Emergency Medicine Australasia最新文献

{"title":"Should we be reassured by a zero? A comment on “Utility of computed tomography brain scans in intubated patients with overdose”","authors":"Aaron Bola, Rana Biary","doi":"10.1111/1742-6723.14561","DOIUrl":"10.1111/1742-6723.14561","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002157","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":"Review article: Efficacy of cyproheptadine in the management of serotonin toxicity following deliberate self-poisoning – A systematic review","authors":"Emily King MD,&nbsp;Joe A Rotella MBBS, BSc, MMedTox, FACEM","doi":"10.1111/1742-6723.14554","DOIUrl":"10.1111/1742-6723.14554","url":null,"abstract":"<p>Serotonin toxicity is a potentially fatal condition caused by increased serotonergic activity in the central nervous system. Cyproheptadine, a serotonergic antagonist, is recommended for treatment; however, there is a lack of evidence to support its use. The present study aimed to evaluate the evidence for the use of cyproheptadine in the management of serotonin toxicity following deliberate self-poisoning. Publications from 2003 were identified by searching electronic databases Cochrane, MEDLINE, EMBASE and PsycINFO. The inclusion criteria for studies to be included were determined <i>a priori</i> and consisted of studies published in English (or where an English translation was available) where the primary diagnosis of serotonin toxicity (or syndrome) following deliberate self-poisoning and cyproheptadine was administered as the sole serotonergic antagonist. Studies were evaluated for quality and risk of bias. Twelve articles were identified, of which 11 were case reports and one was a case series. Serotonin toxicity was most attributed to selective serotonin reuptake inhibitors and all cases fulfilled Hunter serotonin toxicity criteria. Cyproheptadine regimen varied widely with respect to reporting of initial dose, repeat doses, frequency and duration. Few reports commented on clinical resolution and therefore efficacy was not established. All studies were graded as being of very low evidence and at high risk of bias. There is a lack of evidence to support the efficacy of cyproheptadine or its recommendation in clinical guidelines pertaining to the management of serotonin toxicity.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946578","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":"Superior efficacy of intramuscular diclofenac compared to intravenous tramadol for acute renal colic in northern Thai patients: A randomised double-blind, sham-controlled trial","authors":"Jarupa Yaowalaorng MD,&nbsp;Wiracha Kunthasook MD,&nbsp;Thanin Lokeskrawee MD, PhD,&nbsp;Jayanton Patumanond MD, Phd, DSc,&nbsp;Pakpoom Wongyikul MD,&nbsp;Suppachai Lawanaskol MD,&nbsp;Narada Udornpim","doi":"10.1111/1742-6723.14550","DOIUrl":"10.1111/1742-6723.14550","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The present study aimed to compare time to effective pain relief between diclofenac 75 mg intramuscular (IM) and tramadol 50 mg intravenous (IV) for ED patients with acute renal colic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A randomised, double-blinded, sham-controlled, superiority trial was conducted. Patients diagnosed with acute renal colic (hydronephrosis and/or stone visualisation on point-of-care ultrasound) in the ED were randomly assigned to receive an IM injection of 75 mg of diclofenac or IV tramadol 50 mg. Pain relief was defined as a numerical rating scale reduction of two or more points (standard 0–10 scale) and a reduction of at least one level of pain transition question (‘much better’, ‘little better’, ‘unchanged’, ‘little worse’, ‘much worse’). The primary outcome was the multivariable-adjusted subdistribution-hazard ratio (SHRs) within 120 min in the ED, estimated using the cumulative incidence function (CIF). The secondary outcome compared the average time to pain relief using the restricted mean survival time (RMST).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 68 patients were randomised, with 34 patients allocated to each group. At the 120 min, pain relief was reported in diclofenac and tramadol, 32 (94%) and 22 (65%) patients respectively. SHR was 2.86 (95% CI: 1.80–4.55; <i>P</i> value &lt;0.001). For diclofenac and tramadol, the RMSTs were 37.09 min (95% CI: 30.00, 44.15) and 78.74 min (95% CI: 66.49, 90.99) respectively, with the difference of 41.67 min (95% CI: 55.71, 27.62).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Diclofenac 75 mg IM provides faster effective pain relief compared with tramadol 50 mg IV.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946579","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":"Renal colic: Streamlining investigations to improve patient outcomes in emergency medicine","authors":"Joshua A Wren MBChB,&nbsp;Alison Lally FACEM, MBBS","doi":"10.1111/1742-6723.14551","DOIUrl":"10.1111/1742-6723.14551","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>In Australian EDs, patients experience long waits for imaging, particularly for presentations such as renal colic. Computed tomography (CT) imaging is the gold-standard for renal stones, although ultrasonography is recommended for young patients and those susceptible to radiation, an approach supported by The Canberra Hospital (TCH) ED guidelines for renal colic. This audit aims to not only assess how well these guidelines are adhered to, but also to discuss possible methods of improving flow through ED and thus patient outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective audit was conducted using 100 attendances to TCH ED between the dates of 02/04/2022 and 15/06/2022 with the diagnosis of renal colic or calculus. Data were collected on biochemical and radiographic results and patient outcomes with the associations between these datasets statistically analysed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Blood tests demonstrating abnormal renal function, white cell count and C-reactive protein (CRP) together with haematuria on urine analysis conferred high positive and negative predictive values (83.3% and 100%, respectively) for renal stones. Larger renal stones were associated with higher creatinine and CRP levels and a lower estimated glomerular filtration rate (<i>P</i> = 0.0145, <i>P</i> = 0.0062 and <i>P</i> = 0.0022, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We propose that patients with significant clinical and biochemical features of renal stones could be referred to urology earlier to await CT as an inpatient and those without be referred to their general practitioner for outpatient imaging and medical management. This could improve flow through the department and improve patient outcomes through reduced waiting times and radiation burden.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930885","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":"Impact of the XVII Pacific Games on the National Referral Hospital Emergency Department, Solomon Islands","authors":"Adelaide Pratt BMed, MPH,&nbsp;Trina Sale MBBS, MEmMed,&nbsp;Elizabeth Sanau BN,&nbsp;Jacinta Ramo MBBS, PGDipEmMed, MEmMed,&nbsp;Georgina Phillips MBBS, FACEM","doi":"10.1111/1742-6723.14548","DOIUrl":"10.1111/1742-6723.14548","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The XVII Pacific Games was held in Honiara, Solomon Islands in 2023 and was attended by competitors from 24 Pacific nations. The National Referral Hospital (NRH) is the sole tertiary hospital and largest emergency department (ED) in the Solomon Islands, located in the capital city, Honiara, and was the designated referral hospital for the Pacific Games.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This report documents the lessons learnt from supporting a large international sporting event within a resource-limited health setting, and may help other EDs prepare for similar planned mass gatherings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Senior staff members at NRH ED collaborated to document their experiences during the Pacific Games, with a focus on the impact of the games on the ED and utilizing a strengths based approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>NRH ED responded to challenges in preparing for and responding to the demands of the Pacific Games, including strains on staff and physical resources, and logistical, procedural, and governance challenges, whilst capitalising on opportunities for capacity building, cross-sectoral collaboration, and disaster preparedness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Planned mass gathering events can provide opportunities for EDs to increase workforce capacity and strengthen systems, but proper preparedness is required to minimise additional strain on already busy departments.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14548","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913580","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":"Rethinking the pan scan in stable trauma: A comparison of whole-body computed tomography and selective imaging in clinically stable blunt force trauma","authors":"Milo Kerslake MD, BMed,&nbsp;Yingbin Chui MD,&nbsp;Tan-Phu Pham MD,&nbsp;Michael Dinh MBBS, PhD, FACEM,&nbsp;Mahsa Kaikhosrovi MBBS,&nbsp;Katherine Bennett MBBS BA(Oxon), FACEM,&nbsp;Matthew Oliver MBBS, MSc, FACEM","doi":"10.1111/1742-6723.14552","DOIUrl":"10.1111/1742-6723.14552","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare the frequency of clinically significant missed injuries in clinically stable trauma patients undergoing initial whole-body computed tomography (WBCT) <i>versus</i> selective imaging. Secondary objectives include comparisons of radiation exposure, incidental findings, ED length of stay (LOS), hospital LOS and mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a retrospective cohort study of trauma activations at a tertiary trauma centre in patients with normal vital signs from 1st January 2022 to 31st December 2022. Data were collected from the trauma registry and chart review of medical records.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 665 patients were included with 42% (<i>n</i> = 277) receiving a WBCT, compared to 58% (<i>n</i> = 388) undergoing selective imaging. Most patients (52%) did not have any traumatic axial injuries identified. Missed injuries were identified in 0.8% (<i>n</i> = 3/388) of patients in the selective imaging cohort, with no adverse patient outcomes or major alteration to inpatient management. No missed injuries were identified in the WBCT group. Mortality was rare (0.9%, <i>n</i> = 6/665), occurring exclusively in elderly patients and mostly attributed to non-traumatic pathologies. Patients undergoing WBCT had a significantly increased likelihood of incidental findings (75% <i>vs</i> 35%, <i>P</i> &lt; 0.001), increased radiation exposure (mean 24.67 <i>vs</i> 8.19 millisieverts [mSv], <i>P</i> &lt; 0.001), longer ED LOS (9.86 <i>vs</i> 8.43 h, <i>P</i> = 0.012) and a higher likelihood of admission (65.3% <i>vs</i> 55.7%, <i>P</i> = 0.012).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Missed injuries were rare and without major complications in this clinically stable cohort. The liberal use of WBCT, despite low rates of missed injuries, morbidity and mortality, suggests over-utilisation of WBCT for ‘mechanism only’ traumas.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913657","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":"Somatic symptom and related disorders in a tertiary paediatric hospital: Characteristics of ED use prior to admission","authors":"Aaron Wiggins MBBS,&nbsp;Shazia Marikar MBBS,&nbsp;Lauren Russo MD,&nbsp;Monika Raniti PhD,&nbsp;Susan M Sawyer MD","doi":"10.1111/1742-6723.14559","DOIUrl":"10.1111/1742-6723.14559","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Somatic symptom and related disorders (SSRDs) are complex disorders that are commonly encountered in tertiary paediatric settings. Despite this, little is known about ED use prior to hospital admission. We aimed to describe the pattern of ED use in a cohort of children and adolescents who were subsequently admitted to hospital with SSRD and to identify factors associated with ED presentations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>We conducted a retrospective review of the electronic medical records of 123 patients admitted with SSRD to ascertain their ED contact in the 12 months preceding their initial admission. Documentation about patient and presentation characteristics, ED management and discharge recommendations were recorded. Descriptive statistics, including Fisher's Exact Test, were used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our patient group (65.9% female) had a median age of 14.3 years (range 7.3–18.3 years). Patient and presentation characteristics differed little by frequency of presentation to the ED; the symptom of pain was the only significant factor associated with the multiple ED presentations (<i>P</i> = 0.015). Documentation of a possible SSRD presentation in ED was significantly associated with the recommendation for mental health follow-up (<i>P</i> = 0.005), however engagement with mental healthcare at the time of a patient's initial admission was uncommon.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Children and adolescents with SSRD who go on to have a hospital admission present frequently to EDs, especially in the setting of pain symptoms. Training of ED clinicians in diagnosing SSRD appears indicated, as is the development of local care pathways that may obviate the need for hospital admission in at least some patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913886","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":"Rate and yield of imaging for acute pyelonephritis in the emergency department: A retrospective cohort study","authors":"Jessica Yu BMedSc (Hons),&nbsp;Christine Koolstra CCRN,&nbsp;De Villiers Smit MBChB, MBA, FACEM,&nbsp;Biswadev Mitra MBBS, MHSM, PhD, FACEM","doi":"10.1111/1742-6723.14555","DOIUrl":"10.1111/1742-6723.14555","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The role of imaging in acute pyelonephritis (APN) in the ED is poorly understood, with variability among clinical guidelines for when patients should be imaged, and the modality of imaging. The objective of this study was to identify the proportion of patients with APN being imaged, the proportion abnormal findings, and the association between abnormal imaging and discharge disposition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A single-centre retrospective review of patients with a discharge diagnosis of APN at an adult tertiary referral hospital over a 5-year period (2018–2022) was conducted. The proportion of patients with APN investigated with imaging, and abnormalities on imaging were reported. Logistic regression analyses were performed to assess whether imaging was associated with change in disposition from the ED.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 778 patients included for analysis. Among these, 210 (27%) were investigated with ultrasound (US) and/or computed tomography (CT) in the ED. Of the 214 imaging reports available, 112 (52%) were abnormal. Imaging was associated with hospital ward admission (adjusted odds ratio [aOR] 5.28; 95% confidence interval [CI] 3.35–8.31) as was abnormal imaging (aOR 4.51; 95% CI 2.62–7.75). Other variables associated with hospital ward admission were higher temperature and heart rate, higher C-reactive protein levels and poorer renal function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among patients with APN, abnormalities on imaging were common and both imaging and abnormalities on imaging were associated with hospital ward admission. This suggests that there is possible utility of early and routine imaging for patients with APN to allow clinicians to efficiently make decisions about patient disposition.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142920849","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":"Research outputs after the Coursework Pathway","authors":"Biswadev Mitra MBBS, MHSM, PhD, FACEM,&nbsp;Gim A. Tan MBBS, FACEM,&nbsp;Gerard M. O'Reilly MBBS, MBioStats, MPH, FACEM,&nbsp;Paul A. Jennings BNur, MClinEpi, PhD, JD,&nbsp;Cristina P. Roman BPharm (Hons), MPP, PhD,&nbsp;Jessica Hocking BEd, MBA,&nbsp;Peter A. Cameron MBBS, MD, FACEM","doi":"10.1111/1742-6723.14553","DOIUrl":"10.1111/1742-6723.14553","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The aim of the present study was to quantify research outputs after completing a Coursework Pathway (CP).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Emergency medicine trainees who completed a CP during 2012–2022 were included. Research outputs were identified using Medline, EMBASE, Pubmed and Google Scholar.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 545 eligible candidates, 129 (23.7%) published at least one manuscript, with 319 publications over the study period. There was a significant increase in publications since course completion (IRR 1.13; 95%CI: 1.09–1.18).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A substantial proportion of trainees who completed the CP published subsequent research. This provides a measure for emergency clinicians undertaking research projects after completing the CP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142920853","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":"Learning from the lived experiences of medical women working and studying at the national hospital in Fiji: A mixed methods study","authors":"Manisha L Shankar MBBS, MMedEM,&nbsp;Shivani Shailin MBBS, MMedEM,&nbsp;Georgina Phillips MBBS, FACEM","doi":"10.1111/1742-6723.14547","DOIUrl":"10.1111/1742-6723.14547","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Our study aimed to explore the experience of attaining higher education among women in medicine at the largest national hospital in Fiji, focusing on barriers and enablers to completing training, and to explore women's perception of gender-based discrimination in the world of medicine. Findings subsequently informed evidence-based recommendations on enablers and barriers at the hospital and medical university to improve experiences of women in medicine.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a mixed-method study, emphasising the phenomenological qualitative component. All women doctors working at the national hospital were invited to complete a survey, and those with past or present engagement in postgraduate specialty medical training participated in semi-structured interviews. Survey data were analysed using descriptive statistics. Interviews were transcribed, coded then organised using thematic analysis. Reflexivity and triangulation were employed at all levels of the research to ensure rigour.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four distinct themes were found to illuminate women's enablers and barriers. Participants described work-life stress, absence of advocacy, coercion-control-power and inflexible systems as barriers. For enablers, they described inner strength, social circles, work culture and mentors/role models/advocates. Participants had mixed perspectives on gender-based discrimination in the workplace, with unanimity in calling for protected maternity leave entitlements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Challenges only become true barriers when enablers are eclipsed by them. Institutional support helps mitigate these barriers especially for those women who lack social support. Gender based discrimination continues in the Pacific, commonly covertly, especially in terms of policy gaps regarding maternity leave during training.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.14547","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827713","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}