This conference was the 10 th annual conference for the Australian Health Outcomes Collaboration,... more This conference was the 10 th annual conference for the Australian Health Outcomes Collaboration, which is comprised of representatives of many state and federal health organisations. The conference was a comparatively small two day event, preceded by some pre-conference workshops which were based on concepts of population health and measures of health outcomes. The conference was public health focussed, and therefore had the results of many large scale trials and interventions presented and discussed in a friendly and reasonably informal environment.
Having completed a PhD a few years ago, I am now beginning to supervise other Higher Degree by Re... more Having completed a PhD a few years ago, I am now beginning to supervise other Higher Degree by Research (HDR) students, including honours, masters, and doctoral students. It's interesting to sit on the other side of the desk, to have limited time available for each student, and so much knowledge and expertise to impart. Throughout my own candidature I read many books on how to improve thesis writing, and found them to be variable in quality and applicability to a thesis in the health area. As a supervisor, I re-read some of the key resources with a view to making a recommendation to my students to provide them with a comprehensive guide to the HDR process in Australia, and some advice on how to survive a HDR and submit a better thesis. One of the bigger obstacles to applicability of the published resources was the thesis writing books which were written and published outside Australia. Internationally, a PhD is examined differently depending on the geographical location of submission. Many European theses must be submitted as a short paper, (ranging from 15,000-40,000 words), and then 'defended' in a face-to-face oral examination. Theses from the US are structured differently and address different examination requirements, and the PhD can involve a coursework component and can be completed in concordance with work placements or as part of a research team. Therefore many of the theses writing resources written for international audiences are not applicable to Australian HDR students, as they fail to focus on the importance of the written thesis component, and are unable to advise on the nuances of Australian thesis examination processes and the HDR experience overall.
This conference was the 1 st conference for the Qual-IT qualitative research and Information Tech... more This conference was the 1 st conference for the Qual-IT qualitative research and Information Technology group, which is comprised of representatives from qualitative social research fields and information technology companies. The conference was a two day event, preceded by some preconference opportunities for training in qualitative data analysis software programs. The conference was focussed on the collection and analysis of qualitative data and covered a range of technical and theoretical perspectives.
Editorial group: Cochrane Heart Group. Publication status and date: New search for studies and co... more Editorial group: Cochrane Heart Group. Publication status and date: New search for studies and content updated (no change to conclusions), published in Issue 2, 2015.
This conference was the 10th annual conference for the Australian Health Outcomes Collaboration, ... more This conference was the 10th annual conference for the Australian Health Outcomes Collaboration, which is comprised of representatives of many state and federal health organisations.
This report is one of a series of products resulting from a National Health and Medical Research ... more This report is one of a series of products resulting from a National Health and Medical Research Council (NHMRC) Urgent Research Grant – Pandemic Influenza [No 409973]. The research targeted two key aspects of planning and preparedness for a human influenza pandemic, namely:
Objective: To describe the clinical presentation and temporal variation in ambulance service case... more Objective: To describe the clinical presentation and temporal variation in ambulance service cases involving patients aged 65 years or older (older adults) from residential aged care facilities and those who are community dwelling (CD). Methods: This study used four years of electronic case records from Ambulance Victoria in Melbourne, Australia. Trigonometric regression was used to analyse demand patterns. Results: Residential aged care facility cases included proportionally more falls and infection-related problems and fewer circulatory-related incidents than CD cases. Community dwelling demand patterns differed between weekdays and weekends and peaked late morning. Residential aged care facility cases peaked late morning, with a secondary peak early evening, but with no significant difference between days. Conclusions: Older adult ambulance demand has distinct temporal patterns that differ by place of residence and are associated with different clinical presentations. These results provide a basis for informing ambulance planning and the identification of alternate health services. Practice Impact: We found that ambulance demand in older adults has distinct time of day patterns that differ by residence type and are associated with different clinical presentations. This information can be used to inform resource planning for ambulance and other health services.
Informed consent is avital part ofethical research. Inemergency health care research environments... more Informed consent is avital part ofethical research. Inemergency health care research environments such as ambulance services and emergency departments, it is sometimes necessary to conduct trial interventions orobservations without patient consent. At times where treatment istime critical, it may be impossible orinappropriate toseek consent from next ofkin. Emergency medicine isone ofthe fewareas where the process of informed consent can be waived toallow research to proceed without patient consent. This article will explore the ethics of informed consent inthe prehospitalemergency research context. This will include an overview ofcurrent Australian guidelines forethical research, and recent changes inlawinternationally which have affected the conduct of international emergency health research. An overview of the ethical reasoning behind the waiver of informed consent in emergency research is presented, also addressing issues relating toemergency health research such as proxy consent, unconscious patients, and patient decision making capacity. The unusual circumstances encountered inthe prehospital ambulance environment willalso be discussed, including the dependent and coercive relationship between patients and ambulance professionals, and a lack ofalternatives forcare and transport for patients who refuse consent. The conflict arising from differences in medical culture and values between patients and health care professionals will alsobriefly be discussed. It will be argued that. while emergency care research should not require informed consent due to the restrictions of time and dependent nature of the relationship between patient and health professional, emergency health researchers stillhave aresponsibility toconsider the patients' perspective when considering the ethical issues of an emergency research project, particularly in the prehospital environment. A health emergency is a situation where a patient requires health care in a timeframe restricted by impending ill health or death. This often begins in the 'prehospital' environment such as in the patient's home, or in a public place. Health emergencies in the prehospital environment sometimes involve Ambulance Paramedics, who provide front line emergency health care with limited resources.
Ambulance-based secondary telephone triage systems have been established in ambulance services to... more Ambulance-based secondary telephone triage systems have been established in ambulance services to divert low-acuity cases away from emergency ambulance dispatch. However, some low-acuity cases still receive an emergency ambulance dispatch following secondary triage. To date, no evidence exists identifying whether these cases required an emergency ambulance. The aim of this study was to investigate whether cases were appropriately referred for emergency ambulance dispatch following secondary telephone triage. Methods A retrospective cohort analysis was conducted of cases referred for emergency ambulance dispatch in Melbourne, Australia following secondary telephone triage between September 2009 and June 2012. Appropriateness was measured by assessing the frequency of advanced life support (ALS) treatment by paramedics, and paramedic transport to hospital. Results There were 23,696 cases included in this study. Overall, 54% of cases received paramedic treatment, which was similar to the statewide rate for emergency ambulance cases (55.5%). All secondary telephone triage cases referred for emergency ambulance dispatch had transportation rates higher than all metropolitan emergency ambulance cases (82.2% versus 71.1%). Two-thirds of the cases that were transported were also treated by paramedics (66.5%), and 17.7% of cases were not transported to hospital by ambulance following paramedic assessment. Conclusions Overall, the cases returned for emergency ambulance dispatch following secondary telephone triage were appropriate. Nevertheless, the paramedic treatment rates in particular
Introduction This survey will focus on a synopsis of novel approaches utilised to deliver trainin... more Introduction This survey will focus on a synopsis of novel approaches utilised to deliver training to Intensive Care Paramedics (ICPs) employed to work in isolated sites, often in solo practitioner roles. Aspen Medical (AM) is an RTO and under AM's scope of registration a range of accredited and non-accredited training is provided to health professionals from various craft groups, including ICPs, that are employed on Defence sites and within the Oil & Gas, Mining & Resource sectors across Australia. Methods ICPs that meet AM credentialing requirements are employed on mine sites located in Queensland, the Northern Territory and Western Australia as well as the Solomon Islands. AM requires that ICPs meet AM minimum credentialing as well as provide annual evidence of a current Certificate to Practice (CTP) or Authority to Practice (ATP) from a state or territory based Australian Ambulance Service. An additional credentialing requirement for AM ICPs is the completion of 20 hours of Continuous Professional Development (CPD) annually. Result Clinical skills advancement, skills maintenance and primary health care education to meet the training needs of ICPs are delivered through: Paramedic in-service (three day session) covering clinical skill set assessment, simulated emergency scenarios and presentations; Paramedic clinical skills assessment day (one day session); On-site simulated emergency response training; Webinar presentations (three weekly); Patient safety meeting case presentations (two weekly); and My Aspen portal online eLearning (platform agnostic). Conclusion Novel approaches to training development and delivery support the steady growth in full, part time and casually employed AM ICPs.
Journal of diabetes and its complications, Aug 23, 2016
Diabetes is associated with several acute, life-threatening complications yet there are limited d... more Diabetes is associated with several acute, life-threatening complications yet there are limited data on the utilisation of prehospital services for their management. This study aimed to examine the utilisation of emergency medical services (EMS) for prehospital hypoglycaemia, including patient characteristics and factors related to hospital transportation. An observational study of patients requiring EMS for hypoglycaemia across Victoria, Australia over three years was conducted. Pre-specified data including patient demographics, comorbidities, examination findings and transport outcomes were obtained. Logistic regression was used to assess factors associated with transportation. During the study period, 12,411 hypoglycaemia events were attended by paramedics for people with diabetes. The majority were individuals with type 1 diabetes (58.8%), followed by type 2 diabetes (35.2%) and unspecified diabetes type (5.9%). Thirty-eight percent of patients were transported to hospital by EM...
This conference was the 10 th annual conference for the Australian Health Outcomes Collaboration,... more This conference was the 10 th annual conference for the Australian Health Outcomes Collaboration, which is comprised of representatives of many state and federal health organisations. The conference was a comparatively small two day event, preceded by some pre-conference workshops which were based on concepts of population health and measures of health outcomes. The conference was public health focussed, and therefore had the results of many large scale trials and interventions presented and discussed in a friendly and reasonably informal environment.
Having completed a PhD a few years ago, I am now beginning to supervise other Higher Degree by Re... more Having completed a PhD a few years ago, I am now beginning to supervise other Higher Degree by Research (HDR) students, including honours, masters, and doctoral students. It's interesting to sit on the other side of the desk, to have limited time available for each student, and so much knowledge and expertise to impart. Throughout my own candidature I read many books on how to improve thesis writing, and found them to be variable in quality and applicability to a thesis in the health area. As a supervisor, I re-read some of the key resources with a view to making a recommendation to my students to provide them with a comprehensive guide to the HDR process in Australia, and some advice on how to survive a HDR and submit a better thesis. One of the bigger obstacles to applicability of the published resources was the thesis writing books which were written and published outside Australia. Internationally, a PhD is examined differently depending on the geographical location of submission. Many European theses must be submitted as a short paper, (ranging from 15,000-40,000 words), and then 'defended' in a face-to-face oral examination. Theses from the US are structured differently and address different examination requirements, and the PhD can involve a coursework component and can be completed in concordance with work placements or as part of a research team. Therefore many of the theses writing resources written for international audiences are not applicable to Australian HDR students, as they fail to focus on the importance of the written thesis component, and are unable to advise on the nuances of Australian thesis examination processes and the HDR experience overall.
This conference was the 1 st conference for the Qual-IT qualitative research and Information Tech... more This conference was the 1 st conference for the Qual-IT qualitative research and Information Technology group, which is comprised of representatives from qualitative social research fields and information technology companies. The conference was a two day event, preceded by some preconference opportunities for training in qualitative data analysis software programs. The conference was focussed on the collection and analysis of qualitative data and covered a range of technical and theoretical perspectives.
Editorial group: Cochrane Heart Group. Publication status and date: New search for studies and co... more Editorial group: Cochrane Heart Group. Publication status and date: New search for studies and content updated (no change to conclusions), published in Issue 2, 2015.
This conference was the 10th annual conference for the Australian Health Outcomes Collaboration, ... more This conference was the 10th annual conference for the Australian Health Outcomes Collaboration, which is comprised of representatives of many state and federal health organisations.
This report is one of a series of products resulting from a National Health and Medical Research ... more This report is one of a series of products resulting from a National Health and Medical Research Council (NHMRC) Urgent Research Grant – Pandemic Influenza [No 409973]. The research targeted two key aspects of planning and preparedness for a human influenza pandemic, namely:
Objective: To describe the clinical presentation and temporal variation in ambulance service case... more Objective: To describe the clinical presentation and temporal variation in ambulance service cases involving patients aged 65 years or older (older adults) from residential aged care facilities and those who are community dwelling (CD). Methods: This study used four years of electronic case records from Ambulance Victoria in Melbourne, Australia. Trigonometric regression was used to analyse demand patterns. Results: Residential aged care facility cases included proportionally more falls and infection-related problems and fewer circulatory-related incidents than CD cases. Community dwelling demand patterns differed between weekdays and weekends and peaked late morning. Residential aged care facility cases peaked late morning, with a secondary peak early evening, but with no significant difference between days. Conclusions: Older adult ambulance demand has distinct temporal patterns that differ by place of residence and are associated with different clinical presentations. These results provide a basis for informing ambulance planning and the identification of alternate health services. Practice Impact: We found that ambulance demand in older adults has distinct time of day patterns that differ by residence type and are associated with different clinical presentations. This information can be used to inform resource planning for ambulance and other health services.
Informed consent is avital part ofethical research. Inemergency health care research environments... more Informed consent is avital part ofethical research. Inemergency health care research environments such as ambulance services and emergency departments, it is sometimes necessary to conduct trial interventions orobservations without patient consent. At times where treatment istime critical, it may be impossible orinappropriate toseek consent from next ofkin. Emergency medicine isone ofthe fewareas where the process of informed consent can be waived toallow research to proceed without patient consent. This article will explore the ethics of informed consent inthe prehospitalemergency research context. This will include an overview ofcurrent Australian guidelines forethical research, and recent changes inlawinternationally which have affected the conduct of international emergency health research. An overview of the ethical reasoning behind the waiver of informed consent in emergency research is presented, also addressing issues relating toemergency health research such as proxy consent, unconscious patients, and patient decision making capacity. The unusual circumstances encountered inthe prehospital ambulance environment willalso be discussed, including the dependent and coercive relationship between patients and ambulance professionals, and a lack ofalternatives forcare and transport for patients who refuse consent. The conflict arising from differences in medical culture and values between patients and health care professionals will alsobriefly be discussed. It will be argued that. while emergency care research should not require informed consent due to the restrictions of time and dependent nature of the relationship between patient and health professional, emergency health researchers stillhave aresponsibility toconsider the patients' perspective when considering the ethical issues of an emergency research project, particularly in the prehospital environment. A health emergency is a situation where a patient requires health care in a timeframe restricted by impending ill health or death. This often begins in the 'prehospital' environment such as in the patient's home, or in a public place. Health emergencies in the prehospital environment sometimes involve Ambulance Paramedics, who provide front line emergency health care with limited resources.
Ambulance-based secondary telephone triage systems have been established in ambulance services to... more Ambulance-based secondary telephone triage systems have been established in ambulance services to divert low-acuity cases away from emergency ambulance dispatch. However, some low-acuity cases still receive an emergency ambulance dispatch following secondary triage. To date, no evidence exists identifying whether these cases required an emergency ambulance. The aim of this study was to investigate whether cases were appropriately referred for emergency ambulance dispatch following secondary telephone triage. Methods A retrospective cohort analysis was conducted of cases referred for emergency ambulance dispatch in Melbourne, Australia following secondary telephone triage between September 2009 and June 2012. Appropriateness was measured by assessing the frequency of advanced life support (ALS) treatment by paramedics, and paramedic transport to hospital. Results There were 23,696 cases included in this study. Overall, 54% of cases received paramedic treatment, which was similar to the statewide rate for emergency ambulance cases (55.5%). All secondary telephone triage cases referred for emergency ambulance dispatch had transportation rates higher than all metropolitan emergency ambulance cases (82.2% versus 71.1%). Two-thirds of the cases that were transported were also treated by paramedics (66.5%), and 17.7% of cases were not transported to hospital by ambulance following paramedic assessment. Conclusions Overall, the cases returned for emergency ambulance dispatch following secondary telephone triage were appropriate. Nevertheless, the paramedic treatment rates in particular
Introduction This survey will focus on a synopsis of novel approaches utilised to deliver trainin... more Introduction This survey will focus on a synopsis of novel approaches utilised to deliver training to Intensive Care Paramedics (ICPs) employed to work in isolated sites, often in solo practitioner roles. Aspen Medical (AM) is an RTO and under AM's scope of registration a range of accredited and non-accredited training is provided to health professionals from various craft groups, including ICPs, that are employed on Defence sites and within the Oil & Gas, Mining & Resource sectors across Australia. Methods ICPs that meet AM credentialing requirements are employed on mine sites located in Queensland, the Northern Territory and Western Australia as well as the Solomon Islands. AM requires that ICPs meet AM minimum credentialing as well as provide annual evidence of a current Certificate to Practice (CTP) or Authority to Practice (ATP) from a state or territory based Australian Ambulance Service. An additional credentialing requirement for AM ICPs is the completion of 20 hours of Continuous Professional Development (CPD) annually. Result Clinical skills advancement, skills maintenance and primary health care education to meet the training needs of ICPs are delivered through: Paramedic in-service (three day session) covering clinical skill set assessment, simulated emergency scenarios and presentations; Paramedic clinical skills assessment day (one day session); On-site simulated emergency response training; Webinar presentations (three weekly); Patient safety meeting case presentations (two weekly); and My Aspen portal online eLearning (platform agnostic). Conclusion Novel approaches to training development and delivery support the steady growth in full, part time and casually employed AM ICPs.
Journal of diabetes and its complications, Aug 23, 2016
Diabetes is associated with several acute, life-threatening complications yet there are limited d... more Diabetes is associated with several acute, life-threatening complications yet there are limited data on the utilisation of prehospital services for their management. This study aimed to examine the utilisation of emergency medical services (EMS) for prehospital hypoglycaemia, including patient characteristics and factors related to hospital transportation. An observational study of patients requiring EMS for hypoglycaemia across Victoria, Australia over three years was conducted. Pre-specified data including patient demographics, comorbidities, examination findings and transport outcomes were obtained. Logistic regression was used to assess factors associated with transportation. During the study period, 12,411 hypoglycaemia events were attended by paramedics for people with diabetes. The majority were individuals with type 1 diabetes (58.8%), followed by type 2 diabetes (35.2%) and unspecified diabetes type (5.9%). Thirty-eight percent of patients were transported to hospital by EM...
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