Emergency Medicine Australasia最新文献

{"title":"Review article: Primer for clinical researchers on innovative trial designs for emergency medicine.","authors":"Katherine J Lee, Melissa Middleton, Robert K Mahar","doi":"10.1111/1742-6723.14532","DOIUrl":"https://doi.org/10.1111/1742-6723.14532","url":null,"abstract":"<p><p>Randomised trials have long been recognised as the gold standard research tool for evidence-based medicine. The past decade has seen the emergence of several innovative trial designs that are revolutionising how trials are conducted. These innovative designs enable more efficient, pragmatic trials that can address complex research questions which were previously not possible. In this paper, we provide an overview of the key innovative designs that are likely to be useful in the emergency medicine context, namely cluster crossover and stepped wedge designs, sequential multiple assignment randomised trial (SMART) designs, and platform trials. We describe the main features of each design, outline their pros and cons, and describe when they may or may not be useful. We also provide examples of these innovative designs in contexts that are relevant to emergency medicine.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142646309","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}

{"title":"The future of emergency medicine in Australasia","authors":"Joshua I Smith MB ChB(Dist), BSc(Hons), PGCertCPU","doi":"10.1111/1742-6723.14526","DOIUrl":"10.1111/1742-6723.14526","url":null,"abstract":"&lt;p&gt;Emergency medicine is sick. Right now, across Australia and Aotearoa New Zealand, EDs are overflowing with patients. Some have received all the care they need from ED staff, but are waiting to see busy inpatient specialists. Others are waiting for beds on wards that are already beyond capacity. Some tried to see their general practitioner when they became unwell a week ago, but there were no available appointments, and their condition worsened, necessitating an ED visit. Many have been assessed by the triage nurse as needing assessment within 30 minutes, but because of overcrowding, they will wait several hours; some will deteriorate before they see a doctor; occasionally, they will die waiting. Increasing numbers of the people waiting in the ED did not decide for themselves to come here: they are residents in understaffed aged care facilities with no after-hours medical care, and have been sent by ambulance after a fall or change in condition. They will spend 12 hours under fluorescent lights being needled by nurses, poked by physicians, missing medications and foregoing food, only to be sent home after a normal CT scan. As the cycle continues, pressure and temperature keep rising in the ED.&lt;/p&gt;&lt;p&gt;ED doctors want to serve their communities, but many are struggling in these unsustainable conditions.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; They were trained to assess, treat, and disposition undifferentiated patients, resuscitating those who require it. Increasingly, they spend their time scanning a screen of unseen patients for risk of deterioration, debating a difficult disposition with a subspecialist over the phone, and attending to the complex needs of boarding inpatients. Overcrowding forces them to focus on optimising flow through an overwhelmed department, rather than walking with individual patients through their ED journey. It also eats into non-clinical time, at the expense of maintaining their skills as a critical care practitioner. Trainees are thinking about how things will look in 10 years; some are wondering if this is really what they want to do.&lt;/p&gt;&lt;p&gt;Overcrowding is a syndrome. ACEM has worked hard to diagnose the causes,&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt; but because these almost all originate outside of ED, they are difficult for ACEM and emergency physicians to address directly, requiring action from governments and other parts of the health system. In 2023, the &lt;i&gt;Emergency Medicine – Building our Future Summit&lt;/i&gt;&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; saw the coming together of College leaders, fellows and trainees, to discuss a way forward. Changing demographics and the expanding demands placed on us by overcrowding were highlighted. In response to this thin-spreading of our scope, and commensurate with trends elsewhere in medicine, the role of subspecialisation was discussed. In this issue, Metcalfe provides a timely review of the state of emergency medicine subspecialties and special interest pathways.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; Protected opportunities to","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14526","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In this December issue","authors":"Geoff Hughes","doi":"10.1111/1742-6723.14520","DOIUrl":"10.1111/1742-6723.14520","url":null,"abstract":"&lt;p&gt;Although Point of care Ultrasound (POCUS) use is widespread in EDs, there are no standardised training standards. A group of Australasian enthusiasts have produced a statement that encompasses current published and unpublished guidance for creating and maintaining robust POCUS programs in EDs. We publish two papers from the group that describe the processes they followed and the outcomes achieved. Their recommendations have five pillars of Infrastructure, Governance, Administration, Education and Quality. The guidelines are comprehensive and consideration should be given to adopting them as the benchmark for our specialty.&lt;/p&gt;&lt;p&gt;Joana Manton provides us with a fascinating literature review of the phenomenon of ED autoresuscitation. A systematic search of five databases with the keywords ‘autoresuscitation’, ‘cardiac arrest’ and ‘emergency department’ produced 240 papers and 26 cases. These then provided 26 cases of interest. The majority of people who auto-resuscitated did so within ten minutes of being pronounced dead. Eleven survivors were discharged neurologically intact. Only five patients had a bedside echocardiogram before resuscitation was stopped. Underreporting of autoresuscitation is suspected due to fears of blame. Passive monitoring for 10 min after resuscitation stops is recommended. There is need for more data on this phenomenon.&lt;/p&gt;&lt;p&gt;In recent years, the landscape of disasters, conflicts, and terror events has become more frequent and complex. Climate change, armed conflicts, terrorism, disinformation, cyber-attacks, inequality, and pandemics now present significant challenges to humanity. Emergency physicians today are likely to encounter ideologically motivated violent extremism or terrorist actions by radicalized lone actors. Terror medicine, distinct from disaster medicine, addresses the unique and severe injuries caused by terrorist incidents, including explosions, gunshots, and chemical agents. Understanding the broader public health implications of these attacks is crucial for emergency physicians to enhance community safety and resilience. We publish an excellent review that offers a comprehensive approach to understanding terror medicine, defining the concept of “terror,” its significance for emergency physicians, and the known health impacts on patients, healthcare workers, and responders.&lt;/p&gt;&lt;p&gt;Equitable access means that timely, sensitive, and respectful treatment is offered to all people. Adults with disability access ED care more frequently than the general population. However, in Australia and internationally, people with disability experience poorer healthcare access and outcomes than the general population. A team from Macquarie University offers us a systematic review of evaluated strategies implemented to improve care for people with disability in the ED.&lt;/p&gt;&lt;p&gt;Emergency physicians are often required to manage a diverse set of complex challenges; navigating direct patient care, systemic issues and inter-profe","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14520","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What can emergency medicine in Australasia learn from the NHS?","authors":"Thomas A G Shanahan BA, MBChB, PGCert, MA, MRCEM","doi":"10.1111/1742-6723.14525","DOIUrl":"10.1111/1742-6723.14525","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644197","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}

{"title":"From Other Journals","authors":"Sierra Beck,&nbsp;Bridget Honan,&nbsp;James L Mallows,&nbsp;Joseph Ting","doi":"10.1111/1742-6723.14523","DOIUrl":"10.1111/1742-6723.14523","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644191","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}

{"title":"Divide and conquer? Emergency medicine subspecialties in Australasia","authors":"Ryan D Metcalfe MBChB, PGCertCPU","doi":"10.1111/1742-6723.14527","DOIUrl":"10.1111/1742-6723.14527","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644181","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}

{"title":"Emergency medicine needs a narrower scope and a broader worldview","authors":"Tom Jerram MBChB, FACEM","doi":"10.1111/1742-6723.14524","DOIUrl":"10.1111/1742-6723.14524","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644187","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}

{"title":"Emergency medicine will stay big and become the acute decision-making nexus of future health systems","authors":"Clare A. Skinner BSc, BA(Hons), MBBS, MPH, FACEM, AFRACMA","doi":"10.1111/1742-6723.14529","DOIUrl":"10.1111/1742-6723.14529","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644190","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}

{"title":"RE: The use and impact of pathology tests in emergency department patients with mental health-related complaints: A cross sectional study.","authors":"Quang La, David F Lo","doi":"10.1111/1742-6723.14533","DOIUrl":"https://doi.org/10.1111/1742-6723.14533","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617061","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}

{"title":"Care during conflicts: Emergency support systems in Oceania.","authors":"Derrick Tin, Lenard Cheng, George Braitberg, Ilikini Naitini, Gustodio A de Jesus, Gregory Ciottone","doi":"10.1111/1742-6723.14522","DOIUrl":"https://doi.org/10.1111/1742-6723.14522","url":null,"abstract":"<p><strong>Objective: </strong>The present study analyses Oceania's protest and conflict events (2021-2022) to aid healthcare systems better understand the scope of the issue.</p><p><strong>Methods: </strong>Data from the Armed Conflict Location & Event Data database were examined for event types and fatalities.</p><p><strong>Results: </strong>A total of 2743 events were recorded, mainly protests (83.3%). Fatalities stemmed from battles, violence against civilians and riots. Australia had the most events (56.1%); Papua New Guinea the highest fatality rate (1.03/event).</p><p><strong>Conclusions: </strong>Australia faced pandemic-related protests; Papua New Guinea grappled with tribal violence, posing healthcare challenges. A comprehensive approach emphasising disaster preparedness, regional cooperation and addressing root causes is crucial to bolster healthcare systems.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617059","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}