Search

BACKGROUND: Poisoning is one of the leading causes of admission to the emergency department and intensive care unit. A large number of epidemiological changes have occurred over the last years such as the exponential growth of new synthetic psychoactive substances. Major progress has also been made in analytical screening and assays, enabling the clinicians to rapidly obtain a definite diagnosis. METHODS: A committee composed of 30 experts from five scientific societies, the Société de Réanimation de Langue Française (SRLF), the Société Française de Médecine d'Urgence (SFMU), the Société de Toxicologie Clinique (STC), the Société Française de Toxicologie Analytique (SFTA) and the Groupe Francophone de Réanimation et d'Urgences Pédiatriques (GFRUP) evaluated eight fields: (1) severity assessment and initial triage; (2) diagnostic approach and role of toxicological analyses; (3) supportive care; (4) decontamination; (5) elimination enhancement; (6) place of antidotes; (7) specificities related to recreational drug poisoning; and (8) characteristics of cardiotoxicant poisoning. Population, Intervention, Comparison, and Outcome (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Analysis of the literature and formulation of recommendations were then conducted according to the GRADE® methodology. RESULTS: The SRLF-SFMU guideline panel provided 41 statements concerning the management of pharmaceutical and recreational drug poisoning. Ethanol and chemical poisoning were excluded from the scope of these recommendations. After two rounds of discussion and various amendments, a strong consensus was reached for all recommendations. Six of these recommendations had a high level of evidence (GRADE 1±) and six had a low level of evidence (GRADE 2±). Twenty-nine recommendations were in the form of expert opinion recommendations due to the low evidences in the literature. CONCLUSIONS: The experts reached a substantial consensus for several st

Background: Australia is a leading alcohol consumer and alcohol-related emergency presentations are common and particularly resource draining. These presentations offer a 'teachable moment' for patients, by utilising brief interventions. Current evidence of brief interventions suggests they have a statistically small effect which is likely to have meaningful population benefits. However, there has been no research which investigates the 'teachable moment' from a patient perspective. Objective(s): Our study aims to develop a theoretical model for the 'teachable moment' to inform future interventions. Method(s): This is a qualitative study of grounded theory in which alcohol-related emergency patients were interviewed. Adult patients who were not: dependent, critically ill, mentally incapable, or, had taken recreational drugs were recruited until saturation of themes was achieved. Semi-structured interviews examined participants': reactions to presentation, usual drinking, motivations to change and, thoughts on the 'teachable moment'. Themes arising from the interviews were coded using NVivo 11. Result(s): From 10 participants, three themes were identified: the perception of their alcohol habits, which was often trivialised; the perception of the event, which reflected injury severity and participant personalities and; the influence on future behaviour, which was predicted to be overall modest alcohol reduction. Nine participants identified alcohol as a trigger for their presentation. Overall, six participants were motivated to change their drinking and four were not, mostly due to feeling in control over their behaviour. Conclusion(s): Our study suggests that encouraging patient reflection of the relationship between their presentation and alcohol may produce a 'teachable moment' without further intervention.

Background: Australia is a leading alcohol consumer and alcohol-related emergency presentations are common and particularly resource draining. These presentations offer a 'teachable moment' for patients, by utilising brief interventions. Current evidence of brief interventions suggests they have a statistically small effect which is likely to have meaningful population benefits. However, there has been no research which investigates the 'teachable moment' from a patient perspective. Objective(s): Our study aims to develop a theoretical model for the 'teachable moment' to inform future interventions. Method(s): This is a qualitative study of grounded theory in which alcohol-related emergency patients were interviewed. Adult patients who were not: dependent, critically ill, mentally incapable, or, had taken recreational drugs were recruited until saturation of themes was achieved. Semi-structured interviews examined participants': reactions to presentation, usual drinking, motivations to change and, thoughts on the 'teachable moment'. Themes arising from the interviews were coded using NVivo 11. Result(s): From 10 participants, three themes were identified: the perception of their alcohol habits, which was often trivialised; the perception of the event, which reflected injury severity and participant personalities and; the influence on future behaviour, which was predicted to be overall modest alcohol reduction. Nine participants identified alcohol as a trigger for their presentation. Overall, six participants were motivated to change their drinking and four were not, mostly due to feeling in control over their behaviour. Conclusion(s): Our study suggests that encouraging patient reflection of the relationship between their presentation and alcohol may produce a 'teachable moment' without further intervention.

In Australia, almost half of HIV-positive people are now aged over 50 and are predominately gay and bisexual men (GBM). Compared to the general HIV-negative population, GBM engage more in behaviours that may increase the risk of age-related comorbidities, including smoking, high alcohol consumption and recreational drug use. The objective of APPLES was to compare comorbidities and risk factors in HIV-positive older GBM with an appropriate control group of HIV-negative GBM. We undertook a prospectively recruited cross-sectional sample of HIV-positive and HIV-negative GBM >= 55 years. Detailed data collection included clinic data, a health and lifestyle survey, and blood sample collection. We report key demographic, laboratory markers and self-reported comorbidities by HIV status. For selected comorbidities we also adjust HIV status a priori for age, smoking and body mass index. Over 16 months 228 HIV-positive and 218 HIV-negative men were recruited. Median age was 63 years (IQR: 59-67). Although more HIV-positive men reported having ever smoked, smoking status was not statistically different between HIV positive and HIV negative men (p = 0.081). Greater alcohol use was reported by HIV-negative men (p = 0.002), and recreational drug use reported more often by HIV-positive men (p<0.001). After adjustment, HIV-positive men had significantly increased odds of diabetes (adjusted Odds ratio (aOR): 1.97, p = 0.038), thrombosis (aOR: 3.08, p = 0.007), neuropathy (aOR: 34.6, P<0.001), and non-significantly increased odds for heart-disease (aOR: 1.71, p = 0.077). In conclusion, HIV-positive GBM have significantly increased odds for key self-reported comorbidities. This study underscores the importance of an appropriate HIV-negative control group for more accurate evaluation of the risk and attribution of age-related comorbidities in HIV-positive people.Copyright © 2017 Petoumenos et al. This is an open access article distributed under the terms of the Creative Commons Attribut

In Australia, almost half of HIV-positive people are now aged over 50 and are predominately gay and bisexual men (GBM). Compared to the general HIV-negative population, GBM engage more in behaviours that may increase the risk of age-related comorbidities, including smoking, high alcohol consumption and recreational drug use. The objective of APPLES was to compare comorbidities and risk factors in HIV-positive older GBM with an appropriate control group of HIV-negative GBM. We undertook a prospectively recruited cross-sectional sample of HIV-positive and HIV-negative GBM >= 55 years. Detailed data collection included clinic data, a health and lifestyle survey, and blood sample collection. We report key demographic, laboratory markers and self-reported comorbidities by HIV status. For selected comorbidities we also adjust HIV status a priori for age, smoking and body mass index. Over 16 months 228 HIV-positive and 218 HIV-negative men were recruited. Median age was 63 years (IQR: 59-67). Although more HIV-positive men reported having ever smoked, smoking status was not statistically different between HIV positive and HIV negative men (p = 0.081). Greater alcohol use was reported by HIV-negative men (p = 0.002), and recreational drug use reported more often by HIV-positive men (p<0.001). After adjustment, HIV-positive men had significantly increased odds of diabetes (adjusted Odds ratio (aOR): 1.97, p = 0.038), thrombosis (aOR: 3.08, p = 0.007), neuropathy (aOR: 34.6, P<0.001), and non-significantly increased odds for heart-disease (aOR: 1.71, p = 0.077). In conclusion, HIV-positive GBM have significantly increased odds for key self-reported comorbidities. This study underscores the importance of an appropriate HIV-negative control group for more accurate evaluation of the risk and attribution of age-related comorbidities in HIV-positive people.Copyright © 2017 Petoumenos et al. This is an open access article distributed under the terms of the Creative Commons Attribut

Background Obstetrics remains the largest medico-legal liability in healthcare. Neither an increasing awareness of patient safety nor a long tradition of reporting obstetric outcomes have reduced either rates of medical error or obstetric litigation. International debate continues about the best approaches to measuring and improving patient safety. In this study, we set out to assess the feasibility and utility of measuring the process of maternity care provision rather than care outcomes. Aims To report the development, application and results of a tool designed to measure the process of maternity care. Materials and Methods A dedicated audit tool was developed, informed by local, national and international standards guiding best practice and then applied to a convenience sample of individual healthcare records as proof of function. Omissions of care were rated in order of severity (low, medium or high) based on the likelihood of serious consequences on patient safety and outcome. Results The rate of high severity omissions of care was less that 2%. However, overall rates of all omissions varied from 0 to 99%, highlighting key areas for clinical practice improvement. Conclusions Measuring process of care provision, rather than pregnancy outcomes, is feasible and insightful, effectively identifying gaps in care provision and affording opportunities for targeted care improvement. This approach to improving patient safety, and potentially reducing litigation burden, promises to be a useful adjunct to the measurement of outcomes.Copyright © 2016 The Authors Australian and New Zealand Journal of Obstetrics and Gynaecology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Obstetricians and Gynaecologists.