15 research outputs found
Cardiac services for care of suspected acute coronary syndromes in Australia and New Zealand hospitals
No full textAbstract 18319Isuru Ranasinghe, Carolyn Astley, Bernadette Aliprandi-Costa, Derek Chew, Christopher J Ellis, Christopher J Hammett, Tom G Briffa, Tegwen E Howell, Karen J Lintern, Hella Parker, Bridie Carr, Greg D Gamble, Rosanna Tavella, Julie Redfern, John French, David Briege
Economics, health promotion expenditure and acute myocardial infarction mortality in Australia
No full textEquitable provision of health services to Aboriginal and Torres Strait Islander people of Queensland
No full textPrescription of secondary prevention medications, lifestyle advice, and referral to rehabilitation among acute coronary syndrome inpatients: results from a large prospective audit in Australia and New Zealand
No full textOBJECTIVE: To evaluate the proportion of patients hospitalised with acute coronary syndrome (ACS) in Australia and New Zealand who received optimal inpatient preventive care and to identify factors associated with preventive care. METHODS: All patients hospitalised bi-nationally with ACS were identified between 14-27 May 2012. Optimal in-hospital preventive care was defined as having received lifestyle advice, referral to rehabilitation, and prescription of secondary prevention pharmacotherapies. Multilevel multivariable logistic regression was used to determine factors associated with receipt of optimal preventive care. RESULTS: For the 2299 ACS survivors, mean (SD) age was 69 (13) years, 46% were referred to rehabilitation, 65% were discharged on sufficient preventive medications, and 27% received optimal preventive care. Diagnosis of ST elevation myocardial infarction (OR: 2.64 [95% CI: 1.88-3.71]; p<0.001) and non-ST elevation myocardial infarction (OR: 1.99 [95% CI: 1.52-2.61]; p<0.001) compared with a diagnosis of unstable angina, having a percutaneous coronary intervention (PCI) (OR: 4.71 [95% CI: 3.67-6.11]; p<0.001) or coronary bypass (OR: 2.10 [95% CI: 1.21-3.60]; p=0.011) during the admission or history of hypertension (OR:1.36 [95% CI: 1.06-1.75]; p=0.017) were associated with greater exposure to preventive care. Age over 70 years (OR:0.53 [95% CI: 0.35-0.79]; p=0.002) or admission to a private hospital (OR:0.59 [95% CI: 0.42-0.84]; p=0.003) were associated with lower exposure to preventive care. CONCLUSIONS: Only one-quarter of ACS patients received optimal secondary prevention in-hospital. Patients with UA, who did not have PCI, were over 70 years or were admitted to a private hospital, were less likely to receive optimal care.Julie Redfern, Karice Hyun, Derek P Chew, Carolyn Astley, Clara Chow, Bernadette Aliprandi-Costa, Tegwen Howell, Bridie Carr, Karen Lintern, Isuru Ranasinghe, Kellie Nallaiah, Fiona Turnbull, Cate Ferry, Chris Hammett, Chris J Ellis, John French, David Brieger, Tom Briff
Availability of highly sensitive troponin assays and acute coronary syndrome care: Insights from the SNAPSHOT registry
No full textFree to read on journal website (may need to create free account first)\ud
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Objectives: To examine differences in care and inhospital course of patients with possible acute coronary syndrome (ACS) in Australia and New Zealand based on whether a highly sensitive (hs) troponin assay was used at the hospital to which they presented.\ud
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Design, setting and patients: A snapshot study of consecutive patients presenting to hospitals in Australia and New Zealand from 14 to 27 May 2012 with possible ACS.\ud
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Main outcome measures: Rates of major adverse cardiac events (inhospital death, new or recurrent myocardial infarction, stroke, cardiac arrest or worsening heart failure); association between assay type and outcome (via propensity score matching and a generalised estimating equation [GEE]; averages of the predicted outcomes among patients who were treated with and without the availability of an hs assay (via inverse probability-weighting [IPW] with regression-adjusted estimators).\ud
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Results: 4371 patients with possible ACS were admitted to 283 hospitals. Over half of the hospitals (156 [55%]) reported using the hs assay and most patients (2624 [60%]) had hs tests (P = 0.004). Use of the hs assay was independent of hospital coronary revascularisation capability. Patients tested with the hs assay had more non-invasive investigations (exercise tests, stress echocardiography, stress nuclear scans, and computed tomography coronary angiography) than those tested with the sensitive assay. However, there were no differences between the groups in rates of angiography or revascularisation. All adjusted analyses showed a consistently lower rate of inhospital events, including recurrent heart failure in patients for whom the hs assay was used (GEE odds ratio, 0.75; 95% CI, 0.60–0.94; P = 0.014); IPW analysis showed a 2.3% absolute reduction in these events with the use of the hs assay (P = 0.018).\ud
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Conclusion: Use of hs troponin testing of patients hospitalised with possible ACS was associated with an increased rate of non-invasive cardiac investigations and fewer inhospital adverse events
Acute coronary syndrome care across Australia and New Zealand: the SNAPSHOT ACS Study
No full textOBJECTIVES: To characterise management of suspected acute coronary syndrome (ACS) in Australia and New Zealand, and to assess the application of recommended therapies according to published guidelines. DESIGN, SETTING AND PATIENTS: All patients hospitalised with suspected or confirmed ACS between 14 and 27 May 2012 were enrolled from participating sites in Australia and New Zealand, which were identified through public records and health networks. Descriptive and logistic regression analysis was performed. MAIN OUTCOME MEASURES: Rates of guideline-recommended investigations and therapies, and inhospital clinical events (death, new or recurrent myocardial infarction [MI], stroke, cardiac arrest and worsening congestive heart failure). RESULTS: Of 478 sites that gained ethics approval to participate, 286 sites provided data on 4398 patients with suspected or confirmed ACS. Patients’ mean age was 67 years (SD, 15 years), 40% were women, and the median Global Registry of Acute Coronary Events (GRACE) risk score was 119 (interquartile range, 96–144). Most patients (66%) presented to principal referral hospitals. MI was diagnosed in 1436 patients (33%), unstable angina or likely ischaemic chest pain in 929 (21%), unlikely ischaemic chest pain in 1196 (27%), and 837 patients (19%) had other diagnoses not due to ACS. Of the patients with MI, 1019 (71%) were treated with angiography, 610 (43%) with percutaneous coronary intervention and 116 (8%) with coronary artery bypass grafting. Invasive management was less likely with increasing patient risk (GRACE score 200, 36.1%; P < 0.001). The inhospital mortality rate was 4.5% and recurrent MI rate was 5.1%. After adjusting for patient risk and other variables, significant variations in care and outcomes by hospital classification and jurisdiction were evident. CONCLUSION: This first comprehensive combined Australia and New Zealand audit of ACS care identified variations in the application of the ACS evidence base and varying rates of inhospital clinical events. A focus on integrated clinical service delivery may provide greater translation of evidence to practice and improve ACS outcomes in Australia and New Zealand.Derek P Chew, John French, Tom G Briffa, Christopher J Hammett, Christopher J Ellis, Isuru Ranasinghe, Bernadette J Aliprandi-Costa, Carolyn M Astley, Fiona M Turnbull, Jeffrey Lefkovits, Julie Redfern, Bridie Carr, Greg D Gamble, Karen J Lintern, Tegwen E J Howell, Hella Parker, Rosanna Tavella, Stephen G Bloomer, Karice K Hyun and David B Briege
A Queensland research support network in emergency healthcare Collaborating to build the research capacity of more clinicians in more locations
No full textPurpose: The purpose of this paper is to describe the structure and impact of a Queensland Research Support Network (RSN) in emergency medicine (EM). Design/methodology/approach: This paper presents a descriptive summary of EM networks, network evaluations and the structure and development of the Emergency Medicine Foundation’s (EMF) RSN in Queensland, including an observational pre- and post-study of research metrics. Findings: In two years, the RSN supported 33 Queensland emergency departments (EDs), of which 14 developed research strategies. There was an increase in research active clinicians, from 23 in 2015 to 181 in 2017. Collaborator engagement increased from 9 in 2015 to 276 in 2017 as did the number of research presentations, from 6 in 2015 to 61 in 2017. EMF experienced a growth in new researchers, with new investigators submitting approximately 60 per cent of grant applications in 2016 and 2017. EMF also received new applications from a further three HHS (taking EMF-funded research activity from 8 to 11 HHS).
Research limitations/implications: This paper describes changes in KPIs and research metrics, which the authors attribute to the establishment of the RSN. However, it is possible that attribution bias plays a role in the KPI improvements.
Social implications: This network has actively boosted and expanded EM research capacity and capability in Queensland. It provides services, in the form of on-the-ground managers, to develop novice clinician-researchers, new projects and engage entire EDs. This model may be replicated nationwide but requires funding commitment.
Originality/value: The RSN improves front-line clinician research capacity and capability and increases research activity and collaborations with clear community outcomes. Collaborations were extended to community, primary health networks, non-government organisations, national and international researchers and academic institutions. Evaluating and measuring a network’s benefits are difficult, but it is likely that evaluations will help networks obtain funding.No Full Tex
Conversion of other opioids to methadone: a retrospective comparison of two methods
No full textContext: A rapid method of methadone conversion known as the Perth Protocol is commonly used in Australian palliative care units. There has been no follow-up or validation of this method and no comparison between different methods of conversion. Objectives: The primary objective of this study was to test the hypothesis that the achieved doses of methadone are independent of the conversion method (rapid vs slower). The secondary objectives included examining the relationship between calculated target doses, actual achieved doses and duration of conversions. Methods: This is a retrospective chart audit conducted at two hospital sites in the Brisbane metropolitan area of Australia which used different methadone conversion methods. Results: Methadone conversion ratios depended on previous opioid exposure and on the method of conversion used. The method most commonly used in Australia for calculating target doses for methadone when converting from strong opioids is a poor predictor of actual dose achieved. More appropriate conversion ratios are suggested. Conclusions: Further research is needed to refine the ratios used in practice when converting patients from strong opioids to methadone. Caution and clinical expertise are required. A palliative methadone registry may provide useful insights
The effects of artificial intelligence applications in educational settings: Challenges and strategies
No full textWith the continuous intervention of AI tools in the education sector, new research is required to evaluate the viability and feasibility of extant AI platforms to inform various pedagogical methods of instruction. The current manuscript explores the cumulative published literature to date in order to evaluate the key challenges that influence the implications of adopting AI models in the Education Sector. The researchers' present works both in favour and against AI-based applications within the Academic milieu. A total of 69 articles from a 618-article population was selected from diverse academic journals between 2018 and 2023. After a careful review of selected articles, the manuscript presents a classification structure based on five distinct dimensions: user, operational, environmental, technological, and ethical challenges. The current review recommends the use of ChatGPT as a complementary teaching-learning aid including the need to afford customized and optimized versions of the tool for the teaching fraternity. The study addresses an important knowledge gap as to how AI models enhance knowledge within educational settings. For instance, the review discusses interalia a range of AI-related effects on learning from the need for creative prompts, training on diverse datasets and genres, incorporation of human input and data confidentiality and elimination of bias. The study concludes by recommending strategic solutions to the emerging challenges identified while summarizing ways to encourage wider adoption of ChatGPT and other AI tools within the education sector. The insights presented in this review can act as a reference for policymakers, teachers, technology experts and stakeholders, and facilitate the means for wider adoption of ChatGPT in the Education sector more generally. Moreover, the review provides an important foundation for future research
Acute Headache Presentations to the Emergency Department: A Statewide Cross-sectional Study
No full textObjectives:The objective of this study was to describe demographic and clinical characteristics includingfeatures that were consistent with subarachnoid hemorrhage (SAH), use of diagnostic tests, emergencydepartment (ED) discharge diagnoses, and disposition of adult patients presenting with an acute headache toEDs statewide across Queensland, Australia. In addition, potential variations in the presentation and diagnosticworkup between principal-referral and city-regional hospitals were examined.Methods: A prospective cross-sectional study was conducted over 4 weeks in September 2014. All patients ≥ 18years presenting to one of 29 public and five private hospital EDs across the state with an acute headache wereincluded. The headache had to be the principal presenting complaint and nontraumatic. The 34 study sites attend toabout 90% of all ED presentations statewide. The treating doctor collected clinical information at the time of the EDvisit including the characteristics of the headache and investigations performed. A study coordinator retrievedresults of investigations, ED discharge diagnoses, and disposition from state databases. Variations in presentation,investigations, and diagnosis between city-regional and principal-referral hospitals were examined.Results: There were 847 headache presentations. Median (range) age was 39 (18–92) years, 62% were female,and 31% arrived by ambulance. Headache peaked instantly in 18% and ≤ 1 hour in 44%. It was “worst ever” in37%, 10/10 in severity in 23%, and associated with physical activity in 7.4%. Glasgow Coma Scale scorewas < 15 in 4.1%. Neck stiffness was noted on examination in 4.8%. Neurologic deficit persisting in the ED wasfound in 6.5%. A computed tomography (CT) head scan was performed in 38% (318/841, 95% CI = 35% to41%) and an lumbar puncture in 4.7% (39/832, 95% CI = 3.4% to 6.3%). There were 18 SAH, sixintraparenchymal hemorrhages, one subdural hematoma, one newly diagnosed brain metastasis, and twobacterial meningitis. Migraine was diagnosed in 23% and “primary headache not further specified” in 45%. CThead scans were more likely to be performed in principal-referral hospitals (41%) compared to city-regional hospitals (33%). The headache in patients presenting to the latter was less likely to be instantly peaking orassociated with activity, but was no less severe in intensity and was more frequently accompanied by nauseaand vomiting. Their diagnosis was more likely to be a benign primary headache. Variations in CT scanning couldthus be due to differences in the case mix. The median (interquartile range) ED length of stay was 3.1 (2.2 to 4.5)hours. Patients was discharged from the ED or admitted to the ED short-stay unit prior to discharge in 57 and23% of cases, respectively.Conclusions: The majority of patients had a benign diagnosis, with intracranial hemorrhage and bacterialmeningitis accounting for only 3% of the diagnoses. There are variations in the proportion of patients receivingCT head scans between city-regional and principal-referral hospitals. As 38% of headache presentations overallunderwent CT scanning, there is scope to rationalize diagnostic testing to rule out life-threatening conditions.No Full Tex
