ORCID Profile
0000-0001-9355-3648
Current Organisations
Nepean Hospital
,
University of Sydney
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Publisher: Wiley
Date: 10-2021
DOI: 10.1002/AET2.10699
Abstract: Emergency cricothyrotomy is a lifesaving procedure performed when intubation fails and oxygenation cannot occur. There are multiple techniques and kits to perform this procedure. However, current evidence does not provide a definitive answer as to which method is superior. Two techniques in common use are a surgical technique and a percutaneous Seldinger‐based cricothyrotomy kit. The objective was to determine which of these two methods was quickest to perform and to determine which was most preferred by participants. A prospective randomized controlled crossover trial was conducted involving emergency physicians and trainees. Each participant performed both cricothyrotomy techniques in succession on an airway model, with the technique performed first being randomized for each participant. The primary outcome was time to first insufflation of the artificial lung. A survey was completed by participants asking their comfort with each technique on a 5‐point scale from 1 (not at all comfortable) to 5 (very comfortable) and which technique they preferred. Twenty‐one emergency physicians and nine emergency medicine trainees were recruited. The surgical technique was performed the fastest, with a mean (±SD) time of 51.6 (±16.3) s versus 66.6 (±14.9) s for the Seldinger technique, with a statistically significant difference of 15.0 s (95% confidence interval = 8.5 to 21.5, p 0.001). The surgical technique was rated the most comfortable to perform, with a median rating of 5 (interquartile range [IQR] = 4–5) versus 4 (IQR = 3–5) for the Seldinger technique. The surgical technique was most preferred by participants (80% vs 20%). The surgical technique was the fastest to perform and was rated the most comfortable to perform and the most preferred technique.
Publisher: AMPCo
Date: 11-2007
Publisher: Wiley
Date: 10-2005
DOI: 10.1111/J.1742-6723.2005.00784.X
Abstract: Background: The Monthly Index of Medical Specialties (MIMS) contains Therapeutic Goods Administration‐approved product information supplied by manufacturers. It is widely used by health‐care professionals but is not specifically designed as a toxicology reference. Objectives: To determine how widespread the use of MIMS is as a toxicology reference. To evaluate the quality of poisoning management advice it contains. Methods: First, a survey of 500 consecutive calls to the NSW Poison Information Centre (PIC) was undertaken asking health‐care workers which toxicology references were consulted prior to calling and which references they would use if the PIC were not available. Second, a consensus opinion for poisoning management was obtained, for 25 medications which are either commonly involved in poisoning or potentially life‐threatening in overdose, by review of 5 current toxicology references for contraindicated treatments, ineffective treatments and specific recommended treatments and antidotes. MIMS poisoning management advice was then compared with this toxicology consensus opinion. Results: In total, 276 doctors and 222 nurses were surveyed. Prior to calling the PIC 22.8% of doctors and 6.8% of nurses consulted MIMS. In total, 25.7% of doctors and 39.6% nurses stated they would use the MIMS for poisoning management advice if the PIC were not available. For the 25 drugs assessed, 14 contained inaccurate poisoning management: 1 recommended ineffective treatments and 14 omitted specific treatments or antidotes. Conclusion: The MIMS is often used as a toxicology reference by physicians prior to calling the PIC. It contains a number of significant inaccuracies pertaining to management of poisonings and should not be used as a primary reference for poisoning advice.
Publisher: AMPCo
Date: 12-2011
DOI: 10.5694/MJA11.11266
Abstract: Helping ward registrars transition from denial to acceptance.
Publisher: Wiley
Date: 11-2022
Abstract: To examine the effect of staffing levels by experience of medical officers and overcrowding on ED key performance indicators (KPIs). Presentations to Nepean ED from 6 May to 3 November 2019 were examined. Staff were designated either Fellows of the Australasian College for Emergency Medicine (FACEMs), non‐FACEM senior decision‐makers (SDMs), non‐senior decision‐makers greater than 2 years postgraduate (non‐SDMs) and junior medical officers up to 2 years postgraduate (JMOs). The number of admitted patients boarded in the ED waiting for a ward bed at 8 am was used as a marker for overcrowding. Multivariable regression analysis was performed using staffing levels, number of admissions at 8 am and total presentations as the independent variables and various ED KPIs as the dependent variables. FACEM and SDM had a significant effect on most ED KPIs, with the effect of FACEM consistently larger than the effect of SDM. There was minimal effect on performance by non‐SDM and JMO staffing. There was significant effect of overcrowding as measured by the number of admitted patients in ED at 8 am on most ED KPIs. Almost no variables had an effect on Emergency Treatment Performance (4‐h target) for admitted patients, suggesting poor performance was caused by factors outside of the ED. Increasing numbers of FACEM and non‐FACEM SDM, but not junior staff, and a reduction in overcrowding as measured by the number of admitted patients boarded in the ED at 8 am, were associated with improvements in the ED performance.
Publisher: Wiley
Date: 17-01-2022
Publisher: Proceedings of the National Academy of Sciences
Date: 03-02-2009
Abstract: Learning-related reductions of the postburst afterhyperpolarization (AHP) in hippoc al pyramidal neurons have been shown ex vivo, after trace eyeblink conditioning. The AHP is also reduced by many neuromodulators, such as norepinephrine, via activation of protein kinases. Trace eyeblink conditioning, like other hippoc us-dependent tasks, relies on protein synthesis for consolidating the learned memory. Protein kinase A (PKA) has been shown to be a key contributor for protein synthesis via the cAMP-response element-binding pathway. Here, we have explored a potential involvement of PKA and protein kinase C (PKC) in maintaining the learning-related postburst AHP reduction observed in CA1 pyramidal neurons. Bath application of isoproterenol (1 μM), a β-adrenergic agonist that activates PKA, significantly reduced the AHP in CA1 neurons from control animals, but not from rats that learned. This occlusion suggests that PKA activity is involved in maintaining the AHP reduction measured ex vivo after successful learning. In contrast, bath application of the PKC activator, (–) indolactam V (0.2 μM), significantly reduced the AHP in CA1 neurons from both control and trained rats, indicating that PKC activity is not involved in maintaining the AHP reduction at this point after learning.
Publisher: Wiley
Date: 09-12-2023
DOI: 10.5694/MJA2.51812
Publisher: Proceedings of the National Academy of Sciences
Date: 10-06-2008
Abstract: Classical conditioning paradigms, such as trace conditioning, in which a silent period elapses between the offset of the conditioned stimulus (CS) and the delivery of the unconditioned stimulus (US), and delay conditioning, in which the CS and US coterminate, are widely used to study the neural substrates of associative learning. However, there are significant gaps in our knowledge of the neural systems underlying conditioning in humans. For ex le, evidence from animal and human patient research suggests that the hippoc us plays a critical role during trace eyeblink conditioning, but there is no evidence to date in humans that the hippoc us is active during trace eyeblink conditioning or is differentially responsive to delay and trace paradigms. The present work provides a direct comparison of the neural correlates of human delay and trace eyeblink conditioning by using functional MRI. Behavioral results showed that humans can learn both delay and trace conditioning in parallel. Comparable delay and trace activation was measured in the cerebellum, whereas greater hippoc al activity was detected during trace compared with delay conditioning. These findings further support the position that the cerebellum is involved in both delay and trace eyeblink conditioning whereas the hippoc us is critical for trace eyeblink conditioning. These results also suggest that the neural circuitry supporting delay and trace eyeblink classical conditioning in humans and laboratory animals may be functionally similar.
Publisher: AMPCo
Date: 04-2007
Publisher: AMPCo
Date: 06-2006
Publisher: Wiley
Date: 04-2014
Abstract: The study aims to evaluate the effect of adding a stream for complex, ambulatory patients in an ED. The setting was an ED in a principal referral hospital in New South Wales, Australia. In 2011, a new stream was added to the pre-existing acute care (high complexity patients) and fast track (low complexity patients) streams. Space in acute care was set aside for the purpose of assessing patients who would previously have been assigned to acute care and who were capable of sitting in a chair with limited nursing care. The stream was separately resourced with staff redeployed from acute care. Early involvement of an emergency physician was a core characteristic of the process. Two 13 week periods before and after the intervention were compared. Presentations increased by 8.2%. Forty-three per cent of patients were triaged to the new stream. The median ED length of stay fell from 327 (interquartile range [IQR] 192-527) min to 267 (IQR 163-412) min (P < 0.001), the average daily occupancy of the department fell from 38.1 patients to 34.9 patients (95% confidence interval [CI] for difference 1.6-4.8, P < 0.001) and the proportion of patients who did not wait to be seen fell from 12% to 5.6% (95% CI for difference 5.8-7.1, P < 0.001). The use of an appropriately resourced stream directed towards seeing a complex group of patients who do not require ongoing nursing care and who are capable of sitting in a chair improved departmental flow.
Publisher: Wiley
Date: 13-11-2023
Abstract: Collegiality is considered to be any extra‐role behaviour that is discretionary, not recognised by a formal reward system and that promotes the effective functioning of the organisation. Although there is much literature on the concept of collegiality, there are few studies examining collegiality in the medical profession and none looking at collegiality among emergency physicians (EPs). The aim of the present study is to explore the perceptions of different ED healthcare professionals on the meaning of collegiality among EPs, the benefits of collegiality and behaviours they identify as indicative of collegiality. This was a qualitative study using grounded theory. Data collection was via focus group interviews of three to four participants per group. Participants included EPs, emergency medicine trainees, senior emergency nurses and nurse practitioners. Three questions were explored: ‘what does collegiality mean to you?’ ‘what are the benefits of collegiality?’ and ‘what specific behaviours do you see as part of collegiality?’ Ten focus group interviews involving a total of 33 participants were conducted. Several themes were identified for both the meaning of collegiality and the benefits of collegiality among EPs. Eight themes regarding collegial behaviour were identified: (i) mutual respect and trust (ii) mutual support (iii) attitude (iv) work ethic (v) staff welfare (vi) patient management (vii) handover and (viii) education. The present study identified distinct themes and behaviours indicative of collegiality among EPs. Promoting these behaviours could improve staff well‐being, ED efficiency, patient safety and productivity.
Publisher: Wiley
Date: 21-03-2022
Publisher: Wiley
Date: 12-05-2020
Publisher: AMPCo
Date: 03-2010
Publisher: Wiley
Date: 19-05-2022
Publisher: Elsevier BV
Date: 2006
Publisher: Wiley
Date: 04-2010
Publisher: Wiley
Date: 16-11-2021
Publisher: Wiley
Date: 07-04-2022
Abstract: To describe on‐scene times for out‐of‐hospital cardiac arrests (OHCA) transferred to hospital, the number of these that were extracorporeal cardiopulmonary resuscitation (ECPR) eligible and potential association between end‐tidal carbon dioxide (ETCO 2 ) and survival so as to inform planned interventional studies. Prospective cohort study of all OHCA, of suspected medical cause, where resuscitation was commenced and who were transported to participating hospitals from October 2020 to May 2021. One hundred and forty‐nine OHCA were included. Forty‐four (30%) patients survived to hospital discharge. Eighteen (8%) met ECPR inclusion criteria. Median on‐scene time was 33 min (interquartile range [IQR] 24–44). Initial hospital ETCO 2 for non‐survivors was 35 mmHg (IQR 19–50), survivors 36 mmHg (IQR 33–45) P = 0.215. No patient with an ETCO 2 less than 20 mmHg on hospital arrival to survived to hospital discharge. Average on‐scene time did not differ on survivorship. A small number of transferred patients with OHCA were ECPR eligible. ETCO 2 less than 20 mmHg portends adverse prognosis. Our data will be used for future interventional studies.
Publisher: AMPCo
Date: 05-2013
DOI: 10.5694/MJA12.11485
Publisher: Wiley
Date: 27-03-2023
Abstract: To examine if there was a high degree of agreement for disposition decisions of emergency nurse practitioners (ENP) compared to plastic surgery trainees (PST) for plastic surgery presentations. A prospective study of disposition decision agreement from February 2020 to January 2021 for patients who required plastic surgery consultation and managed exclusively by an ENP. Absolute percentages were used to determine the exact disposition decision accuracy of ENP and the PST, while Cohen's kappa compared disposition decision agreement. Sub‐analyses of age, gender, ENP experience and presenting condition agreement were also completed. To mitigate confounding factors, operative management (OM) and non‐OM groups were analysed. The study recruited 342 patients who presented mostly with finger or hand‐related conditions (82%, n = 279) and managed by an ENP with less than 10 years of experience (65%, n = 224). Disposition decisions by ENP compared to PST were the same in 80% ( n = 274) of cases. Disposition agreement for all patients was 0.72 (95% confidence interval 0.66–0.78). For the OM and non‐OM groups, disposition decisions were the same in 94% ( n = 320), with a Cohen's kappa 0.85 (95% confidence interval 0.79–0.91). Seven patients (2%) were discharged to GP care by the ENP when determined to need further plastic surgery involvement by the PST. Disposition decisions by ENP and PST were the same in most cases and had a high overall level of agreement. This may lead to greater autonomy of ENP care and reduced ED length of stay and occupancy.
Publisher: AMPCo
Date: 03-2013
DOI: 10.5694/MJA12.10499
Abstract: To determine whether implementation of the Cerner FirstNet electronic medical record system was associated with any change in emergency department (ED) performance. A retrospective observational study conducted during a 6-03 period in 2009 after the introduction of FirstNet and a corresponding 6-03 control period in 2008 when the Emergency Department Information System (EDIS) was operational. Data from all patients presenting to the ED during each period were extracted from each system and analysed for changes in key performance indicators (KPIs). Potential confounding variables, including total number of ED presentations, ED occupancy, ED staffing levels and triage category distribution, were also collected. Waiting time for all patients waiting time, treatment time and total time for patients discharged from the ED proportion of patients who did not wait to be seen by a doctor (DNW rate) and proportion of ambulance offload waiting times longer than 30 minutes. We found a reduction in performance with respect to ED KPIs after implementation of the FirstNet system. There were increases in the waiting time for all patients (median, 40 min v 78 min), and the waiting time (median, 49 min v 87 min), treatment time (median, 128 min v 147 min) and total time (median, 214 min v 280 min) for patients discharged from the ED. There were increases in the DNW rate (8.3% v 15.6%) and the proportion of ambulance offload times longer than 30 minutes (10.5% v 13.3%). All differences were statistically significant (P < 0.05). Implementation of the FirstNet electronic medical record system was associated with deterioration in ED KPIs.
Publisher: AMPCo
Date: 12-2013
DOI: 10.5694/MJA13.11298
Abstract: To examine the effect of an education c aign based around a gold coin fine on ordering of C-reactive protein (CRP) tests. A retrospective analysis of CRP test ordering before and after the intervention in the emergency department (ED) of a tertiary referral hospital in metropolitan Sydney that sees about 60,000 patients per annum. The date of the intervention - 2 August 2013 - corresponded with Jeans for Genes Day. Number of CRP tests ordered in the ED. 1290 CRP tests were ordered before the intervention (1-31 July), and 394 were ordered after the intervention (2-31 August). This decrease in CRP test ordering was despite an increased number of ED presentations in August compared with July (5219 v 5497 presentations). This represented an absolute reduction in the rate of CRP test ordering of 17.6% (95% CI, 16.2%-18.9% P < 0.001). The threat of a gold coin fine for ordering a CRP test, as part of a broader education c aign, significantly reduced the number of CRP tests ordered in a tertiary referral ED.
Publisher: Wiley
Date: 19-01-2012
DOI: 10.1111/J.1742-6723.2011.01523.X
Abstract: To determine which of the disaster triage tag systems in use in Australia and New Zealand is better in terms of the time taken to complete the triage and the ease of use. A disaster scenario was created. Mock patients were provided with clinical information to allow them to be triaged in a disaster sieve. Six different triage tag systems available in Australia and New Zealand were trialled. Participants triaged 10 patients with each triage tag system. The 10 patients used were different for each of the tag systems and were standardized for acuity and triage category. The time to complete the triage of the 10 patients with each different tag system was measured. The participants then completed a questionnaire with regards to the ease of use of the different tags and were asked to nominate their most preferred tag. The Victorian cruciate fold up tag was the quickest to complete, with an average of 6.6 min to triage 10 patients, compared with an average time for all systems of 7.8 min. New Zealand tags were found to be the easiest to use, easiest to fill in and were considered the most preferred tag. The Victorian style of tag was found to be the most efficient in terms of the time to complete a triage. The New Zealand tags were the easiest to use, easiest to fill in and the most preferred tag by the participants. We recommend that one of these tags be adapted for use as a nationwide system.
Publisher: Springer Science and Business Media LLC
Date: 20-07-2009
DOI: 10.1038/NN.2371
No related grants have been discovered for James Mallows.