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Dutch M, Cheng A, Kiely P, Seed C. Revised nucleic acid test window periods: Applications and limitations in organ donation practice. Transpl Infect Dis 2024; 26:e14180. [PMID: 37885419 DOI: 10.1111/tid.14180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/10/2023] [Accepted: 10/15/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Nucleic acid test window periods for HIV, HCV, and HBV facilitate estimation of the residual risk of unexpected disease transmission and assist clinicians in determining the timeframe in which a recently acquired infection is at risk of nondetection. OBJECTIVES Firstly, to provide revised estimates of the NAT window periods based on a currently used triplex NAT assay. Secondly, to examine their validity in organ donation and transplantation practice. METHOD Estimates were based on the Procleix Ultrio Elite Assay (Grifols Diagnostic Solutions Inc. California, USA). The manufacturer's X50 and X95 limits of detection (LOD) were utilised. Viral doubling times of 0.85, 0.45, and 2.56 days and conversion factors for IU per ml to copies per mL of 0.6, 3.4, and 5 were assumed for HIV, HCV, and HBV respectively. Window periods were derived from the X50 and X95 LODs, based on a range of potential inoculum volumes. RESULTS Calculated X50 window periods were 5.1 (4.5-5.8), 2.7 (2.4-2.9), and 16.6 (14.2-19.1) days for HIV, HCV, and HBV respectively. Calculated X50 window periods, based on whole body plasma volume, were 11.8 (10.3-13.3), 6.2 (5.6-6.8) and 36.7 (31.3-42.1) days respectively. CONCLUSION X50 NAT window periods were significantly shorter for HBV and HCV and sit at the lower range of previously published estimates for HIV . Current modeling assumptions may not account for all unexpected transmission events and may no longer be suitable for application to organ donation and transplantation.
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Affiliation(s)
- Martin Dutch
- Emergency Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
| | - Anthea Cheng
- Pathology and Clinical Governance, Australian Red Cross Lifeblood, West Melbourne, Victoria, Australia
| | - Philip Kiely
- Pathology and Clinical Governance, Australian Red Cross Lifeblood, West Melbourne, Victoria, Australia
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, Australia
| | - Clive Seed
- Pathology and Clinical Governance, Australian Red Cross Lifeblood, West Melbourne, Victoria, Australia
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Lawson K, Jay M, Dutch M. 212.5: Automated notification to DonateLife staff of emergency department patients undergoing end-of-life care. Transplantation 2023; 107:42. [PMID: 37845911 DOI: 10.1097/01.tp.0000993224.20470.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Affiliation(s)
- Kathrin Lawson
- Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Australia
- DonateLife, Melbourne, Australia
| | - Michael Jay
- Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Australia
- DonateLife, Melbourne, Australia
| | - Martin Dutch
- DonateLife, Melbourne, Australia
- Emergency Department, Royal Melbourne Hospital, Melbourne, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Australia
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Dutch M, Cheng A, Kiely P, Seed C. 311.6: Procleix® Ultrio Elite®Assay: Revised nucleic acid test window periods and applications in organ donation. Transplantation 2023; 107:74. [PMID: 37845959 DOI: 10.1097/01.tp.0000993416.32044.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Affiliation(s)
- Martin Dutch
- Emergency Department, Royal Melbourne Hospital, Melbourne, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Australia
| | - Anthea Cheng
- Department of Critical Care, University of Melbourne, Melbourne, Australia
| | - Philip Kiely
- Clinical Services and Research, Australian Red Cross Blood Service, Melbourne, Australia
| | - Clive Seed
- Clinical Services and Research, Australian Red Cross Blood Service, Perth, Australia
- Medical School, University of Western Australia, Crawley, Australia
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Dutch M, Wadley G, Knott JC. P6.3: From design to clinical trial: An application to estimate the residual risk of unexpected infections from increased viral risk donors. Transplantation 2023; 107:95. [PMID: 37845999 DOI: 10.1097/01.tp.0000993576.68897.3f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Affiliation(s)
- Martin Dutch
- Emergency Department., Royal Melbourne Hospital, Melbourne, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Australia
| | - Greg Wadley
- School of Computing and Information Systems, University of Melbourne, Melbourne, Australia
| | - Jon C Knott
- Emergency Department., Royal Melbourne Hospital, Melbourne, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Australia
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Dutch M, White J, Knott JC. 218.1: A model to estimate the impact of hospital length of admission on the residual risk of blood-borne virus infection in deceased organ donors. Transplantation 2023; 107:47-48. [PMID: 37845919 DOI: 10.1097/01.tp.0000993256.48920.a0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Affiliation(s)
- Martin Dutch
- Department of Emergency Medicine, Royal Melbourne Hospital, Parkville, Australia
- Department of Critical Care, University of Melbourne, Parkville, Australia
| | - Jonathan White
- Faculty of Business and Economics, University of Melbourne, Parkville, Australia
| | - Jonathan C Knott
- Department of Emergency Medicine, Royal Melbourne Hospital, Parkville, Australia
- Department of Critical Care, University of Melbourne, Parkville, Australia
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Abstract
BACKGROUND Many COVID-19 patients are discharged home from hospital with instructions to self-isolate. This reduces the burden on potentially overwhelmed hospitals. The Royal Melbourne Hospital (RMH) Home Monitoring Programme (HMP) is a model of care for COVID-19 patients which chiefly tracks pulse oximetry and body temperature readings. OBJECTIVE To evaluate the feasibility and acceptability of the HMP from a patient perspective. DESIGN, SETTINGS AND PARTICIPANTS Of 46 COVID-19 patients who used the HMP through RMH during April to August 2020, 16 were invited to participate in this qualitative evaluation study; all accepted, including 6 healthcare workers. Attempts were made to recruit a gender-balanced sample across a range of COVID-19 severities and comorbidities. Participants completed a brief semistructured phone interview discussing their experience of using the HMP. OUTCOME MEASURES AND ANALYSIS A thematic analysis of interview data was conducted. Feasibility was defined as the HMP's reported ease of use. Acceptability was considered holistically by reviewing themes in the interview data. RESULTS The HMP allowed clinical deterioration to be recognised as it occurred enabling prompt intervention. All participants reported a positive opinion of the HMP, stating it was highly acceptable and easy to use. Almost all participants said they found using it reassuring. Patients frequently mentioned the importance of the monitoring clinicians as an information conduit. The most suggested improvement was to monitor a broader set of symptoms. CONCLUSIONS The HMP is highly feasible and acceptable to patients. This model of care could potentially be implemented on a mass-scale to reduce the burden of COVID-19 on hospitals. A key benefit of the HMP is the ability to reassure patients they will receive suitable intervention should they deteriorate while isolating outside of hospital settings.
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Affiliation(s)
- Jane Oliver
- The Peter Doherty Institute for Infection and Immunity at the Department of Infectious Diseases, Melbourne Medical School, University of Melbourne, Melbourne, Victoria 3000, Australia
| | - Martin Dutch
- Emergency Department, Royal Melbourne Hospital, Melbourne, Victoria 3050, Australia
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Victoria 3000, Australia
| | - Amanda Rojek
- Emergency Department, Royal Melbourne Hospital, Melbourne, Victoria 3050, Australia
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Victoria 3000, Australia
| | - Mark Putland
- Emergency Department, Royal Melbourne Hospital, Melbourne, Victoria 3050, Australia
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Victoria 3000, Australia
| | - Jonathan C Knott
- Emergency Department, Royal Melbourne Hospital, Melbourne, Victoria 3050, Australia
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Victoria 3000, Australia
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Gray K, Chapman W, Khan UR, Borda A, Budge M, Dutch M, Hart GK, Gilbert C, Wani TA. The Rapid Development of Virtual Care Tools in Response to COVID-19: Case Studies in Three Australian Health Services. JMIR Form Res 2022; 6:e32619. [PMID: 35297765 PMCID: PMC8993142 DOI: 10.2196/32619] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/24/2021] [Accepted: 03/15/2022] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND News of the impact of COVID-19 around the world delivered a brief opportunity for Australian health services to plan new ways of delivering care to large numbers of people while maintaining staff safety through greater physical separation. The rapid pivot to telemedicine and virtual care provided immediate and longer term benefits; however, such rapid-cycle development also created risks. OBJECTIVE The aim of this study was to understand the sociotechnical aspects of the rapid-cycle development of seven different COVID-19 virtual care tools, and to identify enablers, barriers, and risks at three health services in Victoria, Australia. METHODS A qualitative, embedded, multiple case study design was adopted. Researchers from three health services collaborated with university researchers who were independent from those health services to gather and analyze structured interview data from key people involved in either clinical or technical aspects of designing and deploying seven different virtual care tools. RESULTS The overall objectives of each health service reflected the international requirements for managing large numbers of patients safely but remotely and for protecting staff. However, the governance, digital maturity, and specific use cases at each institution shaped the methodology and specific outcomes required. Dependence on key individuals and their domain knowledge within an existing governance framework generally enabled rapid deployment, but sometimes posed barriers. Existing relationships with technical service developers enabled strong solutions, which in some cases were highly scalable. Conventional project methodologies such as steering committees, scope, budget control, tight functional specification, consumer engagement and codesign, universal accessibility, and postimplementation evaluation were ignored almost universally in this environment. CONCLUSIONS These three health services took a variety of approaches to the rapid-cycle development of virtual care tools to meet their urgent needs for triaging and remote monitoring during the first year of the COVID-19 pandemic. Their experiences provided insights into many social and technical barriers and enablers to the development of virtual care tools. If these are addressed proactively, they will improve clinical governance and technical management of future virtual care. Some changes can be made within individual health services, while others entail health system policy reforms. Enhancing the environment for virtual care tool design and implementation now will yield returns not only during future health emergencies but also in many more routine care settings.
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Affiliation(s)
- Kathleen Gray
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
| | - Wendy Chapman
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
| | - Urooj R Khan
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
| | - Ann Borda
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
| | | | | | | | - Cecily Gilbert
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
| | - Tafheem Ahmad Wani
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
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Miles LF, Austin K, Eade A, Anderson D, Graudins A, McGain F, Maplesden J, Greene S, Rotella JA, Dutch M. Characteristics, presentation and outcomes of music festival patrons with stimulant drug-induced serotonin toxicity. Emerg Med Australas 2021; 33:992-1000. [PMID: 33858034 DOI: 10.1111/1742-6723.13778] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE A large number of stimulant drug-associated deaths at music festivals in Australia were reported during the southern hemisphere summer of 2018-2019. This led to the prehospital deployment of healthcare professional-led critical care response teams. We aimed to describe the characteristics, clinical presentation, management and outcomes of music festival patrons with stimulant drug-induced serotonin toxicity managed using this model during the study period. METHODS We performed a retrospective observational study of patients presenting with stimulant drug-induced serotonin toxicity and/or drug-induced hyperthermia who presented between December 2017 and December 2019. Comprehensive follow-up data were collected for those patients who required hospital admission. Data included demographics, clinical features, management and disposition, hospital outcomes and laboratory data, stratified by severity of presentation. RESULTS Forty-seven patients were included. Median age was 21.9 years (interquartile range 19.6-22.2). 3,4-Methylenedioxymetamphetamine was the most frequently reported agent ingested (32/47). After stratification, 13 of 47 patients were classified as mild, 20 of 47 as moderate and 14 of 47 as severe. Median presenting temperature in this latter cohort was 41.1°C (40.5-42.0°C). All severely ill patients required intensive care unit admission, with a median hospital stay of 4.63 days (interquartile range 2.08-8.36). End-organ complications were reported in 11 of 14 patients. No mortalities were reported. All patients (13/13) from the mild cohort and 15 of 20 patients from the moderate cohort were treated and discharged on-site. CONCLUSIONS Severe illness was associated with a high incidence of end-organ impairment. A high proportion of patients without severe disease were able to be successfully managed at the event without transport to hospital. No deaths are reported in this series.
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Affiliation(s)
- Lachlan F Miles
- Clinical Services, St John Ambulance Australia, Melbourne, Victoria, Australia.,Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kristy Austin
- Clinical Services, St John Ambulance Australia, Melbourne, Victoria, Australia
| | - Alan Eade
- Clinical Services, St John Ambulance Australia, Melbourne, Victoria, Australia.,Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - David Anderson
- Clinical Services, St John Ambulance Australia, Melbourne, Victoria, Australia.,Department of Intensive Care and Hyperbaric Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Andis Graudins
- Monash Toxicology Service, Monash Health, Melbourne, Victoria, Australia
| | - Forbes McGain
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Intensive Care, Western Health, Melbourne, Victoria, Australia
| | - Jacqueline Maplesden
- Department of Emergency Medicine, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Shaun Greene
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.,Victorian Poisons Information Centre, Austin Health, Melbourne, Victoria, Australia
| | - Joe-Anthony Rotella
- Victorian Poisons Information Centre, Austin Health, Melbourne, Victoria, Australia
| | - Martin Dutch
- Clinical Services, St John Ambulance Australia, Melbourne, Victoria, Australia.,Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Emergency Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
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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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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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Rojek AM, Dutch M, Camilleri D, Gardiner E, Smith E, Marshall C, Buising KL, Walsham N, Putland M. Early clinical response to a high consequence infectious disease outbreak: insights from COVID-19. Med J Aust 2020; 212:447-450.e1. [PMID: 32415678 DOI: 10.5694/mja2.50608] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Amanda M Rojek
- Royal Melbourne Hospital, Melbourne, VIC.,Centre for Integrated Critical Care, University of Melbourne, Melbourne, VIC
| | - Martin Dutch
- Royal Melbourne Hospital, Melbourne, VIC.,Centre for Integrated Critical Care, University of Melbourne, Melbourne, VIC
| | | | | | - Emma Smith
- Royal Melbourne Hospital, Melbourne, VIC
| | - Caroline Marshall
- University of Melbourne, Melbourne, VIC.,Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC
| | - Kirsty L Buising
- University of Melbourne, Melbourne, VIC.,Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC
| | | | - Mark Putland
- Royal Melbourne Hospital, Melbourne, VIC.,Centre for Integrated Critical Care, University of Melbourne, Melbourne, VIC
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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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Luke S, Dutch M. Extreme Sporting Events and Transport-Mitigating Strategies: An Australian Perspective. Ann Emerg Med 2014; 64:215-6. [DOI: 10.1016/j.annemergmed.2014.03.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 03/06/2014] [Accepted: 03/21/2014] [Indexed: 10/25/2022]
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Dutch M. PAPER BAGS AND OTHER SOURCES OF DISEASE. West J Med 1905. [DOI: 10.1136/bmj.2.2333.682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Dutch M. Direct Representation of the Profession and the Suppression of Unqualified Practice. West J Med 1886. [DOI: 10.1136/bmj.2.1347.789-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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