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Bevens W, Davenport R, Neate S, Yu M, Jelinek P, Jelinek GA, Reece J. Web-Based Health Information Seeking by People Living With Multiple Sclerosis: Qualitative Investigation of the Multiple Sclerosis Online Course. J Med Internet Res 2024; 26:e53372. [PMID: 38335016 PMCID: PMC10891496 DOI: 10.2196/53372] [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: 10/06/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Digital technologies have afforded people living with multiple sclerosis (MS) access to telehealth consultations, diagnostic tools, and monitoring. Although health care professionals remain the most trusted source of information, the internet has emerged as a valuable resource for providing MS-related information, particularly during the COVID-19 pandemic. Notably, people living with MS are increasingly seeking educational content for a range of topics related to the self-management of MS; however, web-based information seeking remains largely underevaluated. To address this gap and ensure that web-based health-related information is accessible and engaging, this study used qualitative methods to analyze the reflections from participants of web-based educational programs for people living with MS. OBJECTIVE This study aimed to explore the motivations, behaviors, and expectations of web-based health information seeking for people living with MS. METHODS We conducted semistructured interviews for 38 people living with MS 1 month after they completed the novel MS Online Course, which provided information on modifiable lifestyle-related risk factors for people living with MS. Of the 38 participants, 22 (58%) completed the intervention course and 16 (42%) completed the standard care course. Inductive thematic analysis was used within a qualitative paradigm, and 2 authors coded each interview separately and arrived at themes with consensus. RESULTS We identified 2 themes: motivation to learn and MS information on the web. The diagnosis of MS was described as a pivotal moment for precipitating web-based information seeking. People living with MS sought lifestyle-related information to facilitate self-management and increase control of their MS. Although social media sites and MS websites were considered useful for providing both support and information, discretion was needed to critically appraise information. Recognizable institutions were frequently accessed because of their trustworthiness. CONCLUSIONS This study provided novel insights into the motivations of people living with MS for seeking web-based health information. Furthermore, their preferences for the content and format of the web-based information accessed and their experiences and reactions to this information were explored. These findings may guide educators, researchers, and clinicians involved in MS care to optimize the engagement and processing of web-based health information seeking by people living with MS.
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Affiliation(s)
- William Bevens
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
- Institute for Clinical and Translational Science, University of California, Irvine, Irvine, CA, United States
| | - Rebekah Davenport
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| | - Sandra Neate
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| | - Maggie Yu
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| | - Pia Jelinek
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| | - George Alexander Jelinek
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| | - Jeanette Reece
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
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Bevens W, Reece J, Jelinek PL, Weiland TJ, Nag N, Simpson-Yap S, Gray K, Jelinek GA, Neate SL. The feasibility of an online educational lifestyle program for people with multiple sclerosis: A qualitative analysis of participant semi-structured interviews. Digit Health 2022; 8:20552076221123713. [PMID: 36081754 PMCID: PMC9445470 DOI: 10.1177/20552076221123713] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open
Abstract
Objective To explore the feasibility of a randomised controlled trial of a multiple sclerosis online course (MSOC) via qualitative analysis of participant semi-structured interviews. Methods The MSOC was developed in two arms: intervention arm which contained evidence-based lifestyle modification recommendations, and standard-care arm which delivered information from MS websites reflecting standard advice. Participants were recruited via online advertisements, completed a baseline questionnaire, and randomised. Seven modules were delivered over six weeks. Course completers were invited to participate in semi-structured interviews. Within a qualitative paradigm, interviews were analysed using reflexive thematic analysis. Results Fourteen of the 17 course completers were interviewed: 86% (12/14) female; mean age 50 years; residing in Australia, New Zealand, and the USA, predominantly had relapsing-remitting MS, mean time from diagnosis 9.5 years, and patient-determined disease steps disability assessment distributed evenly across all three categories. Four themes were identified: 1) “Hearing our stories” (hope for the future, feeling represented, exploring the journey of others with MS, learning from diversity, and wanting to connect with others); 2) “Taking the plunge” (not wanting to be first, feelings of nervousness or reluctance and feeling confronted); 3) “The accessibility and safety of being online” (ease of access, going at your own pace, making it work and not letting others down); and 4) “unpacking the course” (ease of navigation, visuals, understandability, and length and timing). Conclusion Participants felt represented, found the course accessible and content was easy to understand. These experiences provide important insights and considerations for this digital health intervention.
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Affiliation(s)
- William Bevens
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - J Reece
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - PL Jelinek
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - TJ Weiland
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - N Nag
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - S Simpson-Yap
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - K Gray
- Faculty of Medicine, Dentistry and Health Sciences, Centre for Digital Transformation of Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - GA Jelinek
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - SL Neate
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
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Bevens W, Gray K, Neate SL, Nag N, Weiland TJ, Jelinek GA, Simpson-Yap S. Characteristics of mHealth app use in an international sample of people with multiple sclerosis. Mult Scler Relat Disord 2021; 54:103092. [PMID: 34246024 DOI: 10.1016/j.msard.2021.103092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/25/2021] [Accepted: 06/13/2021] [Indexed: 11/25/2022]
Abstract
The management of multiple sclerosis (MS) has progressed significantly with the emergence of mHealth technologies. Uptake of mHealth apps amongst people with MS, and clinical and demographic characteristics of mHealth adopters is unknown outside North America. Participants of the HOLISM study were queried about their mHealth apps use. We summarize mHealth app usage, and clinical and demographic characteristics of mHealth app adopters using descriptive statistics. Overall, 3.1% of respondents reported using an mHealth app, most of whom were located in Australasia and North America. This study provides insight regarding mHealth app usage within a large international cohort of people with MS.
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Affiliation(s)
- W Bevens
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia.
| | - K Gray
- Centre for Digital Transformation of Health, The University of Melbourne, Australia
| | - S L Neate
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - N Nag
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - T J Weiland
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - G A Jelinek
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - S Simpson-Yap
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia; Menzies Institute for Medical Research, University of Tasmania, Australia
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O'Donnell JM, Jelinek GA, Gray KM, De Livera A, Brown CR, Neate SL, O'Kearney EL, Taylor KL, Bevens W, Weiland TJ. Therapeutic utilization of meditation resources by people with multiple sclerosis: insights from an online patient discussion forum. Inform Health Soc Care 2020; 45:374-384. [PMID: 32508186 DOI: 10.1080/17538157.2020.1755975] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We aimed to describe website traffic and qualitatively analyze an e-health community discussion forum. Participants in this study were people affected by multiple sclerosis visiting the Overcoming Multiple Sclerosis (OMS) website. This mixed methods study combined descriptive analysis of website traffic over 7 years and 1 month, and qualitative analysis of 1 week of posts in the meditation topic, coded into theme groups using qualitative thematic analysis. There were 166 meditation topics posted with 21,530 initial views of primary post and 785 sub-post responses. Meditation posts and sub-posts received 368,713 replies. Number of views increased from 4,684 in 2011 to over 80,000 in 2017, a considerably greater rate of increase than overall traffic. Qualitative analysis of posts on the meditation forum identified themes of barriers and enablers to utilization of meditation resources. Enablement themes dominated, observed across six of the seven theme groups with various forms of positive social and emotional support to learn and practice meditation. One theme, negative emotion, was identified as a barrier. The OMS peer-to-peer patient online discussion forum serves important functions in encouraging, educating and enabling its growing online community. Our analysis may help improve and innovate online support for lifestyle management in many chronic diseases.
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Affiliation(s)
- Jodi Millicent O'Donnell
- Neuroepidemiology Unit (NEU), Melbourne School of Population and Global Health, The University of Melbourne , Carlton, Australia.,School of Allied Health, Australian Catholic University , Fitzroy, Australia
| | - George Alexander Jelinek
- Neuroepidemiology Unit (NEU), Melbourne School of Population and Global Health, The University of Melbourne , Carlton, Australia
| | - Kathleen Mary Gray
- Health and Biomedical Informatics Centre, The University of Melbourne , Carlton, Australia
| | - Alysha De Livera
- Neuroepidemiology Unit (NEU), Melbourne School of Population and Global Health, The University of Melbourne , Carlton, Australia
| | - Chelsea Rae Brown
- Neuroepidemiology Unit (NEU), Melbourne School of Population and Global Health, The University of Melbourne , Carlton, Australia
| | - Sandra Leanne Neate
- Neuroepidemiology Unit (NEU), Melbourne School of Population and Global Health, The University of Melbourne , Carlton, Australia
| | - Emily Louise O'Kearney
- Neuroepidemiology Unit (NEU), Melbourne School of Population and Global Health, The University of Melbourne , Carlton, Australia
| | - Keryn Louise Taylor
- Neuroepidemiology Unit (NEU), Melbourne School of Population and Global Health, The University of Melbourne , Carlton, Australia
| | - William Bevens
- Neuroepidemiology Unit (NEU), Melbourne School of Population and Global Health, The University of Melbourne , Carlton, Australia
| | - Tracey Joy Weiland
- Neuroepidemiology Unit (NEU), Melbourne School of Population and Global Health, The University of Melbourne , Carlton, Australia
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O'Kearney EL, Brown CR, Jelinek GA, Neate SL, Taylor KT, Bevens W, De Livera AM, Simpson S, Weiland TJ. Mastery is associated with greater physical and mental health-related quality of life in two international cohorts of people with multiple sclerosis. Mult Scler Relat Disord 2019; 38:101481. [PMID: 31756608 DOI: 10.1016/j.msard.2019.101481] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 05/17/2019] [Revised: 08/30/2019] [Accepted: 10/26/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mastery is the sense of being in control of one's life and improvement in mastery may help to enhance quality of life. Little research has explored mastery in people with multiple sclerosis (MS), including its association with quality of life. OBJECTIVE To explore the association between mastery and health-related quality of life (HRQOL) in people with MS. METHOD Two cross-sectional cohorts of adults with MS (n = 1401 and n = 573), recruited through convenience sampling, completed an online survey which measured mastery using the Pearlin Mastery Scale, physical and mental HRQOL via physical and mental health composite scores of MSQOL-54, along with other covariates, including demographics, clinical characteristics and lifestyle factors. Linear regression assessed associations between mastery and physical HRQOL adjusting for age, sex, education, disability and depression, and between mastery and mental HRQOL adjusting for age, sex, education, disability and clinically significant fatigue. RESULTS Greater mastery score was associated with higher physical and mental HRQOL in both cohorts, such that a one-point increase in the PMS was associated with an increase of 2.9 (95% Confidence Interval (CI): 2.6, 3.1) and 2.8 points (95% CI: 2.4, 3.2) in the means of physical HRQOL score in the first and second cohorts respectively, and a 2.9-point (95% CI: 2.7, 3.1) and 3.1-point (95% CI: 2.7, 3.4) increase in the means of mental HRQOL score. A dose-dependent relationship was demonstrated between a quartile categorical mastery variable and both physical and mental HRQOL in both cohorts. Mastery was associated with all subscores of both physical and mental HRQOL. CONCLUSIONS Greater mastery is associated with better physical and mental quality of life. Efforts to improve the sense of self control and agency of people with MS may have benefits for their quality of life, even despite clinical features of the illness.
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Affiliation(s)
- E L O'Kearney
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Level 3 bldg 379, 207 Bouverie Street, 3010 Carlton Victoria, Australia
| | - C R Brown
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Level 3 bldg 379, 207 Bouverie Street, 3010 Carlton Victoria, Australia
| | - G A Jelinek
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Level 3 bldg 379, 207 Bouverie Street, 3010 Carlton Victoria, Australia
| | - S L Neate
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Level 3 bldg 379, 207 Bouverie Street, 3010 Carlton Victoria, Australia
| | - K T Taylor
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Level 3 bldg 379, 207 Bouverie Street, 3010 Carlton Victoria, Australia; Department of Psychiatry and Psychosocial Cancer Care, St Vincent's Hospital, Melbourne, Australia
| | - W Bevens
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Level 3 bldg 379, 207 Bouverie Street, 3010 Carlton Victoria, Australia
| | - A M De Livera
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Level 3 bldg 379, 207 Bouverie Street, 3010 Carlton Victoria, Australia
| | - S Simpson
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Level 3 bldg 379, 207 Bouverie Street, 3010 Carlton Victoria, Australia; Menzies Institute for Medical Research, University of Tasmania, Australia
| | - T J Weiland
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Level 3 bldg 379, 207 Bouverie Street, 3010 Carlton Victoria, Australia.
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6
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Jelinek GA, Smith A, Lynch D, Celenza A, Irving I, Michalopoulos N, Erber W, Joske DJL. The Effect of Adjunctive Fresh Frozen Plasma Administration on Coagulation Parameters and Survival in a Canine Model of Antivenom-treated Brown Snake Envenoming. Anaesth Intensive Care 2019; 33:36-40. [PMID: 15957689 DOI: 10.1177/0310057x0503300106] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aimed to assess the effects of dugite envenoming on blood coagulation and platelet count in a canine model, and the efficacy of fresh frozen plasma (FFP) in reversing the clotting disorder after both adequate and inadequate venom neutralization. Following initial dosing and administration studies, an intravenous venom dose of 1μg/kg was administered to eleven dogs. This was followed 30 minutes later by antivenom in either adequate or inadequate doses. A further 30 minutes later, the animals were given either two units of their own FFP or saline. Fibrinogen, aPTT and platelet levels were monitored for eight hours. Of the six study dogs given antivenom plus FFP, two died at around 60 to 90 minutes post envenoming, at the end of the FFP infusions, and all but one of the survivors had persistent afibrinogenaemia. Of the five study dogs given antivenom and no FFP, all but one had return of detectable fibrinogen at eight hours after envenoming. The platelet count fell in all animals with recovery independent of antivenom dose, administration of FFP, or regeneration of fibrinogen. Post mortem examinations of dogs that died during dosage and administration studies showed massive intracardiac clots. We conclude that early death from Brown Snake envenoming may be due to massive intravascular clotting. FFP administration was associated with persistent afibrinogenaemia regardless of antivenom dose. In the absence of any evidence for its efficacy, this study suggests that the role of FFP after Brown Snake envenoming should be reconsidered.
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Affiliation(s)
- G A Jelinek
- Department of Emergency Medicine, Sir Charles Gairdner Hospital and Queen Elizabeth II Medical Centre, University of Western Australia
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7
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Jelinek PL, Simpson S, Brown CR, Jelinek GA, Marck CH, De Livera AM, O'Kearney E, Taylor KL, Neate SL, Weiland TJ. Self-reported cognitive function in a large international cohort of people with multiple sclerosis: associations with lifestyle and other factors. Eur J Neurol 2018; 26:142-154. [PMID: 30133057 PMCID: PMC6585853 DOI: 10.1111/ene.13784] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/16/2018] [Indexed: 01/19/2023]
Abstract
Background and purpose We aimed to estimate the prevalence of perceived cognitive impairment (PCI) and explore its associations with lifestyle and disease characteristics in a large international cohort of people with multiple sclerosis (MS). Methods This study was a cross‐sectional analysis. Participants rated their cognitive function over the preceding 4 weeks using four questions in a subscale within the Multiple Sclerosis Quality of Life questionnaire (MSQOL‐54). These questions assessed perceived concentration, attention and memory by the patient and family/friends. Four definitions of PCI were derived, ranging from lowest to highest specificity. Associations with PCI were assessed by log‐binomial regression. Results The prevalence of PCI in our sample ranged from 41.0% (95% confidence interval, 39.0–43.0) using the least‐specific definition to 11.6% (95% confidence interval, 10.3–12.9) using the most specific definition. A number of factors were associated with PCI, increasing in magnitude as the definition specificity increased, including positive associations for smoking and body mass index, whereas physical activity, dietary quality and use of vitamin D/omega‐3 supplements were inversely associated with PCI. Conclusions Our study reports associations between healthy lifestyle behaviours and PCI in people with MS. Although reverse causality is a potential explanation for our findings, previous studies have shown comparable associations with healthy lifestyle and MS onset and progression. Subject to external validation, these results suggest benefits realized from a healthy lifestyle in people with MS.
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Affiliation(s)
- P L Jelinek
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC.,Sir Charles Gairdner Hospital, Nedlands, WA
| | - S Simpson
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC.,Menzies Institute for Medical Research, University of Tasmania, Tasmania
| | - C R Brown
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC
| | - G A Jelinek
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC
| | - C H Marck
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC
| | - A M De Livera
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC.,Biostatistics Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC
| | - E O'Kearney
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC
| | - K L Taylor
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC.,Department of Psychiatry and Psychosocial Cancer Care, St Vincent's Hospital, Melbourne, VIC, Australia
| | - S L Neate
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC
| | - T J Weiland
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC
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8
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Varney JE, Liew D, Weiland TJ, Inder WJ, Jelinek GA. The cost-effectiveness of hospital-based telephone coaching for people with type 2 diabetes: a 10 year modelling analysis. BMC Health Serv Res 2016; 16:521. [PMID: 27678079 PMCID: PMC5039787 DOI: 10.1186/s12913-016-1645-6] [Citation(s) in RCA: 16] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 08/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Type 2 diabetes (T2DM) is a burdensome condition for individuals to live with and an increasingly costly condition for health services to treat. Cost-effective treatment strategies are required to delay the onset and slow the progression of diabetes related complications. The Diabetes Telephone Coaching Study (DTCS) demonstrated that telephone coaching is an intervention that may improve the risk factor status and diabetes management practices of people with T2DM. Measuring the cost effectiveness of this intervention is important to inform funding decisions that may facilitate the translation of this research into clinical practice. The purpose of this study is to assess the cost-effectiveness of telephone coaching, compared to usual diabetes care, in participants with poorly controlled T2DM. METHODS A cost utility analysis was undertaken using the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model to extrapolate outcomes collected at 6 months in the DTCS over a 10 year time horizon. The intervention's impact on life expectancy, quality-adjusted life expectancy (QALE) and costs was estimated. Costs were reported from a health system perspective. A 5 % discount rate was applied to all future costs and effects. One-way sensitivity analyses were conducted to reflect uncertainty surrounding key input parameters. RESULTS The intervention dominated the control condition in the base-case analysis, contributing to cost savings of $3327 per participant, along with non-significant improvements in QALE (0.2 QALE) and life expectancy (0.3 years). CONCLUSIONS The cost of delivering the telephone coaching intervention continuously, for 10 years, was fully recovered through cost savings and a trend towards net health benefits. Findings of cost savings and net health benefits are rare and should prove attractive to decision makers who will determine whether this intervention is implemented into clinical practice. TRIAL REGISTRATION ACTRN12609000075280.
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Affiliation(s)
- J E Varney
- Department of Gastroenterology, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, 3004, Australia.
| | - D Liew
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, 3004, Australia
| | - T J Weiland
- St Vincent's Hospital, Melbourne and University of Melbourne, Melbourne, Australia
| | - W J Inder
- Princess Alexandra Hospital and The University of Queensland, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia
| | - G A Jelinek
- University of Melbourne, Melbourne, Australia
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Marck CH, Neate SL, Skinner M, Dwyer B, Hickey BB, Radford ST, Weiland TJ, Jelinek GA. Potential donor families' experiences of organ and tissue donation-related communication, processes and outcome. Anaesth Intensive Care 2016; 44:99-106. [PMID: 26673595 DOI: 10.1177/0310057x1604400115] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We aimed to describe the experiences of families of potential organ and tissue donors eligible for donation after circulatory death or brain death. Forty-nine family members of potential donors from four Melbourne hospitals were interviewed to assess their experiences of communication, processes and the outcomes of donation. Interviews were recorded, transcribed verbatim and analysed thematically. Families expressed a range of perspectives on themes of communication, hospital processes and care, the processes of consent and donation and reflected on decisions and outcomes. They expressed satisfaction overall with communication when receiving bad news, discussing death and donation. Honest and frank communication and being kept up-to-date and prepared for potential outcomes were important aspects for families, especially those of post circulatory death donors. Participants reported high levels of trust in healthcare professionals and satisfaction with the level of care received. Many donor families indicated the process was lengthy and stressful, but not significantly enough to adversely affect their satisfaction with the outcome. Both the decision itself and knowing others' lives had been saved provided them with consolation. No consenting families, and only some non-consenting families, regretted their decisions. Many expressed they would benefit from a follow-up opportunity to ask questions and clarify possible misunderstandings. Overall, while experiences varied, Australian families valued frank communication, trusted health professionals, were satisfied with the care their family member received and with donation processes, despite some apparent difficulties. Family satisfaction, infrequently assessed, is an important outcome and these findings may assist education for Australian organ donation professionals.
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Affiliation(s)
- C H Marck
- Emergency Practice Innovation Centre, St Vincent's Hospital, Melbourne, Victoria
| | - S L Neate
- Emergency Department, St Vincent's Hospital, Melbourne, Victoria
| | - M Skinner
- DonateLife Victoria, Melbourne, Victoria
| | - B Dwyer
- Organ and Tissue Authority, Canberra, Australian Capital Territory
| | - B B Hickey
- Intensive Care unit, St Vincent's Hospital, Melbourne, Victoria
| | - S T Radford
- Intensive Care Unit, Austin Hospital, Melbourne, Victoria
| | - T J Weiland
- Emergency Practice Innovation Centre, St Vincent's Hospital, Melbourne, Victoria
| | - G A Jelinek
- Practice Innovation Centre, St Vincent's Hospital, Melbourne, Victoria
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10
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Marck CH, Neate SL, Taylor KL, Weiland TJ, Jelinek GA. Prevalence of Comorbidities, Overweight and Obesity in an International Sample of People with Multiple Sclerosis and Associations with Modifiable Lifestyle Factors. PLoS One 2016; 11:e0148573. [PMID: 26849357 PMCID: PMC4743906 DOI: 10.1371/journal.pone.0148573] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [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: 10/28/2015] [Accepted: 01/19/2016] [Indexed: 11/29/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic neurological disorder, often affecting young people. Comorbid disorders such as depression, anxiety and hypertension are common and can affect disease course, treatment, and quality of life (QOL) of people with MS (PwMS). The associations between comorbidities, body mass index (BMI) and health outcomes are not well studied in MS, although research shows most PwMS are overweight. Most data on the prevalence of comorbidities and obesity in PwMS comes from North American populations. This study describes the prevalence of comorbidities, overweight and obesity and associations with modifiable factors in an international sample of PwMS recruited online through social media, MS societies and websites. The online survey consisted of validated and researcher-devised instruments to assess self-reported health outcomes and lifestyle behaviors. Of the 2399 respondents, 22.5% were overweight, 19.4% were obese and 67.2% reported at least one comorbidity, with back pain (36.2%), depression (31.7%), anxiety (29.1%) and arthritis (13.7%) most prevalent and most limiting in daily activities. Obesity and most comorbid disorders were significantly more prevalent in North America. Obese participants were more likely to have comorbidities, especially diabetes (OR 4.8) and high blood pressure (OR 4.5) but also depression (OR 2.2). Being overweight, obese, or a former, or current smoker was associated with an increase in the number of comorbidities; while healthy diet, physical activity (borderline significant) and moderate alcohol consumption were associated with decreased number of comorbidities. Increasing number of comorbidities was related to worse QOL, increased odds of disability and prior relapse. Obese PwMS had higher odds of disability and lower QOL. The associations between BMI, comorbidities and health outcomes are likely to be bi-directional and associated with lifestyle behaviors. Preventing and treating comorbid disorders and obesity in PwMS is warranted, and advice regarding healthy and risky lifestyle may assist in improving health outcomes.
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Affiliation(s)
- Claudia Helena Marck
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Sandra Leanne Neate
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Keryn Louise Taylor
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Tracey Joy Weiland
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - George Alexander Jelinek
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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Varney JE, Weiland TJ, Inder WJ, Jelinek GA. Effect of hospital-based telephone coaching on glycaemic control and adherence to management guidelines in type 2 diabetes, a randomised controlled trial. Intern Med J 2015; 44:890-7. [PMID: 24963611 DOI: 10.1111/imj.12515] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [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: 02/27/2014] [Accepted: 06/18/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Failure to achieve treatment targets is common among people with type 2 diabetes. Cost-effective treatments are required to delay the onset and slow the progression of diabetes-related complications. AIMS This study aimed to measure the effect of a 6-month telephone coaching intervention on glycaemic control, risk factor status and adherence to diabetes management practices at the intervention's conclusion (6 months) and at 12 months. METHOD This randomised controlled trial recruited 94 adults with type 2 diabetes and an HbA1C > 7% from the Diabetes Clinic of St Vincent's Hospital Melbourne. People who were non-English speaking, cognitively impaired, severely hearing impaired or without telephone access were excluded. Participants were randomised to receive usual care plus 6 months of telephone coaching focusing on achieving treatment targets and complication screening, or usual care only. The primary outcome was HbA1C at 6 months; secondary outcomes included other physiological and monitoring measures. RESULTS Significant interaction effects were observed between group and time at 6 months, demonstrating improvement in HbA1C, fasting glucose, diastolic blood pressure and physical activity. The intervention's effect on these parameters was not sustained at 12 months. Intervention group participants also improved compliance with foot examinations and pneumococcal vaccination by 6 months and retinal screening by 12 months. CONCLUSIONS Telephone coaching improved glycaemic control and adherence to complication screening in people with type 2 diabetes, for the duration of its delivery, but these effects were not maintained on withdrawal of the intervention. Strategies that assist patients to sustain these benefits are required.
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Affiliation(s)
- J E Varney
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia; Restoring Health, St Vincent's Hospital, Melbourne, Victoria, Australia
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Samaei H, Weiland TJ, Dilley S, Jelinek GA. Knowledge and confidence of a convenience sample of australasian emergency doctors in managing dental emergencies: results of a survey. Emerg Med Int 2015; 2015:148384. [PMID: 25821600 PMCID: PMC4364295 DOI: 10.1155/2015/148384] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 12/04/2014] [Revised: 01/28/2015] [Accepted: 01/29/2015] [Indexed: 11/23/2022] Open
Abstract
Background. We aimed to determine Australasian Specialist Emergency Physicians' and Emergency Physicians in Training (Trainees') level of knowledge of common dental emergencies. We also explored confidence in managing dental emergencies; predictors of confidence and knowledge; and preferences for further dental education. Methods. A questionnaire was distributed electronically (September 2011) and directly (November 2011) to Fellows and Trainees of the Australasian College for Emergency Medicine. It explored demographics, confidence, knowledge of dental emergencies, and educational preferences. Results. Response rate was 13.6% (464/3405) and college members were proportionally represented by region. Fewer than half (186/446; 42%) had received dental training. Sixty-two percent (244/391, 95% CI 57.5-67.1) passed (>50%) a knowledge test. More than 60% incorrectly answered questions on dental fracture, periodontal abscess, tooth eruption dates, and ulcerative gingivitis. Forty percent (166/416) incorrectly answered a question about Ludwig's Angina. Eighty-three percent (360/433) were confident in the pharmacological management of toothache but only 26% (112/434) confident in recognizing periodontal disease. Knowledge was correlated with confidence (r = 0.488). Interactive workshops were preferred by most (386/415, 93%). Conclusions. The knowledge and confidence of Australasian Emergency Physicians and Trainees in managing dental emergencies are varied, yet correlated. Interactive training sessions in dental emergencies are warranted.
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Affiliation(s)
- Hossein Samaei
- Department of Emergency Medicine, St. Vincent's Hospital, Melbourne, VIC 3065, Australia
| | - Tracey Joy Weiland
- Emergency Practice Innovation Centre, St. Vincent's Hospital, Melbourne, VIC 3065, Australia
- Department of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Stuart Dilley
- Department of Emergency Medicine, St. Vincent's Hospital, Melbourne, VIC 3065, Australia
- Department of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - George Alexander Jelinek
- Emergency Practice Innovation Centre, St. Vincent's Hospital, Melbourne, VIC 3065, Australia
- Department of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC 3010, Australia
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Jelinek GA, Marck CH, Weil J, Lane H, Philip J, Boughey M, Weiland TJ. Skills, expertise and role of Australian emergency clinicians in caring for people with advanced cancer. BMJ Support Palliat Care 2015; 7:81-87. [DOI: 10.1136/bmjspcare-2014-000671] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 09/03/2014] [Accepted: 12/18/2014] [Indexed: 11/03/2022]
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Neate SL, Marck CH, Weiland TJ, Hickey BB, Jelinek GA. Author reply: To PMID 23841760. Intern Med J 2013; 43:1351. [PMID: 24330370 DOI: 10.1111/imj.12309] [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] [Received: 09/25/2013] [Accepted: 10/02/2013] [Indexed: 11/27/2022]
Affiliation(s)
- S L Neate
- Emergency Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Ng EL, Weiland TJ, Jelinek GA, Hadgkiss E, Wilson A. Prevalence of and risk factors for peripheral arterial disease in older adults in an Australian emergency department. Vascular 2013; 22:1-12. [DOI: 10.1177/1708538112472288] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The aim of the paper is to estimate the prevalence of symptomatic and asymptomatic peripheral arterial disease (PAD) in emergency department (ED) patients aged 50 years or more and to identify associated clinical and demographic factors. A prospective cross-sectional study was conducted at a single ED. The main outcome was estimated prevalence of PAD (ankle brachial index <0.9 in either leg). Demographic and clinical history data were collected. The San Diego Claudication Questionnaire (SDCQ), the Intermittent Claudication Questionnaire (ICQ) and the Kessler Psychological Distress Scale (K10) were also administered. Participants with a positive diagnosis of PAD were referred for further management and followed up by telephone. A total of 329 ED patients aged ≥50 years were screened. PAD prevalence was 10.3% (95% CI 7.5–14.1%). The prevalence of symptomatic and asymptomatic PAD was 6.4% (95% CI 4.2–9.6%) and 3.9% (95% CI 2.3–6.7%), respectively. PAD prevalence increased significantly with age rising to 25.7% (95% CI 17.0–36.7) among those ≥80 years. Multivariate analyses revealed that being aged ≥80 years (odds ratio [OR] 5.97, 95% CI 2.74–13.02), having a history of angina (OR 3.034, 95% CI 1.35–6.80) and being a former smoker (2.77, 95% CI 1.23–6.22) were the strongest predictors of PAD. In conclusion, targeted screening for PAD among the older ED population identifies ED patients with PAD.
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Affiliation(s)
- E L Ng
- Department of Medicine, The University of Melbourne, Fitzroy, VIC, Australia
- Emergency Practice Innovation Centre, St. Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - T J Weiland
- Department of Medicine, The University of Melbourne, Fitzroy, VIC, Australia
- Emergency Practice Innovation Centre, St. Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - G A Jelinek
- Department of Medicine, The University of Melbourne, Fitzroy, VIC, Australia
- Emergency Practice Innovation Centre, St. Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - E Hadgkiss
- Emergency Practice Innovation Centre, St. Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - A Wilson
- Department of Medicine, The University of Melbourne, Fitzroy, VIC, Australia
- Department of Cardiology, St. Vincent's Hospital Melbourne, 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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Abstract
We aimed to describe the characteristics, clinical course, management and outcome of patients presenting to Perth teaching hospitals after envenoming by Tiger snakes. We undertook a chart review from six Perth teaching hospitals over a 16 year period from 1990 to 2005. Data were collected by a trained investigator using a preformatted data abstraction tool. We included patients bitten in the appropriate geographical area, with defibrination coagulopathy and positive Venom Detection Kit result for Tiger snake or response to specific antivenom. Of 381 charts reviewed, 23 patients were envenomed by a Tiger snake. The mean age was 36 years, 83% were male and all were bitten on a limb. First aid was applied poorly and all patients were symptomatic on presentation. Six patients developed rhabdomyolysis, one renal failure, four clinical bleeding, three neurotoxicity, one non-fatal respiratory arrest and one fatal cardiac arrest. All patients received antivenom, 13 received adrenaline premedication, with two mild allergic reactions developing in non-premedicated patients. The average dose of antivenom was four ampoules. Mean hospital stay was 2.6 days. This is the largest series of Tiger snake envenoming reported in Australia. Only one patient of 23 (4%) died, despite all patients being significantly envenomed. With rapid antivenom treatment and modem emergency and intensive care management, most patients envenomed by Tiger snakes survive.
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Affiliation(s)
- J Scop
- Discipline of Emergency Medicine, University of Western Australia, Perth, Western Australia, Australia
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Jelinek GA, Smith A, Lynch D, Celenza A, Irving I, Michalopoulos N, Erber W, Joske DJL. FFP after brown snake envenoming: think twice. Anaesth Intensive Care 2005; 33:542-3. [PMID: 16119508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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Jelinek GA, Gennat H, Celenza T, O'Brien D, Jacobs I, Lynch D. Community attitudes towards performing cardiopulmonary resuscitation in Western Australia. Resuscitation 2001; 51:239-46. [PMID: 11738773 DOI: 10.1016/s0300-9572(01)00411-7] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE to determine the attitudes of the Western Australian community towards performing cardiopulmonary resuscitation, and the factors affecting these attitudes. METHODS telephone survey of a randomly selected sample of people from suburban Perth and rural Western Australia; practical assessment of a sub-sample of volunteers from those surveyed, to correlate survey answers with practical skills. RESULTS of 803 people surveyed, the majority (90.7%) definitely would give mouth-to-mouth ventilation to a friend or relative, but less than half (47.2%) would to a stranger. The reluctance was mostly (56%) because of health and safety concerns, particularly related to HIV infection. Higher percentages of people would definitely provide cardiac massage for a friend or relative (91.4%) or stranger (78.1%). People were more likely to give mouth-to-mouth and cardiac massage if they had been trained in cardiopulmonary resuscitation (CPR), trained several times, trained recently, and used their CPR skills in real life. There were no significant differences between city and country people in whether they would provide CPR, but older people were less willing to provide mouth-to-mouth or cardiac massage. On practical assessment of 100 volunteers, there were significant errors and omissions in airway assessment, mouth-to-mouth resuscitation and cardiac massage. Volunteers with better practical scores were more prepared to provide CPR. DISCUSSION our results indicate a significant reluctance of the Western Australia public to perform mouth-to-mouth, except to a friend or relative. Earlier CPR training, practice and use seemed to diminish this reluctance. Practical CPR skills were not well executed. Those with better skills were less reluctant to use them. We recommend increasing CPR training in the community, greater frequency of refresher courses and public education on the risks of CPR to improve rates of bystander CPR.
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Affiliation(s)
- G A Jelinek
- Department of Emergency Medicine, University of Western Australia, Hospital Avenue, Western Australia 6009, Nedlands, Australia.
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Celenza A, Jelinek GA, Jacobs I, Kruk C, Graydon R, Murray L. Implementation and evaluation of an undergraduate emergency medicine curriculum. Emerg Med (Fremantle) 2001; 13:98-103. [PMID: 11476422 DOI: 10.1046/j.1442-2026.2001.00186.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the implementation and evaluation of an undergraduate course in the first Australian academic emergency medicine unit. METHODS A descriptive study of a course involving fifth year medical students at the University of Western Australia was undertaken. Teaching included self-directed case problem solving, small group tutorials, practical-skills teaching, clinical attachments and information handouts. Evaluation involved questionnaire scores and written feedback regarding life-support skills, tutorial teaching, course materials, clinical attachments and the course in general. Some groups of students underwent pre-course and post-course examinations. RESULTS Subjective and objective testing showed that student knowledge significantly improved. Feedback was especially positive toward clinical attachments in emergency departments, practical skills tutorials and the case-based learning method. Students requested longer attachments to emergency departments, and more practical, case-based, interactive and bedside teaching. Problems encountered included inadequate time for teaching, vagueness about student roles and objectives, and dealing with death for the first time without adequate preparation. CONCLUSION Undergraduate emergency medicine education should become an essential part of Australian and international undergraduate medical education. Emergency medicine is enjoyable and eminently suitable for problem-based, interactive and integrated teaching and improves confidence, clinical experience in emergencies, practical skills and teamwork. Improvements include more problem-based teaching, more practical skills sessions and better definition of student roles. These are general principles that can be applied to other undergraduate courses and to designers of other emergency medicine courses, both undergraduate and postgraduate.
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Affiliation(s)
- A Celenza
- Department of Emergency Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
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Abstract
Plasmas from Pseudonaja textilis and Notechis scutatus were tested in vitro for their ability to neutralise the procoagulant activity, in human plasma, of nine elapid venoms. Pseudonaja textilis plasma inhibited the procoagulant activity of all Pseudonaja species and in one taipan (Oxyuranus scutellatus). However there was no inhibitory activity against any from the Notechis species. Plasma from Notechis scutatus exhibited no inhibitory activity against any Notechis species, including self, only weak inhibition against the Pseudonaja species and, again, total inhibition of Oxyuranus scutellatus. Thus, protection of a species from the effects of its own venom does not appear to be universal.
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Affiliation(s)
- A Smith
- Haematology Department, Women's and Children's Pathology, King Edward Memorial/Princess Margaret Hospitals, Bagot Rd., WA 6008, Subiaco, Australia
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Abstract
Death and bereavement are often poorly dealt with in emergency departments. Guidelines exist for optimal care of bereaved relatives. Establishing a limited bereavement program in a busy emergency department is quite feasible. Bereaved relatives appreciate a more "human" approach from hospital staff. Ultimately hospital staff also benefit from confronting issues surrounding death in the emergency department.
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Affiliation(s)
- A G Williams
- Emergency Department, Sir Charles Gairdner Hospital, Perth, WA.
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Lopez DG, Rosman DL, Jelinek GA, Wilkes GJ, Sprivulis PC. Complementing police road-crash records with trauma registry data--an initial evaluation. Accid Anal Prev 2000; 32:771-777. [PMID: 10994604 DOI: 10.1016/s0001-4575(99)00130-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This paper examines the consistency of hospital and police reporting of outcomes of road traffic crashes using a database of linked police crash reports and trauma registry records. Criteria for inclusion into the trauma registry include trauma-related causes with subsequent stay of more than 24 h or death due to injuries. During the 1997 calendar year there were 497 cases of road-related injuries within the combined trauma registry of Sir Charles Gairdner and Fremantle Hospitals, of which only 82% had matching police records. Linkage rates were associated with gender, injury severity and the number of vehicles involved. Within the road user category, pedestrians were least likely to link. Of the linked records, police classification of injury severity was correct in 78% of cases. Male casualties were more likely to be correctly classified than females, after adjustment for related variables including injury severity. Correct classification of injury by police was also closely related to severity of injury. Identification and targeting of these groups of casualties is vital in refining the road-crash reporting system. Increased crash reporting and availability of data from these two sources will provide road authorities with more reliable measures of injury outcome.
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Affiliation(s)
- D G Lopez
- Department of Emergency Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
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Abstract
OBJECTIVE To determine the effect of establishing an emergency department observation ward (OW) on admission numbers, average length of stay (ALOS) for the entire hospital and overall bed days for conditions commonly treated in the OW. SETTING Sir Charles Gairdner Hospital (SCGH), Perth, a tertiary referral teaching hospital. DESIGN Retrospective analysis of routinely collected hospital data for the 10 most common diagnosis-related group (DRG) categories of patients discharged from the OW for the financial years 1995-96 to 1998-99. Comparison of these data with those for adult patients at the other Perth teaching hospitals over the same period. MAIN OUTCOME MEASURES For patients in the 10 most common DRGs: numbers of admissions to the OW compared with other inpatient wards; total number of patients admitted to the hospital compared with total bed days; ALOS at SCGH compared with other Perth teaching hospitals. RESULTS Increased admissions to the OW were paralleled by a decrease in admissions for the same DRG codes to other inpatient wards. ALOS remained approximately the same from 1995-96 to 1998-99 for patients in the OW (one day) and other inpatient wards (4.38 to 4.20 days). However, overall ALOS for patients in these DRGs fell by over a third (from 3.97 to 2.59 days) over this time. The total number of patients in these DRGs treated by the hospital increased by 19% over the four years, but the total number of bed days fell by 23%. By contrast, the ALOS for patients in the same DRGs treated at the other Perth teaching hospitals rose 8% (from 2.12 to 2.28 days). CONCLUSION Establishment of a formal emergency department OW results in the more efficient management of certain groups of patients, with a decrease in overall hospital bed days and length of stay.
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Hourigan CT, Mountain D, Langton PE, Jacobs IG, Rogers IR, Jelinek GA, Thompson PL. Changing the site of delivery of thrombolytic treatment for acute myocardial infarction from the coronary care unit to the emergency department greatly reduces door to needle time. Heart 2000; 84:157-63. [PMID: 10908251 PMCID: PMC1760916 DOI: 10.1136/heart.84.2.157] [Citation(s) in RCA: 24] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To quantify the change in door to needle time when delivery of thrombolytic treatment of acute myocardial infarction was changed from the coronary care unit to the emergency department. DESIGN A comparative observational study using prospectively collected data. SETTING Coronary care unit and emergency department of an Australian teaching hospital. PARTICIPANTS 89 patients receiving thrombolysis in coronary care unit between June 1994 and January 1996, and 100 patients treated in the emergency department between April 1997 and May 1998. INTERVENTIONS From April 1997, by agreement between cardiology and emergency medicine, all patients with acute myocardial infarction receiving thrombolysis were treated by emergency physicians in the emergency department. MAIN OUTCOME MEASURE Door to needle time measured from time of arrival at the hospital to start of thrombolysis. Other outcomes included pain to needle time and mortality. RESULTS Median door to needle times were less for patients treated in the emergency department than in the coronary care unit (37 minutes, 95% confidence interval (CI) 33 to 44 v 80 minutes, 95% CI 70 to 89, respectively; p < 0.0001). Door to needle time was under 60 minutes in 83% of emergency department patients and 26% of coronary care unit patients (57% difference, 95% CI 45% to 69%; p < 0.0001). Median pain to needle time was less for emergency department patients than for coronary care unit patients (161 minutes, 95% CI 142 to 177 v 195 minutes, 95% CI 180 to 209; p = 0.004); times of less than 90 minutes occurred in 18% of emergency department patients v 1% of coronary care unit patients (17% difference, 95% CI 9% to 25%; p < 0.05). Overall mortality was similar in patients treated in the emergency department and the coronary care unit. CONCLUSIONS With a collaborative interdepartmental approach, thrombolytic treatment of acute myocardial infarction was more rapid in the emergency department, without compromising patient safety. This should improve the outcome in patients with infarcts treated with thrombolytic agents.
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Affiliation(s)
- C T Hourigan
- Department of Emergency Medicine, Sir Charles Gairdner Hospital, Nedlands, Perth, Australia
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Jelinek GA, Mountain D, O'Brien D, Rogers IR, Wilkes G, Wenban J, Carr J, O'Keefe S, Martin PJ. Re-engineering an Australian emergency department: can we measure success? J Qual Clin Pract 1999; 19:133-8. [PMID: 10482320 DOI: 10.1046/j.1440-1762.1999.00326.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In 1996, in response to perceived deficiencies of the Emergency Department, Sir Charles Gairdner Hospital made emergency medicine a key strategic initiative. Major staffing and functional changes occurred as a result, including creation of the first Chair in Emergency Medicine in Australasia. We present a before and after study, using a range of measured variables, including the accepted Australian Council on Healthcare Standards emergency medicine clinical indicators. Clinically, there were great improvements in waiting times, time to thrombolysis in acute myocardial infarction, complaint rate, and misdiagnosed fracture rate. Increased throughput of short stay patients in a re-opened observation ward greatly shortened average length of stay for patients with a range of acute conditions. Data also indicated significant improvements in teaching and research. We conclude that with firm commitment from hospital management, re-engineering an emergency department can be shown to improve the quality-of-care.
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Affiliation(s)
- G A Jelinek
- Sir Charles Gairdner Hospital, Nedlands, WA, Australia
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Rogers IR, Evans L, Jelinek GA, Jacobs I, Inkpen C, Mountain D. Using clinical indicators in emergency medicine: documenting performance improvements to justify increased resource allocation. J Accid Emerg Med 1999; 16:319-21. [PMID: 10505908 PMCID: PMC1347047 DOI: 10.1136/emj.16.5.319] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To demonstrate how emergency department triage scale and thrombolysis indicator data can be used to document the impact of a substantial increase in resource allocation. METHODS Descriptive study in an emergency department of an adult tertiary hospital in Perth, Australia during similar periods of the year both before and after a substantial increase in emergency department staff, equipment, and system resources. The study group comprised a total of 11,048 emergency department attendances and all cases of emergency department initiated thrombolysis or acute angioplasty. Outcome was measured using numbers seen and percentage seen within indicator threshold time together with admission rates in each of the five triage categories as well as by using time from presentation to initiation of reperfusion treatment in acute myocardial infarction. RESULTS The proportion of patients seen within the prescribed indicator time increased by 16.4% (95% confidence interval 14.4% to 18.2%). The increase was most pronounced in triage category 2 (32.7%). Median time to thrombolysis fell by 30 minutes to 37 minutes (p = 0.0002). CONCLUSIONS Use of the Australasian national triage scale and time to thrombolysis clinical indicator data allows a quantitative assessment of the impact of increased emergency department resource allocation.
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Affiliation(s)
- I R Rogers
- Department of Emergency Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
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32
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Abstract
Training programs in emergency medicine differ from country to country. This article compares the allopathic training programs of Australasia and the United States. The perceived advantages of these programs are highlighted, but no attempt is made to determine which is the better program. The Australasian program is significantly longer and places a greater emphasis on the basic clinical sciences, physical examination skills, and academic output. Australasian College for Emergency Medicine (ACEM) regulations are relatively flexible and allow trainees to design their own programs. Trainees are encouraged to arrange accredited positions in a variety of hospitals. Overseas and part-time training may be acceptable. In the United States, trainees rotate within and from one parent institution, which provides a rigid teaching structure for a "critical mass" of trainees, based on a "core" curriculum. Rotations tend to be much shorter but ensure exposure to a broader range of clinical experience. Evaluation of trainees and teaching faculty is more frequent and documentation of procedural and resuscitation skills is required. Trainees are under the close supervision of teaching faculty at all times when working in an ED.
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Affiliation(s)
- D M Taylor
- University of Pittsburgh Medical Center, PA, USA. taylordm+@pitt.edu
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Abstract
This study aimed to review the presentation and management of patients with organophosphate poisoning admitted to the four tertiary teaching hospitals in Perth, Western Australia, over a 10-year period. The case notes of all 69 patients admitted with a discharge diagnosis of organophosphate poisoning were reviewed. Twenty-two of 25 patients (88%) attempting suicide were admitted to Intensive Care Units (ICUs), with a mean stay of 7 days (range 1-25 days). All but one were men, and two died. The 44 patients with accidental exposure were mainly children and had a mean stay of 2 days, with only seven going to the ICU. All survived. Complications overall included respiratory failure, convulsions, and aspiration pneumonia. Intubation and ventilation were required in 11 patients (16%), with a mean ventilation duration of 6 days (range 1-25 days). We conclude that deliberate ingestion of organophosphates is considerably more toxic than accidental exposure. Men aged 30-50 years were the most likely to attempt suicide with these agents and had prolonged ICU admissions with significant complications and mortality.
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Affiliation(s)
- G M Emerson
- Hyperbaric Medicine Unit, Fremantle Hospital, Western Australia, Australia
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Abstract
A 68 year-old-man presented some twelve hours after a presumed Tiger Snake bite with coagulopathy, paralysis and muscle necrosis. He suffered multi-system failure requiring prolonged ventilation, haemodialysis and supportive care, to be discharged after 26 days. Delays to antivenom therapy after tiger snake envenomation can result in significant morbidity. Australian snakes are the most venomous in the world.
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Affiliation(s)
- G A Jelinek
- Department of Emergency Medicine, Sir Charles Gairdner Hospital, Nedlands, W.A
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Abstract
The objective of this study was to review widow spider envenomation on a worldwide basis, with an emphasis on regional variability in management, particularly between the United States and Australia. Data sources were the Medline database (1966-1997) for English language references using as key words widow spider, latrodectism, and red back spider, and Mesh headings. Textbooks of toxinology were also used. Studies involving clinical reports and series were selected. The data indicated that envenomation by widow spiders (latrodectism) is common worldwide. Local pain and sweating predominate, in about 25% of cases becoming generalized or developing in remote sites. The mortality in published series varies from 5% to 10%, although these may be overestimates. Australia may have the highest rate of latrodectism in the world. The literature reveals regional disparities in the treatment and outcome of latrodectism. In Australia, intramuscular antivenin has been used liberally for more than 40 years with a very low rate (0.5% to 0.8%) of allergic reactions and no deaths recorded since its introduction. Antivenin is routinely successful in relieving the effects of latrodectism. In the United States, the antivenin is given intravenously, is usually reserved for very severe cases, and the rate of allergic reaction is high (from 9% up to 80% in those skin testing positive). Deaths have been recorded after antivenin. The literature suggests that antivenin to one species of Latrodectus is likely to be effective against other species. The conclusion drawn was that latrodectism is a common envenomation worldwide. There is a strong case for a comparative trial of Australian vs US antivenin in treating latrodectism due to the black widow spider in the United States.
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Affiliation(s)
- G A Jelinek
- Department of Emergency Medicine, Sir Charles Gairdner Hospital, Nedlands, West Australia
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Sprivulis P, Jelinek GA, Marshall L. Efficacy and potency of antivenoms in neutralizing the procoagulant effects of Australian snake venoms in dog and human plasma. Anaesth Intensive Care 1996; 24:379-81. [PMID: 8805896 DOI: 10.1177/0310057x9602400314] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The efficacy and potency of Commonwealth Serum Laboratories (CSL) snake antivenoms in neutralizing the procoagulant action of Australian snake venoms was studied in vitro. The procoagulant action of venoms from Tiger, Brown and Taipan Snakes were measured in pooled canine or pooled human plasma. Mixtures of the venoms and their appropriate antivenoms, ranging from 0.1 to 15 times the recommended neutralizing dose of antivenom were then added to pooled canine or pooled human plasma and the efficacy and potency of the antivenoms in preventing the procoagulant action was measured. Neutralization was achieved by the addition of the appropriate antivenom in concentrations of 0.5 (Taipan), 10 (Tiger), 10 (Gwardar), 15 (Dugite) and an estimated 20 (Common Brown) times the dose expected. Similar results were obtained in canine and human plasma. The potency of Tiger and especially Brown Snake antivenom is substantially lower (10-20 times) than that predicted by CSL. These findings support an increase in the dose of antivenom to be used for the treatment of Tiger and especially Brown Snake envenomation complicated by coagulopathy. The in vitro canine model may be suitable for studying the procoagulant effects of Australian snake venoms.
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Affiliation(s)
- P Sprivulis
- Department of Emergency Medicine, Fremantle Hospital, Western Australia
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Abstract
OBJECTIVE To describe the epidemiology and clinical features of children presenting to an emergency department with suspected snakebite. DESIGN A retrospective study of patient records. SETTING An emergency department of a children's teaching hospital (Princess Margaret Hospital) in Perth, Western Australia. PARTICIPANTS All children attending the emergency department from 1984 to 1993 with suspected snakebite. MAIN OUTCOME MEASURE Clinical and laboratory evidence of envenomation. RESULTS Over the decade studied, 156 children (mean age, six years and eight months) presented with suspected snakebite; over two-thirds (68%) were boys. In at least 31% of cases, no appropriate first aid had been applied. Only 14 children were envenomed according to clinical and laboratory criteria: 10 of these had coagulopathy; one of the 10 also had rhabdomyolysis. A Venom Detection Kit was used in 117 children. The test gave a positive result in 21 children (13%). Antivenom was given to 18 children, 14 of whom were definitely envenomed. Four of the envenomed children returned a negative result of Venom Detection Kit testing at all sites tested, and in five patients not clinically envenomed the urine specimen tested positive with the Venom Detection Kit (presumably a false positive result or subclinical envenomation). Of the 156 children, 130 were admitted to hospital, and 26 were discharged directly from the emergency department. All children recovered completely. CONCLUSIONS (i) Many children did not receive appropriate first aid for snakebite; (ii) Most children with suspected snakebite presenting to the emergency department were not envenomed; (iii) Envenomation was best diagnosed by clinical features and laboratory investigations, with the Venom Detection Kit being used to determine the appropriate antivenom; (iv) Discharging children directly from the emergency department is not recommended.
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Affiliation(s)
- H J Mead
- Department of Emergency Medicine, Fremantle Hospital, WA, 6160
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Abstract
Paraduodenal hernia is a rare congenital internal hernia which arises from an error of rotation of the midgut with entrapment of the small intestine beneath the developing colon. It is important as it usually presents as intestinal obstruction, and before laparotomy is often misdiagnosed. Mortality increases significantly with delays in surgical treatment. Two cases are presented: an 8 year old boy and a 52 year old man. Both presented with a short history of abdominal pain and an acute abdomen. With prompt surgical treatment, they recovered rapidly.
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Affiliation(s)
- T McDonagh
- Department of Emergency Medicine, Fremantle Hospital, Western Australia
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Affiliation(s)
- P Sprivulis
- Department of Emergency Medicine, Fremantle Hospital, WA
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Affiliation(s)
- N D Banham
- Department of Emergency Medicine, Fremantle Hospital, WA
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Abstract
The selection of appropriate non-inpatient casemix classification systems is pivotal to the overall success of casemix in Australia. Before implementation, an extensive review and evaluation of issues relating to non-inpatient casemix must be undertaken in conjunction with inpatient casemix to avoid adverse economic and clinical outcomes. Here, we review the background to and current status of non-inpatient casemix classification systems. The current Commonwealth/State research agenda is defined and possible options for both classification and funding of non-inpatient services are described.
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Affiliation(s)
- M I Cleary
- Department of Emergency Medicine and Ambulatory Care, Royal Brisbane Hospital, Herston, QLD
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Abstract
The aim of this study was to describe the pattern of illness caused by red-back spider bites to children in Perth, Western Australia, over a 10 year period, and to compare it with that in adults. The case-notes of 241 (89%) of the 271 children admitted to Princess Margaret Hospital and Fremantle Hospital with suspected red-back spider bite from 1979 to 1988 were available for analysis. A definite bite was defined as a definite bite by a positively identified red-back spider, positive identification of a red-back spider with no definite bite but the later development of typical symptoms or no definite history of red-back spider bite but strong clinical evidence and complete recovery after administration of antivenom. Systemic envenomation was accepted if there were symptoms of vomiting, generalized pain or sweating, or abdominal pain. Sixty-five per cent of children were definitely bitten. As found in previous adult and mixed studies, there was a peak incidence in the warmer months with a male preponderance (68%); 81% of bites were to the extremities and 83% of bites occurred in the daytime. The syndrome produced in children was usually similar to that seen in adults. Twenty-one per cent of children received antivenom, a rate comparable to previous studies in older age groups; however, no child received more than one ampoule. Compared with data extracted from a previously published study at Fremantle Hospital, in which 37% of adults treated with antivenom received more than one ampoule, these findings suggest that contrary to current opinion children may not be at an increased risk of morbidity from latrodectism.
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Affiliation(s)
- H J Mead
- Princess Margaret Hospital for Children, Subiaco, Western Australia
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Abstract
OBJECTIVE To describe the epidemiology of snake bite in Perth, and the likelihood of envenomation. DESIGN Information from case notes was retrospectively analysed. SETTING Emergency medicine, teaching hospitals. PATIENTS All patients admitted to the three adult teaching hospitals in Perth for suspected snake bite from 1979 to 1988. MAIN OUTCOME MEASURE Systemic envenomation, was accepted as present if there were definite symptoms, signs or laboratory evidence (vomiting, abdominal pain, ptosis, convulsions, difficulty with breathing or swallowing, coagulopathy, haemolysis, rhabdomyolysis or renal failure). RESULTS Ninety-nine patients were definitely bitten, with 53 envenomed, including three snake handlers. Thirty others may have been envenomed. Nearly half (44%) of the 82 patients with witnessed snake bite were envenomed. The dugite (Pseudonaja affinis) caused most cases of envenomation, most often producing coagulopathy only. The remainder were probably due to bites by the tiger snake (Notechis after occidentalis) and gwardar (Pseudonaja nuchalis), with one by a sea snake. The Commonwealth Serum Laboratories Snake Venom Detection Kit (VDK) enabled identification of the genus in 36% of definite cases of snake bite, and in 51% of cases of envenomation. It may occasionally produce false-positive results. The VDK is of greatest value in establishing the genus of snake in envenomed patients. CONCLUSIONS It is suggested that a mixture of brown and tiger snake antivenom be used to treat patients envenomed by an unidentified snake in the Perth metropolitan area. This does not apply to patients bitten elsewhere in Western Australia or transferred to Perth from country regions where other snakes are more prevalent.
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Affiliation(s)
- G A Jelinek
- Department of Emergency Medicine, Fremantle Hospital, WA
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Abstract
Intravenous regional administration of corticosteroid (IVRAS) in the treatment of rheumatoid arthritis of the hand has not been reported previously. The method is based on a modification of Bier's block, with substitution of corticosteroid for local anaesthetic. Twenty-two patients were assessed in this double-blind, placebo-controlled study. The technique was safe and effective in improving grip strength, with a group mean improvement of more than 50%. Because suppression of endogenous cortisol production 24 h after treatment was commensurate with the dose of methylprednisolone used (40 mg), we could not exclude that the response may have been due to systemic steroid. Further studies are required to define the real value of IVRAS as it may offer alternative treatment of the joints and tendons within the hand and wrist in some patients rather than more prolonged oral therapy or individual, multiple joint or sheath injections.
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Affiliation(s)
- G A Jelinek
- Department of Emergency Medicine, Fremantle Hospital, WA, Australia
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48
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Abstract
Seventy-six patients (30% children) were admitted to Fremantle Hospital over 10 years with suspected snake bite. Twenty-nine patients were definitely bitten, with 26 bites being witnessed. Of the 13 patients definitely envenomated, 11 had a coagulopathy although seven were asymptomatic; four other patients may have been envenomated. The dugite (Pseudonaja affinis) was probably responsible for most envenomations. Eleven of the 13 envenomated patients received antivenom (six brown snake, four polyvalent and one tiger snake antivenom). The patient envenomated by the tiger snake (Notechis ater occidentalis), a 13-year-old girl, was initially incorrectly treated with brown snake antivenom at a country hospital, and did not receive appropriate antivenom until 50 hours after the bite. She developed profound paralysis, rhabdomyolysis and renal failure, and required prolonged ventilation during her 53-day hospital admission, but survived without disability. Snake bite wounds should not be washed, so that venom can be identified from the wound. Attempts to kill snakes are dangerous, often leading to bites on the fingers. First aid measures of a pressure bandage and immobilisation, used in 13 of the 29 cases (45%), should be more widely publicised.
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Abstract
Plain abdominal radiographs are ordered frequently in emergency departments. Previous studies have shown that these radiographs are often requested inappropriately with little likelihood of producing useful information. This study shows that the overall number can be reduced significantly, with little risk to patients, when clear guide-lines are applied.
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Affiliation(s)
- G A Jelinek
- Department of Emergency Medicine, Fremantle Hospital, Western Australia
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Abstract
The first defence of the America's Cup outside of the USA took place off Fremantle, Western Australia, between October, 1986 and February, 1987. Fremantle Hospital, the nearest hospital to the marinas, was involved in the planning for disasters and for the provision of clinical services to the syndicates involved and the projected crowds of tourists and spectators. The impact of this unique sporting event on the hospital was measured by collecting data from all patients whose presence in Fremantle was related to the yachting. The America's Cup resulted in only 654 attendances and 31 admissions over the 5 months of the event. The figures fell far short of those predicted. A number of conclusions have been drawn.
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Affiliation(s)
- G M Galvin
- Department of Emergency Medicine, Fremantle Hospital, Australia
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