Australasian Medical Journal
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Admission Cardiotocography
Get PDFBackground Routine and continuous electronic monitoring of foetal heart rate (FHR) in labour has become an established obstetric practice in high-risk pregnancies in industrialised countries. However, the same may not be possible in non-industrialised countries where antenatal care is inadequate with a large number of high-risk pregnancies being delivered in crowded settings and inadequate health care provider to patient ratios. Aims The objective of this study was to evaluate the predictive value of the admission cardiotocogram (CTG) in detecting foetal hypoxia at the time of admission in labour and to correlate the results of the admission CTG with the perinatal outcome in high-risk obstetric cases. Method This was a prospective observational study conducted in the labour and maternity ward of a hospital in Gangtok, India, during the period 2008 to 2010. The study included high-risk pregnant women, admitted via the emergency or outpatient department with a period of gestation ≥36 weeks, in first stage of labour with foetus in the cephalic presentation. All women were subjected to an admission CTG, which included a 20 minute recording of FHR and uterine contractions. Results One hundred and sixty patients were recruited. The majority of women were primigravida in the 21-30 years age group. About 42% patients were postdated pregnancy followed by pregnancy-induced hypertension (PIH) (15.6%) and premature rupture of membranes (PROM) (11.3%) as the major risk factors. The admission CTG were ‘reactive’ in 77%, ‘equivocal’ in 14.4% and ‘ominous’ in 8.7% women. Incidence of foetal distress, moderate-thick meconium stained liquor and neonatal intensive care unit (NICU) admission was significantly more frequent among patients with ominous test results compared with equivocal or reactive test results on admission. Incidence of vaginal delivery was more common when the test was reactive. Conclusion The admission CTG appears to be a simple non-invasive test that can serve as a screening tool in ‘triaging’ foetuses of high-risk obstetric patients in non-industrialised countries with a heavy workload and limited resources
Managers’ Leadership and Staff Job Satisfaction in Emergency Medicine
No full textBackground/AimsLeadership plays a crucial role in many professions, especially in challenging positions such as emergency medical service jobs. The purpose of this study was to explore the relationship between managers’ leadership styles and emergency medical technicians’ job satisfaction.MethodThis is a descriptive and cross-sectional study that was carried out in 2010. The research population included 21 managers and 87 emergency medical technicians working in 23 stations in Isfahan city, Iran. The main tools used for data accumulation were the Multiple Leadership Questionnaire for evaluating leadership styles and the Job Descriptive Index for measuring job satisfaction levels. Also, the Pearson correlation analysis test was used to evaluate the relationship between leadership style and job satisfaction.ResultsAmong both managers and technicians, the highest mean score related to the transformational management style, whereas the lowest mean score related to the laissez-faire management style. Moreover, a significant relationship (
A Corpus for Evidence Based Medicine Summarisation
Get PDFBackground Automated text summarisers that find the best clinical evidence reported in collections of medical literature are of potential benefit for the practice of Evidence Based Medicine (EBM). Research and development of text summarisers for EBM, however, is impeded by the lack of corpora to train and test such systems. Aims To produce a corpus for research in EBM summarisation. Method We sourced the “Clinical Inquiries” section of the Journal of Family Practice (JFP) and obtained a sizeable sample of questions and evidence based summaries. We further processed the summaries by combining automated techniques, human annotations, and crowdsourcing techniques to identify the PubMed IDs of the references. Results The corpus has 456 questions, 1,396 answer components, 3,036 answer justifications, and 2,908 references. Conclusion The corpus is now available for the research community at http://sourceforge.net/projects/ebmsumcorpus
Measuring Adolescent Attitudes Towards Abortion
Get PDFBackground Measurement scales seeking to quantify latent traits like attitudes, are often developed using traditional psychometric approaches. Application of the Rasch unidimensional measurement model may complement or replace these techniques, as the model can be used to construct scales and check their psychometric properties. If data fit the model, then a scale with invariant measurement properties, including interval-level scores, will have been developed. Aims This paper highlights the unique properties of the Rasch model. Items developed to measure adolescent attitudes towards abortion are used to exemplify the process. MethodTen attitude and intention items relating to abortion were answered by 406 adolescents aged 12 to 19 years, as part of the “Teen Relationships Study”. The sampling framework captured a range of sexual and pregnancy experiences. Items were assessed for fit to the Rasch model including checks for Differential Item Functioning (DIF) by gender, sexual experience or pregnancy experience. ResultsRasch analysis of the original dataset initially demonstrated that some items did not fit the model. Rescoring of one item (B5) and removal of another (L31) resulted in fit, as shown by a non-significant item-trait interaction total chi-square and a mean log residual fit statistic for items of -0.05 (SD=1.43). No DIF existed for the revised scale. However, items did not distinguish as well amongst persons with the most intense attitudes as they did for other persons. A person separation index of 0.82 indicated good reliability. ConclusionApplication of the Rasch model produced a valid and reliable scale measuring adolescent attitudes towards abortion, with stable measurement properties. The Rasch process provided an extensive range of diagnostic information concerning item and person fit, enabling changes to be made to scale items. This example shows the value of the Rasch model in developing scales for both social science and health disciplines
Ventilator-Associated Pneumonia
Get PDFBackground Ventilator-associated pneumonia (VAP) is the most frequent infection in patients intubated for longer than 48 hours. There is a great interest in determining the factors influencing the outcome of VAP, as it may help in reducing the associated morbidity and mortality. This study aimed to determine the impact of appropriate antibiotic therapy based on endotracheal aspirate cultures on the outcome of VAP. We have also studied the other factors that may influence the outcome of VAP. Method A cohort study was conducted in the intensive care units of a tertiary care hospital in South India over a period of 15 months. The outcome of VAP was assessed by prolongation of the duration of mechanical ventilation and/ or death of the patient. Results The duration of mechanical ventilation was significantly prolonged in patients with VAP (16.61 ± 8.2 d vs. 8.21 ± 5.9 d, P 2 days in administering the first dose of appropriate antibiotic therapy significantly prolonged the duration of ventilation (P < 0.0001). Infection by multi-drug resistant pathogens, polymicrobial infection and time of onset of VAP did not have significant impact on the outcome of VAP. Conclusion Early administration of appropriate antibiotic therapy, based on the antibiogram of the VAP pathogens identified by quantitative culture of endotracheal aspirate, could lead to an improved outcome of patients with ventilator-associated pneumonia
Towards Semantic Search and Inference in Electronic Medical Records
Get PDFBackground This paper presents a novel approach to searching electronic medical records that is based on concept matching rather than keyword matching. Aims The concept-based approach is intended to overcome specific challenges we identified in searching medical records. Method Queries and documents were transformed from their term-based originals into medical concepts as defined by the SNOMED-CT ontology. Results Evaluation on a real-world collection of medical records showed our concept-based approach outperformed a keyword baseline by 25% in Mean Average Precision. Conclusion The concept-based approach provides a framework for further development of inference based search systems for dealing with medical data
The Values Fostered by Health Technology
Get PDFAs part of our research team’s knowledge transfer and exchange (KTE) initiatives, we developed a six-minute video-clip to enable productive deliberations among technology developers, clinicians and patient representatives. This video-clip summarises in plain language the valuable goals and features that are embedded in health technology and raises questions regarding the direction that should be taken by health care innovations. The use of such video-clips creates unique opportunities for face-to-face deliberations by enabling participants to interact and debate policy issues that are pivotal to the sustainability of health care systems. In our experience, we found that audiovisual-elicitation-based KTE initiatives can fill an important communication gap among key stakeholders: pondering, from a health care system perspective, why and how certain kinds of medical technologies bring a more valuable response to health care needs when compared to others
Communicating Health Risks Via the Media
Get PDFUnderstanding the viewer impact of the primetime television cooking show, MasterChef Australia, may help us to communicate more positively received messages about food and eating
A Fatal Case of Brucine Poisoning
Get PDFIn some parts of India people follow a religious ritual of drinking an herbal preparation made from the bark of Alstonia scholaris tree (Blackboard tree) on the day of new moon in the month of July. This tree could be easily confused with Strychnos nux vomica tree. Brucine is the predominant alkaloid present in the bark of the tree Strychnos nux vomica. Toxicological property of Brucine is similar to strychnine. Brucine is a neurotoxin. A 29-year-old male presented with a history of consumption of a herbal preparation made from the bark of the Strychnos nux vomica tree confusing it for Alstonia scholaris. Soon after, he developed convulsions and later he died in the hospital on the same day. The main aim of this case report is to highlight the fact that people must be cautious when they follow religious rituals
