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Objectives: This study aimed to determine which method to triage intensive care patients using chronic comorbidity in a pandemic was perceived to be the fairest by the general public. Secondary objectives were to determine whether the public perceived it fair to provide preferential intensive care triage to vulnerable or disadvantaged people, and frontline healthcare workers. Methods: A postal survey of 2000 registered voters randomly selected from the Australian Electoral Commission electoral roll was performed. The main outcome measures were respondents' fairness rating of four hypothetical intensive care triage methods that assess comorbidity (chronic medical conditions, long-term survival, function and frailty); and respondents' fairness rating of providing preferential triage to vulnerable or disadvantaged people, and frontline healthcare workers. Results: The proportion of respondents who considered it fair to triage based on chronic medical conditions, long-term survival, function and frailty, was 52.1, 56.1, 65.0 and 62.4%, respectively. The proportion of respondents who considered it unfair to triage based on these four comorbidities was 31.9, 30.9, 23.8 and 23.2%, respectively. More respondents considered it unfair to preferentially triage vulnerable or disadvantaged people, than fair (41.8% versus 21.2%). More respondents considered it fair to preferentially triage frontline healthcare workers, than unfair (44.2% versus 30.0%). Conclusion: Respondents in this survey perceived all four hypothetical methods to triage intensive care patients based on comorbidity in a pandemic disaster to be fair. However, the sizable minority who consider this to be unfair indicates that these triage methods could encounter significant opposition if they were to be enacted in health policy. What is known about the topic? Triage systems can be used to prioritise the order in which patients are treated in a pandemic, but the views of the general public on using chronic comorbidity as intensive care unit (ICU) triage criteria are unknown. What does this paper add? This Australian survey, conducted during the coronavirus disease 2019 pandemic, demonstrated that the majority of respondents perceived ICU triage methods based on comorbidity to be fair, but significant ethical issues exist. What are the implications for practitioners? It may be possible to develop an ICU triage protocol for future pandemics in Australia, but further research is required. [ABSTRACT FROM AUTHOR]

Background: In the context of nationwide law reform, New South Wales (NSW) became the last state in Australia to legalise voluntary assisted dying (VAD) – commencing 28 November 2023. Clinicians have divergent views regarding VAD, with varying levels of understanding, support, and willingness to be involved, and these may have a significant impact on the successful implementation. Aims: To understand levels of support, understanding and willingness to be involved in VAD among clinical staff across NSW during implementation of VAD. Methods: A multisite, cross‐sectional online survey of clinicians across four local health districts, assessing relevant demographics, awareness of and support for VAD legislation and willingness to be involved in different levels of VAD‐related clinical activities. Results: A total of 3010 clinical staff completed the survey. A majority of participants were aware of VAD legislation in NSW (86.35%) and supportive of it (76%), with nursing and allied health clinicians significantly more likely than medical specialists to express support. Among medical specialists, support was statistically more likely in those who did not care for patients at the end of life and those with limited knowledge of the legislation. Willingness of medical specialists to perform key roles was significantly lower, with 41.49% willing to act in coordinating or consulting roles, and only 23.21% as administering practitioners. Conclusions: The majority of clinical staff surveyed across NSW supported VAD legislation. While many eligible clinicians were reluctant to be actively involved, sufficient numbers appear willing to provide VAD services, indicating that successful implementation should be possible. [ABSTRACT FROM AUTHOR]

This column examines conscientious objection and institutional objection in Australian voluntary assistance in dying. It reviews the current legislative regimes and then examines these practices from an ethical perspective, and raises particular concerns and suggestions with how conscientious objection and institutional objection should be operationalised. [ABSTRACT FROM AUTHOR]

Background: Background: Organ donation (OD) following circulatory determination of death (DCDD) is an increasing source of transplant organs but little is known about community opinions on treatment withdrawal, determination of death and acceptance of OD in DCDD. Aims: To determine attitudes on death determination in DCDD, the importance of patient choice in treatment withdrawal and OD agreement, and the importance of the 'Dead Donor Rule'. Methods: Scenario‐based online survey of 1017 members of the Australian general public. Mean levels of agreement across respondent's responses to statements were compared by repeated measures ANOVA. Results: 54% (548) of respondents agreed that a DCDD scenario patient could be declared dead 2 minutes after circulatory standstill, however over 80% nonetheless agreed OD would be appropriate, including 77% (136/176) of those disagreeing with a 2‐minute death declaration. 48% (484) supported OD even if it caused the patient's death. 75% (766) would accept relatively benign ante‐mortem treatments administered to improve transplant outcomes. Over 70% supported a high quadriplegic patient's request to be allowed to die, with 61% (622) agreeing that he should be allowed to donate his organs under anaesthesia, but 60% (610) also agreed that he should first be declared dead. Conclusions: We found high levels of support for treatment withdrawal in severe brain injury and when requested by a quadriplegic patient. While there was variable agreement with the timing of death determination and with OD under anaesthesia, support for OD was high in both scenarios. For many people death determination prior to OD may not be of paramount importance. [ABSTRACT FROM AUTHOR]

Heart attacks and heart failure may result in pulmonary edema, the accumulation of fluid in the tissues of the lungs. This condition is a common cause of respiratory failure in hospitalized patients and often necessitates inserting an endotracheal tube and providing the patient with mechanical respiratory support. Intubation and mechanical ventilation improve the respiration of the patient, but may themselves result in further complications. A study was conducted to determine if oxygen with continuous positive airway pressure could provide benefits to patients with pulmonary edema without requiring intubation. In continuous positive airway pressure, the patient wears a tight-fitting mask. As the name implies, the pressure of the oxygen and air mixture within the mask is greater than that of the surrounding air. It requires less effort, therefore, to draw oxygen into the lungs. Thirty-nine patients were randomly assigned to receive oxygen or oxygen with continuous positive airway pressure. All patients were suffering from pulmonary edema as a complication of heart disease. Patients receiving oxygen with continuous positive airway pressure experienced a greater decrease in respiration rate in the first 30 minutes and a greater decrease in arterial carbon dioxide, indicators of more effective breathing. Seven of the patients receiving only oxygen required intubation with mechanical ventilation. In contrast, intubation was not required for any of the patients receiving oxygen plus continuous positive airway pressure. Four of 20 patients receiving oxygen died, as did 2 of the 19 patients receiving oxygen with continuous positive airway pressure. This difference in mortality, however, was not statistically significant. It is not yet known whether the early physiological advantages of oxygen and continuous positive airway pressure will result in long-term patient gains. However, the method appears safe and effective, and reduces the need for intubation and mechanical ventilation. (Consumer Summary produced by Reliance Medical Information, Inc.)

ABSTRACT Adverse reactions to intravascular contrast media (ICM) are common and carry a significant mortality rate. Major factors influencing incidence and severity include age, a history of asthma, heart disease, significant allergy, the type of investigation and the type of contrast agent used. Many mechanisms may be involved in producing ICM reactions, including histamine release, complement activation, antigen-antibody reactions and direct cardiovascular effects. In order to deal with these unexpected emergencies, a carefully organised plan is essential. Patients with significant heart disease, asthma, allergy or a history of previous contrast reactions should be referred to major hospitals for their investigation. The use of forearm intravenous cannulae should be encouraged and patients must be carefully observed during ICM administration. Adrenaline is the mainstay of therapy and early intramuscular administration is recommended. Corticosteroids and antihistamines have no role in severe reactions, but bronchodilators and infusion of colloid solutions may be required. [ABSTRACT FROM AUTHOR]