ORCID Profile
0000-0002-8890-1457
Current Organisations
University of Tasmania
,
Tasmanian Department of Health
,
Royal Hobart Hospital
,
Australasian College for Emergency Medicine
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: Wiley
Date: 06-01-2021
Abstract: The aim of the present study was to describe the epidemiology and clinical features of patients presenting to the ED with suspected and confirmed COVID‐19 during Australia's ‘second wave’. The COVID‐19 ED (COVED) Project is an ongoing prospective cohort study in Australian EDs. This analysis presents data from 12 sites across four Australian states for the period from 1 July to 31 August 2020. All adult patients who met the criteria for ‘suspected COVID‐19’ and underwent testing for SARS‐CoV‐2 in the ED were eligible for inclusion. Study outcomes included a positive SARS‐CoV‐2 test result, mechanical ventilation and in‐hospital mortality. There were 106 136 presentations to the participating EDs and 12 055 (11.4% 95% confidence interval [CI] 11.2–11.6) underwent testing for SARS‐CoV‐2. Of these, 255 (2%) patients returned a positive result. Among positive cases, 13 (5%) received mechanical ventilation during their hospital admission compared to 122 (2%) of the SARS‐CoV‐2 negative patients (odds ratio 2.7 95% CI 1.5–4.9, P = 0.001). Nineteen (7%) SARS‐CoV‐2 positive patients died in hospital compared to 212 (3%) of the SARS‐CoV‐2 negative patients (odds ratio 2.3 95% CI 1.4–3.7, P = 0.001). Strong clinical predictors of the SARS‐CoV‐2 test result included self‐reported fever, sore throat, bilateral infiltrates on chest X‐ray, and absence of a leucocytosis on first ED blood tests ( P 0.05). In this prospective multi‐site study during Australia's ‘second wave’, a substantial proportion of ED presentations required SARS‐CoV‐2 testing and isolation. Presence of SARS‐CoV‐2 on nasopharyngeal swab was associated with an increase in the odds of death and mechanical ventilation in hospital.
Publisher: Wiley
Date: 11-2016
Publisher: Wiley
Date: 17-01-2016
Publisher: Wiley
Date: 28-08-2017
Publisher: Wiley
Date: 26-02-2019
Publisher: MDPI AG
Date: 19-04-2022
DOI: 10.3390/HEALTHCARE10050753
Abstract: Computed tomography pulmonary angiography (CTPA) has become the most widely used technique for diagnosis or exclusion of a pulmonary embolism (PE). It has been suggested that overuse of this imaging type may be prevalent, especially in emergency departments (EDs). The purpose of this literature review was to explore the use of CTPAs in EDs worldwide. A review following PRISMA guidelines was completed, with research published between September 2010 and August 2020 included. Five key topics emerged: use of CTPAs explanations for overuse use of D-dimer variability in ordering practices between clinicians and strategies to reduce overuse. This review found that CTPAs continue to be overused in EDs, leading to superfluous risks to patients. Published studies identify that while clinical practice guidelines (CPGs) have a strong effect on reducing unnecessary CTPAs with no significantly increased risk of missed diagnosis, the adoption of these tools by ED clinicians has remained low. This literature review highlights the need for further research into why CTPAs continue to be overused within EDs and why clinicians are hesitant to use CPGs in the clinical setting. Moreover, investigations into other potential strategies that may combat the overuse of this diagnostic tool are essential to reduce potential harm.
Publisher: Wiley
Date: 13-01-2019
Publisher: Wiley
Date: 09-2019
Publisher: Wiley
Date: 09-2019
Publisher: Wiley
Date: 03-09-2018
Publisher: Wiley
Date: 21-09-2018
Publisher: Wiley
Date: 06-05-2018
Publisher: Wiley
Date: 08-09-2019
Publisher: Wiley
Date: 22-04-2023
DOI: 10.5694/MJA2.51934
Abstract: To examine the clinical characteristics and short term outcomes for children with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infections who presented to Australian hospitals during 2020 and 2021. Retrospective case review study in nineteen hospitals of the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network from all Australian states and territories, including seven major paediatric tertiary centres and eight Victorian hospitals. SARS‐CoV‐2‐positive people under 18 years of age who attended emergency departments or were admitted to hospital during 1 February 2020 – 31 December 2021. Epidemiological and clinical characteristics, by hospital care type (emergency department [ED] or inpatient care). A total of 1193 SARS‐CoV‐2‐positive children and adolescents (527 girls, 44%) attended the participating hospitals (107 in 2020, 1086 in 2021). Their median age was 3.8 years (interquartile range [IQR], 0.8–11.4 years) 63 were Aboriginal or Torres Strait Islander people (5%). Other medical conditions were recorded for 293 children (25%), including asthma (86, 7%) and premature birth (68, 6%). Medical interventions were not required during 795 of 1181 ED presentations (67%) children were discharged directly home in 764 cases (65%) and admitted to hospital in 282 (24% sixteen to intensive care units). The 384 admissions to hospital (including 102 direct admissions) of 341 children (25 infants under one month of age) included 23 to intensive care (6%) the median length of stay was three days (IQR, 1–9 days). Medical interventions were not required during 261 admissions (68%) 44 children received respiratory support (11%) and 21 COVID‐19‐specific treatments, including antiviral and biologic agents (5%). Being under three months of age ( v one year to less than six years: odds ratio [OR], 2.6 95% confidence interval [CI], 1.7–4.0) and pre‐existing medical conditions (OR, 2.5 95% CI, 1.9–3.2) were the major predictors of hospital admission. Two children died, including one without a known pre‐existing medical condition. During 2020 and 2021, most SARS‐CoV‐2‐positive children and adolescents who presented to participating hospitals could be managed as outpatients. Outcomes were generally good, including for those admitted to hospital.
Publisher: Wiley
Date: 12-06-2019
Abstract: The present study aims to explore for Australia: (i) the trends of ED presentations with a mental health (MH) diagnosis by age group and (ii) whether those trends differ from all ED presentations. ED presentations to Australian public hospitals, 2004-05 to 2016-17 were captured in the National Non-Admitted Patient Emergency Department Care Database. We assessed total change and annual rate of change in the number and rates of presentations per 10 000 population for all presentations and those with a MH principal diagnosis (ICD-10-AM F00 to F99, MH Between 2004-05 and 2016-17, children (0-14 years), followed by older persons (≥65 years) had the highest ED utilisation while youth (15-24 years) and younger adults (25-34 years) predominated for MH The Australian Institute of Health and Welfare should consider expanding the breadth of MH diagnoses they report to better identify the impact of MH on ED presentations. Between 2004-05 and 2016-17, high ED utilisation by children and older persons, and the increasing burden of MH
Publisher: MDPI AG
Date: 20-03-2023
DOI: 10.3390/J6010015
Abstract: Rapid antigen testing (RAT) is a cost-effective and time-efficient method of identifying severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and therefore a critical part of infection control strategies. There is no published evidence evaluating the use of RAT during the Omicron wave of the COVID-19 pandemic for asymptomatic patients or its performance between waves. All patients presenting to an Emergency Department over a two-week period without COVID-19 symptoms were screened for SARS-CoV-2 using both the Abbott Panbio RAT as well as the gold standard reverse transcriptase real-time polymerase chain reaction (PCR). The Abbott Panbio RAT sensitivity was 13% (95% CI 0.028, 0.336) for asymptomatic patients. The use of this test in asymptomatic patients during the Omicron wave had a statistically significant reduction in sensitivity compared with two reports of the same test in previous waves (13% vs. 86%, p 0.0001 13% vs. 83%, p 0.0001). As SARS-CoV-2 continues to mutate, the sensitivity of RATs are altered and needs to be continually re-evaluated for each variant of concern if they are to be used as part of an infection control strategy.
Publisher: Wiley
Date: 10-05-2016
Publisher: Wiley
Date: 03-11-2017
Publisher: Wiley
Date: 02-03-2016
Publisher: JMIR Publications Inc.
Date: 05-04-2023
Abstract: he Primary Trauma Care (PTC) course was originally developed to instruct healthcare workers in the management of the severely injured patients in low and middle income countries with limited medical resources. The PTC has now been taught for more than 25 years. Many studies have demonstrated that the two-day Primary Trauma Care (PTC) workshop is a useful and informative to front-line health staff and has helped improve knowledge and confidence in trauma management but there is little evidence showing that it leads to changes in clinical practice. The Kirkpatrick (KM) and Knowledge Attitude Practice (KAP) models are effective methods to evaluate this approach. Our study aimed to combine 2 models to evaluate the impact of the PTC program for healthcare staff in two Vietnamese hospitals. o investigate how the “2 day PTC course” impacts on the level of clinical practice in healthcare staff in the emergency departments of two Vietnamese provincial hospitals. e conducted the PTC course over 2 days in the emergency departments (ED) of Thanh Hoa and Ninh Binh hospitals in February and March 2022 respectively. Sequential cross-sectional surveys using validated instruments were conducted immediately pre- and post-course and at 6 months after course delivery. The questionnaires were analysed by simple frequency analysis. t level 1 of KM, nearly 100 % participant were satisfied with the course. At level 2 (knowledge), the multiple-choice question (MCQ) and confident matrix (CM) improved significantly from 60% to 77% and 59.3% to 71.3% respectively (p .01), these improvements were seen in both nurse and doctor subgroups. The focus of Level 3 was on practice and saw a significant incremental change with scenarios checklist (SC) points jumping from 5.9 1.9 to 9.0 0.9 and bedside clinical checklist (BCC) points increased from 5 1.5 to 8.3 0.8 (p .01). At 6-months follow up, MCQ, CM and SC all remained unchanged (p .05) except MCQ score in the nurse subgroup (p .01). he PTC course undertaken in 2 local hospitals of Vietnam was successful in improving 3 levels of KM for ED healthcare staff. This improvement was maintained for at least 6 months post course. The PTC courses are effective in providing improvement and sustainment in 3 Levels for low- and middle-income countries like Vietnam. he trial is registered in ANZCTR with trial ID is ACTRN12621000371897.
Publisher: Elsevier BV
Date: 04-2023
Publisher: MDPI AG
Date: 30-05-2023
DOI: 10.3390/HEALTHCARE11111599
Abstract: Overuse of computed tomography pulmonary angiograms (CTPAs) for diagnosis of pulmonary embolism (PE) has been recognised as an issue for over ten years, with Choosing Wisely Australia recommending that CTPAs only be ordered if indicated by a clinical practice guideline (CPG). This study aimed to explore the use of evidence-based practice within regional Tasmanian emergency departments in relation to CTPA orders by determining whether CTPAs were ordered in accordance with validated CPGs. We conducted a retrospective medical record review of all patients who underwent CTPA across all public emergency departments in Tasmania between 1 August 2018 and 31 December 2019 inclusive. Data from 2758 CTPAs across four emergency departments were included. PE was reported in 343 (12.4%) of CTPAs conducted, with yield ranging from 8.2% to 16.1% between the four sites. Overall, 52.1% of participants had neither a CPG documented, nor a D-dimer conducted before their scan. A CPG was documented before 11.8% of scans, while D-dimer was conducted before 43% of CTPAs. The findings presented in this study indicate that Tasmanian emergency departments are not consistently ‘Choosing Wisely’ when investigating PE. Further research is required to identify explanations for these findings.
Publisher: Wiley
Date: 22-11-2016
Publisher: MDPI AG
Date: 13-01-2023
Abstract: Medication errors are more prevalent in settings with acutely ill patients and heavy workloads, such as in an emergency department (ED). A pragmatic, controlled study compared partnered pharmacist medication charting (PPMC) (pharmacist-documented best-possible medication history [BPMH] followed by clinical discussion between a pharmacist and medical officer to co-develop a treatment plan and chart medications) with early BPMH (pharmacist-documented BPMH followed by medical officer-led traditional medication charting) and usual care (traditional medication charting approach without a pharmacist-collected BPMH in ED). Medication discrepancies were undocumented differences between medication charts and medication reconciliation. An expert panel assessed the discrepancies’ clinical significance, with ‘unintentional’ discrepancies deemed ‘errors’. Fewer patients in the PPMC group had at least one error (3.5% 95% confidence interval [CI]: 1.1% to 5.8%) than in the early BPMH (49.4% 95% CI: 42.5% to 56.3%) and usual care group (61.4% 95% CI: 56.3% to 66.7%). The number of patients who need to be treated with PPMC to prevent at least one high/extreme error was 4.6 (95% CI: 3.4 to 6.9) and 4.0 (95% CI: 3.1 to 5.3) compared to the early BPMH and usual care group, respectively. PPMC within ED, incorporating interdisciplinary discussion, reduced clinically significant errors compared to early BPMH or usual care.
Publisher: Wiley
Date: 23-08-2016
Publisher: Wiley
Date: 28-08-2015
Publisher: Wiley
Date: 10-2008
DOI: 10.1111/J.1445-2197.2008.04689.X
Abstract: Laparoscopic and open techniques are both recognized treatment options for ventral hernias. We conducted a prospective randomized trial of both methods, to assess hernia recurrence, postoperative recovery and complications. Fifty-eight patients with ventral hernias were enrolled into the trial between August 2003 and December 2005. Of these, 31 underwent laparoscopic repair and 27 underwent open repair. Clinical parameters were documented on all patients during a median follow-up period of 27.5 months. The demographics of the two groups were similar. There was one recurrence in each of the laparoscopic and open groups. There was an equivalent rate of operative time, length of stay, postoperative pain scores, return to normal activities, wound infection and seroma formation between the two groups. Laparoscopic and open ventral hernia repair are comparable and offer low recurrence rates.
Publisher: Wiley
Date: 11-01-2020
Publisher: Wiley
Date: 18-12-2019
Abstract: To examine trends in ED presentations with a mental health diagnosis (MH Data were captured in the National Non-Admitted Patient Emergency Department Care Database. Outcomes were the proportion of ED presentations with a principal diagnosis of ICD-10-AM F00-F99 (MH Between 2004-05 and 2016-17, MH The proportion of ED presentations for MH conditions, narrowly defined, has increased in all Australian jurisdictions between 2004-05 and 2016-17, but particularly since 2010-11. Differences between jurisdictions indicate jurisdictional specific issues. However, significant or upward trend of MH
Publisher: Wiley
Date: 16-01-2018
Publisher: Wiley
Date: 13-08-2021
Abstract: The aim of the present study was to describe the characteristics and outcomes of patients presenting to Australian EDs with suspected and confirmed COVID‐19 during 2020, and to determine the predictors of in‐hospital death for SARS‐CoV‐2 positive patients. This analysis from the COVED Project presents data from 12 sites across four Australian states for the period from 1 April to 30 November 2020. All adult patients who met local criteria for suspected COVID‐19 and underwent testing for SARS‐CoV‐2 in the ED were eligible for inclusion. Study outcomes were mechanical ventilation and in‐hospital mortality. Among 24 405 eligible ED presentations over the whole study period, 423 tested positive for SARS‐CoV‐2. During the ‘second wave’ from 1 July to 30 September 2020, 26 (6%) of 406 SARS‐CoV‐2 patients received invasive mechanical ventilation, compared to 175 (2%) of the 9024 SARS‐CoV‐2 negative patients (odds ratio [OR] 3.5 95% confidence interval [CI] 2.3–5.2, P 0.001), and 41 (10%) SARS‐CoV‐2 positive patients died in hospital compared to 312 (3%) SARS‐CoV‐2 negative patients (OR 3.2 95% CI 2.2–4.4, P = 0.001). For SARS‐CoV‐2 positive patients, the strongest independent predictors of hospital death were age (OR 1.1 95% CI 1.1–1.1, P 0.001), higher triage category (OR 3.5 95% CI 1.3–9.4, P = 0.012), obesity (OR 4.2 95% CI 1.2–14.3, P = 0.024) and receiving immunosuppressive treatment (OR 8.2 95% CI 1.8–36.7, P = 0.006). ED patients who tested positive for SARS‐CoV‐2 had higher odds of mechanical ventilation and death in hospital. The strongest predictors of death were age, a higher triage category, obesity and receiving immunosuppressive treatment.
Publisher: Wiley
Date: 23-02-2020
Publisher: Wiley
Date: 11-2018
DOI: 10.1111/IMJ.31_14077
Publisher: Wiley
Date: 12-01-2019
Publisher: JMIR Publications Inc.
Date: 06-02-2023
DOI: 10.2196/40883
Abstract: Despite significant improvement in the last decade, road trauma remains a substantial contributor to deaths in Vietnam. The COVID-19 pandemic necessitated public health measures that had an unforeseen benefit on road trauma in high-income countries. We investigate if this reduction was also seen in a low- to middle-income country like Vietnam. Our aim was to investigate how the COVID-19 pandemic and the government policies implemented in response to it impacted road trauma fatalities in Vietnam. We also compared this impact to other government policies related to road trauma implemented in the preceding 14 years (2007-2020). COVID-19 data were extracted from the Vietnamese Ministry of Health database. Road traffic deaths from 2007 to 2021 were derived from the Vietnamese General Statistical Office. We used Stata software (version 17 StataCorp) for statistical analysis. Poisson regression modeling was used to estimate trends in road fatality rates based on annual national mortality data for the 2007-2021 period. The actual change in road traffic mortality in 2021 was compared with calculated figures to demonstrate the effect of COVID-19 on road trauma fatalities. We also compared this impact to other government policies that aimed to reduce traffic-related fatalities from 2007 to 2020. Between 2007 and 2020, the number of annual road traffic deaths decreased by more than 50%, from 15.3 to 7 per 100,000 population, resulting in an average reduction of 5.4% per annum. We estimated that the road traffic mortality rate declined by 12.1% (95% CI 8.9-15.3%) in 2021 relative to this trend. The actual number of road trauma deaths fell by 16.4%. This reduction was largely seen from August to October 2021 when lockdown and social distancing measures were in force. In 2021, the road traffic–related death reduction in Vietnam was 3 times greater than the trend seen in the preceding 14 years. The public health response to the COVID-19 pandemic in Vietnam was associated with a third of this reduction. It can thus be concluded that government policies implemented to address the COVID-19 pandemic resulted in a 4.3% decrease in road traffic deaths in 2021. This has been observed in high-income countries, but we have demonstrated this for the first time in a low- and middle-income country.
Publisher: Wiley
Date: 19-10-2020
Publisher: Wiley
Date: 26-02-2019
Publisher: Wiley
Date: 28-02-2019
No related grants have been discovered for Viet Tran.