Did attending P.A.R.T.Y. change youth perceptions? Results from 148 Queensland schools participating in the Prevent Alcohol and Risk-Related Trauma in Youth Program, 2018-2019.

BACKGROUND: Prevent Alcohol and Risk-Related Trauma in Youth (P.A.R.T.Y.) is an immersive 1 day in-hospital injury awareness and prevention programme designed to educate high-school students on the consequences of a variety of risk-taking behaviours. This multisite contemporary analysis examined differences in programme effect and temporal changes on participant knowledge and attitudes. METHODS: Metropolitan and rural schools were invited to attend the programme at one of the 11 hospital sites throughout Queensland, Australia. Pre-post study design with participant questionnaires provided at three time periods: immediately preprogramme and postprogramme, and 4 months later. The questionnaire used scenarios to determine a participant's opinion on the safety of drugs/alcohol, driving and risk-taking activities, using Likert scales. RESULTS: A total of 5999 students participated in the programme between 1 January 2018 and 31 December 2019. Responses to all questions related to safety, harm or risk followed a similar pattern. The immediate postcourse responses demonstrated significant increased awareness of risk or change in action, followed by a decay at 4 months to within 10% of preprogramme levels. Public school students, males and students from Central and North Queensland demonstrated lower risk-aversion (p<0.05). CONCLUSION: This study demonstrated across more than 100 school sites, the positive change in knowledge and student participant attitudes towards risk-taking behaviours after attending the P.A.R.T.Y. programme. The need to address the significant decay at the 4-month follow-up was identified. Findings offered potential for tailoring of messaging to target key demographic groups/topics where the decay was greatest.

Factors that impact Australian early career nurses' intentions to remain in their position and the profession: A prospective cohort study.

AIM: The aim of this work is to identify factors that impact on early career nurses' intentions to remain in their current position and compare with what impacts on intention to remain in the profession. BACKGROUND: Early exits of nurses from a position and the profession are a result of evolving factors. A lack of longitudinal follow-up impedes knowledge about these factors or what proportion of temporary exits become permanent. METHOD: The study used prospective cohort survey design. The sample was obtained from non-probability convenience sampling of graduating nursing students from two universities. Data was collected across three time points over 12 months, commencing in November 2016. RESULTS: The professional turnover rate was 6.7% in total. Higher Work Environment, Support and Encouragement scores and Stress in personal life were the only predictors of intending to remain in the profession. Statistical modelling could not predict intention to remain in current position. CONCLUSION: There were differences identified when comparing intention to remain in a position and the profession. Nurses are satisfied with their career choice and intend to remain in the profession, although many are intending to move positions. IMPLICATIONS FOR NURSING MANAGEMENT: To effectively retain the nursing workforce, stakeholders must focus on the work environment, appropriate support and remuneration, and facilitate career progression.

What can we do about occupational violence in emergency departments? A survey of emergency staff.

AIMS: To explore and collate solutions for occupational violence from emergency department (ED) staff. BACKGROUND: Despite publications highlighting the progressively worsening issue of occupational violence in EDs and its detrimental impacts, few strategies aimed to reduce or manage it have been discussed in the literature. METHODS: This was a cross-sectional study involving ED staff. Participants completed an electronic survey that prompted interventions for occupational violence. Free-text data were analysed and logically categorized using validated techniques. RESULTS: Participants (N = 81) suggested 24 interventions: 12 were classified as prevention strategies, 10 as response strategies and two as recovery strategies. Prevention and response strategies for occupational violence targeted key participants: patients, staff and ED environment. Recovery strategies centred around staff management of the personal impacts of incidences of occupational violence and on systems in place to support them after occupational violence incidents. CONCLUSION: Solutions to occupational violence should be multifaceted encompassing prevention, response and recovery for patients, staff and the ED environment. IMPLICATIONS FOR NURSING MANAGEMENT: No single, universal intervention can be endorsed to reduce or mitigate the impacts of occupational violence in EDs. However, a combination of the interventions (strategies) discussed in this paper can be recommended.

Factors that influence Australian early career nurse employment outcomes and settings: A prospective cohort study.

AIM: To identify the factors influencing employment outcomes and settings for early career nurses. BACKGROUND: A shortage of nurses attracted to work in out-of-hospital settings exists. Despite this, not all nursing graduates can secure work as a nurse. Information on the factors that impact wider graduate employment is available. However, a nursing perspective is missing, especially for hard to recruit to areas. METHODS: A prospective cohort study was conducted. Participants were 293 final-year undergraduate nursing students, recruited from two universities. Data were collected over 12 months, commencing November 2016. RESULTS: English as a first language was the greatest predictor of employment for graduates. Previous health care experience and workplace preferences predicted employment in the out-of-hospital setting. CONCLUSIONS: Misalignment between English language requirements and industry expectations about language may lead to bias in recruitment of graduate nurses with English as their second language. Recruitment to out-of-hospital settings may be promoted by having health care experience and targeting those with a preference. IMPLICATIONS FOR NURSING MANAGEMENT: Reviewing current employment policies to ensure they reflect the need for cultural diversity in the nursing workforce is critical. Additionally, research that aims to understand how preferences for out-of-hospital settings are developed will help target graduate employment strategies.

The Effects of Occupational Violence on the Well-being and Resilience of Nurses.

OBJECTIVE: This article reports findings from a 2016 survey exploring the working life of nurses/midwives in Queensland, Australia. Responses related to occupational violence (OV) are reported. BACKGROUND: OV is linked to high rates of burnout. It is imperative to continue efforts to understand how to avoid burnout and build nurse/midwives' resilience. METHODS: A total of 2397 nurse/midwives working in Queensland responded to the survey and were asked to answer 8 questions related to OV. RESULTS: In the last 3 months, 53% of nurses/midwives had experienced OV. Those respondents had significantly higher rates of burnout and lower resilience and rated the practice environment lower than their counterparts who had not experienced violence. CONCLUSIONS: The experience of OV significantly impacts nurse resilience and levels of burnout. To retain nurses, attention must be given to reduce OV and support nurses who have experienced it.

Who is less likely to die in association with improved National Emergency Access Target (NEAT) compliance for emergency admissions in a tertiary referral hospital?

Objective The aim of the present study was to identify patient and non-patient factors associated with reduced mortality among patients admitted from the emergency department (ED) to in-patient wards in a major tertiary hospital that had previously reported a near halving in mortality in association with a doubling in National Emergency Access Target (NEAT) compliance over a 2-year period from 2012 to 2014. Methods We retrospectively analysed routinely collected data from the Emergency Department Information System (EDIS) and hospital discharge abstracts on all emergency admissions during calendar years 2011 (pre-NEAT interventions) and 2013 (post-NEAT interventions). Patients admitted to short-stay wards and then discharged home, as well as patients dying in the ED, were excluded. Patients included in the study were categorised according to age, time and day of arrival to the ED, mode of transport to the ED, emergency triage category, type of clinical presentation and major diagnostic codes. Results The in-patient mortality rate for emergency admissions decreased from 1.9% (320/17022) in 2011 to 1.2% (202/17162) in 2013 (P<0.001). There was no change from 2011 to 2013 in the percentage of deaths in the ED (0.19% vs 0.17%) or those coded as in-patient palliative care (17.9% vs 22.2%). Although deaths were not associated with age by itself, the mortality rate of older patients admitted to medical wards decreased significantly from 3.5% to 1.7% (P=0.011). A higher mortality rate was seen among patients presenting to ED triage between midnight and 12 noon than at other times in 2011 (2.5% vs 1.5%; P<0.001), but this difference disappeared by 2013 (1.3% vs 1.1%; P=0.150). A similar pattern was seen among patients presenting on weekends versus weekdays: 2.2% versus 1.7% (P=0.038) in 2011 and 1.3% versus 1.1% (P=0.150) in 2013. Fewer deaths were noted among patients with acute cardiovascular or respiratory disease in 2013 than in 2011 (1.7% vs 3.6% and 1.5% vs 3.4%, respectively; P<0.001 for both comparisons). Mode of transport to the ED or triage category was not associated with changes in mortality. These analyses took account of any possible confounding resulting from differences over time in emergency admission rates. Conclusions Improved NEAT compliance as a result of clinical redesign is associated with improved in-patient mortality among particular subgroups of emergency admissions, namely older patients with complex medical conditions, those presenting after hours and on weekends and those presenting with time-sensitive acute cardiorespiratory conditions. What is known about the topic? Clinical redesign aimed at improving compliance with NEAT and reducing time spent within the ED of acutely admitted patients has been associated with reduced mortality. To date, no study has attempted to identify subgroups of patients who potentially derive the greatest benefit from improved NEAT compliance in terms of reduced risk of in-patient death. It also remains unclear as to what extent non-patient factors (e.g. admission practices and differences in coding of palliative care patients) affect or confound this reduced risk. What does this paper add? The present study is the first to reveal that enhanced NEAT compliance is associated with lower mortality among particular subgroups of emergency patients admitted to in-patient wards. These include older patients with complex medical conditions, those presenting after hours or on weekends or those with time-sensitive acute cardiorespiratory conditions. These results took account of any possible confounding resulting from differences over time in emergency admission rates, deaths in the ED, numbers of short-stay ward admissions and coding of palliative care deaths. What are the implications for practitioners? Efforts aimed at improving NEAT compliance and efficiencies at the ED-in-patient interface appear to be worthwhile in reducing in-patient mortality among particular subgroups of emergency admissions at high risk. More research is urgently needed in identifying patient- and system-level factors that predispose to higher mortality rates in such populations, but are potentially amenable to focused interventions aimed at optimising transitions of care at the ED-in-patient interface and increasing NEAT compliance for patients admitted to in-patient wards from the ED.

S100B protein as a screening tool for computed tomography findings after mild traumatic brain injury: Systematic review and meta-analysis.

PRIMARY OBJECTIVE: To determine whether S100B protein in serum can predict intracranial lesions on computed tomography (CT) scan after mild traumatic brain injury (MTBI). RESEARCH DESIGN: Systematic review and meta-analysis Methods and procedures: A literature search was conducted using Medline, Embase, Cochrane, Google Scholar, CINAHL, SUMSearch, Bandolier, Trip databases, bibliographies from identified articles and review article references. Eligible articles were defined as observational studies including patients with MTBI who underwent post-traumatic head CT scan and assessing the screening role of S100B protein. MAIN OUTCOMES AND RESULTS: There was a significant positive association between S100B protein concentration and positive CT scan (22 studies, SMD = 1.92, 95% CI = 1.29-2.45, I2 = 100%; p < 0.001). The pooled sensitivity and specificity values for a cut-point range = 0.16-0.20 µg L-1 were 98.65 (95% CI = 95.53-101.77; I2 = 0.0%) and 50.69 (95% CI = 40.69-60.69; I2 = 76.3%), respectively. The threshold for serum S100B protein with 99.63 (95% CI = 96.00-103.25; I2 = 0.0%) sensitivity and 46.94 (95% CI = 39.01-54.87; I2 = 95.5%) specificity was > 0.20 µg L-1. CONCLUSIONS: After MTBI, serum S100B protein levels are significantly associated with the presence of intracranial lesions on CT scan. Measuring the protein could be useful in screening high risk MTBI patients and decreasing unnecessary CT examinations.

Subjective reasons why immigrant patients attend the emergency department.

BACKGROUND: Some patients visit a hospital's emergency department (ED) for reasons other than an urgent medical condition. There is evidence that this practice may differ among patients from different backgrounds. The objective of this study was to examine the reasons why patients from a non-English speaking background (NESB) and patients with an English speaking background but not born in Australia (ESB-NBA) visit the ED, as compared to patients from English-speaking backgrounds but born in Australia (ESB-BA). METHODS: A cross-sectional survey was conducted at the ED of a tertiary hospital in metropolitan Brisbane, Queensland, Australia. Over a four-month period patients who were assigned an Australasian Triage Scale score of 3, 4 or 5 were surveyed. Pearson chi-square test and multivariate logistic regression analyses were performed to examine the differences between the ESB and NESB patients' reported reasons for attending the ED. RESULTS: A total of 828 patients participated in this study. Compared to ESB-BA patients NESB patients were less likely to consider contacting a general practitioner (GP) before attending the ED (Odds Ratios (OR) 0.6 (95% Confidence Interval (CI) 0.4-0.8, p < .05) While ESB-NBA were more likely to consider contacting a GP 1.7 (1.1-2.5, p < .05). Both the NESB patients and the ESB-NBA patients were far more likely than ESB-BA patients to report that they had visited the ED either because they do not have a GP (OR 7.9, 95% CI 4.7-13.4, p < .001) and 2.2 (95% CI 1.1-4.4, p < .05) respectively and less likely to think that the ED could deal with their problem better than a GP (OR 0.5 (95% CI 0.3-0.8, p < .05) and 0.7 (0.3-0.9, p < .05) respectively. The NESB patients also thought it would take too long to make an appointment to consult a GP (OR 6.2, 95% CI 3.7-10.4, p < 0.001). CONCLUSIONS: NESB patients were the least likely to consider contacting a GP before attending hospital EDs. Educational interventions may help direct NESB people to the appropriate health services and therefore reduce the burden on tertiary hospitals ED.

National Emergency Access Targets metrics of the emergency department-inpatient interface: measures of patient flow and mortality for emergency admissions to hospital.

BACKGROUND: Movement of emergency patients across the emergency department (ED)-inpatient ward interface influences compliance with National Emergency Access Targets (NEAT). Uncertainty exists as to how best measure patient flow, NEAT compliance and patient mortality across this interface. OBJECTIVE: To compare the association of NEAT with new and traditional markers of patient flow across the ED-inpatient interface and to investigate new markers of mortality and NEAT compliance across this interface. METHODS: Retrospective study of consecutive emergency admissions to a tertiary hospital (January 2012 to June 2014) using routinely collected hospital data. The practical access number for emergency (PANE) and inpatient cubicles in emergency (ICE) are new measures reflecting boarding of inpatients in ED; traditional markers were hospital bed occupancy and ED attendance numbers. The Hospital Standardised Mortality Ratio (HSMR) for patients admitted via ED (eHSMR) was correlated with inpatientNEAT compliance rates. Linear regression analyses assessed for statistically significant associations (expressed as Pearson R coefficient) between all measures and inpatient NEAT compliance rates. RESULTS: PANE and ICE were inversely related to inpatient NEAT compliance rates (r = 0.698 and 0.734 respectively, P < 0.003 for both); no significant relation was seen with traditional patient flow markers. Inpatient NEAT compliance rates were inversely related to both eHSMR (r = 0.914, P = 0.0006) and all-patient HSMR (r = 0.943, P = 0.0001). CONCLUSIONS: Traditional markers of patient flow do not correlate with inpatient NEAT compliance in contrast to two new markers of inpatient boarding in ED (PANE and ICE). Standardised mortality rates for both emergency and all patients show a strong inverse relation with inpatient NEAT compliance.

Why did I become a nurse? Personality traits and reasons for entering nursing.

AIMS: This article is a report of a mixed method study of the association between personality traits of nurses and their reasons for entering nursing. Background. The worldwide nursing shortage prompts research into better understanding of why individuals enter nursing and may assist in exploring ways to increase their recruitment and long term retention. DESIGN: A mixed method sequential explanatory design employed semi-structured interviews and a validated personality inventory measuring temperament and character traits. METHODS: Registered Nurses (n = 12) and nursing students (n = 11) working and studying in a regional area of Queensland Australia were purposively sampled for the interviews in 2010 from their participation in the survey in 2009 investigating their personality traits. Qualitative data collection stopped at saturation. A thematic content analysis of the qualitative data using the framework approach was interpreted alongside their personality trait profiles. RESULTS: Two dominant themes were identified from the participant interviews about reasons for entering nursing; 'opportunity for caring' and 'my vocation in life'. These themes were congruent with key temperament and character traits measured in the participants. All nurses and students were very high in traits that exude empathy and altruistic ideals regardless of other characteristics which included highly pragmatic and self-serving principles. CONCLUSIONS: Qualitative and quantitative findings suggest that a caring nature is a principal quality of the nursing personality. Recruitment and retention strategies whilst promoting multiple benefits for the profession should not forget that the prime impetus for entering nursing is the opportunity to care for others.

Exploring temperament and character traits in nurses and nursing students in a large regional area of Australia.

AIMS AND OBJECTIVES: To describe individual temperament and character trait profiles associated with nurses and nursing students in a large regional health district and university in Australia. BACKGROUND: Identification of personality characteristics have been undertaken in most professions; however there is little extant literature on nurses which looks at specific aspects of temperament and character. DESIGN: A cross-sectional quantitative study of nurses and nursing students in a large regional health service district and university in South East Queensland, Australia. METHOD: An online survey to nurses and nursing students included a demographic questionnaire and the temperament and character inventory (TCI) to identify levels of the seven basic dimensions of temperament and character. Univariate analysis made multiple and covariate comparisons between TCI scores, nurses, students, working status and age. RESULTS: The target number of responses was exceeded and totalled 451. Results are reported for females who comprised 90% of respondents; 53.5% students and 46.5% nurses. Significant main effects for age and student status were detected in several temperament and character inventory dimensions. Working students had significantly different temperament and character profiles compared to non-working students. CONCLUSIONS: Overall, this sample displays levels of temperament and character traits congruent with a profession requiring high levels of persistence, self-directedness, cooperativeness and reward dependence. Our findings prompt further investigation of whether individuals with the requisite temperament traits are attracted to nursing, or do individuals develop certain character traits as a product of their professional experiences/training. RELEVANCE TO CLINICAL PRACTICE: The identification of distinct profiles of temperament and character traits among different nursing roles may provide insight into what traits are conducive to retention of nurses in these roles. The predictive potential of the temperament traits plus the modifiable component of character traits may provide scope for nursing educators and policy-makers to assist in recruitment and retention of nurses in the workforce.

Presenting patterns of dermatology conditions to an Australian emergency department.

BACKGROUND: Approximately 5%-8% of emergency department (ED) presentations are due to a dermatological condition. This study aimed to identify and characterise patients with skin conditions presenting to a busy ED. METHODS: A 5-year retrospective study on patients with dermatological conditions presenting to the Princess Alexandra Hospital ED in Brisbane, Australia was performed. Electronic medical records were used to compare demographics and admission status of the dermatology group and the total ED group presentations. A prospective survey was conducted on low priority triage (triage 4 and 5) patients identifying reasons presenting to the ED. RESULTS: Of a total 281,718 ED presentations, 11,748 dermatology presentations were identified between January 2012 to December 2016. Of the dermatology presentations, 41.5% were female and had an average age of 47. The most common dermatology presentations were cellulitis, abscess, rash unspecified, and ulcer. Of those admitted, 36% were female, average age was 53, mean length of stay of 294 minutes and 83.1% had an infectious aetiology. Of triage 4 and 5 presentations, 66% patients we approached had been seen by a health practitioner prior to coming to the ED. CONCLUSION: Within the population presenting with a skin related condition to the Princess Alexandra Hospital ED, characteristics associated with admission include male sex, older age, and an infectious etiology. This data may help ED clinicians decide on the discharge disposition of these patients. There may be a role for streamlined admissions for skin related infections, or improved hospital in the home services to support this group.

Beyond Access Block: Understanding the Role of Health Literacy and Self-Efficacy in Low-Acuity Emergency Department Patients.

Background: Health literacy, self-efficacy, and patient satisfaction are factors associated with healthcare utilization. The relationships among these factors and their combined impact on patients' self-rated health have historically been studied in chronic disease populations. This study assessed low-acuity emergency department (ED) patients' ratings of these factors, the relationships among these factors, and their effect on re-presentation rates to the ED. Methods: In this single-arm cohort survey, patients provided demographic data, completed health literacy and self-efficacy assessments prior to being seen by a physician, and completed a discharge perceptions questionnaire that included a global satisfaction question at the time of departure. Three months later, patients answered a telephone survey to measure post-ED visit health outcomes. Results: Health literacy (r=0.114, P=0.023) and self-efficacy (r=0.469, P<0.001) were both independently and positively associated with self-rated health. Neither factor was associated with patient satisfaction. Self-rated health was negatively associated with return ED visits (r=-0.137, P=0.011). Conclusion: Existing research shows that health literacy has a linear association with self-efficacy and self-rated health. The results of this study suggest that in the context of low-acuity ED patients, health literacy and self-efficacy affect patients' understanding of their health status (self-rated health) but do not lead to better utilization of healthcare resources. Improvement of health literacy and self-efficacy, specifically to increase self-rated health, may provide a future avenue of intervention to reduce low-acuity ED patient re-presentation.

Long term impact of ladder-related injuries as measured by the AQoL instrument.

INTRODUCTION: Ladder-related falls are a common cause of patients presenting to emergency departments (ED) with serious injury. The impacts of ladder-related injuries were assessed at six-months post-injury using the quality of life, AQoL 4D Basic (AQoL) instrument. MATERIALS AND METHODS: This was a prospective observational study, conducted and reported according to the STROBE statement. All adult patients with ladder-related injuries who presented to two EDs in southeast Queensland, Australia between October 2015 and October 2016 were approached. Initial participant interviews took place at the time of ED presentation or shortly thereafter, with follow-up telephone interview at six-months. RESULTS: There were 177 enrolments, 43 (24%) were lost to follow up. There were statistically significant changes post-injury for three of the four AQoL dimensions: independence, social relationships and psychological wellbeing, as well as the global AQoL. Twenty-four (18%) participants reported a clinically significant deterioration in independence, 26 (20%) participants reported a clinically significant deterioration in their social relationships, and 34 participants (40%) reporting a clinically significant deterioration in their psychological wellbeing. Nine of the twelve individual items (in AQoL dimension) deteriorated after injury, there was no change in two items (vision and hearing) and an improvement reported in one (communication). The largest changes (> 25% of participants) were reported with sleeping, anxiety worry and depression, and pain. Across the global AQoL dimension, 65 (49%) participants reported a clinically significant deterioration. The severity of injury as measured by the ISS was an independent predictor of the change in AQoL scores (p<0.001). CONCLUSIONS: Injuries related to falls from ladders continue to have a profound impact on patients at six-months post-injury as measured using the AQoL instrument. This adds to previous research which has demonstrated considerable morbidity and mortality at the time of injury. PREVENTION: Older males using ladders at home are at high risk for serious long-term injury. Injury prevention strategies and the safety instructions packaged with the ladder need to be targeted to this at-risk community group. There may also be a role for regulatory bodies to mandate a stabilising device to be included with the ladder at the time of purchase.

Understanding sharps use in an Australian Emergency Department: A mixed methods organisational case study.

BACKGROUND: Despite the introduction of a range of safety policies and sharps equipment designed to protect healthcare workers, rates of percutaneous injuries from occupational exposure to sharps remains high. This study examined the availability and use of various types of sharps devices in a tertiary hospital emergency department, to understand clinician choice between non-safety and safety devices; and to document their safe and unsafe use of sharps. METHODS: This mixed methods study consisted of areview of stock levels, a survey of staff usage, and a content analysis of semi-structured interview data to explore factors which impact on staff preferences for different sharps devices. RESULTS: Staff identified a range of sharps risks, as well as barriers and enablers to the use of safety devices. Availability of, and preference for, familiar devices influenced choice of devices used in clinical practice, despite awareness of associated risks. CONCLUSIONS: This understanding of equipment use and the factors that motivate such use have informed the first stage of the knowledge-to-action cycle. Knowledge translation, should include the development of policies to help reduce the risk of sharps injury. Culture change and ongoing skills development might help to overcome entrenched procedures and increase voluntary engagement with safer sharps.

Digital transformation of the emergency department-inpatient interface (EDii): integration for future innovation.

As the focus of clinicians and government shifts from speciality-based care to system-based key performance indicators such as the National Emergency Access Target (NEAT) or the 4-h rule, integration between emergency department (ED) and inpatient clinical workflows and information systems is becoming increasingly necessary. Such system measures drive the implementation of integrated electronic medical records (ieMR) to digitally integrate these workflows. The objective of this case study was to describe the impact of digital transformation of the ED-in-patient interface (EDii) of a large tertiary hospital on process measures and clinical outcomes for patients requiring emergency admission to hospital. Data were collected from routine clinical and administrative information systems to measure process and clinical outcome measures, including ED length of stay, compliance with the 4-h rule and in-patient mortality between 28 November 2014 and 28 February 2017. The 4-h rule compliance for all patients, as well as for the EDii group (admitted to hospital excluding short stay ward), declined after digitisation. There were 55 fewer deaths in the postintervention group (15% relative reduction; P = 0.02) and a 10% relative reduction in adjusted mortality as measured by the Hospital Standardised Mortality Ratio for emergency patients (eHSMR), which did not reach statistical significance. Digital deceleration in ED performance did occur with an ieMR rollout, but worsening of key patient outcomes was not observed.

Enhancing the knowledge and skills of Advisory and Extension Agents in mental health issues of farmers.

OBJECTIVES: The aim of this study was to increase knowledge and skills of Advisory and Extension Agents (AEAs) in recognizing the symptoms of mental disorders, providing initial help, and offering the referral pathway for appropriate professional help. METHOD: Mental Health First Aid (MHFA) training was provided to AEAs and knowledge and skills pre-training were compared to 6-months post-training. RESULTS: The MHFA training improved the AEAs' ability to recognize a mental disorder, it increased their confidence level in providing help to someone with a mental health problem, it decreased social distances and positively changed their beliefs about treatment. CONCLUSION: MHFA training is effective in enhancing the mental health knowledge and skills of AEAs. The agents, who are a main line of contact of farmers, are able to recognize mental disorders of people and help them appropriately. They are more willing to work with stigmatized people and know who to refer people to for help.

Value of emergency department triage data to describe and understand patterns and mechanisms of cycling injuries.

OBJECTIVE: To characterise patients presenting to EDs for a bicycle-related injury, identify contributing factors to the injuries and describe the data gaps. METHODS: A retrospective study of bicycle-related injury presentations over the 5 year period 2010-2014 to two major metropolitan EDs. Data collected from the emergency presentation database consisted of patient demographics, presenting complaint, discharge diagnosis and details about the circumstances and mechanism of the accident. RESULTS: Bicycle injuries (n = 4144) increased from 20.0 to 25.2 per 1000 injury presentations over 5 years. Patients were 80% male across all age groups and 35% of presentations occurred at the weekend. Fractures accounted for one-third (34%) of all injuries, while injuries to the upper extremities and head resulted in 36% and 19% of cases, respectively. Admission rate was 17%. The number of falls exceeded collisions (1611 vs 937), and in the 13.3% of the fall cases where documentation was present for which how the fall occurred, over half were attributed to bike handling errors. Information related to type of bicycle, accident location, type of activity, protective clothing worn (including helmets) and visibility aids was not recorded for over 95% of the cases. CONCLUSION: Bicycle injuries carry a considerable burden to the ED and the incidence of presentations appears to be rising. The current triage data, designed to provide a rapid assessment for medical urgency, are limited to describing broad demographics, trends and causes.

Characteristics of accidental injuries from power tools treated at two emergency departments in Queensland.

OBJECTIVE: Injuries are a major burden on the Australian healthcare system. Power tool usage is a common cause of accidental injury. A better understanding of the trends of power tool injuries will inform prevention strategies and potentially mitigate costs. METHODS: The ED databases from two level 1 hospitals were reviewed for presentations between 2005 and 2015 resulting from accidental injury with power tools. A subgroup of patients presenting to one hospital between 2016 and 2017 were interviewed about the activities and circumstances that led to their injuries, and followed up 3 months later to assess outcomes. RESULTS: A total of 4057 cases of accidental injury from power tool use were identified. Power saws and grinders contributed to 54% of injuries. Most injuries were located on an upper limb (48%) or the head and neck (30%). Over half (54%) of all head injuries were associated with metal and wood fragments to the eye from grinders, drills and saws. Hospital admission rates were highest for patients aged >60 years. Injuries to females were <5% of all presentations, but 40% of those caused by lawnmowers. Among the 200 patients interviewed, lapses in concentration during use, and modification and inappropriate use of a power tool were the main contributors to injury. Recovery periods >3 months were common. CONCLUSIONS: Accidental injuries from power tool use have a considerable impact on ED resources and can affect the long-term quality of life of those injured. Effective education about safe usage and protection may prevent many injuries.

Mental health of farmers in Southern Queensland: issues and support.

OBJECTIVE: To inform the development of an initiative designed to support the mental well-being of farmers in Queensland. DESIGN: Interactive focus groups. SETTING: Rural and remote Queensland. PARTICIPANTS: Health professionals, farmers and representatives of organisations and agencies working with farmers. MAIN OUTCOME MEASURES: Determination of factors contributing to the declining mental health of rural landholders. Content material for inclusion into mental health first aid programs held for field officers. RESULTS: Key areas identified to contribute to the decline in mental health of farmers were: increasing isolation in its varying forms, the ongoing drought, increased government regulations and widening of the schism between urban and rural Australians. The issues that affect farmers are recognised to have a 'knock-on' effect on the people who interact with them. In particular, rural support organisations are concerned for the well-being of their staff, prompting some to begin to put protocols in place to address their staff need for mental health support. Additional mental health training of field officers that involves awareness, recognition, communication skills, understanding and empathy was recognised by participants to be beneficial. CONCLUSION: Training of field officers was considered to be of benefit to the support of farmers. An understanding of the various and diverse issues that rural landholders face should be a fundamental component of that training.