for Ultrasound in Medicine
,
Australasian College for Emergency Medicine
,
Monash University
,
Monash Health
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Health Policy | Public Health and Health Services not elsewhere classified | Family and Household Studies | Policy and Administration
Publisher: Wiley
Date: 08-12-2021
Publisher: Wiley
Date: 16-02-2011
DOI: 10.1111/J.1742-6723.2011.01386.X
Abstract: To describe the treatment and assessment of emergency department nausea and vomiting (EDNV) in Australasia by Fellows of the Australasian College for Emergency Medicine (FACEM). To determine the influence of various factors on FACEM anti-emetic choice. To compare the influence of drug effectiveness, side effects, cost and pharmacy directives on adult EDNV anti-emetic choice between FACEM choosing the two most common first-line agents. A cross-sectional survey of all FACEM practising in Australasian ED was conducted by mail-out in February 2009. Of all FACEM surveyed 48.7% (532/1092) responded. The most common first-line drugs for adult EDNV were metoclopramide (87.3%, 453/519), 5HT3 antagonists (7.9%, 41/519) and prochlorperazine (2.3%, 12/519). For paediatric EDNV, the most common first-line agents were 5HT3 antagonists (86.2%, 307/356), metoclopramide (6.7%, 24/356) and promethazine (5.1%, 18/356). For most FACEM anti-emetic choice was highly influenced by perceived drug efficacy (96.1%) and side effects (82.5%), and 32.9% of FACEM were highly influenced by drug cost. Few FACEM reported ED anti-emetic protocols for adults (13.0%) or children (16.7%) in their ED. FACEM seldom used scales or tools to measure EDNV severity in adult (2.5%) or paediatric (3.4%) patients. Fellows of the Australasian College for Emergency Medicine anti-emetic choice in Australasian ED has been described. The main influences on anti-emetic choice were patient age, perceived drug efficacy and drug side-effect profiles.
Publisher: BMJ
Date: 18-07-2017
DOI: 10.1136/EMERMED-2016-206572
Abstract: Patients presenting to the ED with suspected renal colic are frequently imaged with CT urography (CTU), which rarely alters diagnosis or management. To reduce use of CTU in this population, we instigated a new imaging and management guideline in our ED. This was a quasi-experimental prospective study, whereby a new guideline was commenced at the intervention site (Monash Medical Centre) and the existing guideline continued at the control site (Dandenong Hospital). The new guideline promotes focused ultrasound for diagnosing renal colic and restricts CT to those with poor response to analgesia or 'red flags'. A consecutive series of patients with suspected renal colic were prospectively enrolled and outcomes compared between the sites. The primary outcome was CTU utilisation and secondary outcomes were radiation exposure, stone rate on CTU, admission, ED length of stay and rates of urological intervention and returns to ED at 4-week follow-up. Preintervention CTU rates were 76.7% at Monash and 72.1% at Dandenong. 324 patients were enrolled 148 at Monash and 176 at Dandenong. Median age 47 years vs 49 years, males 76.4% vs 66.5% and medianSex, Timing, Origin, Nausea, Erythrocytes (STONE) score 10 vs 10 for Monash and Dandenong, respectively. CTU was performed in 54.1% vs 75.0% (p<0.001), median radiation exposure 2.8 vs 4.0 mSv (p<0.001) and urological intervention occurred in 16.4% vs 15.7% for Monash and Dandenong, respectively. We found that use of CTU for renal colic was significantly reduced by introduction of a guideline promoting ultrasound and encouraging selective CTU. Although intervention rates were similar between the two sites, further prospective study is needed to ensure other patient-centred outcomes do not differ.
Publisher: Wiley
Date: 09-1998
Publisher: SAGE Publications
Date: 13-05-2019
Abstract: The aim of the current study was to review drug harms as they occur in Australia using the Multi-criteria Decision Analysis (MCDA) methodology adopted in earlier studies in other jurisdictions. A facilitated workshop with 25 experts from across Australia, was held to score 22 drugs on 16 criteria: 9 related to harms that a drug produces in the in idual and 7 to harms to others. Participants were guided by facilitators through the methodology and principles of MCDA. In open discussion, each drug was scored on each criterion. The criteria were then weighted using a process of swing weighting. Scoring was captured in MCDA software tool. MCDA modelling showed the most harmful substances to users were fentanyls (part score 50), heroin (part score 45) and crystal meth hetamine (part score 42). The most harmful substances to others were alcohol (part score 41), crystal meth hetamine (part score 24) and cigarettes/tobacco (part score 14). Overall, alcohol was the most harmful drug when harm to users and harm to others was combined. A supplementary analysis took into consideration the prevalence of each substance in Australia. Alcohol was again ranked the most harmful substance overall, followed by cigarettes, crystal meth hetamine, cannabis, heroin and pharmaceutical opioids. The results of this study make an important contribution to the emerging international picture of drug harms. They highlight the persistent and pervasive harms caused by alcohol. Policy implications and recommendations are discussed. Policies to reduce harm from alcohol and meth hetamine should be a priority.
Publisher: John Wiley & Sons, Ltd
Date: 12-09-2012
Publisher: AMPCo
Date: 26-02-2018
DOI: 10.5694/MJA17.01111
Publisher: Wiley
Date: 12-06-2019
Abstract: To quantify the direct cost of alcohol-related presentations to Royal Perth Hospital ED, as part of the binational Alcohol Harm in Emergency Departments study. Secondary analysis of a prospective observational study of all ED presentations over a 168-h period in December 2014. Direct costs for health service usage were based on activity-based costing methodologies from the Royal Perth Hospital Business Intelligence Unit. Patients were classified as either alcohol positive or alcohol negative (using predetermined criteria) to determine the direct cost of these presentations. Of the 213 alcohol-positive presentations in the original study, 206 had costing data available. Direct cost of care in the ED for alcohol-positive patients was $121 619 across all age groups during the study week (annual estimate $6.3 million). This cost was largely driven by injuries. On average, the direct cost of care in the ED was $590 per alcohol-positive and $575 per alcohol-negative patient. Costs of care provided in the ED were largely attributable to ED (72%) and radiology (17%) services. Extrapolation using mean costs for the patients without costing data, the study week cost was $144 629, with the annual estimate $7.5 million. Alcohol-related presentations to the ED are a significant public health burden. If the study week is representative, the annual cost is substantial. Although the direct mean cost of presentations to the ED is similar between alcohol-positive and alcohol-negative patients, these presentations would not have occurred without the influence of alcohol.
Publisher: Wiley
Date: 20-04-2021
Abstract: Deliberate clinical inertia is the art of doing nothing as a positive response. In idual clinicians can promote deliberate clinical inertia through teaching, re‐framing the act of ‘doing nothing’ as ‘doing something’ and engaging in shared decision making. Behaviour change on a larger scale requires a systematic approach. Nudging is a subtle change to the decision‐making context to prompt specific choices. A nudge unit is a team of relevant professionals who engage with various multidisciplinary teams within a health service who help test and implement nudge interventions in a clinical environment. A nudge unit could be used to design environments to prompt clinicians to re‐think before ordering unnecessary tests or treatments. Nudge units could improve knowledge translation, support continuous quality improvement and help build a learning health system. They could also boost collaboration and empower staff to evaluate their workplace decision‐making frameworks.
Publisher: Wiley
Date: 08-2013
Publisher: Wiley
Date: 14-03-2019
Abstract: Sharing anonymised ED data with community agencies to reduce alcohol-related injury and assaults has been found effective in the UK. This protocol document outlines the design of an Australian multi-site trial using shared, anonymised ED data to reduce alcohol-related harm. Nine hospitals will participate in a 36 month stepped-wedge cluster randomised trial. After a 9 month baseline period, EDs will be randomised in five groups, clustered on geographic proximity, to commence the intervention at 3 monthly intervals. 'Last-drinks' data regarding alcohol use in the preceding 12 h, typical alcohol consumption amount, and location of alcohol purchase and consumption, are to be prospectively collected by ED triage nurses and clinicians at all nine EDs as a part of standard clinical process. Brief information flyers will be delivered to all ED patients who self-report risky alcohol consumption. Public Health Interventions to be conducted are: (i) information sharing with venues (via letter), and (ii) with police and other community agencies, and (iii) the option for public release of 'Top 5' venue lists. Primary outcomes will be: (i) the number and proportion of ED attendances among patients reporting recent alcohol use and (ii) the number and proportion of ED attendances during high-alcohol hours (Friday and Saturday nights, 20.00-06.00 hours) assigned an injury diagnosis. Process measures will assess logistical and feasibility concerns, and clinical impacts of implementing this systems-change model in an Australian context. An economic cost-benefit analysis will evaluate the economic impact, or return on investment.
Publisher: AMPCo
Date: 11-2013
DOI: 10.5694/MJA13.10733
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 17-09-2019
Publisher: Elsevier BV
Date: 06-2017
Publisher: Wiley
Date: 22-11-2010
DOI: 10.1111/J.1742-6723.2010.01347.X
Abstract: To survey Fellows of the Australasian College for Emergency Medicine (FACEMs) in order to describe current ultrasound (US) usage during central venous catheter (CVC) placement and to compare practice and opinions between FACEMs routinely using US and those not. Descriptive and analytical cross-sectional electronic survey of all FACEMs. Baseline variables including hospital type, US availability, frequency of CVC insertion, US usage and technique are presented descriptively. US practice and opinions on usage are compared between routine and non-routine users. Responses were obtained from 486 (42.4%) of 1146 FACEMs emailed. Whereas 88.5% of respondents had US available and 70% had done an US course, only 37% routinely used US for CVC placement. Completion of an US course and performance of >11 CVC per year were strongly associated with routine US use (odds ratio 10.0 [5.5-18.4] and 2.6 [1.7-3.9], respectively). Common barriers to more frequent US use were not having completed an US course (20%) and US-guided CVC placement taking too long (18%). Eighty-five per cent of FACEMs agreed that there should be ED access to US and US training but only 34% thought its use should be mandatory. We found that only 37% of FACEM respondents routinely used US to guide placement of CVCs and a number of barriers to more frequent use are identified. Practices and opinions regarding US use differed significantly between routine and non-routine users.
Publisher: Wiley
Date: 13-11-2014
DOI: 10.5694/MJA14.00344
Abstract: To determine the proportion of alcohol-related presentations to emergency departments (EDs) in Australia and New Zealand, at a single time point on a weekend night shift. A point prevalence survey of ED patients either waiting to be seen or currently being seen conducted at 02:00 local time on 14 December 2013 in 106 EDs in Australia and New Zealand. The number of ED presentations that were alcohol-related, defined using World Health Organization ICD-10 codes. At the 106 hospitals (92 Australia, 14 New Zealand) that provided data, 395 (14.3% 95% CI, 13.0%-15.6%) of 2766 patients in EDs at the study time were presenting for alcohol-related reasons 13.8% (95% CI, 12.5%-15.2%) in Australia and 17.9% (95% CI, 13.9%-22.8%) in New Zealand. The distribution was skewed left, with proportions ranging from 0 to 50% and a median of 12.5%. Nine Australian hospitals and one New Zealand hospital reported that more than a third of their ED patients had alcohol-related presentations the Northern Territory (38.1%) and Western Australia (21.1%) reported the highest proportions of alcohol-related presentations. One in seven ED presentations in Australian and New Zealand at this 02:00 snapshot were alcohol-related, with some EDs seeing more than one in three alcohol-related presentations. This confirms that alcohol-related presentations to EDs are currently underreported and makes a strong case for public health initiatives.
Publisher: Wiley
Date: 16-06-2014
Publisher: Massachusetts Medical Society
Date: 30-01-2020
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: Wiley
Date: 08-04-2014
Abstract: There are currently no studies assessing effectiveness of sub-dissociative intranasal (IN) ketamine as the initial analgesic for adult patients in the ED. The study aims to examine the effectiveness of sub-dissociative IN ketamine as a primary analgesic agent for adult patients in the ED. This is a prospective, observational study of adult ED patients presenting with severe pain (≥6 on 11-point scale at triage). IN ketamine dose was 0.7 mg/kg, with secondary dose of 0.5 mg/kg at 15 min if pain did not improve. After 6 months, initial dose was increased to 1.0 mg/kg with the same optional secondary dose. The primary outcomes are change in VAS rating at 30 min percentage of patients reporting clinically significant reduction in VAS (≥20 mm) at 30 min dose resulting in clinically significant pain reduction. Of the 72 patients available for analysis, median age was 34.5 years and 64% were men. Median initial VAS rating was 76 mm (interquartile range [IQR]: 65-82). Median total dose of IN ketamine for all patients was 0.98 mg/kg (IQR: 0.75-1.15, range: 0.59-1.57). Median reduction in VAS rating at 30 min was 24 mm (IQR: 2-45). Forty (56%, 95% CI: 44.0-66.7) reported VAS reduction ≥20 mm, these patients having had a total median ketamine dose of 0.94 mg/kg (IQR: 0.72-1.04). IN ketamine, at a dose of about 1 mg/kg, was an effective analgesic agent in 56% of study patients. The place of IN ketamine in analgesic guidelines for adults requires further investigation.
Publisher: Elsevier BV
Date: 03-2015
DOI: 10.1016/J.ANNEMERGMED.2014.09.024
Abstract: We compare the analgesic effectiveness of intranasal fentanyl and ketamine in children. This was a double-blind, randomized, controlled trial comparing fentanyl at 1.5 μg/kg with ketamine at 1 mg/kg in children aged 3 to 13 years and weighing less than 50 kg, with isolated limb injury and pain of more than 6 of 10 at triage. The s le size was 40 in each arm. Subjects were coadministered oral ibuprofen at 10 mg/kg. The primary outcome was median pain rating reduction at 30 minutes. Secondary outcomes were pain rating reduction at 15 and 60 minutes, subjective improvement and satisfaction, University of Michigan Sedation Score, adverse events, and rescue analgesia. Eighty children enrolled, and 73 were available for analysis: 37 fentanyl and 36 ketamine. Median age was 8 years 63% were male children median baseline pain rating was 80 mm. At 30 minutes, median reductions for ketamine and fentanyl were 45 and 40 mm, respectively (difference 5 mm 95% confidence interval [CI] -10 to 20 mm). Reductions exceeded 20 mm for ketamine and fentanyl in 82% and 79% of patients, respectively (difference 3% 95% CI -22% to 16%). Pain rating reduction was maintained to 60 minutes in both groups. Satisfaction was reported for ketamine and fentanyl by 83% and 72% of patients, respectively (difference 11% 95% CI -9% to 30%). Adverse events, mainly mild, were reported for ketamine and fentanyl by 78% and 40% of patients, respectively (difference 38% 95% CI -58% to 16%). Three ketamine patients had a moderate degree of sedation by University of Michigan Sedation Score. Intranasal fentanyl and ketamine were associated with similar pain reduction in children with moderate to severe pain from limb injury. Ketamine was associated with more minor adverse events.
Publisher: Wiley
Date: 08-2013
Publisher: Wiley
Date: 03-1998
Publisher: Wiley
Date: 07-11-2016
Publisher: Wiley
Date: 26-07-2016
Abstract: To assess the effectiveness of ultra-brief interventions (ultra-BI) or technology-involved preventive measures in the ED to reduce alcohol harm and risky drinking. Medline, Embase, PsycINFO, CINAHL and EBM reviews were searched for articles published between 1996 and 2015. Randomised controlled trials and quasi-randomised trials, which compared an ultra-BI with screening, standard care or minimal intervention for adults and adolescents at risk for alcohol-related harm presenting to an ED, were included. Outcomes of interest were frequency of alcohol consumption, quantity of alcohol consumed, binge drinking and ED representation. Thirteen studies (nine single centre and four multicentre) were included. Six studies showed a significant reduction in the quantity consumed with intermediate effect size at 3 months (d = -0.40) and small effect size at 12 months (d = -0.15). Two studies showed a significant reduction in binge drinking with small effect size at 3 months (d = -0.12) and 12 months (d = -0.09). No studies showed an effect on frequency of alcohol consumption or ED representation. Heterogeneity in study design, definition of risky, harmful or hazardous alcohol use, intervention types, outcomes, outcome timeframes and outcome measures prevented the performance of quantitative meta-analysis. Despite its limited effectiveness in reducing alcohol use in the short-term, with the large number of people attending EDs with risky drinking, the use of an effective ultra-BI would have the potential to have a measurable population effect.
Publisher: Elsevier BV
Date: 04-2018
Publisher: Elsevier BV
Date: 09-2020
Publisher: Elsevier BV
Date: 12-2018
Publisher: Elsevier BV
Date: 03-2017
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: Wiley
Date: 12-1998
Publisher: Wiley
Date: 02-04-2019
Abstract: There is growing recognition of the vital roles that Emergency Physicians can play in public health. Accordingly, there is a need for emergency medicine trainees to have opportunities to acquire relevant public health skillsets. This article provides an ex le of such a possibility. It describes the experience of an emergency medicine trainee in undertaking a 6 month training rotation at a Public Health Unit. The ex le illustrates the feasibility and benefits of a public health rotation for interested trainees, and offers recommendations for establishing such rotations. There are challenges, including eligibility requirements and funding. However, possible approaches exist at the in idual and college levels to facilitate such training opportunities so that emergency medicine trainees can acquire necessary and valuable public health skills.
Publisher: Wiley
Date: 15-04-2018
Publisher: Elsevier BV
Date: 12-2022
Abstract: Alcohol is the most widely consumed psychoactive substance in Australia and the consequences of alcohol consumption have enormous personal and social impacts. This study aimed to describe the principal diagnoses of emergency department (ED) presentations involving alcohol use in the previous 12 hours at eight hospitals in Victoria and the Australian Capital Territory, Australia. Twelve months' data (1 July 2018 - 30 June 2019) were collected from eight EDs, including demographics, ICD-10 codes, hospital location and self-reported drinking in the preceding 12 hours. The ten most common ICD-10 discharge codes were analysed based on age, sex and hospital geographic area. ICD codes pertaining to mental and behavioural disorders due to alcohol use accounted for the highest proportion in most EDs. Suicide ideation/attempt was in the five highest ICD codes for all but one hospital. It was the second most common alcohol-related presentation for both males and females. Alcohol plays a major role in a range of presentations, especially in relation to mental health and suicide. The collection of alcohol involvement in ED presentations represents a major step forward in informing the community about the burden of alcohol on their health resources.
Publisher: Wiley
Date: 12-2010
DOI: 10.1111/J.1742-6723.2010.01353.X
Abstract: The aim of the present study is to describe ACEM trainees' perspectives on assessment and feedback during their training. From May to July 2009, an anonymous Web-based survey on training and supervision in emergency medicine was conducted, addressing trainees' perceptions of mandatory assessments (primary examination, fellowship examination and mandatory trainee research requirement) and feedback at work. Qualitative data were analysed using grounded theory methodology--themes were identified by close examination of full text responses. In total, 622 trainees responded to the survey (response rate of 37%). Trainees report that general clinical supervision is adequate however, direct supervision at the bedside and feedback could be significantly improved. They perceive that the primary examination is necessary, although they feel it is irrelevant to their development as emergency trainees and are keen for more clinically applied knowledge to be tested. They dislike mandatory trainee research, feel inadequately supported and distracted from other aspects of their training. The fellowship examination was overall thought to be fair however, there were concerns with the time pressures and restrictions to the written component of the examination. Additionally, the structured clinical examination was popular, whereas short cases and long cases were very unpopular. ACEM trainees' views of training may help inform curriculum development, and might assist those providing education to improve local training programs.
Publisher: Wiley
Date: 08-04-2013
Abstract: The study aims to determine if slow intravenous infusion of metoclopramide reduces the incidence of acute drug-induced akathisia (DIA) compared with intravenous bolus. A prospective, double-blind, double dummy trial of adult patients requiring intravenous metoclopramide in the ED. Participants were randomised to receive either: metoclopramide 20 mg as a bolus and normal saline infusion over 15 min, or normal saline bolus and metoclopramide 20 mg infused over 15 min. Patients were assessed for DIA using the Prince Henry Akathisia Rating Scale before treatment was commenced and at 20, 40 and 60 min post. Nausea was assessed with a visual analog scale. Of 210 participants assessed for eligibility, 206 were randomised and 205 were included in the final analysis. Participant characteristics and indication for metoclopramide were well matched between the treatment groups. Overall, incidence of DIA was 26 out of 205 participants (12.68%, 95% confidence interval [CI] 8.09-17.3). DIA occurred in 11 out of 103 (10.68%, 95% CI 4.61-16.74%) in the bolus group, and in 15 out of 102 (14.71%, 95% CI 7.71-21.70%) in the infusion group (P = 0.67). Severe DIA occurred in six patients in each group. The mean age of patients experiencing DIA was 34 years (interquartile range 29-40) and 42 years (interquartile range 40-45) in those without akathisia (P = 0.04). Nausea reduction was equivalent in both groups. The incidence of DIA and reduction in nausea is unaffected by the rate of administration of intravenous metoclopramide 20 mg.
Publisher: BMJ
Date: 15-05-2020
DOI: 10.1136/EMERMED-2019-208852
Abstract: Multimodal interventions (MMI) are frequently used in various healthcare settings to encourage change in healthcare personnel practices and improve patient safety. In 2013, an MMI conducted in an Australian metropolitan ED used clinician ch ions, guidelines, education sessions and promotional materials to encourage a reduction in unused and inappropriate peripheral intravenous cannulas (PIVC). A 60-day postintervention demonstrated a successful reduction in the number of unused PIVCs without changes in appropriate insertions. We aimed to investigate if this MMI produced a sustained effect in reducing the frequency of unused PIVCs inserted in this ED. A single-centre retrospective cohort study of adult patients presenting to the above ED in Victoria, Australia, was conducted in April 2018. A random s le of 380 patients with a PIVC inserted in ED was assessed to determine if the PIVC was used (termed ‘Long-term follow-up’). The appropriateness of unused PIVCs was assessed. Our findings were compared with previously collected data in 2013 (‘Pre-Intervention’ and ‘Immediately Post-Intervention’) to determine a sustained reduction in the frequency of unused PIVC insertions was achieved. Long-term analysis of the MMI, including the overall frequency of PIVC insertions in ED before and after the MMI, was also collected. In our Long-term follow-up cohort, 101 of 373 (27.1%, 95% CI 22.6% to 31.9%) PIVCs were unused (seven cases excluded). This was significantly lower than the Pre-Intervention cohort (139/376, 37.0%, 95% CI 32.1% to 42.1%). While not significant, the frequency of unused PIVCs in the Post-Intervention cohort was lower in comparison (73/378, 19.3%, 95% CI 15.4% to 23.7%). No significant change in the appropriateness of unused PIVCs was observed between the Post-Intervention and Long-term follow-up. The overall proportion of patients receiving a PIVC has remained low since the MMI. An MMI aimed at reducing unused PIVC insertions in ED has been effective in eliciting sustained change. Unused but appropriately inserted PIVCs seem unaffected by the intervention.
Publisher: Wiley
Date: 03-2016
DOI: 10.5694/MJA15.00858
Abstract: To survey emergency department (ED) clinical staff about their perceptions of alcohol-related presentations. A mixed methods online survey of ED clinicians in Australia and New Zealand, conducted from 30 May to 7 July 2014. The frequency of aggression from alcohol-affected patients or their carers experienced by ED staff the perceived impact of alcohol-related presentations on ED function, waiting times, other patients and staff. In total, 2002 ED clinical staff completed the survey, including 904 ED nurses (45.2%) and 1016 ED doctors (50.7%). Alcohol-related verbal aggression from patients had been experienced in the past 12 months by 97.9% of respondents, and physical aggression by 92.2%. ED nurses were the group most likely to have felt unsafe because of the behaviour of these patients (92% reported such feelings). Alcohol-related presentations were perceived to negatively or very negatively affect waiting times (noted by 85.5% of respondents), other patients in the waiting room (94.4%), and the care of other patients (88.3%). Alcohol-affected patients were perceived to have a negative or very negative impact on staff workload (94.2%), wellbeing (74.1%) and job satisfaction (80.9%). Verbal and physical aggression by alcohol-affected patients is commonly experienced by ED clinical staff. This has a negative impact on the care of other patients, as well as on staff wellbeing. Managers of health services must ensure a safe environment for staff and patients. More importantly, a comprehensive public health approach to changing the prevailing culture that tolerates alcohol-induced unacceptable behaviour is required.
Publisher: Wiley
Date: 25-04-2018
Abstract: Appropriate deliberate clinical inertia refers to the art of doing nothing as a positive clinical response. It includes shared decision-making to improve patient care with the use of clinical judgement. We discuss common clinical scenarios where the use of deliberate clinical inertia can occur. The insertion of peripheral intravenous cannulae, investigating patients with suspected renal colic and the investigation of low risk chest pain are all opportunities for the thoughtful clinician to 'stand there' and use effective patient communication to avoid low value tests and procedures. Awareness is key to identifying these opportunities to practice deliberate clinical inertia, as many of the situations may be so much a part of our environment that they are hidden in plain view.
Publisher: Wiley
Date: 02-07-2018
Abstract: Deliberate clinical inertia is the art of doing nothing as a positive response. To be able to apply this concept, in idual clinicians need to specifically focus on their clinical decision-making. The skill of solving problems and making optimal clinical decisions requires more attention in medical training and should play a more prominent part of the medical curriculum. This paper provides suggestions on how this may be achieved. Strategies to mitigate common biases are outlined, with an emphasis on reversing a 'more is better' culture towards more temperate, critical thinking. To incorporate such an approach in medical curricula and in clinical practice, institutional endorsement and support is required.
Publisher: Wiley
Date: 12-2020
Abstract: To explore women's expectations and experiences when presenting to the ED with early pregnancy bleeding. We conducted a qualitative study where women presenting to the ED with early pregnancy bleeding participated in two semi-structured interviews. An initial interview explored expectations of care and was conducted prior to ED treatment. A follow-up interview about experiences with care was conducted after discharge from the ED. Women were recruited from three EDs in suburban Melbourne: one tertiary referral centre and two urban district hospitals. Thirty women with early pregnancy bleeding completed the initial interview and 22 completed the follow-up interview. Eleven participants were primigravid women and 21 participants had never experienced early pregnancy bleeding prior to their ED presentation. Four themes relating to the patient experience were identified: (i) Acknowledgement of patients' concerns by hospital staff, including informing patients of progress and explanation of investigation results (ii) Early pregnancy bleeding as a distressing experience, with most participants expecting that this would be acknowledged by ED staff, and privacy provided to allow for grieving (iii) Prolonged waiting time for an urgent medical condition and (iv) Ongoing care and support, such as providing recommendations of available services to support patients on discharge from the ED. Early pregnancy bleeding is a distressing and anxiety-provoking experience for women attending the ED. Appropriate emotional support is critical to the holistic care for those seeking emergency care.
Publisher: Elsevier BV
Date: 11-2013
DOI: 10.1016/J.ANNEMERGMED.2013.02.022
Abstract: Our study aims to determine the incidence of unused peripheral intravenous cannulas inserted in the emergency department (ED). A retrospective cohort study using a structured electronic medical record review was performed in a 640-bed tertiary care hospital in Melbourne, Australia. During a 30-day period, all patients who had a peripheral intravenous cannula recorded as a procedure on their electronic medical record in the ED were included in this study. Fifty percent of peripheral intravenous cannulas inserted in the ED were unused. Patients presenting with obstetric and gynecologic and neurologic symptoms were significantly more likely to have an unused cannula. Forty-three percent of patients admitted to the hospital with unused peripheral intravenous cannulas in the ED continued to have them unused 72 hours later. There is a high incidence of unused peripheral intravenous cannulas inserted in the ED. The risk of having an unused peripheral intravenous cannula is associated with the patient's presenting complaint. Efforts should be directed to reduce this rate of unused peripheral intravenous cannula insertion, especially in patients being admitted, to minimize the risk of complications.
Publisher: Western Journal of Emergency Medicine
Date: 23-02-2017
Publisher: Springer Science and Business Media LLC
Date: 2013
Publisher: Wiley
Date: 25-04-2023
DOI: 10.1111/ADD.16205
Abstract: Alcohol's harm to others (AHTO) has become a key driver of national and international alcohol policy. This study aimed to produce a contemporary, comprehensive estimate of the correlates and harms from others' drinking in 2021 in Australia. Across Australia, 2574 adults (1380 women 1172 men) were s led via two cross‐sectional survey modes: a random‐digit dial mobile phone s le of 1000 people and 1574 people from the Life in Australia™ panel survey. In 2021 participants were asked about harms they had experienced from the drinking of family, friends, co‐workers and the public in the past year. Applying combined s le weights from each mode, bivariable and adjusted multivariable logistic regressions were used to analyse differences in rates of AHTO by participant gender, age, residence in rural or metropolitan regions, country of birth, education and employment. In 2021, 23.6% reported being negatively affected by strangers' drinking and 21.3% by the drinking of someone they knew, with 34.3% reporting being negatively affected a lot or a little by either 42.4% of respondents reported specific harms from strangers' drinking. Thus, 48.1% of respondents reported any harm (negative effects or specific harms) from others' drinking. Women, younger people, Australian‐born and heavier episodic drinkers reported significantly higher rates of AHTO compared with other respondents. Smaller percentages (7.5%) of participants reported being harmed substantially by others' drinking, including by people they knew (5.8%) or strangers (2.3%). Stratified analyses showed that heavier drinking, furloughed, younger men who were born overseas in English‐speaking countries were affected by others' drinking, whereas women were affected regardless of these factors (apart from age). More than one‐third of Australian adults appear to have been negatively affected by others' drinking in 2021, with women, younger people and heavier drinkers at greater risk. Substantial harm appears to be more likely to arise from the drinking of people Australians know than from strangers' drinking.
Publisher: Wiley
Date: 12-09-2019
Abstract: Our objective was to examine the impact of a human factor-designed multimodal intervention on the proportion of unused peripheral i.v. cannula (PIVC) insertion in our ED. A pre- and post-multimodal intervention retrospective cohort study was conducted using a structured electronic medical record review within a single adult tertiary ED in Australia. Pre-intervention data was collected 30 days prior to the multimodal intervention, with 30 day post-intervention data collected 3 months after the intervention commenced. The rates of PIVC inserted, the unused rate and the unused but appropriately inserted cannulas were the main outcome measures. Intravenous cannula insertion rates decreased by 12.9% (95% confidence interval [CI] 12.19-13.61) between the pre-intervention (1413/4167 [33.9%] 95% CI 32.5-35.4) and post-intervention cohort (928/4421 [21.0%] 95% CI 19.8-22.2). An analysis of 754 cases (376 pre-intervention and 378 post-intervention) showed that 139 of 376 (37.0% 95% CI 32.1-42.1) i.v. cannulas were unused pre-intervention, while 73 of 378 (19.3% 95% CI 15.4-23.7) was unused post-intervention an absolute reduction of 17.7% (95% CI 14.98-20.42). The relative risk of an unused i.v. cannula was 0.52 (95% CI 0.41-0.67). The proportion of unused but appropriately inserted i.v. cannulas remained unchanged in both cohorts, with a relative risk of 0.91 (95% CI 0.58-1.42). Our multimodal intervention successfully reduced the number of unused PIVCs inserted in the ED, with a reduction in overall and unused PIVC insertions without any change in appropriate insertions.
Publisher: AMPCo
Date: 08-2014
DOI: 10.5694/MJA14.00363
Publisher: Wiley
Date: 04-03-2019
Abstract: To describe and model a decade of ED presentations in metropolitan Melbourne, Australia, from July 2000 to June 2010 and to validate the model of ED presentations by testing the model's performance in forecasting the subsequent 2 year period of daily presentations, from July 2010 to June 2012. Retrospective analyses of prospectively collected data sourced from the Victorian Emergency Minimum Dataset were performed and included 13 public hospitals. Time series modelling involved unobserved components modelling and forward selection of variables using incidence rate ratios. Forecasting with the model and validation were performed using the 2 year period up to June 2012. Model performance was calculated using the mean average percentage error. A total of 7 031 242 patient presentations occurred to the s le metropolitan EDs in the 12 year study period. An absolute increase in mean daily ED presentations of 81.3% was observed. Presentations increased on Sunday and Monday incidence rate ratio of 1.10 (95% CI 1.08-1.11, P < 0.05). No monthly or seasonal pattern was evident. Public holidays were associated with increased presentations, incidence rate ratio of 1.11 (95% CI 1.08-1.15, P < 0.05). The model with the best goodness-of-fit and Wald χ We have produced and validated a model for predicting daily ED presentations across a major city. Even though ED presentations are multifactorial, city-wide daily presentations are predictable and explained by a small number of variables. The model will have implications for future health planning.
Publisher: Wiley
Date: 10-04-2014
Abstract: Patient outcome feedback has been defined as 'the natural process of finding out what happens to one's patients after their evaluation and treatment (in the ED)'. It seems likely that emergency medicine trainees and Fellows will improve their diagnostic accuracy if they increase the frequency with which they find out what happens to their patients. Not only does this allow testing of their own diagnosis with the final diagnosis, but also allows meaningful feedback on therapies commenced in the ED. We believe that seeking outcome feedback should be more actively encouraged by the ACEM training programme.
Publisher: Wiley
Date: 07-09-2015
Abstract: To understand the attitudes of consultant emergency medicine physicians and advanced trainees and the perceived barriers to public health interventions in Australasian EDs. This was a voluntary cross-sectional, mixed-methods online survey of consultant emergency physicians and advanced trainees of the ACEM, conducted between December 2011 and March 2012. Eight hundred and fifty-six ACEM members responded to the survey - a response rate of 33%. A similar number of consultants (70%) and trainees (75%) believed public health initiatives should be provided in the ED. Barriers identified by a similar majority of consultants and trainees to the implementation of public health interventions in EDs included dedicated time available for staff to be involved available public health resources available funding clinical staff skills and expertise in public health and the availability of staff training. Public health and health promotion are perceived by the majority of emergency medicine physicians as important in emergency medicine however, substantial barriers exists to their implementation. Development of an evidence-based approach to public health interventions, which are effective and feasible in the ED environment, will facilitate a more comprehensive approach to public health initiatives in emergency medicine.
Publisher: Wiley
Date: 07-09-2016
Abstract: Compare pain relief from non-opioid, codeine and oxycodone analgesic regimens in adults with moderate pain from limb injury. Double-blind, randomised, controlled, non-inferiority trial. Three regimens of six tablets, each included 2 × 500 mg paracetamol and 2 × 200 mg ibuprofen with 2 × 100 mg thiamine (non-opioid), 2 × 30 mg codeine (codeine) or 2 × 5 mg oxycodone tablets (oxycodone). difference in mean visual analogue scale (VAS) change between groups at 30 min, with a limit of inferiority of 13. Secondary outcomes included mean change in VAS rating from baseline to 30 min for each group, patient satisfaction, need for additional analgesia and adverse events. Pain ratings taken at 60 and 90 min for patients still in ED are described. Of 182 patients randomised, non-opioid, codeine and oxycodone numbers were 61, 62 and 59. Differences (95% CI) between groups at 30 min were as follows: non-opioid versus codeine -2.6 (-8.8 to 3.6) non-opioid versus oxycodone -2.7 (-9.3 to 3.9) codeine versus oxycodone 0.1 (-6.6 to 6.4). Mean VAS reductions for non-opioid, codeine and oxycodone were -13.5, -16.1 and -16.2 mm, respectively. Satisfaction with analgesia was reported by 77.6% (64.7-87.5), 81.0% (67.2-89.0) and 73.6% (59.7-84.7) and adverse events by 3.3% (0.4-11.3), 1.6% (0.4-8.7) and 16.9% (8.4-29.0), respectively. Mean VAS reductions at 60 and 90 min were as follows: -23.2 and -18.7 mm for non-opioid -30.7 and -33.3 mm for codeine and -26.1 and -31.7 mm for oxycodone. At 30 min, analgesic effects of non-opioid, codeine and oxycodone groups were non-inferior.
Publisher: SAGE Publications
Date: 29-08-2023
DOI: 10.1177/00185787231194999
Abstract: Background: Hospital medication errors are frequent and may result in adverse events. Data on non-prescription of regular medications to emergency department short stay unit patients is lacking. In response to local reports of regular medication omissions, a multi-disciplinary team was tasked to introduce corrective emergency department (ED) process changes, but with no additional financing or resources. Aim: To reduce the rate of non-prescription of regular medications for patients admitted to the ED Short Stay Unit (SSU), through process change within existing resource constraints. Methods: A pre- and post-intervention observational study compared regular medication omission rates for patients admitted to the ED SSU. Included patients were those who usually took regular home medications at 08:00 or 20:00. Omissions were classified as clinically significant medications (CSMs) or non-clinically significant medications (non-CSMs). The intervention included reinforcement that the initially treating acute ED doctor was responsible for prescription completion, formal checking of prescription presence at SSU handover rounds, double-checking of prescription completeness by the overnight SSU lead nurse and junior doctor, and ED pharmacist medication reconciliation for those still identified as having regular medication non-prescription at 07:30. Results: For the 110 and 106 patients in the pre- and post-intervention periods, there was a non-significant reduction in the CSM omission rate of −11% (95% CI: −23 to 2), from 41% (95% CI: 32-50) to 30% (95% CI: 21-39). Conclusion: Non-prescription of regular CSMs for SSU patients was not significantly reduced by institution of work practice changes within existing resource constraints.
Publisher: Wiley
Date: 08-04-2014
Abstract: To describe current practice of EDUS by ACEM Trainees and Fellows to describe potential barriers to US use in the Australasian setting to determine compliance with current college guidelines regarding US credentialing. Data were collected by a cross-sectional online survey. Respondents were Trainees and Fellows of the ACEM. Outcome measures included the percentage of respondents currently undergoing or that had completed US credentialing for Focused Assessment with Sonography for Trauma (FAST) and assessment of abdominal aortic aneurysm (AAA) scans. The perceived barriers to use of emergency US were explored. There were 512 survey respondents, giving an overall response rate of 15%. Fellows were more likely to be credentialed compared with Trainees. There were 61% of respondents not credentialed for FAST and assessment of AAA scans. However, a significant proportion performed these scans regularly, and did not routinely seek independent confirmation of their findings. Barriers to credentialing included limited time and no credentialing programme at the in idual's hospital. The present study showed that only a minority of ACEM Trainees and Fellows are credentialed to perform routine ED scans. Many non-credentialed ACEM Trainees and Fellows are performing scans, many without independent confirmation of their findings.
Publisher: Wiley
Date: 06-01-2018
DOI: 10.1111/ADD.14109
Abstract: Emergency department (ED) alcohol-related presentation data are not routinely collected in Australia and New Zealand. It is likely that previous research has underestimated the numbers of patients presenting with alcohol-related conditions. This study aimed to quantify the level of alcohol harm presenting to EDs in Australia and New Zealand [Correction added on 23 Jan 2018, after first online publication: The 'aims' section was missing and is updated in this version]. Multi-centre, prospective study. Patients were screened prospectively for alcohol-related presentations during a 7-day period in December 2014. Part 1 involved screening to determine alcohol-positive ED presentations and data collection of patient demographic and clinical information. Part 2 involved a consent-based survey conducted with patients aged ≥ 14 years to perform Alcohol Use Disorders Identification Test (AUDIT) scores. Eight EDs in Australia and New Zealand, representing differing hospital role delineations. A total of 8652 patients aged ≥ 14 years attended and 8435 (97.5%) were screened. The main outcome measure was the proportion of patients who had an alcohol-related presentation termed 'alcohol-positive', using pre-defined criteria. It included injuries, intoxication, medical conditions and injuries caused by an alcohol-affected third party. Secondary outcomes included demographic and clinical information, the type of alcohol-related presentations and AUDIT scores. A total of 801 [9.5% 95% confidence interval (CI) = 8.9-10.1%] presentations were identified as alcohol-positive, ranging between 4.9 and 15.2% throughout sites. Compared with alcohol-negative patients, alcohol-positive patients were more likely to be male [odds ratio (OR) = 1.90, 95% CI = 1.63-2.21], younger (median age 37 versus 46 years, P < 0.0001), arrive by ambulance (OR = 1.94, 95% CI = 1.68-2.25) or police/correctional vehicle (OR = 4.56, 95% CI = 3.05-6.81) and require immediate treatment (OR = 3.20, 95% CI = 2.03-05.06). The median AUDIT score was 16 (interquartile range = 10-24). Almost one in 10 presentations to emergency departments in Australia and New Zealand are alcohol related.
Publisher: AMPCo
Date: 02-2015
DOI: 10.5694/MJA14.01508
Publisher: Wiley
Date: 12-01-2018
Abstract: It can be difficult to avoid unnecessary investigations and treatments, which are a form of low-value care. Yet every intervention in medicine has potential harms, which may outweigh the potential benefits. Deliberate clinical inertia is the art of doing nothing as a positive response. This paper provides suggestions on how to incorporate deliberate clinical inertia into our daily clinical practice, and gives an overview of current initiatives such as 'Choosing Wisely' and the 'Right Care Alliance'. The decision to 'do nothing' can be complex due to competing factors, and barriers to implementation are highlighted. Several strategies to promote deliberate clinical inertia are outlined, with an emphasis on shared decision-making. Preventing medical harm must become one of the pillars of modern health care and the art of not intervening, that is, deliberate clinical inertia, can be a novel patient-centred quality indicator to promote harm reduction.
Publisher: Wiley
Date: 04-12-2019
DOI: 10.1111/ACEM.13650
Abstract: The objective was to separately compare effectiveness of 1.25 mg of intravenous (IV) droperidol and 8 mg of IV ondansetron with 0.9% saline placebo for adult emergency department (ED) patients with nausea. A novel primary outcome measure, expected to aid clinical interpretation of reported results, was employed. A randomized controlled trial was conducted at the three EDs of Monash Health, Melbourne, Australia. The design was to demonstrate superiority of the active drugs over placebo. The primary outcome measure of symptom improvement was defined as a visual analog scale (VAS) rating change of -8 mm or more from baseline at 30 minutes posttreatment. Mean VAS changes per group and percentages experiencing the desired treatment effect were also compared. The study was concluded after recruitment of 215 of the planned 378 patients, as interim analysis confirmed that continuation could not result in a finding of superiority. Of 215 patients, 73 (34%), 71 (33%), and 71 (33%) received droperidol, ondansetron, and placebo. Symptom improvement occurred in 75% (95% confidence interval [CI] = 64% to 85%), 80% (95% CI = 69% to 89%), and 76% (95% CI = 64% to 85%), respectively. Mean VAS changes were -29 mm (95% CI = -36 to -23 mm), -34 mm (95% CI = -41 to -28 mm), and -24 mm (95% CI = -29 to -19 mm), respectively. Desired treatment effects were experienced by 77% (95% CI = 65% to 86%), 73% (95% CI = 61% to 83%), and 59% (95% CI = 47% to 71%), respectively. For adult ED patients with nausea, superiority was not demonstrated for droperidol or ondansetron over placebo.
Publisher: Wiley
Date: 20-01-2016
Abstract: The majority of ureteric calculi pass spontaneously and are uncomplicated, yet use of computed tomography urography (CTU) has increased in recent years. This study describes a cohort of ED patients undergoing CTU for renal colic and assesses the predictors of urologic intervention. A retrospective cohort study enrolled patients who underwent CTU at three Melbourne EDs. Demographic data, clinical assessments, laboratory and radiological findings and interventions were abstracted. Univariate analysis was performed and significant predictors were entered into a multivariate logistic regression model to calculate adjusted odds ratios for associations with urologic intervention. Six hundred and seventeen patients underwent 626 CTUs mean age was 48 and 67.7% were male. 58.2% of scans found calculi, of which median size was 4 mm. 9.2% of scans revealed an alternate diagnosis, of which 2.7% were acutely important. 14.6% of patients with calculi received an intervention. Multivariate analysis found the factors associated with intervention were female sex (OR 3.9, 95% CI 1.8-8.7), proximal calculus site (OR 4.1, 95% CI 1.5-11.7), single kidney (OR 9.0, 95% CI 1.7-49.0) and calculus size > 5 mm (OR 7.0, 95% CI 3.3-14.7). Factors associated with urologic intervention included female sex, single kidney, calculus size >5 mm and proximal calculus. Information on acute alternate diagnoses was uncommon. A prospective study is needed to further clarify clinical parameters that could predict intervention to allow targeting of CTU to those most likely to benefit.
Publisher: Elsevier BV
Date: 11-2014
DOI: 10.1016/J.ANNEMERGMED.2014.03.017
Abstract: We compare efficacy of ondansetron and metoclopramide with placebo for adults with undifferentiated emergency department (ED) nausea and vomiting. A prospective, randomized, double-blind, placebo-controlled trial was conducted in 2 metropolitan EDs in Melbourne, Australia. Eligible patients with ED nausea and vomiting were randomized to receive 4 mg intravenous ondansetron, 20 mg intravenous metoclopramide, or saline solution placebo. Primary outcome was mean change in visual analog scale (VAS) rating of nausea severity from enrollment to 30 minutes after study drug administration. Secondary outcomes included patient satisfaction, need for rescue antiemetic treatment, and adverse events. Of 270 recruited patients, 258 (95.6%) were available for analysis. Of these patients, 87 (33.7%) received ondansetron 88 (34.1%), metoclopramide and 83 (32.2%), placebo. Baseline characteristics between treatment groups and recruitment site were similar. Mean decrease in VAS score was 27 mm (95% confidence interval [CI] 22 to 33 mm) for ondansetron, 28 mm (95% CI 22 to 34 mm) for metoclopramide, and 23 mm (95% CI 16 to 30 mm) for placebo. Satisfaction with treatment was reported by 54.1% (95% CI 43.5% to 64.5%), 61.6% (95% CI 51.0% to 71.4%), and 59.5% (95% CI 48.4% to 69.9%) for ondansetron, metoclopramide, and placebo, respectively rescue medication was required by 34.5% (95% CI 25.0% to 45.1%), 17.9% (95% CI 10.8% to 27.2%), and 36.3% (95% CI 26.3% to 47.2%), respectively. Nine minor adverse events were reported. Reductions in nausea severity for this adult ED nausea and vomiting population were similar for 4 mg intravenous ondansetron, 20 mg intravenous metoclopramide, and placebo. There was a trend toward greater reductions in VAS ratings and a lesser requirement for rescue medication in the antiemetic drug groups, but differences from the placebo group did not reach significance. The majority of patients in all groups were satisfied with treatment.
Publisher: Wiley
Date: 28-02-2021
DOI: 10.1111/ACEM.14225
Publisher: Wiley
Date: 20-05-2015
DOI: 10.1111/ACEM.12685
Abstract: The objective was to investigate the correlation of the visual analog scale (VAS) and numeric rating scale (NRS) for nausea severity measurement and to explore options for improved reporting of antiemetic efficacy trial results. This was a multicenter observational study of adult emergency department (ED) patients with nausea. Participants rated severity at enrollment and 30 minutes posttreatment using an adjectival scale, a VAS, and an NRS. Posttreatment, patients described symptom change and rated satisfaction. Ratings were performed by 258 patients. Both the VAS (0 to 100 mm) and the NRS (0 to 10) discriminated between adjectival severity categories. Median ratings with interquartile ranges (IQRs) were "severe" VAS 90.5 (IQR = 79 to 97) and NRS 9 (IQR = 8 to 9), "moderate" VAS 59 (IQR = 48 to 71) and NRS 6 (IQR = 5 to 7), "mild" VAS 34 (IQR = 25 to 49) and NRS 4 (IQR = 3 to 5), and "none" VAS 5 (IQR = 0 to 9) and NRS 0 (IQR = 0 to 1). Correlation between the VAS and NRS was high (0.83, Spearman). For the VAS, median mm (IQR) reductions for posttreatment change were "a lot less" -42 (IQR = -26 to -58.5), "a little less" -20.5 (IQR = -11 to -33), "the same" -2 (IQR = -8 to 3.5), "a little more" 14 (IQR = -2 to 22), and "a lot more" 17 (IQR = 6 to 23) and for satisfaction were "very satisfied" -45 (IQR = -27 to 63), "satisfied" -27 (IQR = -13 to 46), "unsure" -15 (IQR = -3 to -24), "dissatisfied" 4.5 (IQR = -5.5 to 13.5), and "very dissatisfied" 8.5 (IQR = 0 to 23). A VAS cutoff of ≥-5 mm detected symptom improvement with sensitivity 91.6% (95% CI = 86.7% to 95.1%), specificity 72.1% (95% CI = 59.9% to 82.3%), and positive predictive value 90.2% (95% CI = 85.1% to 94.0%). The VAS and NRS correlate highly. A VAS cutoff level of ≥-5 mm was a good predictor of symptom improvement, suggesting that its inclusion as an outcome measure would enhance reporting in antiemetic efficacy trials.
Publisher: Wiley
Date: 28-09-2015
Publisher: Wiley
Date: 22-08-2021
DOI: 10.5694/MJA2.51237
Publisher: BMJ
Date: 09-2016
DOI: 10.1136/BMJOPEN-2016-011826
Abstract: Current management of primary spontaneous pneumothorax (PSP) is variable, with little evidence from randomised controlled trials to guide treatment. Guidelines emphasise intervention in many patients, which involves chest drain insertion, hospital admission and occasionally surgery. However, there is evidence that conservative management may be effective and safe, and it may also reduce the risk of recurrence. Significant questions remain regarding the optimal initial approach to the management of PSP. This multicentre, prospective, randomised, open label, parallel group, non-inferiority study will randomise 342 participants with a first large PSP to conservative or interventional management. To maintain allocation concealment, randomisation will be performed in real time by computer and stratified by study site. Conservative management will involve a period of observation prior to discharge, with intervention for worsening symptoms or physiological instability. Interventional treatment will involve insertion of a small bore drain. If drainage continues after 1 hour, the patient will be admitted. If drainage stops, the drain will be cl ed for 4 hours. The patient will be discharged if the lung remains inflated. Otherwise, the patient will be admitted. The primary end point is the proportion of participants with complete lung re-expansion by 8 weeks. Secondary end points are as follows: days in hospital, persistent air leak, predefined complications and adverse events, time to resolution of symptoms, and pneumothorax recurrence during a follow-up period of at least 1 year. The study has 95% power to detect an absolute non-inferiority margin of 9%, assuming 99% successful expansion at 8 weeks in the invasive treatment arm. The primary analysis will be by intention to treat. Local ethics approval has been obtained for all sites. Study findings will be disseminated by publication in a high-impact international journal and presentation at major international Emergency Medicine and Respiratory meetings. ACTRN12611000184976 Pre-results.
Publisher: German Medical Science GMS Publishing House
Date: 2014
DOI: 10.3205/DGKH000223
Publisher: Elsevier BV
Date: 06-2021
Publisher: Wiley
Date: 12-1999
Publisher: Elsevier BV
Date: 06-2019
Publisher: Wiley
Date: 20-04-2023
DOI: 10.1111/AJR.12983
Abstract: The Cardiff model is a data sharing approach that aims to reduce the volume of intoxicated patients in emergency departments (EDs). This approach has not been tested in a rural setting. This study assessed whether this approach would reduce the number of alcohol‐associated presentations during high‐alcohol hours (HAH) in a regional ED. From July 2017, people over the age of 18 attending the ED were asked by the triage nurse (1) whether they had consumed alcohol in the past 12 h, (2) their typical alcohol consumption level, (3) the location where most alcohol was purchased and (4) the location of the last drink. From April 2018, quarterly letters were sent to the top five venues reported within the ED. Deidentified, aggregated data were shared with local police, licensing authorities and local government, identifying the top five venues reported in the ED and providing a summary of alcohol‐related attendances to the ED. Interrupted time series analyses were used to estimate the influence of the intervention on monthly injury and alcohol‐related ED presentations. ITS models found that there was a significant gradual decrease in the monthly rate of injury attendances during HAH (Coefficient = −0.004, p = 0.044). No other significant results were found. Our study found that sharing last drinks data collected in the ED with a local violence prevention committee was associated with a small, but significant reduction in the rate of injury presentations compared with all ED presentations. This intervention continues to have promise for reducing alcohol‐related harm.
Publisher: Wiley
Date: 03-09-2014
Start Date: 2015
End Date: 2017
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2021
End Date: 2024
Funder: Australian Research Council
View Funded ActivityStart Date: 2014
End Date: 2016
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2020
End Date: 2025
Funder: Department of Health
View Funded ActivityStart Date: 2016
End Date: 2021
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 05-2021
End Date: 05-2024
Amount: $502,501.00
Funder: Australian Research Council
View Funded Activity