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Dicker B, Garrett N, Howie G, Brett A, Scott T, Stewart R, Perkins GD, Smith T, Garcia E, Todd VF. Association between direct transport to a cardiac arrest centre and survival following out-of-hospital cardiac arrest: A propensity-matched Aotearoa New Zealand study. Resusc Plus 2024; 18:100625. [PMID: 38601710 PMCID: PMC11004390 DOI: 10.1016/j.resplu.2024.100625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/20/2024] [Accepted: 03/20/2024] [Indexed: 04/12/2024] Open
Abstract
Background and Objectives Direct transport to a cardiac arrest centre following out-of-hospital cardiac arrest may be associated with higher survival. However, there is limited evidence available to support this within the New Zealand context. This study used a propensity score-matched cohort to investigate whether direct transport to a cardiac arrest centre improved survival in New Zealand. Methods A retrospective cohort study was conducted using the Aotearoa New Zealand Paramedic Care Collection (ANZPaCC) database for adults treated for out-of-hospital cardiac arrest of presumed cardiac aetiology between 1 July 2018 to 30 June 2023. Propensity score-matched analysis was used to investigate survival at 30-days post-event according to the receiving hospital being a cardiac arrest centre versus a non-cardiac arrest centre. Results There were 2,297 OHCA patients included. Propensity matching resulted in 554 matched pairs (n = 1108). Thirty-day survival in propensity score-matched patients transported directly to a cardiac arrest centre (56%) versus a non-cardiac arrest centre (45%) was not significantly different (adjusted Odds Ratio 0.78 95%CI 0.54, 1.13, p = 0.19). Shockable presenting rhythm, bystander CPR, and presence of STEMI were associated with a higher odds of 30 day survival (p < 0.05). Māori or Pacific Peoples ethnicity and older age were associated with lower survival (p < 0.05). Conclusions This study found no statistically significant difference in outcomes for OHCA patients transferred to a cardiac arrest compared to a non-cardiac arrest centre. However, the odds ratio of 0.78, equivalent to a 22% decrease in 30-day mortality, is consistent with benefit associated with management by a cardiac arrest centre. Further research in larger cohorts with detailed information on known outcome predictors, or large randomised clinical trials are needed.
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Affiliation(s)
- Bridget Dicker
- Clinical Audit and Research, Hato Hone St John New Zealand, Auckland, New Zealand
- Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Auckland, New Zealand
| | - Nick Garrett
- Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Auckland, New Zealand
| | - Graham Howie
- Clinical Audit and Research, Hato Hone St John New Zealand, Auckland, New Zealand
- Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Auckland, New Zealand
| | - Aroha Brett
- Clinical Audit and Research, Hato Hone St John New Zealand, Auckland, New Zealand
| | - Tony Scott
- Cardiology Department, Northshore Hospital, Takapuna, Auckland, New Zealand
| | - Ralph Stewart
- Te Toka Tumai, Auckland City Hospital, Auckland, New Zealand
| | - Gavin D. Perkins
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, United Kingdom
| | - Tony Smith
- Clinical Audit and Research, Hato Hone St John New Zealand, Auckland, New Zealand
| | - Elena Garcia
- Clinical Audit and Research, Hato Hone St John New Zealand, Auckland, New Zealand
| | - Verity F. Todd
- Clinical Audit and Research, Hato Hone St John New Zealand, Auckland, New Zealand
- Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Auckland, New Zealand
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Jones B, Dicker B, Howie G, Todd V. Review article: Emergency medical services transfer of severe traumatic brain injured patients to a neuroscience centre: A systematic review. Emerg Med Australas 2024; 36:187-196. [PMID: 38263532 DOI: 10.1111/1742-6723.14375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/06/2023] [Accepted: 01/01/2024] [Indexed: 01/25/2024]
Abstract
Patients with severe traumatic brain injuries require urgent medical attention at a hospital. We evaluated whether transporting adult patients with a severe traumatic brain injury (TBI) to a Neuroscience Centre is associated with reduced mortality. We reviewed studies published between 2010 and 2023 on severe TBI in adults (>18 years) using Medline, CINAHL, Google Scholar and Cochrane databases. We focused on mortality rates and the impact of transferring patients to a Neuroscience Centre, delays to neurosurgery and EMS triage accuracy. This review analysed seven studies consisting of 53 365 patients. When patients were directly transported to a Neuroscience Centre, no improvement in survivability was demonstrated. Subsequently, transferring patients from a local hospital to a Neuroscience Centre was significantly associated with reduced mortality in one study (adjusted odds ratio: 0.79, 95% confidence interval: 0.64-0.96), and 24-h (relative risk [RR]: 0.31, 0.11-0.83) and 30-day (RR: 0.66, 0.46-0.96) mortality in another. Patients directly transported to a Neuroscience Centre were more unwell than those taken to a local hospital. Subsequent transfers increased time to CT scanning and neurosurgery in several studies, although these were not statistically significant. Additionally, EMS could accurately triage. None of the included studies demonstrated statistically significant findings indicating that direct transportation to a Neuroscience Centre increased survivability for patients with severe traumatic brain injuries. Subsequent transfers from a non-Neuroscience Centre to a Neuroscience Centre reduced mortality rates at 24 h and 30 days. Further research is required to understand the differences between direct transport and subsequent transfers to Neuroscience Centres.
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Affiliation(s)
- Ben Jones
- Paramedicine Research Unit, Paramedicine Department, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Bridget Dicker
- Paramedicine Research Unit, Paramedicine Department, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
- Clinical Audit and Research Team, Hato Hone St John, Auckland, New Zealand
| | - Graham Howie
- Paramedicine Research Unit, Paramedicine Department, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Verity Todd
- Paramedicine Research Unit, Paramedicine Department, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
- Clinical Audit and Research Team, Hato Hone St John, Auckland, New Zealand
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Wilson MK, Pienaar F, Large R, Wright M, Howie G, Foliaki S, Mikaere M, Davis R, Todd V. Analysis of skin condition emergency department outcomes via the free Healthline service from Whakarongorau Aotearoa. N Z Med J 2023; 136:32-50. [PMID: 38033239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
The aim of this research is to gain a deeper understanding of the ethnic and socio-demographic differences in the utilisation of the national 24/7 Healthline service in relation to skin condition calls and their outcomes. Healthline is one of the 39 free telehealth services that Whakarongorau Aotearoa | New Zealand Telehealth Services provides to New Zealanders. This is a retrospective observational study analysing Healthline data over a 4-year period: January 2019 through to December 2022. A total of 61,876 skin condition calls were analysed including demographics of service users: age group, ethnicity, area of residence and call outcome. Higher acuity skin condition calls resulting in an outcome of a recommendation for emergency department (ED) care accounted for 5.3% (n=3,294) of calls. This research found that Māori were over-represented in this ED recommendation data over four years (942 ED outcomes; 28.6%), and Pasifika were under-represented (203 ED outcomes; 5.9%). Wairarapa and West Coast were found to have the highest number of ED outcomes per capita. Our results support the theory that severe skin conditions positively correlate with smaller district populations and increased deprivation in access to services. This study highlights the potential that telehealth services have to help reduce the inequity of access to care.
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Affiliation(s)
- Miriama K Wilson
- Research Officer, Paramedicine Research Unit, Auckland University of Technology, Auckland, New Zealand
| | - Fiona Pienaar
- Senior Clinical Advisor, Whakarongorau Aotearoa | New Zealand Telehealth Services, Auckland, New Zealand
| | - Ruth Large
- Chief Clinical Officer, Whakarongorau Aotearoa | New Zealand Telehealth Services, Auckland, New Zealand
| | - Matt Wright
- Clinical Lead, Urgent Care, Whakarongorau Aotearoa | New Zealand Telehealth Services, Auckland, New Zealand
| | - Graham Howie
- Senior Lecturer, Paramedicine Research Unit, Department of Paramedicine, Auckland University of Technology, Auckland, New Zealand
| | - Siale Foliaki
- Clinical Lead, Crisis Mental Health, Whakarongorau Aotearoa | New Zealand Telehealth Services, Auckland, New Zealand
| | - Martin Mikaere
- Mana Hapori Clinical Lead, Whakarongorau Aotearoa | New Zealand Telehealth Services, Auckland, New Zealand
| | - Rebecca Davis
- University Student, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Verity Todd
- Senior Lecturer, Paramedicine Research Unit, Department of Paramedicine, Auckland University of Technology, Auckland, New Zealand
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Todd V, Dicker B, Okyere D, Smith K, Smith T, Howie G, Stub D, Ray M, Stewart R, Scott T, Swain A, Heriot N, Brett A, Mahony E, Nehme Z. A study protocol for a cluster-randomised controlled trial of smartphone-activated first responders with ultraportable defibrillators in out-of-hospital cardiac arrest: The First Responder Shock Trial (FIRST). Resusc Plus 2023; 16:100466. [PMID: 37711685 PMCID: PMC10497988 DOI: 10.1016/j.resplu.2023.100466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
Objective To describe the First Responder Shock Trial (FIRST), which aims to determine whether equipping frequently responding, smartphone-activated (GoodSAM) first responders with an ultraportable AED can increase 30-day survival rates in OHCA. Methods The FIRST trial is an investigator-initiated, bi-national (Victoria, Australia and New Zealand), registry-nested cluster-randomised controlled trial where the unit of randomisation is the smartphone-activated (GoodSAM) first responder. High-frequency GoodSAM responders are randomised 1:1 to receive an ultraportable, single-use AED or standard alert procedures using the GoodSAM app.The primary outcome is survival to 30 days. The secondary outcome measures (shockable rhythm, return of spontaneous circulation, event survival, and time to first shock delivery) are routinely collected by OHCA registries in both regions. The trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) (Registration: ACTRN12622000448741) on 22 March 2022. Results The trial started in November 2022 and the last patient is expected to be enrolled in November 2024. We aim to detect a 7% increase in the proportion of 30-day survivors, from 9% in patients attended by control responders to 16% in patients attended by responders randomised to the ultraportable AED intervention arm. With 80% power, an alpha of 0.05, a cluster size of 1.5 and a coefficient of variation for cluster sizes of 1, the sample size required to detect this difference is 714 (357 per arm). Conclusion The FIRST study will increase our understanding of the potential role of portable AED use by smartphone-activated community responders and their impact on survival outcomes.
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Affiliation(s)
- Verity Todd
- Clinical Audit and Research Team, Hato Hone St John, National Headquarters, Ellerslie, Auckland, New Zealand
- Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Manukau, Auckland, New Zealand
| | - Bridget Dicker
- Clinical Audit and Research Team, Hato Hone St John, National Headquarters, Ellerslie, Auckland, New Zealand
- Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Manukau, Auckland, New Zealand
| | - Daniel Okyere
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Karen Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Paramedicine, Monash University, Frankston, Victoria, Australia
- Department of Research and Innovation, Silverchain, Victoria, Australia
| | - Tony Smith
- Clinical Audit and Research Team, Hato Hone St John, National Headquarters, Ellerslie, Auckland, New Zealand
| | - Graham Howie
- Clinical Audit and Research Team, Hato Hone St John, National Headquarters, Ellerslie, Auckland, New Zealand
- Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Manukau, Auckland, New Zealand
| | - Dion Stub
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michael Ray
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
| | - Ralph Stewart
- Green Lane Cardiovascular Service, Auckland City Hospital, Te Toka Tumai, Te Whatu Ora – Health New Zealand, 2 Park Road, Grafton, Auckland 1023, New Zealand
| | - Tony Scott
- Cardiology Department, North Shore Hospital, Waitematā, Te Whatu Ora – Health New Zealand, Takapuna, Auckland, New Zealand
| | - Andy Swain
- Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Manukau, Auckland, New Zealand
- Wellington Free Ambulance, Wellington, New Zealand
| | - Natalie Heriot
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
| | - Aroha Brett
- Clinical Audit and Research Team, Hato Hone St John, National Headquarters, Ellerslie, Auckland, New Zealand
| | - Emily Mahony
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
| | - Ziad Nehme
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Paramedicine, Monash University, Frankston, Victoria, Australia
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Kibblewhite C, Todd VF, Howie G, Sanders J, Ellis C, Dittmer B, Garcia E, Swain A, Smith T, Dicker B. Out-of-Hospital emergency airway management practices: A nationwide observational study from Aotearoa New Zealand. Resusc Plus 2023; 15:100432. [PMID: 37547539 PMCID: PMC10400901 DOI: 10.1016/j.resplu.2023.100432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/29/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023] Open
Abstract
Background and Objectives Airway management is crucial for emergency care in critically ill patients outside the hospital setting. An Airway Registry is useful in providing essential information for quality improvement purposes. Therefore, this study aimed to develop an out-of-hospital airway registry and describe airway management practices in Aotearoa New Zealand (AoNZ). Methods Data from the Aotearoa New Zealand Paramedic Care Collection (ANZPaCC) database were used in a retrospective cohort study covering July 2020 to June 2021. All patients receiving airway interventions were included. An airway intervention was defined as one or more of the following: non-drug assisted endotracheal intubation (NDA-ETI), drug-assisted endotracheal intubation (DA-ETI; where a combination of paralytic agent and sedative were used to aid in intubation), laryngeal mask airway (LMA), oropharyngeal airway (OPA), nasopharyngeal airway (NPA), surgical airway (cricothyroidotomy), suction, jaw thrust. Descriptive statistics were analysed using Chi-Square and logistic regression modelling investigated the relationship between advanced airway success and patient characteristics. Results The study included 4,529 patients who underwent 7,779 airway interventions. Basic airway interventions were used most frequently: OPA (45.1%), NPA (29.3%), LMA (28.9%), suction (19.9%) and jaw thrust (17.6%). Advanced airway interventions were used less frequently: NDA-ETI (19.8%), DA-ETI (8.7%), and surgical airways (0.2%). The success rate for ETI (including both NDA-ETI and DA-ETI) was 89.4%, with NDA-ETI success at 85.8% and DA-ETI success at 97.7%. ETI first-pass success rates were significantly lower for males (aOR 0.65, 95%CI 0.48-0.87, p < 0.001) and higher for non-cardiac arrest injury patients (aOR 2.94, 95%CI 1.43-6.00, p < 0.001). In this cohort receiving airway interventions the 1-day mortality rate was 41.1%, demonstrating that a high proportion of these patients were severely clinically compromised. Conclusions Out-of-hospital airway management practices and success rates in AoNZ are comparable to those elsewhere. This research has determined the variables to be used as the AoNZ Paramedic Airway Registry ongoing and has demonstrated baseline outcomes in airway management for ongoing quality improvement using this registry.
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Affiliation(s)
- Chris Kibblewhite
- Clinical Audit and Research, Hato Hone St John New Zealand, Auckland, New Zealand
| | - Verity F. Todd
- Clinical Audit and Research, Hato Hone St John New Zealand, Auckland, New Zealand
- Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Auckland, New Zealand
| | - Graham Howie
- Clinical Audit and Research, Hato Hone St John New Zealand, Auckland, New Zealand
- Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Auckland, New Zealand
| | - Josh Sanders
- Clinical Audit and Research, Hato Hone St John New Zealand, Auckland, New Zealand
| | - Craig Ellis
- Clinical Audit and Research, Hato Hone St John New Zealand, Auckland, New Zealand
| | - Bryan Dittmer
- Clinical Audit and Research, Hato Hone St John New Zealand, Auckland, New Zealand
| | - Elena Garcia
- Clinical Audit and Research, Hato Hone St John New Zealand, Auckland, New Zealand
| | - Andy Swain
- Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Auckland, New Zealand
- Wellington Free Ambulance, Wellington, New Zealand
| | - Tony Smith
- Clinical Audit and Research, Hato Hone St John New Zealand, Auckland, New Zealand
| | - Bridget Dicker
- Clinical Audit and Research, Hato Hone St John New Zealand, Auckland, New Zealand
- Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Auckland, New Zealand
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Todd VF, Moylan M, Howie G, Swain A, Brett A, Smith T, Dicker B. Predictive value of the New Zealand Early Warning Score for early mortality in low-acuity patients discharged at scene by paramedics: an observational study. BMJ Open 2022; 12:e058462. [PMID: 35835524 PMCID: PMC9289032 DOI: 10.1136/bmjopen-2021-058462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The utility of New Zealand Early Warning Score (NZEWS) for prediction of adversity in low-acuity patients discharged at scene by paramedics has not been investigated. The objective of this study was to evaluate the association between the NZEWS risk-assessment tool and adverse outcomes of early mortality or ambulance reattendance within 48 hours in low-acuity, prehospital patients not transported by ambulance. DESIGN A retrospective cohort study. SETTING Prehospital emergency medical service provided by St John New Zealand over a 2-year period (1 July 2016 through 30 June 2018). PARTICIPANTS 83 171 low-acuity, adult patients who were attended by an ambulance and discharged at scene. Of these, 41 406 had sufficient recorded data to calculate an NZEWS. PRIMARY AND SECONDARY OUTCOMES AND MEASURES Binary logistic regression modelling was used to investigate the association between the NZEWS and adverse outcomes of reattendance within 48 hours, mortality within 2 days, mortality within 7 days and mortality within 30 days. RESULTS An NZEWS greater than 0 was significantly associated with all adverse outcomes studied (p<0.01), compared with the reference group (NZEWS=0). There was a startling correlation between 2-day, 7-day and 30-day mortality and higher early warning scores; the odds of 2-day mortality in patients with an early warning score>10 was 70 times that of those scoring 0 (adjusted OR 70.64, 95% CI: 30.73 to 162.36). The best predictability for adverse outcome was observed for 2-day and 7-day mortality, with moderate area under the receiver operating characteristic curve scores of 0.78 (95% CI: 0.73 to 0.82) and 0.74 (95% CI: 0.71 to 0.77), respectively. CONCLUSIONS Adverse outcomes in low-acuity non-transported patients show a significant association with risk prediction by the NZEWS. There was a very high association between large early warning scores and 2-day mortality in this patient group. These findings suggest that NZEWS has significant utility for decision support and improving safety when determining the appropriateness of discharging low-acuity patients at the scene.
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Affiliation(s)
- Verity Frances Todd
- St John New Zealand (Hato Hone Aotearoa), Auckland, New Zealand
- Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Auckland, New Zealand
| | - Melanie Moylan
- Department of Biostatistics and Epidemiology, Auckland University of Technology, Auckland, New Zealand
| | - Graham Howie
- St John New Zealand (Hato Hone Aotearoa), Auckland, New Zealand
- Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Auckland, New Zealand
| | - Andy Swain
- Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Auckland, New Zealand
- Wellington Free Ambulance, Wellington, New Zealand
| | - Aroha Brett
- St John New Zealand (Hato Hone Aotearoa), Auckland, New Zealand
| | - Tony Smith
- St John New Zealand (Hato Hone Aotearoa), Auckland, New Zealand
| | - Bridget Dicker
- St John New Zealand (Hato Hone Aotearoa), Auckland, New Zealand
- Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Auckland, New Zealand
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Dicker B, Callejas P, Howie G, Govender K, Wilson M, Tunnage B, Drake H, Swain A, Brett A, Spearing D, Todd V. OR09 Impact of socioeconomic deprivation on availability of smartphone-activated (GoodSAM) community responders to out-of-hospital cardiac arrest: A New Zealand observational study. Resuscitation 2022. [DOI: 10.1016/s0300-9572(22)00391-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Dicker B, Govender K, Howie G, Swain A, Todd VF. Positive association between ambulance double-crewing and OHCA outcomes: A New Zealand observational study. Resusc Plus 2021; 8:100187. [PMID: 34934997 DOI: 10.1016/j.resplu.2021.100187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 11/16/2022] Open
Abstract
Background and objectives New Zealand emergency medical service (EMS) crewing configurations generally place one (single) or two (double) crew on each responding ambulance unit. Recent studies demonstrated that double-crewing was associated with improved survival from out-of-hospital cardiac arrest (OHCA), therefore single-crewed ambulances have been phased out. We aimed to determine the association between this crewing policy change and OHCA outcomes in New Zealand. Methods This is a retrospective observational study using data from the St John OHCA Registry on patients treated during two different time periods: the Pre-Period (1 October 2013-30 June 2015), when single-crewed ambulances were in use by EMS, and the Post-Period (1 July 2016-30 June 2018) when single-crewed ambulances were being phased out. Geographic areas identified as having low levels of double crewing during the Pre-Period were selected for investigation. The outcome of survival to thirty-days post-OHCA was investigated using logistic regression analysis. Results The proportion of double-crewed ambulances arriving at OHCA events increased in the Post-Period (81.8%) compared to the Pre-Period (67.5%) (p ≤ 0.001). Response times decreased by two minutes (Pre-Period: median 8 min, IQR [6-11], Post-Period: median 6 min, IQR [4-9]; p ≤ 0.001). Thirty-day survival was significantly improved in the Post-Period (OR 1.63, 95%CI (1.04-2.55), p = 0.03). Conclusions An association between improved OHCA survival following increased responses by double-crewed ambulances was demonstrated. This study suggests that improvements in resourcing are associated with improved OHCA outcomes.
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Affiliation(s)
- Bridget Dicker
- Paramedicine Department, Auckland University of Technology, Auckland, New Zealand.,Clinical Audit and Research, St John New Zealand, Auckland, New Zealand
| | - Kevin Govender
- Paramedicine Department, Auckland University of Technology, Auckland, New Zealand
| | - Graham Howie
- Paramedicine Department, Auckland University of Technology, Auckland, New Zealand.,Clinical Audit and Research, St John New Zealand, Auckland, New Zealand
| | - Andy Swain
- Paramedicine Department, Auckland University of Technology, Auckland, New Zealand.,Wellington Free Ambulance, Wellington, New Zealand
| | - Verity F Todd
- Paramedicine Department, Auckland University of Technology, Auckland, New Zealand.,Clinical Audit and Research, St John New Zealand, Auckland, New Zealand
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Britnell S, Mearns G, Howie G, Parry D. Regression Equations for Weight Estimation in Paediatric Resuscitation. Stud Health Technol Inform 2021; 284:311-315. [PMID: 34920532 DOI: 10.3233/shti210729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Weight estimation is critical in paediatric resuscitation, as stopping to weigh a child could influence their survival. Weight estimation methods used in New Zealand (NZ) are not accurate for the population, increasing the complexity of prescribing medication and selecting equipment. AIM Develop regression equations (RE) to predict the weight of NZ children based on height, sex, age and ethnicity to be deployed in a mobile application (Weight Estimation Without Waiting). METHODS The RE was derived from retrospective regression modelling of a large existing dataset. Data were presented using descriptive statistics and calculation of means, limits of agreement and the proportion of weight estimates within a percentage of actual weight. CONCLUSION The RE developed in this study outperformed existing age-based weight estimation methods while providing a method to ensure that weight estimation techniques evolve with NZ children.
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Affiliation(s)
- Sally Britnell
- School of Clinical Sciences, Auckland University of Technology
| | - Gael Mearns
- School of Clinical Sciences, Auckland University of Technology
| | - Graham Howie
- School of Clinical Sciences, Auckland University of Technology
| | - Dave Parry
- Engineering Computer & Mathematical Sciences, Auckland University of Technology
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Todd VF, Swain A, Howie G, Tunnage B, Smith T, Dicker B. Factors Associated with Emergency Medical Service Reattendance in Low Acuity Patients Not Transported by Ambulance. PREHOSP EMERG CARE 2021:1-17. [PMID: 33320722 DOI: 10.1080/10903127.2020.1862943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 12/03/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
Background: The decision for emergency medical services (EMS) personnel not to transport a patient is challenging: there is a risk of subsequent deterioration but transportation of all patients to hospital would overburden emergency departments. The aim of this large-scale EMS study was to identify factors associated with an increased likelihood of ambulance reattendance within 48 hours in low acuity patients who were not transported by ambulance.Methods: We conducted a 2-year retrospective cohort study using data from the St John New Zealand EMS between 1 July 2016 and 30 June 2018 to investigate demographic and clinical associations with ambulance reattendance.Results: In total, 83,171 low acuity patients not transported by ambulance were included, of whom 4,512 (5.4%) had an EMS ambulance reattend within 48 hours. There were significant associations between EMS reattendance and patient age, sex, ethnicity, deprivation, and event location. Patients aged 60-74 years old had the highest likelihood of ambulance recall (OR 2.87, 95% CI: 2.51-3.28). Males were more likely to have an EMS ambulance reattend within 48 hours (OR 1.17, 95% CI: 1.09-1.25). Māori and Pacific Peoples had a similar likelihood of EMS recall to European/Others; however, the Asian cohort showed a reduced likelihood of reattendance (OR 0.76, 95% CI: 0.62-0.93).There were significant associations between EMS reattendance and non-transport reason, time spent on scene, event type, clinical acuity level (status), and pain score. Shorter (<30 minutes) on scene times were associated with a decreased likelihood of ambulance reattendance, whereas longer scene times (>45 minutes) were associated with an increased likelihood. Medical events were more likely to require reattendance than accident-related events (OR 1.22, 95% CI: 1.13-1.32). Non-transported patients with a severe pain score (7-10/10) were at increased likelihood of requiring reattendance (OR 1.60, 95% CI: 1.33-1.92).Discussion: The overall low rate of EMS reattendance is encouraging. Further research is needed into the clinical presentation of patients requiring ambulance reattendance within 48 hours to determine if there are early warning signs indicative of subsequent deterioration.
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Affiliation(s)
- Verity F Todd
- Received November 25, 2019 from Clinical Audit and Research Team, St John New Zealand, Auckland, New Zealand (VFT, GH, BT, TS, BD); Paramedicine Department, Auckland University of Technology, Auckland, New Zealand (VFT, AS, GH, BT, BD); Wellington Free Ambulance, Wellington, New Zealand (AS). Revision received December 3, 2020; accepted for publication December 6, 2020
| | - Andy Swain
- Received November 25, 2019 from Clinical Audit and Research Team, St John New Zealand, Auckland, New Zealand (VFT, GH, BT, TS, BD); Paramedicine Department, Auckland University of Technology, Auckland, New Zealand (VFT, AS, GH, BT, BD); Wellington Free Ambulance, Wellington, New Zealand (AS). Revision received December 3, 2020; accepted for publication December 6, 2020
| | - Graham Howie
- Received November 25, 2019 from Clinical Audit and Research Team, St John New Zealand, Auckland, New Zealand (VFT, GH, BT, TS, BD); Paramedicine Department, Auckland University of Technology, Auckland, New Zealand (VFT, AS, GH, BT, BD); Wellington Free Ambulance, Wellington, New Zealand (AS). Revision received December 3, 2020; accepted for publication December 6, 2020
| | - Bronwyn Tunnage
- Received November 25, 2019 from Clinical Audit and Research Team, St John New Zealand, Auckland, New Zealand (VFT, GH, BT, TS, BD); Paramedicine Department, Auckland University of Technology, Auckland, New Zealand (VFT, AS, GH, BT, BD); Wellington Free Ambulance, Wellington, New Zealand (AS). Revision received December 3, 2020; accepted for publication December 6, 2020
| | - Tony Smith
- Received November 25, 2019 from Clinical Audit and Research Team, St John New Zealand, Auckland, New Zealand (VFT, GH, BT, TS, BD); Paramedicine Department, Auckland University of Technology, Auckland, New Zealand (VFT, AS, GH, BT, BD); Wellington Free Ambulance, Wellington, New Zealand (AS). Revision received December 3, 2020; accepted for publication December 6, 2020
| | - Bridget Dicker
- Received November 25, 2019 from Clinical Audit and Research Team, St John New Zealand, Auckland, New Zealand (VFT, GH, BT, TS, BD); Paramedicine Department, Auckland University of Technology, Auckland, New Zealand (VFT, AS, GH, BT, BD); Wellington Free Ambulance, Wellington, New Zealand (AS). Revision received December 3, 2020; accepted for publication December 6, 2020
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Dicker B, Todd VF, Tunnage B, Swain A, Conaglen K, Smith T, Brett M, Laufale C, Howie G. Ethnic disparities in the incidence and outcome from out-of-hospital cardiac arrest: A New Zealand observational study. Resuscitation 2019; 145:56-62. [PMID: 31585186 DOI: 10.1016/j.resuscitation.2019.09.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 09/22/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND New Zealand (NZ) has an ethnically diverse population. International studies have demonstrated significant differences in health equity by ethnicity; however, there is limited evidence in the context of out-of-hospital cardiac arrest in NZ. We investigated whether heath disparities in incidence and outcome of out-of-hospital cardiac arrest exist between NZ ethnic groups. METHOD A retrospective observational study was conducted using NZ cardiac arrest registry data for a 2-year period. Ethnic cohorts investigated were the indigenous Māori population, Pacific Peoples and European/Others. Incidence rates, population characteristics and outcomes (Return of Spontaneous Circulation sustained to hospital handover and thirty-day survival) were compared. RESULTS Age-adjusted incidence rates per 100,000 person-years were higher in Māori (144.4) and Pacific Peoples (113.5) compared to European/Others (93.8). Return of spontaneous circulation sustained to hospital handover was significantly lower in Māori (adjusted OR 0.74, 95% CI 0.64-0.87, p < 0.001). Survival to thirty-days was lower for both Māori (adjusted OR 0.61, 95% CI 0.48-0.78, p < 0.001) and Pacific Peoples (adjusted OR 0.52, 95% CI 0.37-0.72, p < 0.001). A higher proportion of events occurred in all age groups below 65 years old in Māori and Pacific Peoples (p < 0.001), and a higher proportion of events occurred among women in Māori and Pacific Peoples (p < 0.001). CONCLUSIONS There are significant differences in health equity by ethnicity. Both Māori and Pacific Peoples have higher incidence of out-of-hospital cardiac arrest and at a younger age. Māori and Pacific Peoples have lower rates of survival to thirty-days. Our results provide impetus for targeted health strategies for at-risk ethnic populations.
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Affiliation(s)
- Bridget Dicker
- Paramedicine Department, Auckland University of Technology, Auckland, New Zealand; Clinical Audit and Research, St John New Zealand, Auckland, New Zealand.
| | - Verity F Todd
- Paramedicine Department, Auckland University of Technology, Auckland, New Zealand; Clinical Audit and Research, St John New Zealand, Auckland, New Zealand
| | - Bronwyn Tunnage
- Paramedicine Department, Auckland University of Technology, Auckland, New Zealand; Clinical Audit and Research, St John New Zealand, Auckland, New Zealand
| | - Andy Swain
- Paramedicine Department, Auckland University of Technology, Auckland, New Zealand
| | - Kate Conaglen
- Paramedicine Department, Auckland University of Technology, Auckland, New Zealand
| | - Tony Smith
- Clinical Audit and Research, St John New Zealand, Auckland, New Zealand
| | - Michelle Brett
- Clinical Audit and Research, St John New Zealand, Auckland, New Zealand
| | - Chris Laufale
- Clinical Audit and Research, St John New Zealand, Auckland, New Zealand
| | - Graham Howie
- Paramedicine Department, Auckland University of Technology, Auckland, New Zealand; Clinical Audit and Research, St John New Zealand, Auckland, New Zealand
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Dicker B, Todd VF, Tunnage B, Swain A, Smith T, Howie G. Direct transport to PCI-capable hospitals after out-of-hospital cardiac arrest in New Zealand: Inequities and outcomes. Resuscitation 2019; 142:111-116. [DOI: 10.1016/j.resuscitation.2019.06.283] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/05/2019] [Accepted: 06/21/2019] [Indexed: 11/26/2022]
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Todd V, Dicker B, Conaglen K, Tunnage B, Smith T, Swain A, Brett M, Laufale C, Howie G. Out-of-Hospital Cardiac Arrest Registry Highlights Ethnic Disparities in NZ. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.05.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dicker B, Tunnage B, Howie G, Smith T, Swain A, Todd V. Impact of Ambulance Resourcing on Outcomes from Out-of-Hospital Cardiac Arrest. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.05.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Dicker B, Tunnage B, Howie G, Smith T, Swain A, Todd V. Strategies for Equity in Community Response to Out-of-Hospital Cardiac Arrest. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.05.154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Howie G, Dicker B, Todd V, Tunnage B, Swain A, Smith T. Ethnic Differences in Direct Transport to PCI-Capable Hospitals Following OHCA. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.05.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Howie G, Conaglen K, Dicker B. Ethnicity and survival from out-of-hospital cardiac arrest: A New Zealand registry study. Resuscitation 2018. [DOI: 10.1016/j.resuscitation.2018.07.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Dicker B, Conaglen K, Howie G. Gender and survival from out-of-hospital cardiac arrest: a New Zealand registry study. Emerg Med J 2018; 35:367-371. [DOI: 10.1136/emermed-2017-207176] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 03/07/2018] [Accepted: 03/21/2018] [Indexed: 11/03/2022]
Abstract
ObjectiveTo determine the relationships between survival from all-cause out-of-hospital cardiac arrest (OHCA) and gender in New Zealand.MethodsA retrospective observational study was conducted using data compliant with the Utstein guidelines from the St John New Zealand OHCA Registry for adult patients who were treated for an OHCA between 1 October 2013 and 30 September 2015. Univariate logistic regression was used to investigate factors associated with return of spontaneous circulation sustained to handover at hospital and survival to 30 days. Multivariate logistic regression models were used to investigate outcome differences in survival according to gender at 30 days postevent.ResultsWomen survived to hospital handover in 29% of cases, which was not significantly different from men (31%). When adjusted for age, location, aetiology, initial rhythm and witnessed status, there was no significant difference in 30-day survival between men (16%) and women (13%) (adjusted OR 1.22, 95% CI (0.96 to 1.55), p=0.11).ConclusionNo statistical differences were found in 30-day survival between genders when adjustments for unfavourable Utstein variables were accounted for.
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Christie A, Costa-Scorse B, Nicholls M, Jones P, Howie G. Accuracy of working diagnosis by paramedics for patients presenting with dyspnoea. Emerg Med Australas 2016; 28:525-30. [PMID: 27397643 DOI: 10.1111/1742-6723.12618] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 04/06/2016] [Accepted: 04/17/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The present study aims to determine the agreement between paramedic and ED or hospital working diagnosis in dyspnoeic patients. METHODS Non-consecutive written patient report forms were retrospectively audited for patients suffering from dyspnoea, who were transported to a tertiary hospital ED by ambulance paramedics. Accuracy of the paramedic working diagnosis was assessed by comparing agreement with either the primary or secondary ED diagnoses or hospital discharge diagnosis. RESULTS The study cohort was 293 patients. Exact agreement between paramedic versus ED or hospital diagnosis was 64%, 95% CI 58-69, k = 0.58, 95% CI 0.52-0.64. Only 226 (77%) had a 'clearly documented' paramedic diagnosis. Among these, agreement with either ED or hospital diagnosis was 79%, and there was a trend towards more agreement as paramedic level of practice increased (74%, 78% and 87% for Basic, Intermediate and ALS paramedics, respectively, P = 0.07). Conversely, ALS paramedics were less likely to document a working diagnosis (30/98, 31%) compared with Intermediate (22/102, 23%) and BLS paramedics (15/93, 16%), P = 0.008. Diagnostic agreement varied according to medical condition, from anaphylaxis (100%) and asthma (86%) to acute pulmonary oedema (46%). CONCLUSIONS There was moderate agreement between paramedic and ED or hospital diagnosis. The number of cases with no clearly documented working diagnosis suggested that a singular working diagnosis may not always serve the complexity of presentation of some dyspnoea patients: more open descriptors such as 'mixed disease' or 'atypical features' should be encouraged.
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Affiliation(s)
| | - Brenda Costa-Scorse
- Discipline of Paramedicine, School of Clinical Sciences, Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand
| | - Mike Nicholls
- Emergency Department, Auckland City Hospital, Auckland, New Zealand
| | - Peter Jones
- Emergency Department, Auckland City Hospital, Auckland, New Zealand
| | - Graham Howie
- Discipline of Paramedicine, School of Clinical Sciences, Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand.
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Davis P, Ruygrok P, Jennison S, Howard R, Howie G. Paramedic-initiated Helivac to Tertiary Hospital for Primary Percutaneous Coronary Intervention: A Strategy for Improving Treatment Delivery Times. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Davis P, Ruygrok P, Howard R, Howie G. Paramedic initiated helivac to tertiary hospital for primary percutaneous coronary intervention: Initial experience and outcomes. Heart Lung Circ 2014. [DOI: 10.1016/j.hlc.2014.04.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Goldberg D, Brown G, Hutchinson S, Dillon J, Taylor A, Howie G, Ahmed S, Roy K, King M. Hepatitis C action plan for Scotland: phase II (May 2008-March 2011). ACTA ACUST UNITED AC 2008; 13. [PMID: 18761968 DOI: 10.2807/ese.13.21.18876-en] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- D Goldberg
- Health Protection Scotland, Glasgow, Scotland.
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Norinkavich KM, Howie G, Cariofiles P. Quality improvement study of day surgery for tonsillectomy and adenoidectomy patients. Pediatr Nurs 1995; 21:341-4. [PMID: 7644281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Ongoing efforts to contain costs in health care have had an impact on the delivery of care in the ambulatory setting. Many patients previously admitted to the hospital for an overnight stay are now discharged home within hours of surgery. In response to concerns raised by nursing staff about same-day discharge of patients undergoing tonsillectomy and adenoidectomy (T&A), a quality improvement (QI) study was conducted. Data from more than 150 families over a 2-year period were collected, using the clinical indicator of safe discharge. The data were obtained during the patient's recovery room stay, the first post-operative day, and 2 weeks after surgery. Findings suggested that some of the teaching done by nurses was useful and some needed revision to meet patients' needs. Changes regarding pain management, fluid management, and post-operative bleeding were addressed.
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Howie G, Carter H. Survey of the implementation of workplace alcohol and smoking policies among employers in Fife. Health Bull (Edinb) 1992; 50:151-5. [PMID: 1517088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A survey of major employers in Fife shows that at present 33% of respondents have implemented written alcohol policies, while 40% have implemented written smoking policies. A total of 19% have both alcohol and smoking policies in place. The initiative for policy development appears to have arisen mainly from management, but trade unions and management have co-operated well during policy formulation. The majority of policies have been implemented for more than three years. A small number of companies in Fife appear to be interested in the development and implementation of written alcohol and smoking policies in the workplace.
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Affiliation(s)
- G Howie
- Fife Health Board, Glenrothes
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Schneider LC, Insel RA, Howie G, Madore DV, Geha RS. Response to a Haemophilus influenzae type b diphtheria CRM197 conjugate vaccine in children with a defect of antibody production to Haemophilus influenzae type b polysaccharide. J Allergy Clin Immunol 1990; 85:948-53. [PMID: 2332568 DOI: 10.1016/0091-6749(90)90082-f] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A defect in antibody response to immunization with Haemophilus influenzae type b (Hib) capsular polysaccharide vaccine has been reported in children with recurrent infections and normal immunoglobin levels. We identified 15 children, aged 2 to 6 years, with this defect, and we evaluated their response to immunization with an Hib capsular oligosaccharide diphtheria CRM197 protein-conjugate vaccine (HbOC). The children received a series of three vaccines: HbOC at 0 and 8 weeks, and the Hib polysaccharide vaccine at 16 weeks. Levels of antibody to the Hib capsular polysaccharide (polyribosyl ribitol phosphate, PRP) and to diphtheria toxoid were obtained before and 4 weeks after each vaccination. The geometric mean serum anti-PRP concentration was 0.17 microgram/ml before immunization and 29.3 micrograms/ml after the second HbOC immunization (week 12). All 15 children had postvaccination anti-PRP antibody levels greater than 1.0 microgram/ml after receiving the second HbOC (week 12). In addition, booster responses were observed after the second Hib conjugate in 13 of the patients and after the Hib polysaccharide in four of the patients. All patients with low preimmunization diphtheria titers had a response to the diphtheria toxoid. These results suggest that conjugation of Hib polysaccharide with diphtheria CRM197 overcomes the defective antibody response to Hib oligosaccharide in children who are initially observed with recurrent infections and inability to respond to the Hib polysaccharide vaccine.
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Affiliation(s)
- L C Schneider
- Division of Immunology, Children's Hospital, Boston, MA 02115
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Ambrosino DM, Umetsu DT, Siber GR, Howie G, Goularte TA, Michaels R, Martin P, Schur PH, Noyes J, Schiffman G. Selective defect in the antibody response to Haemophilus influenzae type b in children with recurrent infections and normal serum IgG subclass levels. J Allergy Clin Immunol 1988; 81:1175-9. [PMID: 3259962 DOI: 10.1016/0091-6749(88)90887-1] [Citation(s) in RCA: 70] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We studied 15 children with recurrent infections and normal serum IgG, IgM, IgA, and IgG-subclass levels. After immunization, the geometric mean serum IgG antibody concentration to Haemophilus influenzae type b (Hib) was eightfold lower than that of age-matched control subjects (p = 0.002). The patients also had a lower geometric mean concentration of serum IgM and IgA directed to Hib, although these differences did not reach significance. However, the groups did not differ in their response to diphtheria toxoid and pneumococcal polysaccharides. To confirm these findings, an additional 11 patients were identified and immunized. The geometric mean serum IgG anti-Hib concentration for this group of patients was also significantly lower than of normal subjects (p = 0.004). We propose that the defect in the antibody response to Hib may be a marker for a poor antibody response to a variety of bacterial and viral antigens that results in an increased propensity to recurrent infections. The defect was not associated with IgG-subclass deficiency. The identification of children with selective antibody deficiency and recurrent infections is important for diagnostic and therapeutic reasons.
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Affiliation(s)
- D M Ambrosino
- Laboratory of Infectious Diseases, Dana-Farber Cancer Institute, Boston, MA 02115
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Spence VA, Kester RC, Howie G, Walker WF. Current status of thermography in peripheral vascular disease. J Cardiovasc Surg (Torino) 1975; 16:572-9. [PMID: 1194342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Abstract
Sixty-three girls with covert bacteriuria were included in a controlled trial of therapy. Recurrent infection in the treated group was common and was not significantly different from the rate of persistent infection in the untreated control group. Two children in each group developed clinical pyelonephritis; the others have remained healthy and all of them have a normal rate of growth. 2 years after diagnosis three of the thirty-four children in the control group and one of twenty-six children in the treated group have radiological evidence of new scars of pyelonephritis. These changes were relatively minor and in both groups of children renal growth was similar to that in normal children. It is suggested that for most of these children therapy is not essential, and that when renal changes occur they are of little or no significance. Prescriptive screening for cobert bacteriuria of childhood cannot be recommended at present.
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