[This corrects the article DOI: 10.1371/journal.pone.0301176.].
AIM: This study aims to explore regional variation and identify regions within Australia with high incidence of out-of-hospital cardiac arrest (OHCA) and low rates of bystander cardiopulmonary resuscitation (CPR). METHOD: Adult OHCAs of presumed medical aetiology occurring across Australia between 2017 and 2019 were mapped onto local government areas (LGA) using the location of arrest coordinates. Bayesian spatial models were applied to provide "smoothed" estimates of OHCA incidence and bystander CPR rates (for bystander-witnessed OHCAs) for each LGA. For each state and territory, high-risk LGAs were defined as those with an incidence rate greater than the state or territory's 75th percentile and a bystander CPR rate less than the state or territory's 25th percentile. RESULTS: A total of 62,579 OHCA cases attended by emergency medical services across 543 LGAs nationwide were included in the study. Nationally, the OHCA incidence rate across LGA ranged from 58.5 to 198.3 persons per 100,000, while bystander CPR rates ranged from 45% to 75%. We identified 60 high-risk LGAs, which were predominantly located in the state of New South Wales. Within each region, high-risk LGAs were typically located in regional and remote areas of the country, except for four metropolitan areas-two in Adelaide and two in Perth. CONCLUSIONS: We have identified high-risk LGAs, characterised by high incidence and low bystander CPR rates, which are predominantly in regional and remote areas of Australia. Strategies for reducing OHCA and improving bystander response may be best targeted at these regions.
Cardiopulmonary Resuscitation , Emergency Medical Services , Out-of-Hospital Cardiac Arrest , Out-of-Hospital Cardiac Arrest/epidemiology , Out-of-Hospital Cardiac Arrest/therapy , Humans , Retrospective Studies , Incidence , Australia/epidemiology , Male , Emergency Medical Services/statistics & numerical data , Female , Aged , Middle Aged , Adult
INTRODUCTION: The aim of this study was to develop a risk adjustment strategy, including effect modifiers, for benchmarking emergency medical service (EMS) performance for out-of-hospital cardiac arrest (OHCA) in Australia and New Zealand. METHOD: Using 2017-2019 data from the Australasian Resuscitation Outcomes Consortium (Aus-ROC) OHCA Epistry, we included adults who received an EMS attempted resuscitation for a presumed medical OHCA. Logistic regression was applied to develop risk adjustment models for event survival (return of spontaneous circulation at hospital handover) and survival to hospital discharge/30 days. We examined potential effect modifiers, and assessed model discrimination and validity. RESULTS: Both OHCA survival outcome models included EMS agency and the Utstein variables (age, sex, location of arrest, witnessed arrest, initial rhythm, bystander cardiopulmonary resuscitation, defibrillation prior to EMS arrival, and EMS response time). The model for event survival had good discrimination according to the concordance statistic (0.77) and explained 28% of the variation in survival. The corresponding figures for survival to hospital discharge/30 days were 0.87 and 49%. The addition of effect modifiers did little to improve the performance of either model. CONCLUSION: The development of risk adjustment models with good discrimination is an important step in benchmarking EMS performance for OHCA. The Utstein variables are important in risk-adjustment, but only explain a small proportion of the variation in survival. Further research is required to understand what factors contribute to the variation in survival between EMS.
Cardiopulmonary Resuscitation , Emergency Medical Services , Out-of-Hospital Cardiac Arrest , Adult , Humans , Out-of-Hospital Cardiac Arrest/therapy , Benchmarking , Cohort Studies , Risk Adjustment , New Zealand/epidemiology , Registries , Australia/epidemiology
An outbreak of severe diarrheal illness was recently reported in northeastern Oklahoma, and Shiga toxin-producing Escherichia coli serotype O111 was identified as the etiological agent. Our results indicated that this isolate is unable to decarboxylate lysine, a characteristic that is shared with other outbreak-linked O111 isolates. Therefore, further investigation is recommended to determine whether the lysine decarboxylase test could be used to identify a subset of pathogenic E. coli, particularly Shiga toxin-producing E. coli O111 isolates, that have the potential of causing human infections and outbreaks.
Carboxy-Lyases/genetics , Disease Outbreaks , Escherichia coli Infections/epidemiology , Lysine/metabolism , Operon , Shiga-Toxigenic Escherichia coli/pathogenicity , Carboxy-Lyases/metabolism , Dysentery/epidemiology , Dysentery/microbiology , Escherichia coli Infections/microbiology , Escherichia coli Proteins/genetics , Foodborne Diseases/epidemiology , Foodborne Diseases/microbiology , Genes, Bacterial , Genetic Variation , Genotype , Humans , Oklahoma/epidemiology , Phenotype , Polymerase Chain Reaction , Shiga-Toxigenic Escherichia coli/enzymology , Shiga-Toxigenic Escherichia coli/genetics , Shiga-Toxigenic Escherichia coli/isolation & purification , Species Specificity , Virulence/genetics
Brain Neoplasms/diagnosis , Carcinoma, Non-Small-Cell Lung/secondary , Frontal Lobe , Magnetic Resonance Imaging , Radiosurgery , Antineoplastic Agents/therapeutic use , Brain Neoplasms/radiotherapy , Brain Neoplasms/secondary , Brain Neoplasms/surgery , Carcinoma, Non-Small-Cell Lung/drug therapy , Carcinoma, Non-Small-Cell Lung/radiotherapy , Carcinoma, Non-Small-Cell Lung/surgery , Combined Modality Therapy , Fatal Outcome , Female , Frontal Lobe/pathology , Glioblastoma/drug therapy , Glioblastoma/radiotherapy , Glioblastoma/surgery , Humans , Lung Neoplasms/drug therapy , Lung Neoplasms/radiotherapy , Middle Aged , Palliative Care , Salvage Therapy
Brain Neoplasms/diagnosis , Frontal Lobe , Magnetic Resonance Imaging , Oligodendroglioma/diagnosis , Adult , Brain Neoplasms/pathology , Brain Neoplasms/radiotherapy , Brain Neoplasms/surgery , Craniotomy , Diagnosis, Differential , Disease Progression , Female , Frontal Lobe/pathology , Frontal Lobe/surgery , Headache/etiology , Humans , Oligodendroglioma/radiotherapy , Oligodendroglioma/surgery , Photophobia/etiology , Radiotherapy, Adjuvant , Radiotherapy, Conformal , Reoperation
Brain Abscess/diagnosis , Brain Neoplasms/diagnosis , Cysts/diagnosis , Frontal Lobe , Magnetic Resonance Imaging , Parietal Lobe , Antineoplastic Agents/therapeutic use , Brain Neoplasms/drug therapy , Brain Neoplasms/pathology , Brain Neoplasms/radiotherapy , Brain Neoplasms/surgery , Chemotherapy, Adjuvant , Combined Modality Therapy , Craniotomy , Cysts/pathology , Cysts/radiotherapy , Cysts/surgery , Diagnosis, Differential , Fatal Outcome , Frontal Lobe/pathology , Frontal Lobe/surgery , Gefitinib , Glioblastoma/drug therapy , Glioblastoma/radiotherapy , Glioblastoma/surgery , Humans , Male , Middle Aged , Parietal Lobe/pathology , Parietal Lobe/surgery , Quinazolines/therapeutic use , Radiotherapy, Adjuvant , Radiotherapy, Conformal
Diagnostic Errors , Glioma/diagnosis , Magnetic Resonance Imaging , Meningeal Neoplasms/diagnosis , Meningioma/diagnosis , Optic Nerve Neoplasms/diagnosis , Radiotherapy, Conformal , Adult , Female , Humans , Meningeal Neoplasms/radiotherapy , Meningioma/radiotherapy , Multiple Sclerosis/diagnosis , Optic Nerve Neoplasms/radiotherapy , Optic Neuritis/diagnosis