Medicine (Western Health) - Research Publications
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ItemOutcome of reduction of paediatric forearm fracture by emergency department clinicians(Wiley, 2023-04)OBJECTIVES: Paediatric forearm fractures are common. Anecdotally, there is a trend towards ED reduction of selected fractures under procedural sedation. We aimed to determine the rate of subsequent operative intervention for fracture re-displacement. METHODS: Retrospective observational study of children with a forearm/wrist fracture undergoing fracture reduction in ED. Outcome of interest was operative intervention for fracture re-displacement within 6 weeks. RESULTS: Among 176 patients studied, operative intervention occurred in nine patients (5.1%, 95% confidence interval 2.7-9.4%). CONCLUSION: Reduction of paediatric forearm fractures under procedural sedation by ED clinicians is increasingly common and results in a low rate of subsequent operative intervention.
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ItemWhat can be done to improve diagnosis of aortic dissection?(WILEY, 2023-02)Aortic dissection (AD) is rare. Missed AD is a common reason for coronial investigations and civil claims for medical negligence. Recommendations include improved education, supervision and information transfer, reminders in chest pain pathways and higher rates of investigation for AD. Higher investigation rates pose risks to patients and the health system which may not be in balance with the likelihood of AD. The appropriate diagnostic yield of investigation to balance risk and benefit has not been defined. The AD detection risk score pathway has been proposed as a useful diagnostic tool but concerns about its derivation, validation and utility remain. In this paper, we try to draw together published literature and local audit data to develop recommendations about what might be done to reduce the number of missed AD cases in EDs and what the impact of higher investigation rates might be.
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ItemVirtual patient simulation in undergraduate emergency medicine education during COVID-19: Randomized controlled trial(Wiley, 2023-11-01)Objective: To examine whether a 2-week or 4-week virtual patient simulation program can improve clinical competence for undergraduate emergency medicine education during COVID-19. Methods: This randomized controlled trial was conducted between October and December 2021. Final-year medical students were randomized into a 2-week short exposure group and a 4-week long exposure group on a 1:1 allocation. They were assessed using a virtual case with structured scoring system before and after the virtual patient simulation learning program. An end-of-program questionnaire on learners’ perceptions was also administered. Results: A total of 138 students were recruited. After the virtual patient simulation program, the virtual case score increment in the long exposure group was significantly higher than in the short exposure group with a mean score difference of 18/100 (95% confidence interval = 9.8 to 26.3). Questionnaire showed generally positive perceptions toward the use of virtual patient simulation program for emergency medicine teaching. Conclusion: Virtual reality learning of 2 and 4 weeks’ duration may be beneficial for improving emergency medicine clinical competence for final-year medical students, especially during periods of limited clinical exposure like the COVID-19 pandemic. A longer 4-week virtual patient simulation program may produce a better learning effect on clinical competence.
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ItemVale Joseph Epstein AM FIFEM(WILEY, 2022-10)
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ItemIs headache during pregnancy a higher risk for serious secondary headache cause? A HEAD study report(WILEY, 2022-08)OBJECTIVES: Pregnancy is defined as a 'red flag' in headache assessment. We aimed to describe the prevalence and causes of serious secondary headache in pregnant ED patients. METHODS: Unplanned secondary analysis of HEAD Study/HEAD Colombia data. RESULTS: 3.2% (117/3643) of ED headache patients aged 18-50 years were pregnant, of whom six (5.1%) had a serious secondary cause identified. The proportion of patients with serious headache causes was not significantly different between pregnant female, non-pregnant female and male patient subgroups (P = 0.89). CONCLUSION: Inclusion of pregnancy as a 'red flag' in ED headache assessment is not supported by these data.
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ItemWho should provide expert opinion in emergency medicine-related medical litigation?(WILEY, 2022-06)Expert evidence plays a central role in establishing the relevant standard of care in medical litigation. In Australia, little is known about the expert witnesses who provide evidence about the standard of care provided in ED. A sample of recent published case law suggests that a proportion of expert evidence about breach of the standard of reasonable care in ED is provided by medical practitioners who are not emergency physicians and/or have no recent practice experience in an ED. This may potentially distort the identification of the relevant standard of care. In the United States, the American College of Emergency Physicians has attempted to address this issue by developing and promulgating expert witness guidelines. Is there a case for the Australasian College for Emergency Medicine to assume an advocacy role and/or develop standards in this area?
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ItemIs waiver of consent for the use of health information for research acceptable to emergency department patients?(WILEY, 2021-04)Some emergency medicine research, especially retrospective studies using medical records review, rely on waiver of consent for use of personal health information (PHI) contained in clinical records. This is a secondary use of PHI and waiver of consent raises ethical, legal and practical issues. Granting of a waiver of consent is often (but not always) approved by a human research ethics committee and requires separate but inter-related consideration of the legal and ethical issues. In part, this involves a balancing of the public interest versus the risk to privacy and an evaluation of whether subjects would, mostly likely, have agreed to the use of their PHI had they been asked. To date, there are no robust data about whether use of PHI without consent for research would be acceptable to people who attend Australasian EDs for care.