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Richards H, Rajaram G, Lamblin M, Knott J, Connolly O, Hetrick S, Robinson J. Staff perceptions of barriers to self-harm care in the emergency department: A cross-sectional survey study. Australas Emerg Care 2024; 27:15-20. [PMID: 37516604 DOI: 10.1016/j.auec.2023.07.002] [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: 02/28/2023] [Revised: 07/12/2023] [Accepted: 07/16/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Emergency departments (EDs) are often the first point of contact for people with self-harm; however, they do not always receive optimal care. The study objective was to examine the perspectives of ED staff who respond to self-harm presentations, perceived barriers to providing optimal, guideline-concordant care, and staff's familiarity with existing guidelines. METHODS An online cross-sectional survey comprising purpose-designed questions concerning self-harm in the ED was completed by 131 staff (83.2% nurses) from two hospitals in Victoria, Australia. Survey results were analysed using Stata version 16 and frequencies and percentages were calculated. RESULTS Respondents reported knowledge of how to appropriately manage a person presenting with self-harm. However, lack of space (62.3%) and time (78.7%) to conduct the appropriate assessments, lack of self-harm training (71.8%), and limited awareness of or access to guidelines and recommendations for self-harm management within the ED (63.6%), were identified as primary barriers to their ability to appropriately manage these presenters. CONCLUSIONS Improvements to the ED environment and processes, as well as the provision of regular self-harm specific education and training for all ED staff are needed. Implementation of best-practice standards should prioritise guideline-concordant care, with a particular focus on the education needs of nursing staff.
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Affiliation(s)
- Hannah Richards
- Orygen, 35 Poplar Road, Parkville, VIC 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, VIC, Australia; Department of Medical Education, The University of Melbourne, VIC, Australia.
| | - Gowri Rajaram
- Orygen, 35 Poplar Road, Parkville, VIC 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, VIC, Australia; Department of Medical Education, The University of Melbourne, VIC, Australia
| | - Michelle Lamblin
- Orygen, 35 Poplar Road, Parkville, VIC 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, VIC, Australia; Department of Medical Education, The University of Melbourne, VIC, Australia
| | - Jonathan Knott
- Royal Melbourne Hospital, VIC, Australia; Department of Critical Care, The University of Melbourne, VIC, Australia; Department of Medical Education, The University of Melbourne, VIC, Australia
| | | | - Sarah Hetrick
- Orygen, 35 Poplar Road, Parkville, VIC 3052, Australia; Department of Medical Education, The University of Melbourne, VIC, Australia; University of Auckland, Auckland, New Zealand
| | - Jo Robinson
- Orygen, 35 Poplar Road, Parkville, VIC 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, VIC, Australia; Department of Medical Education, The University of Melbourne, VIC, Australia
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Knott J, Engheta M, Michel J, Mixon T, Widmer RJ. Patient characteristics associated with acute kidney injury following coronary angiography. Proc AMIA Symp 2024; 37:382-387. [PMID: 38628321 PMCID: PMC11018084 DOI: 10.1080/08998280.2024.2301903] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 12/27/2023] [Indexed: 04/19/2024] Open
Abstract
Objective The objective of this study was to identify patient characteristics associated with acute kidney injury (AKI) post-coronary angiography with or without percutaneous coronary intervention. Methods This retrospective, single-center study analyzed 350 patients from October 1, 2017 to September 30, 2018. The primary endpoint was AKI, defined as a rise in creatinine >0.3 mg/dL within 48 hours of coronary angiography. Results AKI occurred in 41 of 350 patients (8.8%). Patients experiencing AKI had a higher incidence of hypertension (100%; P = 0.005), hyperlipidemia (98%; P = 0.001), diabetes mellitus (68%; P = 0.0005), and heart failure (37%; P = 0.0057). AKI occurred in 30 of 185 (16%) and 11 of 165 (6.7%) patients undergoing femoral and radial access, respectively. AKI incidence was not significantly affected by contrast dose (99 ± 9 vs 93 ± 3 mL; P = 0.52), fluoroscopy time (10.3 min [IQR 6.3, 17.7] vs 8.5 min [IQR 4.5, 13.9]; P = 0.2), or preprocedural computed tomography with contrast (P = 0.66). Multivariable regression showed significantly higher AKI among patients with peripheral artery disease (odds ratio [OR] = 12.4; 95% confidence interval [CI] 3.4-33.6; P = 0.0001), multivessel coronary artery disease (OR = 11.9; 95% CI 2.3-61.1; P = 0.003), and initial creatinine >1.5 mg/dL (OR = 4.4; 95% CI 1.4-13.6; P = 0.01). Conclusion Peripheral artery disease, multivessel disease, and creatinine >1.5 mg/dL were associated with a higher risk of AKI in patients undergoing coronary angiography in this single-center retrospective cohort.
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Affiliation(s)
- Jonathan Knott
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael Engheta
- Division of Cardiology, Department of Internal Medicine, Baylor Scott & White Medical Center, Temple, Texas, USA
| | - Jeffery Michel
- Division of Cardiology, Department of Internal Medicine, Baylor Scott & White Medical Center, Temple, Texas, USA
| | - Timothy Mixon
- Division of Cardiology, Department of Internal Medicine, Baylor Scott & White Medical Center, Temple, Texas, USA
| | - R. Jay Widmer
- Division of Cardiology, Department of Internal Medicine, Baylor Scott & White Medical Center, Temple, Texas, USA
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Syrjanen R, Greene SL, Weber C, Smith JL, Hodgson SE, Abouchedid R, Gerostamoulos D, Maplesden J, Knott J, Hollerer H, Rotella JA, Graudins A, Schumann JL. Characteristics and time course of benzodiazepine-type new psychoactive substance detections in Australia: results from the Emerging Drugs Network of Australia - Victoria project 2020-2022. Int J Drug Policy 2023; 122:104245. [PMID: 37944339 DOI: 10.1016/j.drugpo.2023.104245] [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: 06/11/2023] [Revised: 09/28/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION The emergence of benzodiazepine-type new psychoactive substances (NPSs) are a growing international public health concern, with increasing detections in drug seizures and clinical and coronial casework. This study describes the patterns and nature of benzodiazepine-type NPS detections extracted from the Emerging Drugs Network of Australia - Victoria (EDNAV) project, to better characterise benzodiazepine-type NPS exposures within an Australian context. METHODS EDNAV is a state-wide illicit drug toxicosurveillance project collecting data from patients presenting to an emergency department with illicit drug-related toxicity. Patient blood samples were screened for illicit, pharmaceutical and NPSs utilising liquid chromatography-tandem mass spectrometry. Demographic, clinical, and analytical data was extracted from the centralised registry for cases with an analytical confirmation of a benzodiazepine-type NPS(s) between September 2020-August 2022. RESULTS A benzodiazepine-type NPS was detected in 16.5 % of the EDNAV cohort (n = 183/1112). Benzodiazepine-type NPS positive patients were predominately male (69.4 %, n = 127), with a median age of 24 (range 16-68) years. Twelve different benzodiazepine-type NPSs were detected over the two-year period, most commonly clonazolam (n = 82, 44.8 %), etizolam (n = 62, 33.9 %), clobromazolam (n = 43, 23.5 %), flualprazolam (n = 42, 23.0 %), and phenazepam (n = 31, 16.9 %). Two or more benzodiazepine-type NPSs were detected in 47.0 % of benzodiazepine-type NPS positive patients. No patient referenced the use of a benzodiazepine-type NPS by name or reported the possibility of heterogenous product content. CONCLUSION Non-prescription benzodiazepine use may be an emerging concern in Australia, particularly amongst young males. The large variety of benzodiazepine-type NPS combinations suggest that consumers may not be aware of product heterogeneity upon purchase or use. Continued monitoring efforts are paramount to inform harm reduction opportunities.
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Affiliation(s)
- Rebekka Syrjanen
- Monash University, Department of Forensic Medicine, Southbank, Victoria, Australia; Austin Health, Victorian Poisons Information Centre, Austin Hospital, Heidelberg, Victoria, Australia
| | - Shaun L Greene
- Austin Health, Victorian Poisons Information Centre, Austin Hospital, Heidelberg, Victoria, Australia; Austin Health, Emergency Department, Austin Hospital, Heidelberg, Victoria, Australia; The University of Melbourne, Melbourne Medical School, Department of Critical Care, Parkville, Victoria, Australia.
| | - Courtney Weber
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Australia; East Metropolitan Health Service, Department of Health, Perth, Australia
| | - Jennifer L Smith
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Australia; East Metropolitan Health Service, Department of Health, Perth, Australia
| | - Sarah E Hodgson
- Austin Health, Victorian Poisons Information Centre, Austin Hospital, Heidelberg, Victoria, Australia; Austin Health, Emergency Department, Austin Hospital, Heidelberg, Victoria, Australia
| | - Rachelle Abouchedid
- Austin Health, Victorian Poisons Information Centre, Austin Hospital, Heidelberg, Victoria, Australia; Bendigo Health, Emergency Department, Bendigo Hospital, Bendigo, Victoria, Australia
| | - Dimitri Gerostamoulos
- Monash University, Department of Forensic Medicine, Southbank, Victoria, Australia; Victorian Institute of Forensic Medicine, Toxicology Department, Southbank, Victoria, Australia
| | - Jacqueline Maplesden
- St Vincent's Hospital Melbourne, Emergency Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Jonathan Knott
- The University of Melbourne, Melbourne Medical School, Department of Critical Care, Parkville, Victoria, Australia; Melbourne Health, Emergency Department, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Hans Hollerer
- Western Health, Emergency Department, Footscray Hospital, Footscray, Victoria, Australia
| | - Joe-Anthony Rotella
- Austin Health, Victorian Poisons Information Centre, Austin Hospital, Heidelberg, Victoria, Australia; The University of Melbourne, Melbourne Medical School, Department of Critical Care, Parkville, Victoria, Australia; Northern Health, Emergency Department, The Northern Hospital, Epping, Victoria, Australia
| | - Andis Graudins
- Monash Health, Monash Toxicology Unit, Emergency Service, Dandenong Hospital, Dandenong, Victoria, Australia; Monash University, Department of Medicine, Clinical Sciences at Monash Health, FMNHS
| | - Jennifer L Schumann
- Monash University, Department of Forensic Medicine, Southbank, Victoria, Australia; Victorian Institute of Forensic Medicine, Toxicology Department, Southbank, Victoria, Australia; Monash University, Monash Addiction Research Centre, Frankston, Victoria, Australia
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Moon F, Knott J, Feely S. Examining management plans for patients who frequently presented to the emergency department. Australas Emerg Care 2023:S2588-994X(23)00081-7. [PMID: 37923610 DOI: 10.1016/j.auec.2023.10.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Patients who frequently present to Emergency Department (ED) experience complex health and social needs. While research has examined interventions that aim to decrease frequent ED attendances, there is a need to understand the types of interventions provided to patients by hospital clinicians during presentations. METHODS Using qualitative content analysis, 82 management plans were evaluated to understand the scope and type of interventions provided by clinicians for patients frequently presenting to the ED at the Royal Melbourne Hospital, Australia. RESULTS Patients often presented to the ED due to mental and psychological distress, substance use and physical health concerns alongside psychosocial vulnerabilities. The goals of care documented in plans focussed on management of health issues, aggression within the ED, and coordinating care with community services. Recommended interventions addressed presenting needs with multi-disciplinary approach to respond to distress and aggression. Finally, the plans provided insight into service coordination dynamics between the ED and community-based health and social care services. CONCLUSIONS The plans recommended interventions that sought to provide holistic care for patients in collaboration with relevant community-based services. The findings suggest that clinicians in the ED can provide appropriate and meaningful care for patients who experience frequent presentations.
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Affiliation(s)
- Felicity Moon
- Emergency Department, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC 3050, Australia.
| | - Jonathan Knott
- Emergency Department, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC 3050, Australia; Department of Critical Care, University of Melbourne, Grattan Street, Parkville, VIC 3050, Australia
| | - Siobhan Feely
- Emergency Department, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC 3050, Australia
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Woliansky J, Gumm K, Clark N, Knott J, Read DJ. Drug and alcohol intoxication in major trauma: Associations, trends and outcomes over a decade. Emerg Med Australas 2023; 35:792-798. [PMID: 37156569 DOI: 10.1111/1742-6723.14231] [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: 11/29/2022] [Revised: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVES Drug and alcohol intoxication is common among injured patients altering trauma presentation and characteristics. However, uncertainty exists regarding the effect of intoxication on injury severity, as well as outcomes. The present study aims to provide an update on substance-use patterns and their association with traumatic presentation and outcome within a contemporary Australian context. METHODS All major trauma patients captured in our centre's Trauma Registry between July 2010 and June 2020 were included. Demographic, injury characteristic, outcome and substance-use data were collected. Differences in injury severity and characteristics were explored using χ2 tests, while outcomes were modelled using adjusted binomial logistic regression. RESULTS Among 9700 patients, 9% were drug-intoxicated prior to injury, while 9.4% were alcohol-intoxicated. Drug use almost tripled between 2010 (4.8%) and 2020 (13.3%), while alcohol intoxication fell, from 11.7% to 7.3%, over the same period. Although there were significant differences in trauma mechanism among intoxicated patients, group comparison found no difference in Injury Severity Score for any group. Regarding outcomes, all intoxication resulted in significantly greater odds (odds ratio 1.62-2.41) of ICU admission. No difference in mortality was found among individual substance-use groups; however, polysubstance-intoxicated patients had 3.52 times greater odds of dying (95% confidence interval 1.21-10.23) compared to non-intoxicated patients. CONCLUSION Within this contemporary Australian population, we demonstrate escalating rates of drug intoxication and declining rates of alcohol intoxication prior to trauma. Intoxication was associated with more frequent violent and non-accidental injury, and despite no difference in severity, it was associated with worse outcomes.
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Affiliation(s)
- Jonathan Woliansky
- Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Kellie Gumm
- Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Nico Clark
- Addiction Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Jonathan Knott
- Department of Emergency Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - David J Read
- Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
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6
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Witt K, Rajaram G, Lamblin M, Knott J, Dean A, Spittal MJ, Carter G, Page A, Pirkis J, Robinson J. Characteristics of self-harm presentations to the emergency department of the Royal Melbourne Hospital, 2012-2019: Data from the Self-Harm Monitoring System for Victoria. Australas Emerg Care 2023; 26:230-238. [PMID: 36710228 DOI: 10.1016/j.auec.2023.01.003] [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: 09/26/2022] [Revised: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND Rates of self-harm and suicide are increasing world-wide, particularly in young females. Emergency departments (EDs) are a common first point-of-contact for young people who self-harm. We examined age- and sex-related differences in: (1) rates of self-harm over an eight-year period; (2) changes in demographic, presentation, and treatment characteristics over this period, and; (3) rates of, and time to, self-harm re-presentation. METHODS This was a retrospective observational study of all self-harm presentations in persons aged nine years and older to the Royal Melbourne Hospital ED over an eight-year period, 1 January 2012-31 December 2019. The Royal Melbourne Hospital is one of the largest and busiest public EDs in Melbourne, Australia and serves a primary catchment area of approximately 1.5 million people. RESULTS There were 551,692 presentations to the Royal Melbourne Hospital ED over this period (57.6 % by females). Of these, 7736 (1.4 %) were self-harm related. These self-harm presentations involved 5428 individuals (54.8 % female), giving an overall repetition event-rate of 11.2 %. Self-harm related presentations increased by 5 % per year (Incidence Rate Ratio [IRR 1.05, 95 % CI 1.02-1.08); a 44 % increase over the eight-year period (IRR 1.44, 95 % CI 1.15-1.80). This increase was more pronounced for young people aged< 25 years. The most common method was self-poisoning, primarily by anxiolytics or analgesics. The proportion of presentations involving self-poisoning alone declined modestly over time, whilst the proportion involving self-injury alone increased. For just over half of all presentations the person was seen by ED mental health staff. The median time to first re-presentation was 4.5 months (Inter-Quartile Range [IQR] 0.7-13.2 months). CONCLUSIONS Rates of hospital presenting self-harm may be increasing, particularly amongst young people, whilst most self-harm presentations occurred outside office hours; so appropriate ED staffing, training and clinical care models are needed. Around half of those with a repeat episode of self-harm repeated within three months of their index (i.e., first recorded) presentation. Efforts to establish appropriate aftercare services, including alternatives to ED services with service availability 24 h a day 7 days a week, aimed at reducing repetition rates, should be prioritised.
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Affiliation(s)
- Katrina Witt
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.
| | - Gowri Rajaram
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Michelle Lamblin
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Jonathan Knott
- Emergency Department, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Angela Dean
- Emergency Department, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Matthew J Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Greg Carter
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University of Newcastle, Callaghan, New South Wales, Australia; Calvary Mater Newcastle, Waratah, New South Wales, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Jo Robinson
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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7
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Syrjanen R, Schumann J, Fitzgerald J, Gerostamoulos D, Abouchedid R, Rotella JA, Knott J, Maplesden J, Hollerer H, Hannon L, Bourke E, Hodgson SE, Greene SL. The Emerging Drugs Network of Australia - Victoria Clinical Registry: A state-wide illicit substance surveillance and alert network. Emerg Med Australas 2023; 35:82-88. [PMID: 36053993 DOI: 10.1111/1742-6723.14059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/28/2022] [Revised: 07/11/2022] [Accepted: 07/26/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES With an increasingly dynamic global illicit drug market, including the emergence of novel psychoactive substances, many jurisdictions have moved to establish toxicosurveillance systems to enable timely detection of harmful substances in the community. This paper describes the methodology for the Emerging Drugs Network of Australia - Victoria (EDNAV) project, a clinical registry focused on the collection of high-quality clinical and analytical data from ED presentations involving illicit drug intoxications. Drug intelligence collected from the project is utilised by local health authorities with the aim to identify patterns of drug use and emerging drugs of concern. METHODS The project involves 10 public hospital EDs in Victoria, Australia. Patients 16 years and over, presenting to a network ED with a suspected illicit drug-related toxicity and a requirement for venepuncture are eligible for inclusion in the study under a waiver of consent. Clinical and demographic parameters are documented by site-based clinicians and comprehensive toxicological analysis is conducted on patient blood samples via specialised forensic services. All data are then deidentified and compiled in a project specific database. RESULTS Cases are discussed in weekly multidisciplinary team meetings, with a view to identify potentially harmful substances circulating in the community. High-risk signals are escalated to key stakeholders to produce timely and proportionate public health alerts with a focus on harm minimisation. CONCLUSIONS The EDNAV project represents the first centralised system providing near real-time monitoring of community drug use in Victoria and is fundamental in facilitating evidence-based public health intervention.
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Affiliation(s)
- Rebekka Syrjanen
- Victorian Institute of Forensic Medicine, Melbourne, Victoria, Australia.,Department of Forensic Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jennifer Schumann
- Victorian Institute of Forensic Medicine, Melbourne, Victoria, Australia.,Department of Forensic Medicine, Monash University, Melbourne, Victoria, Australia.,Monash Addiction Research Centre, Monash University, Melbourne, Victoria, Australia
| | - John Fitzgerald
- Department of Criminology, School of Social and Political Sciences, Faculty of Arts, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dimitri Gerostamoulos
- Victorian Institute of Forensic Medicine, Melbourne, Victoria, Australia.,Department of Forensic Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rachelle Abouchedid
- Emergency Department, Bendigo Hospital, Bendigo Health, Bendigo, Victoria, Australia.,Victorian Poisons Information Centre, Austin Hospital, Austin Health, Melbourne, Victoria, Australia
| | - Joe-Anthony Rotella
- Victorian Poisons Information Centre, Austin Hospital, Austin Health, Melbourne, Victoria, Australia.,Emergency Department, The Northern Hospital, Northern Health, Melbourne, Victoria, Australia.,Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jonathan Knott
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, The Royal Melbourne Hospital, Melbourne Health, Melbourne, Victoria, Australia
| | - Jacqueline Maplesden
- Emergency Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Hans Hollerer
- Emergency Department, Footscray Hospital, Western Health, Melbourne, Victoria, Australia
| | - Liam Hannon
- Emergency Department, Bendigo Hospital, Bendigo Health, Bendigo, Victoria, Australia
| | - Elyssia Bourke
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, Ballarat Base Hospital, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Sarah E Hodgson
- Victorian Poisons Information Centre, Austin Hospital, Austin Health, Melbourne, Victoria, Australia.,Emergency Department, Austin Hospital, Austin Health, Melbourne, Victoria, Australia
| | - Shaun L Greene
- Victorian Poisons Information Centre, Austin Hospital, Austin Health, Melbourne, Victoria, Australia.,Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, Austin Hospital, Austin Health, Melbourne, Victoria, Australia
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8
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De Michieli L, Knott J, Attia Z, Ola O, Akula A, Mehta R, Dworak M, Lobo R, Hodge D, Tak T, Cagin C, Friedman P, Gulati R, Jaffe A, Sandoval Y. Artificial intelligence-enabled electrocardiographic algorithm for the detection of left ventricular dysfunction in emergency department patients undergoing high-sensitivity cardiac troponin T. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Artificial intelligence-augmented electrocardiogram (AI-ECG) algorithms have been developed from the standard 12-lead ECG and validated for the recognition of left ventricular systolic dysfunction (LVSD), defined as LV ejection fraction (LVEF)≤35%. Whether AI-ECG facilitates identification of LVSD and is associated with adverse outcomes in emergency department (ED) patients undergoing high-sensitivity cardiac troponin (hs-cTnT) testing is uncertain.
Purpose
To investigate the diagnostic and prognostic performance of AI-ECG in ED patients undergoing hs-cTnT measurement.
Methods
Observational US cohort study of ED patients undergoing hs-cTnT measurement. Cases with hs-cTnT increases >sex-specific 99th percentiles were adjudicated following the Fourth Universal Definition of Myocardial Infarction (MI). Post-discharge major adverse cardiac events (MACE) included death, MI, heart failure (HF) hospitalization, stroke or transient ischemic attack, and new onset atrial fibrillation/flutter during 2-years follow-up. The AI-ECG network output, which is a continuous number between 0–1, that provides a probability of LVSD, was obtained for each patient from the first ECG during the index presentation. An AI-ECG threshold of ≥0.256 indicates a positive screen that correlates with a high probability of LVSD.
Results
Among 1977 patients, 1729 (87%) had a negative AI-ECG screen, while 248 (13%) had a positive AI-ECG screen. Patients with a positive AI-ECG screen were older and had more comorbidities. As compared to patients with hs-cTnT≤99th percentile in whom AI-ECG was positive in 5.8%, those with hs-cTnT>99th percentile had a positive AI-ECG in 22% of cases (p<0.0001). Based on adjudicated diagnoses, the frequency of a positive AI-ECG was 20% in myocardial injury, 38% in type 1 MI, and 20% in type 2 MI. At 2-years follow-up, as compared to patients with a negative AI-ECG, those with a positive AI-ECG had a higher risk for MACE (48% vs. 21%, p<0.0001, adjusted HR 1.39, 95% CI 1.11–1.75) (Figure 1), mainly because of more deaths (43% vs. 30%, p=0.004) and HF hospitalizations (36% vs. 13%, p<0.0001). A positive AI-ECG was associated with a higher risk for MACE (60% vs. 41%, p<0.0001, adjusted HR 1.30, 95% CI 1.02–1.64) in those with hs-cTnT increases >99th percentile, but not in those without hs-cTnT increases. Among patients with an echocardiogram during index presentation or within 30-days (n=452), the diagnostic accuracy of AI-ECG for LVEF ≤35% was 81.4% (95% CI 77.5, 84.9) with a negative predictive value of 96.5% (95% CI 94.0, 98.2). A normal LVEF (>50%) was observed in 87% of those with a negative AI ECG, whereas in those with a positive AI-ECG LVEF was reduced (<50%) in 60%.
Conclusions
Among ED patients evaluated with hs-cTnT, a positive AI-ECG screen for LVSD identifies patients at high risk of MACE. These findings are largely because of more deaths and HF hospitalizations in those with hs-cTnT increases >sex-specific 99th percentiles.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - J Knott
- Mayo Clinic , Rochester , United States of America
| | - Z Attia
- Mayo Clinic , Rochester , United States of America
| | - O Ola
- Franciscan Skemp Healthcare Mayo Health System , La Crosse , United States of America
| | - A Akula
- Franciscan Skemp Healthcare Mayo Health System , La Crosse , United States of America
| | - R Mehta
- Mayo Clinic , Rochester , United States of America
| | - M Dworak
- Franciscan Skemp Healthcare Mayo Health System , La Crosse , United States of America
| | - R Lobo
- Mayo Clinic , Rochester , United States of America
| | - D Hodge
- Mayo Clinic , Jacksonville , United States of America
| | - T Tak
- Franciscan Skemp Healthcare Mayo Health System , La Crosse , United States of America
| | - C Cagin
- Franciscan Skemp Healthcare Mayo Health System , La Crosse , United States of America
| | - P Friedman
- Mayo Clinic , Rochester , United States of America
| | - R Gulati
- Mayo Clinic , Rochester , United States of America
| | - A Jaffe
- Mayo Clinic , Rochester , United States of America
| | - Y Sandoval
- Mayo Clinic , Rochester , United States of America
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9
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Knott J, Ola OO, Michieli LD, Akula A, Mehta R, Dworak M, Crockford E, Lobo R, Rastas N, Karturi S, Wohlrab S, Hodge DO, Grube E, Tak T, Cagin CR, Gulati R, Jaffe AS, Sandoval Y. LONG-TERM MAJOR ADVERSE CARDIOVASCULAR OUTCOMES IN PATIENTS WITH MYOCARDIAL INJURY AND TYPE 1 AND 2 MYOCARDIAL INFARCTION. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02067-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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O'Reilly GM, Mitchell RD, Mitra B, Akhlaghi H, Tran V, Furyk JS, Buntine P, Wong A, Gangathimmaiah V, Knott J, Moore A, Ahn JR, Chan Q, Wang A, Goh H, Loughman A, Lowry N, Hackett L, Sri-Ganeshan M, Chapman N, Raos M, Noonan MP, Smit DV, Cameron PA. Outcomes for emergency department patients with suspected and confirmed COVID-19: An analysis of the Australian experience in 2020 (COVED-5). Emerg Med Australas 2021; 33:911-921. [PMID: 34312991 PMCID: PMC8420351 DOI: 10.1111/1742-6723.13837] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 12/24/2022]
Abstract
Objective 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. Methods 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. Results 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). Conclusions 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.
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Affiliation(s)
- Gerard M O'Reilly
- Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,National Trauma Research Institute, Alfred Health, Melbourne, Victoria, Australia
| | - Rob D Mitchell
- Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Biswadev Mitra
- Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,National Trauma Research Institute, Alfred Health, Melbourne, Victoria, Australia
| | - Hamed Akhlaghi
- Emergency Department, St Vincent's Hospital, Melbourne, Victoria, Australia.,Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Viet Tran
- Emergency Department, Royal Hobart Hospital, Hobart, Tasmania, Australia.,Tasmanian School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Jeremy S Furyk
- Emergency Department, Barwon Health, Geelong, Victoria, Australia.,School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Paul Buntine
- Emergency Department, Eastern Health, Melbourne, Victoria, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Anselm Wong
- Emergency Department, Austin Hospital, Melbourne, Victoria, Australia.,Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.,School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Vinay Gangathimmaiah
- Emergency Department, Townsville University Hospital, Townsville, Queensland, Australia
| | - Jonathan Knott
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Allison Moore
- Emergency Department, Sutherland Hospital, Sydney, New South Wales, Australia
| | - Jung Ro Ahn
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Quillan Chan
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Andrew Wang
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Han Goh
- Emergency Department, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Ashley Loughman
- Emergency Department, Royal Hobart Hospital, Hobart, Tasmania, Australia.,Ambulance Tasmania, Hobart, Tasmania, Australia
| | - Nicole Lowry
- Emergency Department, Barwon Health, Geelong, Victoria, Australia
| | - Liam Hackett
- Emergency Department, Eastern Health, Melbourne, Victoria, Australia
| | | | - Nicole Chapman
- Emergency Department, Townsville University Hospital, Townsville, Queensland, Australia
| | - Maximilian Raos
- Emergency Department, Sutherland Hospital, Sydney, New South Wales, Australia
| | - Michael P Noonan
- Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia.,National Trauma Research Institute, Alfred Health, Melbourne, Victoria, Australia.,Trauma Service, Alfred Health, Melbourne, Victoria, Australia
| | - De Villiers Smit
- Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,National Trauma Research Institute, Alfred Health, Melbourne, Victoria, Australia
| | - Peter A Cameron
- Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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11
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Knott J, Yap C, Mitra B, Gerdtz M, Daniel C, Braitberg G. Screening major trauma patients for prevalence of illicit drugs. Drug Alcohol Rev 2021; 41:285-292. [PMID: 34263497 DOI: 10.1111/dar.13355] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 06/21/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Australasian emergency departments (ED) routinely test patient alcohol levels following major trauma, but assessment for illicit drugs is uncommon. METHODS A prospective cross-sectional study of major motor-vehicle-related trauma patients attending both adult major trauma centres in Victoria, Australia. All eligible patients had point-of-care saliva testing to determine the prevalence of common illicit drugs. RESULTS Over 12 months, 1411 patients were screened, 36 refused (2.6%) and 63 were excluded. Of the final 1312 cases included, 173 (13.2%; 95% confidence interval 11.5, 15.1) tested positive to at least one illicit substance, with 133 (76.9%; 69.7, 82.8) positive for meth/amphetamines. One in five had more than one illicit substance detected. Patients testing positive were most frequently in motor vehicles (91.9% vs. 85.6%) and least frequently cyclists (2.3% vs. 4.2%) or pedestrians (5.2% vs. 10.3%), compared to those testing negative. They were younger (mean age 35.4 vs. 43.1 years), more likely to arrive overnight (27.2% vs. 12.1%) or after single vehicle crashes (54.3% vs. 42.3%). Although the initial disposition from ED did not differ, those testing positive were more likely to re-present within 28 days (13.9% vs. 5.4%). DISCUSSION AND CONCLUSIONS A high prevalence of potentially illicit substances among patients presenting with suspected major trauma supports the need for urgent preventive strategies. The low rate of patient refusal and large numbers screened by ED staff suggests that point-of care testing for illicit substances in major trauma is acceptable and feasible. This study and ongoing surveillance may be used to inform driver education strategies.
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Affiliation(s)
- Jonathan Knott
- Emergency Department, Royal Melbourne Hospital, Melbourne, Australia
| | - Celene Yap
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Biswadev Mitra
- Emergency Department, Alfred Hospital, Melbourne, Australia
| | - Marie Gerdtz
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Catherine Daniel
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - George Braitberg
- Department of Medicine, Royal Melbourne Hospital, Melbourne, Australia
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12
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Santamaria N, Gerdtz M, Liu W, Rakis S, Sage S, Ng AW, Tudor H, McCann J, Vassiliou T, Morrow F, Smith K, Knott J, Liew D. Clinical effectiveness of a silicone foam dressing for the prevention of heel pressure ulcers in critically ill patients: Border II Trial. J Wound Care 2021. [PMID: 32931366 DOI: 10.12968/jowc.2020.29.sup9a.s26] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
• OBJECTIVE Critically ill patients are at high risk of developing pressure ulcers (PU), with the sacrum and heels being highly susceptible to pressure injuries. The objective of our study was to evaluate the clinical effectiveness of a new multi-layer, self-adhesive soft silicone foam heel dressing to prevent PU development in trauma and critically ill patients in the intensive care unit (ICU). • METHOD A cohort of critically ill patients were enrolled at the Royal Melbourne Hospital. Each patient had the multi-layer soft silicone foam dressing applied to each heel on admission to the emergency department. The dressings were retained with a tubular bandage for the duration of the patients' stay in the ICU. The skin under the dressings was examined daily and the dressings were replaced every three days. The comparator for our cohort study was the control group from the recently completed Border Trial. • RESULTS Of the 191 patients in the initial cohort, excluding deaths, loss to follow-up and transfers to another ward, 150 patients were included in the final analysis. There was no difference in key demographic or physiological variables between the cohorts, apart from a longer ICU length of stay for our current cohort. No PUs developed in any of our intervention cohort patients compared with 14 patients in the control cohort (n=152; p<0.001) who developed a total of 19 heel PUs. • CONCLUSION We conclude, based on our results, that the multi-layer soft silicone foam dressing under investigation was clinically effective in reducing ICU-acquired heel PUs. The findings also support previous research on the clinical effectiveness of multi-layer soft silicone foam dressings for PU prevention in the ICU.
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Affiliation(s)
- N Santamaria
- University of Melbourne & Royal Melbourne Hospital
| | - M Gerdtz
- University of Melbourne & Royal Melbourne Hospital
| | - W Liu
- Adelphi University, New York
| | | | | | | | | | | | | | | | | | - J Knott
- University of Melbourne & Royal Melbourne Hospital
| | - D Liew
- University of Melbourne & Royal Melbourne Hospital
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13
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O'Reilly GM, Mitchell RD, Mitra B, Akhlaghi H, Tran V, Furyk JS, Buntine P, Wong A, Gangathimmaiah V, Knott J, Raos M, Chatterton E, Sevior C, Parker S, Baker S, Loughman A, Lowry N, Freeman D, Sri-Ganeshan M, Chapman N, Siu S, Noonan MP, Smit DV, Cameron PA. Epidemiology and clinical features of emergency department patients with suspected COVID-19: Insights from Australia's 'second wave' (COVED-4). Emerg Med Australas 2021; 33:331-342. [PMID: 33315310 DOI: 10.1111/1742-6723.13706] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE 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'. METHODS 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. RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- Gerard M O'Reilly
- Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,National Trauma Research Institute, Alfred Health, Melbourne, Victoria, Australia
| | - Robert D Mitchell
- Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Biswadev Mitra
- Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,National Trauma Research Institute, Alfred Health, Melbourne, Victoria, Australia
| | - Hamed Akhlaghi
- Emergency Department, St Vincent's Hospital, Melbourne, Victoria, Australia.,Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Viet Tran
- Emergency Department, Royal Hobart Hospital, Hobart, Tasmania, Australia.,Tasmanian School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Jeremy S Furyk
- Emergency Department, Barwon Health, Geelong, Victoria, Australia.,School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Paul Buntine
- Emergency Department, Eastern Health, Melbourne, Victoria, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Anselm Wong
- Emergency Department, Austin Hospital, Melbourne, Victoria, Australia.,Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.,School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Vinay Gangathimmaiah
- Emergency Department, Townsville University Hospital, Townsville, Queensland, Australia
| | - Jonathan Knott
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Max Raos
- Emergency Department, Sutherland Hospital, Sydney, New South Wales, Australia
| | - Erica Chatterton
- Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia.,School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia.,School of Nursing and Midwifery, Deakin University, Melbourne, Victoria, Australia
| | - Carolyne Sevior
- Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Sophie Parker
- Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia.,Department of Anaesthetics, Peter MacCallum Hospital, Melbourne, Victoria, Australia
| | - Samuel Baker
- Emergency Department, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Ashley Loughman
- Emergency Department, Royal Hobart Hospital, Hobart, Tasmania, Australia.,Ambulance Tasmania, Hobart, Tasmania, Australia
| | - Nicole Lowry
- Emergency Department, Barwon Health, Geelong, Victoria, Australia
| | - Dylan Freeman
- Emergency Department, Eastern Health, Melbourne, Victoria, Australia
| | | | - Nicole Chapman
- Emergency Department, Townsville University Hospital, Townsville, Queensland, Australia
| | - Sherman Siu
- Emergency Department, Sutherland Hospital, Sydney, New South Wales, Australia
| | - Michael P Noonan
- Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia.,National Trauma Research Institute, Alfred Health, Melbourne, Victoria, Australia.,Trauma Service, Alfred Health, Melbourne, Victoria, Australia
| | - De Villiers Smit
- Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,National Trauma Research Institute, Alfred Health, Melbourne, Victoria, Australia
| | - Peter A Cameron
- Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Graham CA, Simon EL, Knott J. Study design: A research primer for low- and middle-income countries. Afr J Emerg Med 2020; 10:S115-S119. [PMID: 33304793 PMCID: PMC7718464 DOI: 10.1016/j.afjem.2020.10.007] [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: 02/24/2020] [Revised: 09/06/2020] [Accepted: 10/11/2020] [Indexed: 11/26/2022] Open
Abstract
Study design is critical to ensure that research questions are answered in an appropriate and rational manner for all aspects of health, but particularly in emergency care. Appropriate study design selection is one of the most critical decisions to make at the earliest stage of a research project; once this is clear, much of the methodology and sample size estimations should be straightforward. Selection of an appropriate study design is fundamental to good research and deserves careful consideration at the outset of any research project. The classic gold standard for study design is the double-blind randomised clinical trial, but it is often not possible to achieve this ideal in the busy clinical emergency environment or with the resources available. Descriptive studies are common in emergency care; they include retrospective clinical records reviews, prospective cohort studies and case-control studies. Case reports and surveys can be a useful introduction to research for novice researchers. When sufficient empirical evidence on a topic exists, results of similar studies can be combined in systematic reviews and/or meta-analyses to pool the results from multiple studies to determine stronger evidence for or against an intervention or treatment, but these techniques require specialist expertise and statistical skills.
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Affiliation(s)
- Colin A. Graham
- Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong Special Administrative Region
- Corresponding author.
| | - Erin L. Simon
- Cleveland Clinic Akron General, Department of Emergency Medicine, Akron, OH, USA
- Northeast Ohio Medical University, Rootstown, OH, USA
| | - Jonathan Knott
- University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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15
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Rojek A, Dutch M, Peyton D, Pelly R, Putland M, Hiscock H, Knott J. Patients presenting for hospital-based screening for the coronavirus disease 2019: Risk of disease, and healthcare access preferences. Emerg Med Australas 2020; 32:809-813. [PMID: 32671974 PMCID: PMC7405479 DOI: 10.1111/1742-6723.13589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/03/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 01/08/2023]
Abstract
Objective Early during the coronavirus disease 2019 (COVID‐19) pandemic, Australian EDs experienced an unprecedented surge in patients seeking screening. Understanding what proportion of these patients require testing and who can be safely screened in community‐based models of care is critical for workforce and infrastructure planning across the healthcare system, as well as public messaging campaigns. Methods In this cross‐sectional survey, we screened patients presenting to a COVID‐19 screening clinic in a tertiary ED. We assessed the proportion of patients who met testing criteria; self‐reported symptom severity; reasons why they came to the ED for screening and views on community‐based care. Results We include findings from 1846 patients. Most patients (55.3%) did not meet contemporaneous criteria for testing and most (57.6%) had mild or no (13.4%) symptoms. The main reason for coming to the ED was being referred by a telephone health service (31.3%) and 136 (7.4%) said they tried to contact their general practitioner but could not get an appointment. Only 47 (2.6%) said they thought the disease was too specialised for their general practitioner to manage. Conclusions While capacity building in acute care facilities is an important part of pandemic planning, it is also important that patients not needing hospital level of care can be assessed and treated elsewhere. We have identified a significant proportion of people at this early stage in the pandemic who have sought healthcare at hospital but who might have been assisted in the community had services been available and public health messaging structured to guide them there.
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Affiliation(s)
- Amanda Rojek
- Emergency Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Martin Dutch
- Emergency Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Daniel Peyton
- Health Services Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rachel Pelly
- Health Services Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Mark Putland
- Emergency Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Harriet Hiscock
- Health Services Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Health Services Research Unit, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Jonathan Knott
- Emergency Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
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16
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Affiliation(s)
- Martin Dutch
- Emergency Department Royal Melbourne Hospital Parkville Victoria Australia
| | - Jonathan Knott
- Clinical Sub‐Dean (Emergency Medicine) University of Melbourne Melbourne Victoria Australia
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17
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Walker K, Tan SI, Fatovich D, Watkins G, Stephenson M, Ting J, Whittome R, Wang W, Knott J. Research capacity of Australian and New Zealand emergency medicine departments. Int J Emerg Med 2020; 13:16. [PMID: 32293255 PMCID: PMC7161130 DOI: 10.1186/s12245-020-00275-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 02/11/2020] [Accepted: 03/31/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Large, multicentre studies are required in emergency medicine to advance clinical care and improve patient outcomes. The Australasian College for Emergency Medicine clinical trials network is available to researchers to assist with facilitating large, multicentre research. However, there is no current information about the research capacity of emergency departments (EDs) in Australia and New Zealand. METHODS All EDs accredited for emergency medicine training in Australia and New Zealand were eligible to participate. Research leads or ED directors were invited via email and telephone to complete a survey. Data were collected regarding the presence of a research lead; their research experience; available research resources including colleagues, funding, departmental paid research time; publications; and research culture. RESULTS One hundred and twelve responses were received on behalf of 122 (84%) sites (10 satellite plus main) from a possible 143 sites with all types of hospitals and regions represented. Research leads were identified at 66 (59%) sites; 32 (29%) had a director of emergency medicine research. A wide range of research was underway. Ninety-six sites (66%) contributed data to multicentre projects. Twenty-one centres (17%) were highly productive with multiple resources (skilled colleagues, funding, staffing), a positive research culture and high-volume output. Sixty to seventy centres (50-58%) had limited resources, experienced an unsupportive research culture and authored manuscripts infrequently. Paid time for research directors was associated with increased research outputs. DISCUSSION ACEM sites have the capacity to undertake large multicentre studies with a varied network of sites and researchers. While some sites are well equipped for research, the majority of EDs had minimal research output.
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Affiliation(s)
- Katie Walker
- Emergency Department, Cabrini, 183 Wattletree Rd, Malvern, Melbourne, Victoria, 3144, Australia. .,Health Services, Monash University, Melbourne, Victoria, 3004, Australia.
| | - Shijie Ian Tan
- Emergency Department, Cabrini, 183 Wattletree Rd, Malvern, Melbourne, Victoria, 3144, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Building 15, 27 Rainforest Walk, Clayton Campus, Wellington Rd, Clayton, Victoria, 3800, Australia.,Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore, 609606, Singapore
| | - Daniel Fatovich
- Department of Emergency Medicine, Royal Perth Hospital, GPO Box X2213, Perth, 6001, Western Australia.,Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, University of Western Australia, Perth, 6001, Australia
| | - Gina Watkins
- Emergency Department, Sutherland Hospital, Caringbah, Sydney, NSW, 2229, Australia.,School of Medicine, University of New South Wales, Sydney, New South Wales, 2052, Australia
| | - Melanie Stephenson
- Emergency Department, Cabrini, 183 Wattletree Rd, Malvern, Melbourne, Victoria, 3144, Australia.,Health Services, Monash University, Melbourne, Victoria, 3004, Australia.,Emergency Department, Austin Hospital, Heidelberg, Victoria, 3084, Australia
| | - Joseph Ting
- Mater Hospital, Raymond Terrace, South Brisbane, Queensland, 4101, Australia.,Ipswich Hospital, Chelmsford Ave, Ipswich, Queensland, 4305, Australia.,School of Public Health and Social Work, Queensland University of Technology, 2 George St, Brisbane City, Queensland, 4000, Australia
| | - Richard Whittome
- Australasian College for Emergency Medicine, West Melbourne, Victoria, 3003, Australia
| | - Wei Wang
- Cabrini Institute, 154 Wattletree Rd, Malvern, Victoria, 3144, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia
| | - Jonathan Knott
- Emergency Department, Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria, 3050, Australia.,Melbourne Medical School, University of Melbourne, Grattan Street, Melbourne, Victoria, 3010, Australia
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18
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Chavda R, Knott J, Virani S, Zamin S, Saenz A. Abstract No. 677 Reduced right heart dysfunction following pulmonary embolism treated with catheter-directed therapy: a retrospective study. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.801] [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: 10/25/2022] Open
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19
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Knott J, Gerdtz M, Dobson S, Daniel C, Graudins A, Mitra B, Bartley B, Chapman P. Restrictive interventions in Victorian emergency departments: A study of current clinical practice. Emerg Med Australas 2019; 32:393-400. [DOI: 10.1111/1742-6723.13412] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 07/21/2019] [Accepted: 10/17/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Jonathan Knott
- Emergency DepartmentThe Royal Melbourne Hospital Melbourne Victoria Australia
- Faculty of Medicine, Dentistry and Health ScienceThe University of Melbourne Melbourne Victoria Australia
| | - Marie Gerdtz
- Emergency DepartmentThe Royal Melbourne Hospital Melbourne Victoria Australia
- Faculty of Medicine, Dentistry and Health ScienceThe University of Melbourne Melbourne Victoria Australia
| | - Sheriden Dobson
- Emergency DepartmentThe Royal Melbourne Hospital Melbourne Victoria Australia
- Faculty of Medicine, Dentistry and Health ScienceThe University of Melbourne Melbourne Victoria Australia
| | - Catherine Daniel
- Emergency DepartmentThe Royal Melbourne Hospital Melbourne Victoria Australia
- Faculty of Medicine, Dentistry and Health ScienceThe University of Melbourne Melbourne Victoria Australia
| | - Andis Graudins
- Emergency DepartmentDandenong Hospital Melbourne Victoria Australia
| | - Biswadev Mitra
- Emergency and Trauma CentreThe Alfred Hospital Melbourne Victoria Australia
| | - Bruce Bartley
- Emergency DepartmentUniversity Hospital Geelong Geelong Victoria Australia
| | - Pauline Chapman
- Emergency DepartmentBallarat Hospital Ballarat Victoria Australia
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Gerdtz MF, Kapp S, Michael E, Prematunga R, Virtue E, Knott J. An evaluation of the use of management care plans for people who frequently attend the emergency department. Australas Emerg Care 2019; 22:229-235. [PMID: 31501073 DOI: 10.1016/j.auec.2019.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 05/25/2019] [Revised: 08/16/2019] [Accepted: 08/16/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the use of management plans for people who frequently attend the emergency department (ED). BACKGROUND Management plans are used to decrease ED utilisation by people who frequently attend. There is limited evidence regarding the use management plans for this population and the perspectives of staff who use them has previously not been considered. DESIGN A descriptive observational design including before and after measures of attendance (November 2010 to September 2014) and survey of staff perceptions (July to November 2014). The setting was a major metropolitan hospital ED in Australia. METHODS The date for commencement of each plan was determined. Data were extracted regarding ED attendance 12 months before and after implementation. Staff perspectives were obtained via an online survey. RESULTS Fifty-seven patients made 1482 ED attendances. Of these 830 occurred in the 12 months before the management plan was implemented and 652 during the 12 months after. The number of attendances per patient decreased from a median of 11 to 4. Staff considered management plans to be beneficial to care planning practices and individual patient outcomes. CONCLUSIONS Management plans were acceptable to staff, and implementation of management plans was associated with a decrease in ED attendance.
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Affiliation(s)
- Marie Frances Gerdtz
- Royal Melbourne Hospital Emergency Department - Melbourne Health (study site), Australia; Department of Nursing, Melbourne School of Health Sciences, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Australia.
| | - Suzanne Kapp
- Department of Nursing, Melbourne School of Health Sciences, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Australia
| | - Elaine Michael
- Royal Melbourne Hospital Emergency Department - Melbourne Health (study site), Australia
| | - Roshani Prematunga
- Department of Nursing, Melbourne School of Health Sciences, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Australia
| | - Elizabeth Virtue
- Royal Melbourne Hospital Emergency Department - Melbourne Health (study site), Australia
| | - Jonathan Knott
- Royal Melbourne Hospital Emergency Department - Melbourne Health (study site), Australia; Integrated Centre for Critical Care Medicine, The University of Melbourne, Australia
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Kesiilwe AB, Lederman R, Dreyfus S, Kurnia S, Knott J. The Impact of Information Systems Use on Work Tasks and Work Practices in an Emergency Department. Stud Health Technol Inform 2019; 266:108-114. [PMID: 31397310 DOI: 10.3233/shti190781] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This paper describes the plan for the third stage of a longitudinal assessment of the progressive implementation of IS in an emergency department. The assessment adopts a case study approach with nested mixed methods where quantitative data will be collected through observations and qualitative data will be collected through focus group interviews. The findings from the study can inform the design of IS that is well aligned with the intended strategic outcomes of IS implementation in emergency medicine.
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Affiliation(s)
| | - Reeva Lederman
- School of Computing and Information Systems, The University of Melbourne, Australia
| | - Suelette Dreyfus
- School of Computing and Information Systems, The University of Melbourne, Australia
| | - Sherah Kurnia
- School of Computing and Information Systems, The University of Melbourne, Australia
| | - Jonathan Knott
- Department of Emergency Medicine, The Royal Melbourne Hospital, Australia
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Knott J, LaRue E, Ward S, McCallen E, Ordonez K, Wagner F, Jo I, Elliott J, Fei S. A roadmap for exploring the thematic content of ecology journals. Ecosphere 2019. [DOI: 10.1002/ecs2.2801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Jonathan Knott
- Department of Forestry and Natural Resources Purdue University West Lafayette Indiana 47907 USA
| | - Elizabeth LaRue
- Department of Forestry and Natural Resources Purdue University West Lafayette Indiana 47907 USA
| | - Samuel Ward
- Department of Forestry and Natural Resources Purdue University West Lafayette Indiana 47907 USA
| | - Emily McCallen
- Department of Forestry and Natural Resources Purdue University West Lafayette Indiana 47907 USA
| | - Kimberly Ordonez
- Department of Forestry and Natural Resources Purdue University West Lafayette Indiana 47907 USA
| | - Franklin Wagner
- Department of Forestry and Natural Resources Purdue University West Lafayette Indiana 47907 USA
| | - Insu Jo
- Department of Forestry and Natural Resources Purdue University West Lafayette Indiana 47907 USA
- Manaaki Whenua – Landcare Research Lincoln 7608 New Zealand
| | - Jessica Elliott
- Department of Forestry and Natural Resources Purdue University West Lafayette Indiana 47907 USA
| | - Songlin Fei
- Department of Forestry and Natural Resources Purdue University West Lafayette Indiana 47907 USA
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Voskoboinik A, Kalman E, Plunkett G, Knott J, Moskovitch J, Sanders P, Kistler PM, Kalman JM. A comparison of early versus delayed elective electrical cardioversion for recurrent episodes of persistent atrial fibrillation: A multi-center study. Int J Cardiol 2019; 284:33-37. [DOI: 10.1016/j.ijcard.2018.10.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 09/30/2018] [Accepted: 10/22/2018] [Indexed: 10/28/2022]
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24
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Ponsford J, Nguyen S, Downing M, Bosch M, McKenzie J, Turner S, Chau M, Mortimer D, Gruen R, Knott J, Green S. Factors associated with persistent post-concussion symptoms following mild traumatic brain injury in adults. J Rehabil Med 2019; 51:32-39. [DOI: 10.2340/16501977-2492] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Braitberg G, Gerdtz M, Harding S, Pincus S, Thompson M, Knott J. Behavioural assessment unit improves outcomes for patients with complex psychosocial needs. Emerg Med Australas 2017; 30:353-358. [DOI: 10.1111/1742-6723.12905] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 10/05/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022]
Affiliation(s)
- George Braitberg
- Emergency Department; The Royal Melbourne Hospital; Melbourne Victoria Australia
- Faculty of Medicine, Dentistry and Health Sciences; The University of Melbourne; Melbourne Victoria Australia
| | - Marie Gerdtz
- Emergency Department; The Royal Melbourne Hospital; Melbourne Victoria Australia
- Faculty of Medicine, Dentistry and Health Sciences; The University of Melbourne; Melbourne Victoria Australia
| | - Susan Harding
- Emergency Department; The Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Steven Pincus
- Emergency Department; The Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Michelle Thompson
- Emergency Department; The Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Jonathan Knott
- Emergency Department; The Royal Melbourne Hospital; Melbourne Victoria Australia
- Faculty of Medicine, Dentistry and Health Sciences; The University of Melbourne; Melbourne Victoria Australia
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McIntosh S, Hemphill M, McDevitt M, Gurung TY, Ghale M, Knott J, Thapa GB, Basnyat B, Dow J, Weber D, Grissom C. Reduced Acetazolamide Dosing for Acute Mountain Sickness Prevention Study: A Comparison of 62.5 vs 125 mg BID (the RAD AMS prevention study). Wilderness Environ Med 2017. [DOI: 10.1016/j.wem.2017.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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27
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Mueller M, Pander J, Knott J, Geist J. Comparison of nine different methods to assess fish communities in lentic flood-plain habitats. J Fish Biol 2017; 91:144-174. [PMID: 28542802 DOI: 10.1111/jfb.13333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 04/12/2017] [Indexed: 06/07/2023]
Abstract
This study compares the effectiveness and representativeness of electrofishing, snorkelling, seining, baited lift netting, multi-mesh gillnetting, baited fish traps, fyke netting, angling and longline fishing, considering three typical lentic flood-plain habitats at different times of day. Electrofishing was by far the most effective method yielding highest species richness, species trait representation and catch per unit of effort (CPUE), followed by seining. For single species like dace Leuciscus leuciscus, European ruffe Gymnocephalus cernua, common bream Abramis brama and silver bream Blicca bjoerkna, seining was more effective than electrofishing. With both methods, some species were more consistently caught during night, dusk or dawn than during daylight. All other methods tested cannot be generally recommended for fish community assessments in shallow backwaters due to their low representativeness of species inventory and generally low CPUE. Based on these results, electrofishing of 30 m transect replicates at different times of day for monitoring the fish community in shallow backwaters, can be recommended, enabling the maximum possible comparability to adjacent river habitats. Seining should be considered as an alternative if accessibility of habitats is restricted or electrofishing is prohibited. The 25 species detected in the backwaters also suggest that these habitats contribute a large proportion of fish diversity and should be included in standard assessments of river ecological status.
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Affiliation(s)
- M Mueller
- Aquatic Systems Biology Unit, Department of Ecology and Ecosystem Management, Technical University of Munich, Mühlenweg 22, D-85350, Freising, Germany
| | - J Pander
- Aquatic Systems Biology Unit, Department of Ecology and Ecosystem Management, Technical University of Munich, Mühlenweg 22, D-85350, Freising, Germany
| | - J Knott
- Aquatic Systems Biology Unit, Department of Ecology and Ecosystem Management, Technical University of Munich, Mühlenweg 22, D-85350, Freising, Germany
| | - J Geist
- Aquatic Systems Biology Unit, Department of Ecology and Ecosystem Management, Technical University of Munich, Mühlenweg 22, D-85350, Freising, Germany
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Fouche PF, Jennings PA, Smith K, Boyle M, Blecher G, Knott J, Raji M, Rosengarten P, Augello MR, Bernard S. Survival in Out-of-hospital Rapid Sequence Intubation of Non-Traumatic Brain Pathologies. PREHOSP EMERG CARE 2017. [DOI: 10.1080/10903127.2017.1325952] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Johnson OG, Taylor DM, Lee M, Ding JL, Ashok A, Johnson D, Peck D, Knott J, Weinberg L. Patient satisfaction with procedural sedation in the emergency department. Emerg Med Australas 2017; 29:303-309. [DOI: 10.1111/1742-6723.12762] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 12/01/2016] [Accepted: 12/28/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Olivia G Johnson
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
| | - David McD Taylor
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
- Emergency Department; Austin Hospital; Melbourne Victoria Australia
| | - Marina Lee
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
| | - Juen-Li Ding
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
| | - Aadith Ashok
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
| | - Damian Johnson
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
| | - Daniel Peck
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
| | - Jonathan Knott
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
- Emergency Department; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Laurence Weinberg
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
- Department of Anaesthesia; Austin Hospital; Melbourne Victoria Australia
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30
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Berlingeri P, Cunningham N, Taylor DM, Knott J, McLean D, Gavan R, Plant L, Chen H, Weiland T. Adherence to national exercise guidelines by patients attending emergency departments: A multi-site survey. Emerg Med Australas 2017; 29:276-282. [DOI: 10.1111/1742-6723.12764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 01/04/2017] [Accepted: 01/16/2017] [Indexed: 11/27/2022]
Affiliation(s)
| | - Neil Cunningham
- Emergency Department; St Vincent's Hospital; Melbourne Victoria Australia
| | - David McD Taylor
- Emergency Department; Austin Health; Melbourne Victoria Australia
| | - Jonathan Knott
- Emergency Department; The Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Daniel McLean
- The University of Melbourne; Melbourne Victoria Australia
| | - Rex Gavan
- The University of Melbourne; Melbourne Victoria Australia
| | - Luke Plant
- The University of Melbourne; Melbourne Victoria Australia
| | - Hayley Chen
- The University of Melbourne; Melbourne Victoria Australia
| | - Tracey Weiland
- Emergency Practice Innovation Centre; St Vincent's Hospital; Melbourne Victoria Australia
- Melbourne School of Population and Global Health; The University of Melbourne, Melbourne; Victoria Australia
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31
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Kelly AM, Keijzers G, Klim S, Graham CA, Craig S, Kuan WS, Jones P, Holdgate A, Lawoko C, Laribi S, Cowell DL, Jain N, Villecourt T, Lee K, Chalkley D, Lozzi L, Asha SE, Duffy M, Watkins G, Rosengren D, Thone J, Martin S, Orda U, Thom O, Kinnear F, Watson M, Eley R, Ryan A, Morel DG, Furyk J, Smith RD, Grummisch M, Meek R, Rosengarten P, Chan B, Haythorne H, Archer P, Wilson K, Knott J, Ritchie P, Bryant M, MacDonald S, Mahlangu M, Scott M, Cheri T, Nguyen M, Chor MS, Wong CP, Wong TW, Leung L, Man CK, Rahman NH, Lee WY, Lee FCY, Goh SE, Russell K. An Observational Study of Dyspnea in Emergency Departments: The Asia, Australia, and New Zealand Dyspnea in Emergency Departments Study (AANZDEM). Acad Emerg Med 2017; 24:328-336. [PMID: 27743490 DOI: 10.1111/acem.13118] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/29/2016] [Accepted: 09/30/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The objective was to describe the epidemiology of dyspnea presenting to emergency departments (EDs) in the Asia-Pacific region, to understand how it is investigated and treated and its outcome. METHODS Prospective interrupted time series cohort study conducted at three time points in EDs in Australia, New Zealand, Singapore, Hong Kong, and Malaysia of adult patients presenting to the ED with dyspnea as a main symptom. Data were collected over three 72-hour periods and included demographics, comorbidities, mode of arrival, usual medications, prehospital treatment, initial assessment, ED investigations, treatment in the ED, ED diagnosis, disposition from ED, in-hospital outcome, and final hospital diagnosis. The primary outcomes of interest are the epidemiology, investigation, treatment, and outcome of patients presenting to ED with dyspnea. RESULTS A total of 3,044 patients were studied. Patients with dyspnea made up 5.2% (3,105/60,059, 95% confidence interval [CI] = 5.0% to 5.4%) of ED presentations, 11.4% of ward admissions (1,956/17,184, 95% CI = 10.9% to 11.9%), and 19.9% of intensive care unit (ICU) admissions (104/523, 95% CI = 16.7% to 23.5%). The most common diagnoses were lower respiratory tract infection (20.2%), heart failure (14.9%), chronic obstructive pulmonary disease (13.6%), and asthma (12.7%). Hospital ward admission was required for 64% of patients (95% CI = 62% to 66%) with 3.3% (95% CI = 2.8% to 4.1%) requiring ICU admission. In-hospital mortality was 6% (95% CI = 5.0% to 7.2%). CONCLUSION Dyspnea is a common symptom in ED patients contributing substantially to ED, hospital, and ICU workload. It is also associated with significant mortality. There are a wide variety of causes however chronic disease accounts for a large proportion.
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Affiliation(s)
- Anne Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research @ Western Health Sunshine Hospital Parkville Australia
- Faculty of Medicine Dentistry and Health Sciences The University of Melbourne Parkville Australia
| | - Gerben Keijzers
- Department of Emergency Medicine Gold Coast University Hospital Gold Coast QLD Australia
- School of Medicine Bond University Gold Coast QLD Australia
- School of Medicine Griffith University Gold Coast QLD Australia
| | - Sharon Klim
- Joseph Epstein Centre for Emergency Medicine Research @ Western Health Sunshine Hospital Parkville Australia
| | - Colin A. Graham
- Chinese University of Hong Kong Prince of Wales Hospital Shatin Hong Kong SAR
| | - Simon Craig
- Emergency Department Monash Medical Centre Clayton Australia
- School of Clinical Sciences Monash University Clayton Australia
- Murdoch Children's Research Institute Parkville Australia
| | - Win Sen Kuan
- Emergency Medicine Department National University Health System and the Department of Surgery Yong Loo Lin School of Medicine National University of Singapore Singapore
| | - Peter Jones
- Department of Emergency Medicine Auckland City Hospital Auckland New Zealand
| | - Anna Holdgate
- Department of Emergency Medicine Liverpool Hospital and the University of New South Wales (Southwest Clinical School) Sydney Australia
| | - Charles Lawoko
- Statistical Consulting Service Graduate Research Centre Victoria University Footscray Australia
| | - Said Laribi
- Emergency Medicine Department Tours University Hospital (SL) Tours France
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Szirt R, Ullah I, Knott J, Sun P, Ison G, Ramsay D, Weaver J. Percutaneous Coronary Intervention for Chronic Total Occlusions – Evolution of Technique and Radiation Reduction Within a Dedicated Program. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.414] [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: 10/19/2022]
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Johnson D, Dutch M, Knott J. Estimation of the potential eye and tissue donor pool in an Australian emergency department. Emerg Med Australas 2016; 28:300-6. [PMID: 27250670 DOI: 10.1111/1742-6723.12576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 12/03/2015] [Revised: 02/09/2016] [Accepted: 02/25/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE EDs have long been considered a potential source of eye and tissue donors, but no specific evidence to support this was identified in the Australian setting. The present study aims to bridge that knowledge gap, by analysing medical and social histories of those who have died over a 5 year period so as to determine donation eligibility in this population. METHODS A retrospective audit was undertaken of all patients who died within the Royal Melbourne Hospital ED between 2010 and 2014. ED records, pharmacy records and electronic medical histories were audited for the presence of eye and tissue donation exclusion criteria and the distribution of these criteria within the target population. RESULTS Over the 5 year period, of 326 deaths that occurred in the ED, one third was suitable for eye donation (n = 106) and one in seven (n = 45) for tissue donation. Of the age appropriate patients, five criteria were identified that excluded up to 85% of the population not eligible to donate. These were: haematological malignancies, neurodegenerative conditions, non-haematological malignancies, chronic renal failure and eye disease. CONCLUSION The present study has identified a large pool of potential eye and tissue donors; a pool mostly unrecognised by emergency clinicians. An extensive list of exclusion criteria restricts donor potential. However, the present study has identified that only five fundamentally limit donation in the ED population. Utilisation of this knowledge will allow for the development of clinical triggers that will improve identification, and increase realisation, of potential donors.
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Affiliation(s)
- Damian Johnson
- Ballarat Health Services, Ballarat Base Hospital, Ballarat, Victoria, Australia
| | - Martin Dutch
- Emergency Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Jonathan Knott
- Emergency Medicine Research Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Peck D, Knott J, Lefkovits J. Clinical impact of a high-sensitivity troponin assay introduction on patients presenting to the emergency department. Emerg Med Australas 2016; 28:273-8. [PMID: 26989877 DOI: 10.1111/1742-6723.12566] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 11/02/2015] [Revised: 01/04/2016] [Accepted: 01/31/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Biomarkers are a critical component in the investigation of patients with potential ischaemic heart disease. The proposed benefits of a high-sensitivity troponin (hs-Tn) assay include earlier diagnosis of myocardial infarction. However, the decreased specificity may adversely affect clinical practice. The present study aims to investigate the impact that the introduction of a hs-Tn assay had on patients presenting to the ED. METHODS A pre- and post-interventional analysis was performed on all patients presenting to the Royal Melbourne Hospital ED, and had a troponin, in the 12 months before and after the introduction of the hs-Tn assay. The main outcome measures were ED length of stay, admission rates, proportion of patients undergoing interventional cardiac procedures and proportion diagnosed with myocardial infarction. RESULTS There were 6557 patients who had a conventional assay and 7335 patients who had a hs-Tn assay. The introduction of a hs-Tn assay was associated with an increased abnormal troponin rate (23.4% vs 28.1%, P < 0.001). The median length of ED stay decreased by 9.1% (P < 0.001). The proportion admitted to hospital increased (60.9% vs 65.9%, P < 0.001); however, there was no difference in the proportion undergoing revascularisation or the proportion diagnosed with myocardial infarction. CONCLUSIONS Although the introduction of a hs-Tn assay led to an increase in hospital admissions, the unchanged rate of cardiac procedures or final diagnoses of acute myocardial infarction and ischaemic heart disease suggests that the hs-Tn did not improve the detection of these conditions. It remains unclear whether there was a benefit admitting the additional cohort of patients.
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Affiliation(s)
- Daniel Peck
- Emergency Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Jonathan Knott
- Emergency Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Jeffrey Lefkovits
- Emergency Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Bosch M, Tavender EJ, Brennan SE, Knott J, Gruen RL, Green SE. The Many Organisational Factors Relevant to Planning Change in Emergency Care Departments: A Qualitative Study to Inform a Cluster Randomised Controlled Trial Aiming to Improve the Management of Patients with Mild Traumatic Brain Injuries. PLoS One 2016; 11:e0148091. [PMID: 26845772 PMCID: PMC4742078 DOI: 10.1371/journal.pone.0148091] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 01/12/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The Neurotrauma Evidence Translation (NET) Trial aims to design and evaluate the effectiveness of a targeted theory-and evidence-informed intervention to increase the uptake of evidence-based recommended practices for the management of patients who present to an emergency department (ED) with mild head injuries. When designing interventions to bring about change in organisational settings such as the ED, it is important to understand the impact of the context to ensure successful implementation of practice change. Few studies explicitly use organisational theory to study which factors are likely to be most important to address when planning change processes in the ED. Yet, this setting may have a unique set of organisational pressures that need to be taken into account when implementing new clinical practices. This paper aims to provide an in depth analysis of the organisational context in which ED management of mild head injuries and implementation of new practices occurs, drawing upon organisational level theory. METHODS Semi-structured interviews were conducted with ED staff in Australia. The interviews explored the organisational context in relation to change and organisational factors influencing the management of patients presenting with mild head injuries. Two researchers coded the interview transcripts using thematic content analysis. The "model of diffusion in service organisations" was used to guide analyses and organisation of the results. RESULTS Nine directors, 20 doctors and 13 nurses of 13 hospitals were interviewed. With regard to characteristics of the innovation (i.e. the recommended practices) the most important factor was whether they were perceived as being in line with values and needs. Tension for change (the degree to which stakeholders perceive the current situation as intolerable or needing change) was relatively low for managing acute mild head injury symptoms, and mixed for managing longer-term symptoms (higher change commitment, but relatively low change efficacy). Regarding implementation processes, the importance of (visible) senior leadership for all professions involved was identified as a critical factor. An unpredictable and hectic environment brings challenges in creating an environment in which team-based and organisational learning can thrive (system antecedents for innovation). In addition, the position of the ED as the entry-point of the hospital points to the relevance of securing buy-in from other units. CONCLUSIONS We identified several organisational factors relevant to realising change in ED management of patients who present with mild head injuries. These factors will inform the intervention design and process evaluation in a trial evaluating the effectiveness of our implementation intervention.
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Affiliation(s)
- Marije Bosch
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
- National Trauma Research Institute, The Alfred, Monash University, Melbourne, Australia
- * E-mail:
| | - Emma J. Tavender
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
- National Trauma Research Institute, The Alfred, Monash University, Melbourne, Australia
| | - Sue E. Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jonathan Knott
- Melbourne Medical School, The University of Melbourne, Melbourne, Australia
- Department of Emergency Medicine, Royal Melbourne Hospital, Melbourne, Australia
| | - Russell L. Gruen
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
- National Trauma Research Institute, The Alfred, Monash University, Melbourne, Australia
- The Alfred Trauma Service, The Alfred Hospital, Melbourne, Australia
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Sally E. Green
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Santamaria N, Gerdtz M, Liu W, Rakis S, Sage S, Ng AW, Tudor H, McCann J, Vassiliou T, Morrow F, Smith K, Knott J, Liew D. Clinical effectiveness of a silicone foam dressing for the prevention of heel pressure ulcers in critically ill patients: Border II Trial. J Wound Care 2016; 24:340-5. [PMID: 26562376 DOI: 10.12968/jowc.2015.24.8.340] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Critically ill patients are at high risk of developing pressure ulcers (PU), with the sacrum and heels being highly susceptible to pressure injuries. The objective of our study was to evaluate the clinical effectiveness of a new multi-layer, self-adhesive soft silicone foam heel dressing to prevent PU development in trauma and critically ill patients in the intensive care unit (ICU). METHOD A cohort of critically ill patients were enrolled at the Royal Melbourne Hospital. Each patient had the multi-layer soft silicone foam dressing applied to each heel on admission to the emergency department. The dressings were retained with a tubular bandage for the duration of the patients' stay in the ICU. The skin under the dressings was examined daily and the dressings were replaced every three days. The comparator for our cohort study was the control group from the recently completed Border Trial. RESULTS Of the 191 patients in the initial cohort, excluding deaths, loss to follow-up and transfers to another ward, 150 patients were included in the final analysis. There was no difference in key demographic or physiological variables between the cohorts, apart from a longer ICU length of stay for our current cohort. No PUs developed in any of our intervention cohort patients compared with 14 patients in the control cohort (n=152; p<0.001) who developed a total of 19 heel PUs. CONCLUSION We conclude, based on our results, that the multi-layer soft silicone foam dressing under investigation was clinically effective in reducing ICU-acquired heel PUs. The findings also support previous research on the clinical effectiveness of multi-layer soft silicone foam dressings for PU prevention in the ICU.
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Affiliation(s)
- N Santamaria
- University of Melbourne & Royal Melbourne Hospital
| | - M Gerdtz
- University of Melbourne & Royal Melbourne Hospital
| | - W Liu
- Adelphi University, New York
| | | | | | | | | | | | | | | | | | - J Knott
- University of Melbourne & Royal Melbourne Hospital
| | - D Liew
- University of Melbourne & Royal Melbourne Hospital
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Alarcon Manchego P, Knott J, Graudins A, Bartley B, Mitra B. Management of mental health patients in Victorian emergency departments: A 10 year follow-up study. Emerg Med Australas 2015; 27:529-536. [DOI: 10.1111/1742-6723.12500] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 06/20/2015] [Accepted: 08/12/2015] [Indexed: 11/29/2022]
Affiliation(s)
| | - Jonathan Knott
- Melbourne Medical School; The University of Melbourne; Melbourne Victoria Australia
- Emergency Department; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Andis Graudins
- Emergency Department; Dandenong Hospital; Melbourne Victoria Australia
- Department of Medicine; Monash University; Melbourne Victoria Australia
| | - Bruce Bartley
- Emergency Department; Geelong Hospital; Geelong Victoria Australia
| | - Biswadev Mitra
- Emergency and Trauma Centre; The Alfred Hospital; Melbourne Victoria Australia
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Victoria Australia
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van der Meer DM, Weiland TJ, Philip J, Jelinek GA, Boughey M, Knott J, Marck CH, Weil JL, Lane HP, Dowling AJ, Kelly AM. Presentation patterns and outcomes of patients with cancer accessing care in emergency departments in Victoria, Australia. Support Care Cancer 2015; 24:1251-60. [PMID: 26306522 DOI: 10.1007/s00520-015-2921-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [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: 04/20/2015] [Accepted: 08/18/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE People with cancer attend emergency departments (EDs) for many reasons. Improved understanding of the specific needs of these patients may assist in optimizing health service delivery. ED presentation and hospital utilization characteristics were explored for people with cancer and compared with those patients without cancer. METHODS This descriptive, retrospective, multicentre cohort study used hospital administrative data. Descriptive and inferential statistics were used to summarise and compare ED presentation characteristics amongst cancer and non-cancer groups. Predictive analyses were used to identify ED presentation features predictive of hospital admission for cancer patients. Outcomes of interest were level of acuity, ED and inpatient length of stay, re-presentation rates and admission rates amongst cancer patients and non-cancer patients. RESULTS ED (529,377) presentations occurred over the 36 months, of which 2.4% (n = 12,489) were cancer-related. Compared with all other attendances, cancer-related attendances had a higher level of acuity, requiring longer management time and length of stay in ED. Re-presentation rates for people with cancer were nearly double those of others (64 vs 33%, p < 0.001), with twice the rate of hospital admission (90 vs 46%, p < 0.001), longer inpatient length of stay (5.6 vs 2.8 days, p < 0.001) and had higher inpatient mortality (7.9 vs 1.0%, p < 0.001). Acuity and arriving by ambulance were significant predictors of hospital admission, with cancer-related attendances having ten times the odds of admission compared to other attendances (OR = 10.4, 95% CI 9.8-11.1). CONCLUSIONS ED presentations by people with cancer represent a more urgent, complex caseload frequently requiring hospital admission when compared to other presentations, suggesting that for optimal cancer care, close collaboration and integration of oncology, palliative care and emergency medicine providers are needed to improve pathways of care.
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Affiliation(s)
- Dania M van der Meer
- Emergency Practice Innovation Centre, St. Vincent's Hospital, PO Box 2900, Fitzroy, Melbourne, VIC, 3065, Australia
| | - Tracey J Weiland
- Emergency Practice Innovation Centre, St. Vincent's Hospital, PO Box 2900, Fitzroy, Melbourne, VIC, 3065, Australia.,Department of Medicine, The University of Melbourne (St. Vincent's Hospital), Melbourne, Victoria, Australia
| | - Jennifer Philip
- Palliative Medicine, St. Vincent's Hospital, Melbourne, Victoria, Australia.,Centre for Palliative Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - George A Jelinek
- Emergency Practice Innovation Centre, St. Vincent's Hospital, PO Box 2900, Fitzroy, Melbourne, VIC, 3065, Australia. .,Department of Medicine, The University of Melbourne (St. Vincent's Hospital), Melbourne, Victoria, Australia. .,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Mark Boughey
- Palliative Medicine, St. Vincent's Hospital, Melbourne, Victoria, Australia.,Centre for Palliative Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jonathan Knott
- Emergency Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Claudia H Marck
- Emergency Practice Innovation Centre, St. Vincent's Hospital, PO Box 2900, Fitzroy, Melbourne, VIC, 3065, Australia
| | - Jennifer L Weil
- Palliative Medicine, St. Vincent's Hospital, Melbourne, Victoria, Australia.,Centre for Palliative Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Heather P Lane
- Palliative Medicine, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Anthony J Dowling
- Department of Oncology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research at Western Health, Sunshine Hospital, Victoria, Australia
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Daniel C, Gerdtz M, Elsom S, Knott J, Prematunga R, Virtue E. Feasibility and need for violence risk screening at triage: an exploration of clinical processes and public perceptions in one Australian emergency department. Emerg Med J 2014; 32:457-62. [PMID: 25004918 DOI: 10.1136/emermed-2013-202979] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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: 06/25/2013] [Accepted: 06/12/2014] [Indexed: 11/04/2022]
Abstract
BACKGROUND Research on patient aggression in hospital emergency departments supports the development of a systematic process for identifying individuals at risk of becoming violent. The feasibility and community acceptance of this approach is unknown. In this study, we determine the feasibility and explore the need for a violence risk screening process in one Australian emergency department. METHOD We used a descriptive exploratory design that involved semistructured interviews and observations of practice. The setting was an adult tertiary referral hospital and major trauma centre located in Melbourne, Australia. A convenience sample of nine triage nurses were observed assessing patients to explore how risk screening was undertaken in practice. Semistructured interviews were conducted with emergency department (ED) service users (N=19) to explore community perspectives on the process of violence risk screening. RESULTS Observations of practice revealed that nurses used observed and reported information to screen for potential risk of violence rather than employing a direct questioning approach. Interviews with community members in the emergency department waiting room highlighted a public expectation that nurses screen and accurately identify patients at risk of violence on arrival to the ED. CONCLUSIONS Consistent with local prevalence data, public expectations of emergency care supported the need to adopt a uniform approach to identifying people at risk of becoming violent on arrival to hospital. Observations of triage nurses interactions with patients revealed that the existing violence risk screening approach was not being consistently used by triage nurses. An integrated approach to determining violence risk during triage assessment is recommended.
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Affiliation(s)
- Catherine Daniel
- Consultation Liaison Psychiatry, The Royal Melbourne Hospital, Melbourne, Australia
| | - Marie Gerdtz
- School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Stephen Elsom
- Centre for Psychiatric Nursing, University of Melbourne, Melbourne, Australia
| | - Jonathan Knott
- Emergency Department, Melbourne Health, Melbourne, Australia
| | - Roshani Prematunga
- Centre for Psychiatric Nursing, University of Melbourne, Melbourne, Australia
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40
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Thom O, Keijzers G, Davies S, McD Taylor D, Knott J, Middleton PM. Clinical research priorities in emergency medicine: Results of a consensus meeting and development of a weighting method for assessment of clinical research priorities. Emerg Med Australas 2014; 26:28-33. [DOI: 10.1111/1742-6723.12186] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ogilvie Thom
- Department of Emergency Medicine; Nambour General Hospital; Sunshine Coast Queensland Australia
- School of Medicine; University of Queensland; Sunshine Coast Queensland Australia
| | - Gerben Keijzers
- Department of Emergency Medicine; Gold Coast University Hospital; Gold Coast Queensland Australia
- School of Medicine; Bond University; Gold Coast Queensland Australia
- School of Medicine; Griffith University; Gold Coast Queensland Australia
| | - Suzanne Davies
- Distributed Research in Emergency and Acute Medicine (DREAM) Collaboration; Sydney New South Wales Australia
- Australian Resuscitation Council; NSW Branch; Australia
- School of Medicine; University of Tasmania; Hobart Tasmania Australia
| | - David McD Taylor
- Emergency and General Medicine Research; Austin Health; Melbourne Victoria Australia
- University of Melbourne; Parkville Victoria Australia
| | - Jonathan Knott
- University of Melbourne; Parkville Victoria Australia
- Department of Emergency Medicine; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Paul M Middleton
- Distributed Research in Emergency and Acute Medicine (DREAM) Collaboration; Sydney New South Wales Australia
- Australian Resuscitation Council; NSW Branch; Australia
- Discipline of Emergency Medicine; University of Sydney; Sydney New South Wales Australia
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Abstract
OBJECTIVE To determine the clinical research priorities of Fellows of the Australasian College for Emergency Medicine (ACEM) in order to inform the strategic research agenda specific to multicentre clinical research. METHODS An anonymous survey of all ACEM Fellows (FACEMs) listed on the ACEM researcher database was conducted between January and March 2013. RESULTS Of 108 FACEMs invited to participate, 54 (50%) responded. Over half of respondents (61%) had a higher research degree but only a minority (24%) had funded research positions. The top research categories identified as priorities were resuscitation, trauma, cardiology, ED ultrasound, acute behavioural disturbance and geriatrics. The most common specific sub-categories included anterior chest pain, fluid resuscitation in trauma, and drug therapy for both atrial fibrillation and acute behavioural disturbance. Several specific research questions related to chest pain, resuscitation/sepsis, stroke, paediatrics and pulmonary embolus. CONCLUSION The findings provide guidance and support for research areas amenable to collaborative multicentre clinical research within emergency medicine. Discussion rounds are planned to translate these perceived research priorities to actual priorities.
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Affiliation(s)
- Gerben Keijzers
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia; School of Medicine, Bond University, Gold Coast, Queensland, Australia; School of Medicine, Griffith University, Gold Coast, Queensland, Australia
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Santamaria N, Liu W, Gerdtz M, Sage S, McCann J, Freeman A, Vassiliou T, DeVincentis S, Ng AW, Manias E, Knott J, Liew D. The cost-benefit of using soft silicone multilayered foam dressings to prevent sacral and heel pressure ulcers in trauma and critically ill patients: a within-trial analysis of the Border Trial. Int Wound J 2013; 12:344-50. [PMID: 24750780 DOI: 10.1111/iwj.12160] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [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: 07/23/2013] [Accepted: 08/28/2013] [Indexed: 12/01/2022] Open
Abstract
Little is known about the cost-benefit of soft silicone foam dressings in pressure ulcer (PU) prevention among critically ill patients in the emergency department (ED) and intensive care unit (ICU). A randomised controlled trial to assess the efficacy of soft silicone foam dressings in preventing sacral and heel PUs was undertaken among 440 critically ill patients in an acute care hospital. Participants were randomly allocated either to an intervention group with prophylactic dressings applied to the sacrum and heels in the ED and changed every 3 days in the ICU or to a control group with standard PU prevention care provided during their ED and ICU stay. The results showed a significant reduction of PU incidence rates in the intervention group (P = 0·001). The intervention cost was estimated to be AU$36·61 per person based on an intention-to-treat analysis, but this was offset by lower downstream costs associated with PU treatment (AU$1103·52). Therefore, the average net cost of the intervention was lower than that of the control (AU$70·82 versus AU$144·56). We conclude that the use of soft silicone multilayered foam dressings to prevent sacral and heel PUs among critically ill patients results in cost savings in the acute care hospital.
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Affiliation(s)
- Nick Santamaria
- Department of Nursing, Royal Melbourne Hospital & University of Melbourne, Melbourne, Australia
| | - Wei Liu
- Emergency Department, Royal Melbourne Hospital & University of Melbourne, Melbourne, Australia
| | - Marie Gerdtz
- Emergency Department, Royal Melbourne Hospital & University of Melbourne, Melbourne, Australia
| | - Sarah Sage
- Department of Nursing, Royal Melbourne Hospital, Melbourne, Australia
| | - Jane McCann
- Department of Podiatry, Royal Melbourne Hospital, Melbourne, Australia
| | - Amy Freeman
- Department of Podiatry, Royal Melbourne Hospital, Melbourne, Australia
| | - Theresa Vassiliou
- Emergency Department, Royal Melbourne Hospital & University of Melbourne, Melbourne, Australia
| | | | - Ai W Ng
- Department of Nursing, Royal Melbourne Hospital, Melbourne, Australia
| | - Elizabeth Manias
- Department of Nursing, Royal Melbourne Hospital & University of Melbourne, Melbourne, Australia
| | - Jonathan Knott
- Emergency Department, Royal Melbourne Hospital & University of Melbourne, Melbourne, Australia
| | - Danny Liew
- EpiCentre, Royal Melbourne Hospital & University of Melbourne, Melbourne, Australia
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Santamaria N, Gerdtz M, Sage S, McCann J, Freeman A, Vassiliou T, De Vincentis S, Ng AW, Manias E, Liu W, Knott J. A randomised controlled trial of the effectiveness of soft silicone multi-layered foam dressings in the prevention of sacral and heel pressure ulcers in trauma and critically ill patients: the border trial. Int Wound J 2013; 12:302-8. [PMID: 23711244 DOI: 10.1111/iwj.12101] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [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: 01/30/2013] [Accepted: 04/19/2013] [Indexed: 12/29/2022] Open
Abstract
The prevention of hospital acquired pressure ulcers in critically ill patients remains a significant clinical challenge. The aim of this trial was to investigate the effectiveness of multi-layered soft silicone foam dressings in preventing intensive care unit (ICU) pressure ulcers when applied in the emergency department to 440 trauma and critically ill patients. Intervention group patients (n = 219) had Mepilex(®) Border Sacrum and Mepilex(®) Heel dressings applied in the emergency department and maintained throughout their ICU stay. Results revealed that there were significantly fewer patients with pressure ulcers in the intervention group compared to the control group (5 versus 20, P = 0·001). This represented a 10% difference in incidence between the groups (3·1% versus 13·1%) and a number needed to treat of ten patients to prevent one pressure ulcer. Overall there were fewer sacral (2 versus 8, P = 0·05) and heel pressure ulcers (5 versus 19, P = 0·002) and pressure injuries overall (7 versus 27, P = 0·002) in interventions than in controls. The time to injury survival analysis indicated that intervention group patients had a hazard ratio of 0·19 (P = 0·002) compared to control group patients. We conclude that multi-layered soft silicone foam dressings are effective in preventing pressure ulcers in critically ill patients when applied in the emergency department prior to ICU transfer.
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Affiliation(s)
- Nick Santamaria
- Nursing Research, University of Melbourne & Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Marie Gerdtz
- Emergency Department, University of Melbourne & Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Sarah Sage
- Nursing, Royal Park Hospital, Melbourne, VIC, Australia
| | - Jane McCann
- Nursing, Royal Park Hospital, Melbourne, VIC, Australia
| | - Amy Freeman
- Department of Podiatry, Western Health, Melbourne, VIC, Australia
| | - Theresa Vassiliou
- Emergency Department, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | - Ai Wei Ng
- Nursing, Royal Park Hospital, Melbourne, VIC, Australia
| | | | - Wei Liu
- Emergency Department, University of Melbourne & Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Jonathan Knott
- Emergency Department, University of Melbourne & Royal Melbourne Hospital, Melbourne, VIC, Australia
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Doherty S, Knott J, Bennetts S, Jazayeri M, Huckson S. National project seeking to improve pain management in the emergency department setting: Findings from the NHMRC-NICS National Pain Management Initiative. Emerg Med Australas 2012; 25:120-6. [DOI: 10.1111/1742-6723.12022] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Steven Doherty
- Emergency Department; Tamworth Rural Referral Hospital; Tamworth; New South Wales; Australia
| | - Jonathan Knott
- Department of Emergency Services; Royal Melbourne Hospital; Melbourne; Victoria; Australia
| | | | - Mitra Jazayeri
- Department of Mathematics and Statistics; La Trobe University; Melbourne; Victoria; Australia
| | - Sue Huckson
- Centre for Outcome and Resource Evaluation; Australian and New Zealand Intensive Care Society; Melbourne; Victoria; Australia
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Jhummon-Mahadnac ND, Knott J, Marshall C. A cross-sectional study of pandemic influenza health literacy and the effect of a public health campaign. BMC Res Notes 2012; 5:377. [PMID: 22830499 PMCID: PMC3502135 DOI: 10.1186/1756-0500-5-377] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Accepted: 07/10/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To ascertain the understanding of 2009 pandemic (H1N1) influenza and relevant infection control measures in an emergency department population and to assess the effectiveness of education campaigns in informing the public about the pandemic. METHODS Questionnaires were administered to patients, visitors, non-clinical staff and volunteers. Data were collected on knowledge, preventative measures, information sources, attitudes to government and media reporting, perceived seriousness, behaviour change and intended compliance with future measures. Results were used to construct an overall knowledge score. RESULTS There were 252 participants. Traditional forms of mass media (138 [55%]) remained the principal information source. Approximately 70% (176) accurately described mode of transmission and recommended precautions and 68% (175) reported behaviour change because of the pandemic. Gaps in knowledge included failure to identify certain high risk groups. Recall of government campaigns was significantly associated with a higher knowledge score. 60% (151) thought that authorities and media had exaggerated the threat; only 40% (101) would comply with recommended measures in a future pandemic. CONCLUSIONS The knowledge regarding pandemic influenza was high in this population and positively affected by official campaigns. Pandemic planning should address knowledge gaps and the impression that authorities had exaggerated the public-health threat.
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Abstract
AIMS To assess the numeracy and literacy skills of individuals with Type 1 diabetes and determine if there is a relationship with achieved glycaemic control independent of their duration of diabetes, diabetes education, demographic and socio-economic factors. METHODS One hundred and twelve patients completed the study (mean current age 43.8 ± 12.5 years, 47% male, mean duration of diabetes 22.0 ± 13.2 years) out of 650 randomly selected patients from the Bournemouth Diabetes and Endocrine Centre's diabetes register. The Skills for Life Initial Assessments were used to measure numeracy and literacy. These indicate skills levels up to level 2, equivalent to the national General Certificate of Secondary Education grades A*-C. HbA(1c) was also measured. Pearson's correlation was used to measure the correlation of numeracy and literacy scores with HbA(1c.) To compare mean HbA(1c) between those with or without level 2 skills, t-tests were used, and multiple linear regression was used to investigate whether any differences were independent of duration of diabetes, diabetes education, demographic and socio-economic factors. RESULTS Literacy was not associated with achieved HbA(1c). In contrast, participants with numeracy skills at level 2 or above achieved an HbA(1c) lower than those with numeracy skills below level 2 (P = 0.027). Although higher socio-economic status was associated with lower mean HbA(1c) , the relationship between numeracy and HbA(1c) appeared to be independent of socio-economic factors. CONCLUSIONS Low numeracy skills were adversely associated with diabetes control. Assessment of numeracy skills may be relevant to the structure of diabetes education programmes.
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Affiliation(s)
- S Marden
- Bournemouth Diabetes and Endocrine Centre, Royal Bournemouth Hospital NHS Foundation Trust, Bournemouth, UK.
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Abstract
AIMS To determine 5-year mortality rates, following the diagnosis of Type 2 diabetes, in a large local cohort of individuals with new onset of Type 2 diabetes seen within a few weeks of diagnosis in a single, community-based education programme. METHODS We reviewed referrals for people with Type 2 diabetes to our service over 5 years from 1999 to 2003 and determined, via regression analysis, which factors contributed significantly to mortality rates up to the end of 2007. RESULTS A total of 3781 new referrals were reviewed with an approximate doubling of referral rates over 5 years (546 in 1999-997 in 2003). Although the number of people developing the condition has increased, mortality rates over the 5 years from diagnosis has fallen from 11% in 1999-9% in 2003 (P < 0.005) Age at diagnosis was the strongest predictor of mortality (P < 0.001) but HbA(1c) at 3 months after diagnosis (P < 0.001), systolic (P < 0.001) and diastolic (P = 0.05) blood pressure, smoking status (P < 0.001) and gender (P = 0.04) were also significant predictors. CONCLUSIONS Our retrospective analysis adds weight to evidence suggesting that referral rates for people with Type 2 diabetes are increasing rapidly and that mortality rates are reducing but that the reasons for this are multifactorial. In addition to blood pressure, smoking and gender, the HbA(1c) achieved 3 months after the initial diagnosis also appears to predict subsequent mortality. It may be appropriate to consider early and intensive intervention for individuals with new onset type 2 diabetes.
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Affiliation(s)
- D Kerr
- Bournemouth Diabetes and Endocrine Centre and Centre of Postgraduate Medical Research and Education, Bournemouth University, UK
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Browne V, Knott J, Dakis J, Fielding J, Lyle D, Daniel C, Bruce M, Virtue E. Improving the care of mentally ill patients in a tertiary emergency department: development of a psychiatric assessment and planning unit. Australas Psychiatry 2011; 19:350-3. [PMID: 21879869 DOI: 10.3109/10398562.2011.579612] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim was to describe the Psychiatric Assessment and Planning Unit (PAPU), established at the Royal Melbourne Hospital (RMH) to improve access to psychiatric care for patients presenting via the Emergency Department (ED). METHOD PAPU was opened in January 2007. Data was recorded from RMH ED databases to compare ED lengths of stay (LOS) prior to and after establishing PAPU. Interventions including requirement for one-to-one nursing (i.e. one nurse dedicated to the care and observation of one patient) and mechanical restraint and unarmed security threats are routinely documented and were compared before and after PAPU opened. Demographic data and inpatient LOS information was collected by clinicians in PAPU. RESULTS During the 12 months of initial evaluation we found that PAPU assisted with reducing the number of patients waiting excessive LOS in the RMH ED essentially to zero, due to both expedient transfers from ED and increased direct admissions from the community. We were also able to demonstrate a reduction in mechanical restraint, security codes for unarmed threats and one-to-one nursing in the ED. CONCLUSIONS The establishment of the PAPU at RMH has resulted in significant improvement in the care of patients with mental illness in the least restrictive environment, based on decreased LOS and need for interventions.
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Affiliation(s)
- Veronique Browne
- Acute Psychiatry Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia.
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Kevric J, Jelinek GA, Knott J, Weiland TJ. Validation of the Full Outline of Unresponsiveness (FOUR) Scale for conscious state in the emergency department: comparison against the Glasgow Coma Scale. Emerg Med J 2010; 28:486-90. [PMID: 20943845 DOI: 10.1136/emj.2009.085845] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine (a) the inter-rater reliability of pairs of emergency doctors' and/or nurses' ratings of the Glasgow Coma Scale (GCS) and the Full Outline of Unresponsiveness (FOUR) Scale in emergency department (ED) patients, (b) the concurrent validity of the FOUR Scale using the GCS as the reference scale and (c) doctors' and nurses' knowledge and attitudes towards the GCS and FOUR Scale. METHODS A prospective observational study was conducted using staff participants' ratings for a convenience sample of ED patients requiring quantification of conscious state. Participating doctors and nurses attended a formal training session on the correct use of the GCS and FOUR Scale. Pairs of clinicians then independently completed the GCS and FOUR Scale on patients within 5 min of each other. RESULTS 140 clinicians were recruited and trained in the use of the GCS and FOUR Scale. A total of 217 observations were performed on 203 patients presenting to the ED with various conditions. The inter-rater reliability for the FOUR Scale was greater than that of the GCS (FOUR: к = 0.76, p < 0.01; GCS: к = 0.59, p < 0.01). The reliability for both the GCS and the FOUR Scale was poorest within doctor-nurse pairs. CONCLUSION The FOUR Scale showed greater reliability than the GCS in ED patients using ED clinicians as raters. A larger study of ED patients is warranted to determine the predictive validity of the FOUR Scale and to further examine the reliability of the scale in various patient populations.
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Affiliation(s)
- J Kevric
- Emergency Practice Innovation Centre, St Vincent's Hospital Melbourne, Fitzroy, Melbourne, Victoria 3065, Australia
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