Australasian Emergency Care最新文献_第6页

Effects of cold needle and ShotBlocker applied in the emergency department on pain and satisfaction in intramuscular injection pain: A randomized controlled trial. 急诊科应用冷针和注射阻断剂对肌内注射疼痛的疼痛和满意度的影响：一项随机对照试验。

IF 2.1 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2025-09-01 Epub Date: 2025-02-08 DOI: 10.1016/j.auec.2025.02.001

Yadigar Ordu, Hilal Türkben Polat, Kadir Küçükceran

Background: The most commonly reported side effect of intramuscular injection is pain. Cold needles and ShotBlocker can be used as non-pharmacological methods for pain relief. This study aims to determine the effect of cold needle and ShotBlocker on pain and satisfaction in intramuscular injection pain.

Methods: This is a triple-blind, randomized controlled study. The study was conducted on 120 patients (40: control, 40: cold needle, 40: ShotBlocker) who presented to the emergency department of a university hospital in Turkey for cyanocobalamin injection in July-August 2024. Data were collected using a patient identification form, visual pain scale (VPS), and injection satisfaction scale. SPSS statistical package (version 22.0; SPSS, Inc., USA) was used to analyze the data.

Results: In the study, the groups were found to be similar except for age and continuous drug use. The pain scores of the control group were significantly higher than those of the cold needle and ShotBlocker groups. Injection satisfaction was significantly higher in the cold needle and ShotBlocker groups than in the control group.

Conclusion: Both the Cold Needle and the ShotBlocker can be used as effective methods to reduce pain associated with intramuscular injections and improve injection satisfaction. Both methods are non-pharmacological, inexpensive, and easy to use, and they can be used safely and effectively in all clinical settings.

背景：肌内注射最常见的副作用是疼痛。冷针和注射阻断剂可以作为非药物缓解疼痛的方法。本研究旨在确定冷针和注射阻断剂对肌内注射疼痛的疼痛和满意度的影响。方法：这是一项三盲、随机对照研究。本研究对2024年7 - 8月在土耳其一所大学医院急诊科接受氰钴胺素注射的120例患者（对照组40例，冷针40例，注射阻断剂40例）进行了研究。数据收集采用患者识别表，视觉疼痛量表（VPS）和注射满意度量表。SPSS统计软件包（22.0版）；采用SPSS， Inc.， USA)对数据进行分析。结果：两组患者除年龄和持续用药情况外无明显差异。对照组疼痛评分明显高于冷针组和注射阻断剂组。注射满意度在冷针组和注射阻断剂组明显高于对照组。结论：Cold Needle和ShotBlocker均可作为减轻肌内注射疼痛和提高注射满意度的有效方法。这两种方法都是非药物、廉价和易于使用的，它们可以在所有临床环境中安全有效地使用。

{"title":"Effects of cold needle and ShotBlocker applied in the emergency department on pain and satisfaction in intramuscular injection pain: A randomized controlled trial.","authors":"Yadigar Ordu, Hilal Türkben Polat, Kadir Küçükceran","doi":"10.1016/j.auec.2025.02.001","DOIUrl":"10.1016/j.auec.2025.02.001","url":null,"abstract":"<p><strong>Background: </strong>The most commonly reported side effect of intramuscular injection is pain. Cold needles and ShotBlocker can be used as non-pharmacological methods for pain relief. This study aims to determine the effect of cold needle and ShotBlocker on pain and satisfaction in intramuscular injection pain.</p><p><strong>Methods: </strong>This is a triple-blind, randomized controlled study. The study was conducted on 120 patients (40: control, 40: cold needle, 40: ShotBlocker) who presented to the emergency department of a university hospital in Turkey for cyanocobalamin injection in July-August 2024. Data were collected using a patient identification form, visual pain scale (VPS), and injection satisfaction scale. SPSS statistical package (version 22.0; SPSS, Inc., USA) was used to analyze the data.</p><p><strong>Results: </strong>In the study, the groups were found to be similar except for age and continuous drug use. The pain scores of the control group were significantly higher than those of the cold needle and ShotBlocker groups. Injection satisfaction was significantly higher in the cold needle and ShotBlocker groups than in the control group.</p><p><strong>Conclusion: </strong>Both the Cold Needle and the ShotBlocker can be used as effective methods to reduce pain associated with intramuscular injections and improve injection satisfaction. Both methods are non-pharmacological, inexpensive, and easy to use, and they can be used safely and effectively in all clinical settings.</p>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":" ","pages":"157-162"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Adherence to ambulance performance indicators and patient outcomes after stroke: An Australian data linkage study. 坚持救护车性能指标和中风后患者的结果：澳大利亚的数据链接研究。

IF 2.1 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2025-09-01 Epub Date: 2025-07-04 DOI: 10.1016/j.auec.2025.04.002

Amminadab L Eliakundu, Joosup Kim, Karen Smith, Monique F Kilkenny, Mulugeta M Birhanu, Kathleen L Bagot, Emily Nehme, Shelley Cox, Bruce C V Campbell, Ben Clissold, Helen M Dewey, Jodie Rabaut, Henry Ma, Christopher F Bladin, Dominique A Cadilhac

Background: The impact of Emergency Medical Service (EMS) stroke performance indicators on patient outcomes is unclear. We aimed to evaluate adherence to EMS indicators (15 minutes response, 60 minutes transport to a stroke centre or both) and associations with treatment access and patient outcomes.

Method: Retrospective cohort study using data from the Australian Stroke Clinical Registry and ambulance records from Victoria (2015-2017) for patients (≥18 years) with stroke transported by ambulance. Multivariable regression models were used to evaluate EMS adherence to performance indicators and outcomes of interest.

Results: Among 4206 patients (72 years; 42 % female), EMS indicators were less frequently met for patients in regional areas (aOR: 0.27; 95 % CI: 0.17, 0.43). Socio-economic disparities were observed, with patients in advantaged areas less likely to receive an ambulance response within 15 minutes. Adherence to EMS performance indicators was associated with shorter off-stretcher time and increased thrombolytic therapy use (aOR: 1.62; 95 % CI: 1.24, 2.11). EMS adherence to performance indicators did not significantly impact functional independence, or health-related quality of life.

Conclusions: EMS adherence to performance indicators improved off-stretcher time and thrombolytic therapy use but was influenced by geographic and socio-economic status. Refining EMS performance targets and tailoring public and EMS education on stroke is needed.

背景：急诊医疗服务（EMS）卒中表现指标对患者预后的影响尚不清楚。我们的目的是评估EMS指标的依从性（15分钟反应，60分钟转移到卒中中心或两者兼有）以及与治疗可及性和患者预后的关系。方法：回顾性队列研究，使用澳大利亚卒中临床登记处和维多利亚州救护车记录（2015-2017）的数据，对救护车运送的卒中患者（≥18岁）进行研究。使用多变量回归模型来评估EMS对绩效指标和相关结果的依从性。结果：4206例患者(72岁；42 %女性)，区域患者的EMS指标达到的频率较低(aOR: 0.27；95 % ci: 0.17, 0.43)。观察到社会经济差异，优势地区的患者不太可能在15分钟内收到救护车响应。遵守EMS绩效指标与较短的下担架时间和增加的溶栓治疗使用相关(aOR: 1.62；95 % ci: 1.24, 2.11)。EMS对绩效指标的依从性没有显著影响功能独立性或与健康相关的生活质量。结论：EMS对绩效指标的依从性提高了下担架时间和溶栓治疗的使用，但受地理和社会经济地位的影响。需要完善医疗服务的绩效目标，并针对中风进行针对性的公共和医疗服务教育。

{"title":"Adherence to ambulance performance indicators and patient outcomes after stroke: An Australian data linkage study.","authors":"Amminadab L Eliakundu, Joosup Kim, Karen Smith, Monique F Kilkenny, Mulugeta M Birhanu, Kathleen L Bagot, Emily Nehme, Shelley Cox, Bruce C V Campbell, Ben Clissold, Helen M Dewey, Jodie Rabaut, Henry Ma, Christopher F Bladin, Dominique A Cadilhac","doi":"10.1016/j.auec.2025.04.002","DOIUrl":"10.1016/j.auec.2025.04.002","url":null,"abstract":"<p><strong>Background: </strong>The impact of Emergency Medical Service (EMS) stroke performance indicators on patient outcomes is unclear. We aimed to evaluate adherence to EMS indicators (15 minutes response, 60 minutes transport to a stroke centre or both) and associations with treatment access and patient outcomes.</p><p><strong>Method: </strong>Retrospective cohort study using data from the Australian Stroke Clinical Registry and ambulance records from Victoria (2015-2017) for patients (≥18 years) with stroke transported by ambulance. Multivariable regression models were used to evaluate EMS adherence to performance indicators and outcomes of interest.</p><p><strong>Results: </strong>Among 4206 patients (72 years; 42 % female), EMS indicators were less frequently met for patients in regional areas (aOR: 0.27; 95 % CI: 0.17, 0.43). Socio-economic disparities were observed, with patients in advantaged areas less likely to receive an ambulance response within 15 minutes. Adherence to EMS performance indicators was associated with shorter off-stretcher time and increased thrombolytic therapy use (aOR: 1.62; 95 % CI: 1.24, 2.11). EMS adherence to performance indicators did not significantly impact functional independence, or health-related quality of life.</p><p><strong>Conclusions: </strong>EMS adherence to performance indicators improved off-stretcher time and thrombolytic therapy use but was influenced by geographic and socio-economic status. Refining EMS performance targets and tailoring public and EMS education on stroke is needed.</p>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":" ","pages":"233-239"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Screening and assessment of falls risk in the emergency department. 急诊科跌倒风险的筛选和评估。

IF 2.1 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2025-09-01 Epub Date: 2025-03-16 DOI: 10.1016/j.auec.2025.03.003

Paul Fulbrook, Sandra J Miles, Faye Jordan, Sarah Hazelwood, Hwee Yong Debbie Lee

Background: Falls are a source of harm, repeat emergency department visits and hospital admission for older adults. Undertaking a comprehensive geriatric screening including falls-risk is recommended in guidelines for optimal older adult emergency department care.

Methods: A pragmatic prospective cohort study was undertaken to evaluate use of further falls-risk screening in older adults in a large tertiary Australian hospital emergency department. Primary outcome measures of interest were length of stay; discharge destination; 30-day and 90-day re-presentations.

Results: Of 651 eligible cases, 320 were randomly recruited for further screening following consent. The implementation cohort spent an average 45 m longer in the emergency department with a greater proportion admitted to the short stay unit, staying there longer than a comparison cohort. There were significantly fewer 30-day fall-related representations (2.9 %) in the implementation cohort.

Conclusions: Despite a small reduction in emergency department re-presentation within 30 days in the implementation cohort, hospital admission was not reduced. Further research is needed to examine any cost-benefit ratio of additional falls-risk screening and intervention in emergency departments.

背景：跌倒是伤害的一个来源，重复急诊就诊和住院的老年人。开展全面的老年筛查，包括跌倒风险，建议在指导方针的最佳老年人急诊科护理。方法：在澳大利亚一家大型三级医院急诊科进行了一项实用的前瞻性队列研究，以评估老年人进一步跌倒风险筛查的使用情况。主要观察指标为住院时间；放电目的地;30天和90天的重新陈述。结果：在651例符合条件的病例中，随机招募320例在同意后进行进一步筛查。实施队列在急诊科平均多花了45 m，其中更大比例的患者住进了短期住院单元，在那里呆的时间比比较队列长。在实施队列中，与30天跌倒相关的表征显著减少（2.9 %）。结论：尽管在实施队列中，30天内急诊科再次就诊的人数略有减少，但住院率并未减少。需要进一步的研究来检验急诊部门额外的跌倒风险筛查和干预的成本效益比。

{"title":"Screening and assessment of falls risk in the emergency department.","authors":"Paul Fulbrook, Sandra J Miles, Faye Jordan, Sarah Hazelwood, Hwee Yong Debbie Lee","doi":"10.1016/j.auec.2025.03.003","DOIUrl":"10.1016/j.auec.2025.03.003","url":null,"abstract":"<p><strong>Background: </strong>Falls are a source of harm, repeat emergency department visits and hospital admission for older adults. Undertaking a comprehensive geriatric screening including falls-risk is recommended in guidelines for optimal older adult emergency department care.</p><p><strong>Methods: </strong>A pragmatic prospective cohort study was undertaken to evaluate use of further falls-risk screening in older adults in a large tertiary Australian hospital emergency department. Primary outcome measures of interest were length of stay; discharge destination; 30-day and 90-day re-presentations.</p><p><strong>Results: </strong>Of 651 eligible cases, 320 were randomly recruited for further screening following consent. The implementation cohort spent an average 45 m longer in the emergency department with a greater proportion admitted to the short stay unit, staying there longer than a comparison cohort. There were significantly fewer 30-day fall-related representations (2.9 %) in the implementation cohort.</p><p><strong>Conclusions: </strong>Despite a small reduction in emergency department re-presentation within 30 days in the implementation cohort, hospital admission was not reduced. Further research is needed to examine any cost-benefit ratio of additional falls-risk screening and intervention in emergency departments.</p>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":" ","pages":"179-185"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Mitigating conflict between emergency department and inpatient staff due to access block 缓解急诊部门和住院人员因通道阻塞而产生的冲突。

IF 2.1 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2025-06-01 Epub Date: 2025-02-12 DOI: 10.1016/j.auec.2025.01.003

Benjamin Aston , Gideon de Jong , Sarah Tillott

Since the outbreak of the COVID-crisis almost five years ago, Emergency Departments (EDs) in Australian hospitals have increasingly been confronted with the phenomenon of "access block" in which the flow of patients to inpatient units is delayed or obstructed. This creates tension between ED staff and health professionals employed in inpatient units. With the current political discourse, there is little reason to hope that this problem will be solved in the short term. As long as no radical changes are made at the political level to combat the issue of access block, the hands of individual clinicians are tied to existing models of care. In this letter to the editor, we outline how the problem of access block occurs in the ED of a Queensland-based hospital and the impact it generates. But also how healthcare leaders can adequately manage the tension between ED and inpatient staff, underscoring the crucial role of emotional intelligence.

自近五年前新冠肺炎疫情爆发以来，澳大利亚医院急诊科越来越多地面临“准入阻塞”现象，即患者前往住院病房的时间被推迟或受阻。这造成了急诊科工作人员和住院单位的卫生专业人员之间的紧张关系。根据目前的政治话语，几乎没有理由希望这个问题能在短期内得到解决。只要在政治层面上没有根本性的改变来解决获取障碍的问题，个别临床医生的手就会被现有的护理模式所束缚。在这封致编辑的信中，我们概述了在昆士兰一家医院的急诊科中，访问阻塞问题是如何发生的，以及它产生的影响。但也包括医疗保健领导者如何妥善处理急诊科和住院员工之间的紧张关系，强调了情商的关键作用。

引用次数: 0

How confident are Queensland paramedics with seizure recognition, differentiation, and management? A pilot study 昆士兰护理人员对癫痫的识别、鉴别和管理有多自信？一项初步研究。

IF 2.1 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2025-06-01 Epub Date: 2025-01-29 DOI: 10.1016/j.auec.2025.01.002

Jordan J. Hill , Brooke L. Hill , Brett Williams

Background

Paramedics in Australia present as the opportune medical personnel to initiate medical intervention of seizure presentations and perform a fundamental role in the prevention of seizure associated morbidity and mortality. Despite being well equipped to manage seizures, no literature exists regarding their confidence to recognise, differentiate, or manage seizures.

Methods

An online cross-sectional survey was undertaken by 168 paramedics practicing clinically for the Queensland Ambulance Service in Australia. The survey assessed paramedic perceived self-confidence surrounding seizure presentations. Non-parametric Kruskal-Wallis H-Test and post hoc pairwise comparisons were conducted to assess between group differences in relation to practicing qualifications, and years of service.

Results

Paramedics were confident in generalised convulsive seizure recognition and management, however, displayed less confidence surrounding non-convulsive, focal, and psychogenic seizure classifications. Critical care paramedics reported higher confidence than advanced care and graduate paramedics across various seizure presentation elements (p < 0.05). Paramedics with greater than 10 years of service reported higher confidence than those with fewer years of service, particularly less than two years.

Conclusion

Future education and professional development opportunities for paramedics require a greater focus on the development of self-confidence, with mechanisms implemented to increase paramedics’ exposure to the broad spectrum of seizure presentations.

背景：护理人员在澳大利亚目前作为适当的医务人员，以启动医疗干预癫痫的介绍，并执行在预防癫痫相关的发病率和死亡率的基本作用。尽管有很好的装备来管理癫痫发作，没有文献存在关于他们的信心来识别，区分，或管理癫痫发作。方法：对澳大利亚昆士兰救护车服务的168名临床护理人员进行了在线横断面调查。该调查评估了护理人员在癫痫发作时的自信心。进行非参数Kruskal-Wallis h检验和事后两两比较，以评估与执业资格和服务年限相关的组间差异。结果：护理人员对全面性惊厥发作的识别和管理有信心，然而，对非惊厥、局灶性和心因性发作分类的信心较低。在各种癫痫发作表现要素中，重症护理护理人员比高级护理护理人员和研究生护理人员报告的自信心更高(p 结论：护理人员未来的教育和专业发展机会需要更加关注自信心的发展，并实施机制来增加护理人员接触广泛的癫痫发作表现。

{"title":"How confident are Queensland paramedics with seizure recognition, differentiation, and management? A pilot study","authors":"Jordan J. Hill , Brooke L. Hill , Brett Williams","doi":"10.1016/j.auec.2025.01.002","DOIUrl":"10.1016/j.auec.2025.01.002","url":null,"abstract":"<div><h3>Background</h3><div>Paramedics in Australia present as the opportune medical personnel to initiate medical intervention of seizure presentations and perform a fundamental role in the prevention of seizure associated morbidity and mortality. Despite being well equipped to manage seizures, no literature exists regarding their confidence to recognise, differentiate, or manage seizures.</div></div><div><h3>Methods</h3><div>An online cross-sectional survey was undertaken by 168 paramedics practicing clinically for the Queensland Ambulance Service in Australia. The survey assessed paramedic perceived self-confidence surrounding seizure presentations. Non-parametric Kruskal-Wallis <em>H</em>-Test and post hoc pairwise comparisons were conducted to assess between group differences in relation to practicing qualifications, and years of service.</div></div><div><h3>Results</h3><div>Paramedics were confident in generalised convulsive seizure recognition and management, however, displayed less confidence surrounding non-convulsive, focal, and psychogenic seizure classifications. Critical care paramedics reported higher confidence than advanced care and graduate paramedics across various seizure presentation elements (<em>p</em> < 0.05). Paramedics with greater than 10 years of service reported higher confidence than those with fewer years of service, particularly less than two years.</div></div><div><h3>Conclusion</h3><div>Future education and professional development opportunities for paramedics require a greater focus on the development of self-confidence, with mechanisms implemented to increase paramedics’ exposure to the broad spectrum of seizure presentations.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"28 2","pages":"Pages 142-149"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Maintenance of normothermia in the out-of-hospital setting: A pilot comparative crossover study of a foil blanket versus self-warming blanket 院外环境中正常体温的维持：铝箔毯与自温毯的试点比较交叉研究。

IF 2.1 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2025-06-01 Epub Date: 2024-12-18 DOI: 10.1016/j.auec.2024.12.001

Kathleen M. O’Leary , Rebecca Henderson , Joanne N. Caldwell Odgers , Benjamin N. Meadley

Introduction

Hypothermia can increase mortality in certain patients. Paramedics apply cotton and foil "space" blankets for warming, yet their effectiveness remains uncertain. This pilot study aimed to evaluate combining cotton blankets with a self-warming blanket versus a combination of cotton blankets and a foil blanket in an out-of-hospital simulation.

Methods

Eight participants were allocated to warming with either two cotton blankets and one foil blanket, or two cotton blankets and one self-warming blanket, with the alternate method applied in a subsequent session. Participants were cooled using an ice-vest and fan until shivering onset, after which the warming method was applied. Simulation involved transitioning through three environments: baseline (22 °C), cooling/warming (16 °C), and “ambulance” (27 °C). Core temperature was monitored via oesophageal probe, skin temperature via thermistors (recorded every minute), and tympanic temperature and thermal sensation and comfort were recorded five minutely.

Results

There were minor differences in thermal sensation. For the primary outcome there was no significant difference between blanket methods (core: foil 36.98 ± 0.08 °C vs. self-warming 36.95 ± 0.10 °C, P > 0.05).

Conclusion

The combination of cotton and self-warming blankets did not exhibit superiority compared to cotton and foil blankets in out-of-hospital simulation. Future research should explore alternative warming methodologies to optimise normothermia maintenance.

引言：低温可增加某些患者的死亡率。医护人员使用棉和箔“太空”毯取暖，但其效果仍不确定。本初步研究旨在评估在院外模拟中棉毯与自温毯的组合与棉毯与箔毯的组合。方法：8名参与者被分配到使用两个棉毯和一个铝箔毯或两个棉毯和一个自温毯进行加热，并在随后的会议中使用替代方法。参与者使用冰背心和风扇降温，直到开始发抖，之后使用升温方法。模拟涉及三种环境的转换：基线（22°C）、冷却/升温（16°C）和“救护车”（27°C）。通过食管探头监测核心温度，通过热敏电阻监测皮肤温度（每分钟记录一次），每5分钟记录鼓室温度和热感觉及舒适度。结果：两组患者热感觉差异较小。对于主要结局，毯子方法之间无显著差异（核心：箔36.98±0.08°C vs自温36.95±0.10°C, P > 0.05）。结论：在院外模拟中，棉与自温毯组合并不比棉与箔毯组合具有优势。未来的研究应该探索其他的变暖方法来优化恒温维持。

{"title":"Maintenance of normothermia in the out-of-hospital setting: A pilot comparative crossover study of a foil blanket versus self-warming blanket","authors":"Kathleen M. O’Leary , Rebecca Henderson , Joanne N. Caldwell Odgers , Benjamin N. Meadley","doi":"10.1016/j.auec.2024.12.001","DOIUrl":"10.1016/j.auec.2024.12.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Hypothermia can increase mortality in certain patients. Paramedics apply cotton and foil \"space\" blankets for warming, yet their effectiveness remains uncertain. This pilot study aimed to evaluate combining cotton blankets with a self-warming blanket versus a combination of cotton blankets and a foil blanket in an out-of-hospital simulation.</div></div><div><h3>Methods</h3><div>Eight participants were allocated to warming with either two cotton blankets and one foil blanket, or two cotton blankets and one self-warming blanket, with the alternate method applied in a subsequent session. Participants were cooled using an ice-vest and fan until shivering onset, after which the warming method was applied. Simulation involved transitioning through three environments: baseline (22 °C), cooling/warming (16 °C), and “ambulance” (27 °C). Core temperature was monitored via oesophageal probe, skin temperature via thermistors (recorded every minute), and tympanic temperature and thermal sensation and comfort were recorded five minutely.</div></div><div><h3>Results</h3><div>There were minor differences in thermal sensation. For the primary outcome there was no significant difference between blanket methods (core: foil 36.98 ± 0.08 °C vs. self-warming 36.95 ± 0.10 °C, P > 0.05).</div></div><div><h3>Conclusion</h3><div>The combination of cotton and self-warming blankets did not exhibit superiority compared to cotton and foil blankets in out-of-hospital simulation. Future research should explore alternative warming methodologies to optimise normothermia maintenance.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"28 2","pages":"Pages 116-122"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Emergency care experiences of patients known to palliative care services and their family: A qualitative interview study 姑息治疗患者及其家属的急诊护理经验：一项质性访谈研究。

IF 2.1 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2025-06-01 Epub Date: 2024-12-30 DOI: 10.1016/j.auec.2024.12.003

Reuben Sutton , Natalie Elizabeth Anderson , Merryn Gott

Background

With aging and comorbid populations and healthcare services under pressure, emergency department presentations related to palliative care needs are increasing. Little is known about patient and family experiences of care in this context. This study explores the emergency department care experiences of palliative patients and their family members.

Methods

Semi-structured interviews with patients known to palliative care services who had presented to an urban emergency department within the study recruitment period. Six patients and five family members were interviewed. Reflexive thematic analysis methodology was underpinned by social constructivism.

Findings

Participants often described misalignment between emergency care priorities and their own, which was sometimes associated with challenges, including dehumanisation. However, participants also shared stories of supported self-advocacy, associated with positive care experiences.

Conclusion

This research identifies challenges patients and their family experience when accessing emergency department care. Symptom management, time, environment, and advocacy were impactful aspects of patient and family experience. There is a need to develop and support palliative care skills and knowledge within EDs, and adapt the environment to provide a safe space for sensitive communication and person-centred care.

背景：随着老龄化和合并症人群以及医疗保健服务面临压力，与姑息治疗需求相关的急诊科报告正在增加。在这种情况下，对病人和家庭的护理经验知之甚少。本研究探讨姑息病人及其家属在急诊科的护理经验。方法：对在研究招募期间到城市急诊科就诊的已知姑息治疗服务患者进行半结构化访谈。对6名患者和5名家属进行了访谈。反身性主题分析方法以社会建构主义为基础。研究结果：参与者经常描述紧急护理优先事项与他们自己的优先事项之间的不一致，这有时与挑战相关，包括非人性化。然而，参与者也分享了支持自我倡导的故事，这些故事与积极的护理经历有关。结论：本研究确定了患者及其家庭在接受急诊科护理时面临的挑战。症状管理、时间、环境和宣传是影响患者和家庭经验的方面。有必要发展和支持急诊科的姑息治疗技能和知识，并调整环境，为敏感的沟通和以人为本的护理提供安全的空间。

{"title":"Emergency care experiences of patients known to palliative care services and their family: A qualitative interview study","authors":"Reuben Sutton , Natalie Elizabeth Anderson , Merryn Gott","doi":"10.1016/j.auec.2024.12.003","DOIUrl":"10.1016/j.auec.2024.12.003","url":null,"abstract":"<div><h3>Background</h3><div>With aging and comorbid populations and healthcare services under pressure, emergency department presentations related to palliative care needs are increasing. Little is known about patient and family experiences of care in this context. This study explores the emergency department care experiences of palliative patients and their family members.</div></div><div><h3>Methods</h3><div>Semi-structured interviews with patients known to palliative care services who had presented to an urban emergency department within the study recruitment period. Six patients and five family members were interviewed. Reflexive thematic analysis methodology was underpinned by social constructivism.</div></div><div><h3>Findings</h3><div>Participants often described misalignment between emergency care priorities and their own, which was sometimes associated with challenges, including dehumanisation. However, participants also shared stories of supported self-advocacy, associated with positive care experiences.</div></div><div><h3>Conclusion</h3><div>This research identifies challenges patients and their family experience when accessing emergency department care. Symptom management, time, environment, and advocacy were impactful aspects of patient and family experience. There is a need to develop and support palliative care skills and knowledge within EDs, and adapt the environment to provide a safe space for sensitive communication and person-centred care.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"28 2","pages":"Pages 129-135"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Gender bias in text-to-image generative artificial intelligence depiction of Australian paramedics and first responders 澳大利亚护理人员和急救人员的文本到图像生成人工智能描述中的性别偏见。

IF 2.1 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2025-06-01 Epub Date: 2024-12-02 DOI: 10.1016/j.auec.2024.11.003

Geoffrey Currie , Johnathan Hewis , Phillip Ebbs

Introduction

In Australia, almost 50 % of paramedics are female yet they remain under-represented in stereotypical depictions of the profession. The potentially transformative value of generative artificial intelligence (AI) may be limited by stereotypical errors, misrepresentations and bias. Increasing use of text-to-image generative AI, like DALL-E 3, could reinforce gender and ethnicity biases and, therefore, is important to objectively evaluate.

Method

In March 2024, DALL-E 3 was utilised via GPT-4 to generate a series of individual and group images of Australian paramedics, ambulance officers, police officers and firefighters. In total, 82 images were produced including 60 individual-character images, and 22 multiple-character group images. All 326 depicted characters were independently analysed by three reviewers for apparent gender, age, skin tone and ethnicity.

Results

Among first responders, 90.8 % (N = 296) were depicted as male, 90.5 % (N = 295) as Caucasian, 95.7 % (N = 312) as a light skin tone, and 94.8 % (N = 309) as under 55 years of age. For paramedics and police the gender distribution was a statistically significant variation from that of actual Australian workforce data (all p < 0.001). Among the images of individual paramedics and ambulance officers (N = 32), DALL-E 3 depicted 100 % as male, 100 % as Caucasian and 100 % with light skin tone.

Conclusion

Gender and ethnicity bias is a significant limitation for text-to-image generative AI using DALL-E 3 among Australian first responders. Generated images have a disproportionately high misrepresentation of males, Caucasians and light skin tones that are not representative of the diversity of paramedics in Australia today.

导读：在澳大利亚，近50%的护理人员是女性，但她们在职业的刻板印象中仍然代表性不足。生成式人工智能（AI）的潜在变革价值可能会受到刻板错误、虚假陈述和偏见的限制。越来越多地使用文本到图像的生成人工智能，如dall - e3，可能会加强性别和种族偏见，因此，客观评估是很重要的。方法：于2024年3月，利用DALL-E 3通过GPT-4生成一系列澳大利亚护理人员、救护人员、警察和消防员的个人和群体图像。共生成图像82张，其中单字图像60张，多字组图像22张。所有326个描绘的角色都由三名评论者独立分析，包括表面性别、年龄、肤色和种族。结果：在第一反应者中，90.8% （N = 296）为男性，90.5% （N = 295）为白种人，95.7% （N = 312）为浅肤色，94.8% （N = 309）为55岁以下。对于护理人员和警察，性别分布在统计上与澳大利亚实际劳动力数据有显著差异(所有p结论：性别和种族偏见是澳大利亚急救人员使用dall - e3进行文本到图像生成人工智能的重大限制。生成的图像对男性、白种人和浅肤色的歪曲程度过高，不能代表当今澳大利亚护理人员的多样性。

{"title":"Gender bias in text-to-image generative artificial intelligence depiction of Australian paramedics and first responders","authors":"Geoffrey Currie , Johnathan Hewis , Phillip Ebbs","doi":"10.1016/j.auec.2024.11.003","DOIUrl":"10.1016/j.auec.2024.11.003","url":null,"abstract":"<div><h3>Introduction</h3><div>In Australia, almost 50 % of paramedics are female yet they remain under-represented in stereotypical depictions of the profession. The potentially transformative value of generative artificial intelligence (AI) may be limited by stereotypical errors, misrepresentations and bias. Increasing use of text-to-image generative AI, like DALL-E 3, could reinforce gender and ethnicity biases and, therefore, is important to objectively evaluate.</div></div><div><h3>Method</h3><div>In March 2024, DALL-E 3 was utilised via GPT-4 to generate a series of individual and group images of Australian paramedics, ambulance officers, police officers and firefighters. In total, 82 images were produced including 60 individual-character images, and 22 multiple-character group images. All 326 depicted characters were independently analysed by three reviewers for apparent gender, age, skin tone and ethnicity.</div></div><div><h3>Results</h3><div>Among first responders, 90.8 % (<em>N = 296</em>) were depicted as male, 90.5 % (<em>N = 295</em>) as Caucasian, 95.7 % (<em>N = 312</em>) as a light skin tone, and 94.8 % (<em>N = 309</em>) as under 55 years of age. For paramedics and police the gender distribution was a statistically significant variation from that of actual Australian workforce data (all p < 0.001). Among the images of individual paramedics and ambulance officers (<em>N = 32</em>), DALL-E 3 depicted 100 % as male, 100 % as Caucasian and 100 % with light skin tone.</div></div><div><h3>Conclusion</h3><div>Gender and ethnicity bias is a significant limitation for text-to-image generative AI using DALL-E 3 among Australian first responders. Generated images have a disproportionately high misrepresentation of males, Caucasians and light skin tones that are not representative of the diversity of paramedics in Australia today.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"28 2","pages":"Pages 103-109"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Clinical Frailty Scale offers little utility as part of a prediction model for community-dwelling older fallers at risk of re-presenting to the emergency department. 临床虚弱量表作为预测模型的一部分，对社区居住的老年老年人再次出现在急诊科的风险没有多大用处。

IF 2.1 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2025-06-01 Epub Date: 2024-12-02 DOI: 10.1016/j.auec.2024.11.004

Loren Barton , Mark Nelson , Kirsten Strudwick , Corey Scholes

Background

There is no published literature on the predictive ability of the Clinical Frailty Scale (CFS) for falls risk specific to the Emergency Department (ED) population. This study aims to develop a prognostic model to determine the predictive ability of the CFS for ED falls’ re-presentation in community-dwelling older people.

Methods

A retrospective observational cohort study was completed from July 2019 to July 2022 on community dwelling people aged 75 years and over who presented to the ED with an extrinsic fall and had a CFS score recorded. The primary outcome was fall-related re-presentation to ED; the secondary outcome was mortality. A flexible parametric survival model was applied with time to falls re-presentation, and post-estimation, used to predict the probability of another fall re-presentation within 6 months. Calibration was assessed and a decision support curve generated.

Results

The model demonstrated reasonable calibration-in-the-large (Slope = 0.999) and fit between CFS and probability of fall re-presentation. The CFS model displayed negligible discriminant ability (C-statistic = 0.534) for identifying older people at risk of falls-related ED re-presentations within 6 months of index presentation.

Conclusions

The CFS cannot be used to prognosticate an individual’s risk of ED re-presentation within 6 months of an index extrinsic fall.

背景：目前还没有关于临床虚弱量表（CFS）对急诊科（ED）人群跌倒风险的预测能力的已发表文献。本研究旨在建立一个预后模型，以确定CFS对社区居住老年人ED跌倒再次出现的预测能力。方法：一项回顾性观察队列研究于2019年7月至2022年7月完成，研究对象是75岁及以上的社区居民，他们因外源性跌倒而就诊，并记录了CFS评分。主要结局是与跌倒相关的再次出现ED；次要结局是死亡率。采用随时间变化的灵活参数生存模型，预测6个月内再次跌倒的概率。评估校准并生成决策支持曲线。结果：模型具有合理的大尺度标定（斜率= 0.999），CFS与跌倒再现概率拟合良好。CFS模型在识别有跌倒相关ED在指数表现后6个月内再次表现风险的老年人方面显示出可忽略的判别能力（C-statistic = 0.534）。结论：CFS不能用于预测个体在指数外源性下降后6个月内再次出现ED的风险。

{"title":"The Clinical Frailty Scale offers little utility as part of a prediction model for community-dwelling older fallers at risk of re-presenting to the emergency department.","authors":"Loren Barton , Mark Nelson , Kirsten Strudwick , Corey Scholes","doi":"10.1016/j.auec.2024.11.004","DOIUrl":"10.1016/j.auec.2024.11.004","url":null,"abstract":"<div><h3>Background</h3><div>There is no published literature on the predictive ability of the Clinical Frailty Scale (CFS) for falls risk specific to the Emergency Department (ED) population. This study aims to develop a prognostic model to determine the predictive ability of the CFS for ED falls’ re-presentation in community-dwelling older people.</div></div><div><h3>Methods</h3><div>A retrospective observational cohort study was completed from July 2019 to July 2022 on community dwelling people aged 75 years and over who presented to the ED with an extrinsic fall and had a CFS score recorded. The primary outcome was fall-related re-presentation to ED; the secondary outcome was mortality. A flexible parametric survival model was applied with time to falls re-presentation, and post-estimation, used to predict the probability of another fall re-presentation within 6 months. Calibration was assessed and a decision support curve generated.</div></div><div><h3>Results</h3><div>The model demonstrated reasonable calibration-in-the-large (Slope = 0.999) and fit between CFS and probability of fall re-presentation. The CFS model displayed negligible discriminant ability (C-statistic = 0.534) for identifying older people at risk of falls-related ED re-presentations within 6 months of index presentation.</div></div><div><h3>Conclusions</h3><div>The CFS cannot be used to prognosticate an individual’s risk of ED re-presentation within 6 months of an index extrinsic fall.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"28 2","pages":"Pages 110-115"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Consumer experiences of emergency department pre-triage waiting period: A mixed-methods study 急诊科分诊前等待期的消费者体验：一项混合方法研究。

IF 2.1 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2025-06-01 Epub Date: 2025-01-22 DOI: 10.1016/j.auec.2025.01.001

Rebecca Sedgman , Noah Pallot , Annette Peart , Sebastian Wrobel , Joseph Miller , Liam Hackett , Katrina Maybury , Emogene Aldridge , Patrick J. Owen , Paul Buntine

Background

Emergency department pre-triage waiting periods have received limited attention. We aimed to explore the pre-triage experiences and perspectives of consumers attending emergency departments.

Methods

This mixed-methods cross-sectional study included 92 participants (patients, carers, and guardians) who attended one of three public hospital emergency departments in metropolitan Melbourne (Victoria, Australia). Quantitative self-report outcomes were waiting time (minutes) and number of previous emergency department visits. Qualitative outcomes (explored through content analysis) were consumer experiences and perspectives of emergency departments in general and the pre-triage waiting period specifically.

Results

Participants reported a median (IQR) waiting time since triage of 45 (100) minutes and 65 % (n = 60) experienced a pre-triage waiting time of 3–90 minutes. The most common perception of the pre-triage waiting period was an expectation to wait (n = 16, 17 %), yet 46 % (n = 42) reported difficulties during this period, such as other patients cutting in queue (n = 6, 6.5 %). Few positives were associated with the pre-triage waiting period and suggestions to improve this period tended to focus on facilitating a queuing system (n = 18, 20 %).

Conclusion

Consumers expected and understood triage, yet reported various difficulties and few positives during the pre-triage waiting period and suggested improvements to the current system, warranting investigation of interventions to improve queuing.

背景：急诊科分诊前的等待期受到了有限的关注。我们的目的是探讨在急诊室就诊的消费者在分诊前的经验和观点。方法：这项混合方法的横断面研究包括92名参与者（患者、护理人员和监护人），他们在墨尔本大都会（维多利亚，澳大利亚）的三所公立医院急诊科之一就诊。定量自我报告的结果是等待时间（分钟）和以前急诊室就诊的次数。定性结果（通过内容分析探索）是消费者的体验和急诊部门的观点，特别是分诊前的等待期。结果：参与者报告的中位数（IQR）等待时间为45（100）分钟，65% % （n = 60）经历了3-90 分钟的预分流等待时间。最常见的知觉pre-triage等待期是一个期望等(n = 16、17 %),然而46 % (n = 42)报道的困难在此期间,如其他病人减少队列(6.5 n = 6日 %)。与分诊前等待期相关的阳性结果很少，改善这一时期的建议往往侧重于促进排队系统（n = 18,20 %）。结论：消费者期望并理解分诊，但在分诊前等待期报告了各种困难和很少的积极因素，并建议改进现行系统，需要调查改善排队的干预措施。

{"title":"Consumer experiences of emergency department pre-triage waiting period: A mixed-methods study","authors":"Rebecca Sedgman , Noah Pallot , Annette Peart , Sebastian Wrobel , Joseph Miller , Liam Hackett , Katrina Maybury , Emogene Aldridge , Patrick J. Owen , Paul Buntine","doi":"10.1016/j.auec.2025.01.001","DOIUrl":"10.1016/j.auec.2025.01.001","url":null,"abstract":"<div><h3>Background</h3><div>Emergency department pre-triage waiting periods have received limited attention. We aimed to explore the pre-triage experiences and perspectives of consumers attending emergency departments.</div></div><div><h3>Methods</h3><div>This mixed-methods cross-sectional study included 92 participants (patients, carers, and guardians) who attended one of three public hospital emergency departments in metropolitan Melbourne (Victoria, Australia). Quantitative self-report outcomes were waiting time (minutes) and number of previous emergency department visits. Qualitative outcomes (explored through content analysis) were consumer experiences and perspectives of emergency departments in general and the pre-triage waiting period specifically.</div></div><div><h3>Results</h3><div>Participants reported a median (IQR) waiting time since triage of 45 (100) minutes and 65 % (n = 60) experienced a pre-triage waiting time of 3–90 minutes. The most common perception of the pre-triage waiting period was an expectation to wait (n = 16, 17 %), yet 46 % (n = 42) reported difficulties during this period, such as other patients cutting in queue (n = 6, 6.5 %). Few positives were associated with the pre-triage waiting period and suggestions to improve this period tended to focus on facilitating a queuing system (n = 18, 20 %).</div></div><div><h3>Conclusion</h3><div>Consumers expected and understood triage, yet reported various difficulties and few positives during the pre-triage waiting period and suggested improvements to the current system, warranting investigation of interventions to improve queuing.</div></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"28 2","pages":"Pages 136-141"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0