Emergency medicine Australasia : EMA
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Ocular ultrasound (US) is not one of ACEMs 'big 5' in terms of US capability that is expected of a trainee or FACEM. Most texts have a small chapter dedicated to ocular US but it is usually at the back or a subsection of a chapter where it is rarely seen or appreciated. However, it is a straightforward scan to perform with many benefits which will be discussed in this article. ⋯ This has the added benefit of being able to share images with an ophthalmologist remotely, improving time to definitive treatment. It can also be used in patients who cannot cooperate with sitting at a slitlamp, for example moribund or trauma patients. The authors propose that ocular US teaching should be incorporated into the ACEM syllabus, being a vital adjunct to a comprehensive eye examination.
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Emerg Med Australas · Aug 2021
Observational StudyImpact of In-hospital and Outreach models for regional P.A.R.T.Y. Program participants.
This retrospective observational study aimed to compare the impact of the Prevent Alcohol and Risk-Related Trauma Youth (P.A.R.T.Y.) Program when delivered as In-hospital or Outreach models to rural and regional students. ⋯ Although demographically similar, baseline perceptions toward alcohol, risk-taking and injury differed between groups. Improvements in perception were demonstrated across both models. These findings support P.A.R.T.Y. as an injury prevention initiative for regional youth.
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Emerg Med Australas · Aug 2021
Is a nudge all we need to promote deliberate clinical inertia and thoughtful clinical decision making?
Deliberate clinical inertia is the art of doing nothing as a positive response. Individual clinicians can promote deliberate clinical inertia through teaching, re-framing the act of 'doing nothing' as 'doing something' and engaging in shared decision making. Behaviour change on a larger scale requires a systematic approach. ⋯ A nudge unit could be used to design environments to prompt clinicians to re-think before ordering unnecessary tests or treatments. Nudge units could improve knowledge translation, support continuous quality improvement and help build a learning health system. They could also boost collaboration and empower staff to evaluate their workplace decision-making frameworks.
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Emergency medicine researchers face the challenge of prioritising patients' immediate interests and maintaining hospital flow while attempting to collect clinical data. Even in low-risk scenarios, excessive consent processes can make it difficult to recruit patients while observing guidelines on efficient triage. ⋯ We then argue that there need be no conflict between the imperatives of patient wellbeing and clinical research. Apparent conflicts between treatment and research could be reduced through creative recruitment techniques: the adoption of an 'opt-out' approach; securing the budget for a dedicated research assistant; early consultation with the institution's human research ethics committee; and the use of a short, simple participant information and consent form with a QR code linking to a more detailed outline of the study.
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Emerg Med Australas · Aug 2021
Observational StudyAlcohol and acute traumatic brain injury in the emergency department.
There is limited research from Australasian EDs describing the demographic make-up, injury severity and impact of alcohol in patients requiring computed tomography (CT) for suspected traumatic brain injury (TBI). The present study aims to review the frequency and presenting patterns of patients who consume alcohol prior to presenting with suspected TBI. ⋯ One quarter of patients with suspected TBI had consumed alcohol prior to their injury. Predominantly, those affected were young males who reported higher rates of assault; however, alcohol use was recorded in all age groups and sex. Alcohol-affected patients presented later, potentially delaying time to diagnosis. The present study supports the call for public health interventions that aim to reduce alcohol misuse.