Soft collar for acute cervical spine injury immobilisation -patient experiences and outcomes: A single centre mixed methods study.

BACKGROUND: Cervical collars are used as standard care for neck immobilisation after cervical spine injury. Although evidence for the most effective type of collar is lacking, there is evidence regarding adverse patient outcomes when managed in a semi or rigid collar. In response to the evidence of complications and adverse effects when using a hard collar, a large Australian adult trauma hospital that specializes in spinal care, changed its policy from hard to soft collars when managing acute cervical spine injury. OBJECTIVE: The aim of this study was to investigate patients' experiences and outcomes when wearing a soft collar for acute cervical spine injury management in hospital. METHOD: A single centre mixed method sequential study design was used. RESULTS: Medical records from 136 patients were examined and no adverse events resulting from collar use were recorded. Interviews with 20 patients revealed that they understood the value of wearing a soft collar. The soft collars were considered supportive and well tolerated, with good adherence to recommendations for use. CONCLUSIONS: Understanding the patients' experiences informs better care management. This study suggests that soft collars are well tolerated, do not result in pressure injuries or other adverse events and are suitable for managing acute cervical spine injury.

A Retrospective Observational Study of Presentations to an Australian Emergency Department for Injuries Sustained in Exercise Pursuits Over 14 Years.

Background: Concurrent with the increase in the number of local gyms and the number of people engaged in fitness pursuits, exercise-related emergency department (ED) presentations have also increased. Identifying these injuries and the associated activities and equipment will help inform prevention strategies and potentially reduce the burden on the healthcare system. Methods: We reviewed the presentations to an Australian tertiary hospital ED resulting from running/jogging and gym-based exercise from 2005 to 2018. Results: From more than 750,000 ED visits, we identified 1,402 exercise-related presentations. Approximately two-thirds of the patients were males. Nontrauma such as chest pain and shortness of breath accounted for 11% of the presentations. Running and jogging contributed 47% of the total presentations, followed by combat activities (boxing and martial arts) with 31% of the total presentations. In the latter group, most injuries were to the head (25%) and upper limbs (39%). Injuries associated with weights/resistance activities (n=94) and falls from treadmills (n=49) accounted for 55% of the 260 injuries from use of noncombat-sports-related gym equipment. Twenty-three percent of all presentations arrived by ambulance, and overall, 9% of presentations required hospital admission. Over a 14-year period, the annual presentations rate rose from <1 to >2.5 per 1,000. Conclusion: Although the annual rate of presentations to the ED from exercise has more than doubled, exercise-related presentations still constitute only a small proportion of total presentations. Nevertheless, any reduction would be advantageous to an already overstretched health system. Risk awareness and effective education about equipment and its use at point of sale and in gyms could potentially prevent many presentations.

Medical Scribes in the Emergency Department: The Scribes' Point of View.

Background: Studies report the benefit of medical scribes in the emergency department on patient throughput, clinical documentation, patient outcomes, and provider and patient satisfaction. However, studies are silent on the benefits of being a scribe for premedical and medical students. Methods: The senior author interviewed 8 scribes who were applying for medical school and 9 medical students who had been scribes prior to medical school. Discussion was prompted on undergraduate education; scribe recruitment and training; career intentions; experience as a scribe; and the value of being a scribe to themselves, to the doctors with whom they worked, and to the hospital where they were employed. Results: The typical scribe had become a scribe to support his or her chances of entry into medical school. Those already in medical school were not convinced that this experience had actually made a difference in their acceptance. All 17 scribes were emphatic that the role had benefitted them in other ways, specifically, by learning medical terminology, observing communication between doctor and patient, and understanding the practice of medicine in an emergency department. For many scribes, the experience reinforced the desire to become a doctor. The scribes recognized their value in the areas of process and finance. They also recognized that many doctors, particularly those working in academic health centers, derived satisfaction from the training and mentoring that they offered. Conclusion: Scribes perceive the role of a scribe to be highly valuable in terms of their career decision making and future medical education.

Applying the Ottawa subarachnoid haemorrhage rule on a cohort of emergency department patients with headache.

OBJECTIVE: The Ottawa subarachnoid haemorrhage (SAH) rule suggests that alert patients older than 15 years with a severe nontraumatic headache reaching maximum intensity within 1 h and absence of high-risk variables effectively have a SAH ruled out. We aimed to determine the proportion of emergency department (ED) patients with any headache fulfilling the entry criteria for the Ottawa SAH rule. PATIENTS AND METHODS: The Ottawa SAH rule was applied retrospectively in a substudy of a prospective snapshot of 34 EDs in Queensland, Australia, carried out over 4 weeks in September 2014. Patient aged 18 years and older with a nontraumatic headache of any potential cause were included. Clinical data and results of investigations were collected. RESULTS: Data were available for 644 (76%) patients. A total of 149 (23.1%, 95% confidence interval: 20.0-26.5%) fulfilled and 495 (76.9%, 95% confidence interval: 73.5-80.0%) did not fulfil the entry criteria. In patients who fulfilled the entry criteria, 30 (<5% overall) did not have any high-risk variables for SAH. In patients who fulfilled the entry criteria and had at least 1 high-risk feature, almost half (46%) received a computed tomographic brain. No SAH were missed. CONCLUSION: In this descriptive observational study, the majority of ED patients presenting with a headache did not fulfil the entry criteria for the Ottawa SAH rule. Less than 5% of the patients in this cohort could have SAH excluded on the basis of the rule. More definitive studies are needed to determine an accepted benchmark for the proportion of patients receiving further work-up (computed tomographic brain) after fulfilling the entry criteria for the Ottawa SAH rule.

Acute Headache Presentations to the Emergency Department: A Statewide Cross-sectional Study.

OBJECTIVES: The objective of this study was to describe demographic and clinical characteristics including features that were consistent with subarachnoid hemorrhage (SAH), use of diagnostic tests, emergency department (ED) discharge diagnoses, and disposition of adult patients presenting with an acute headache to EDs statewide across Queensland, Australia. In addition, potential variations in the presentation and diagnostic workup between principal-referral and city-regional hospitals were examined. METHODS: A prospective cross-sectional study was conducted over 4 weeks in September 2014. All patients ≥ 18 years presenting to one of 29 public and five private hospital EDs across the state with an acute headache were included. The headache had to be the principal presenting complaint and nontraumatic. The 34 study sites attend to about 90% of all ED presentations statewide. The treating doctor collected clinical information at the time of the ED visit including the characteristics of the headache and investigations performed. A study coordinator retrieved results of investigations, ED discharge diagnoses, and disposition from state databases. Variations in presentation, investigations, and diagnosis between city-regional and principal-referral hospitals were examined. RESULTS: There were 847 headache presentations. Median (range) age was 39 (18-92) years, 62% were female, and 31% arrived by ambulance. Headache peaked instantly in 18% and ≤ 1 hour in 44%. It was "worst ever" in 37%, 10/10 in severity in 23%, and associated with physical activity in 7.4%. Glasgow Coma Scale score was < 15 in 4.1%. Neck stiffness was noted on examination in 4.8%. Neurologic deficit persisting in the ED was found in 6.5%. A computed tomography (CT) head scan was performed in 38% (318/841, 95% CI = 35% to 41%) and an lumbar puncture in 4.7% (39/832, 95% CI = 3.4% to 6.3%). There were 18 SAH, six intraparenchymal hemorrhages, one subdural hematoma, one newly diagnosed brain metastasis, and two bacterial meningitis. Migraine was diagnosed in 23% and "primary headache not further specified" in 45%. CT head scans were more likely to be performed in principal-referral hospitals (41%) compared to city-regional hospitals (33%). The headache in patients presenting to the latter was less likely to be instantly peaking or associated with activity, but was no less severe in intensity and was more frequently accompanied by nausea and vomiting. Their diagnosis was more likely to be a benign primary headache. Variations in CT scanning could thus be due to differences in the case mix. The median (interquartile range) ED length of stay was 3.1 (2.2 to 4.5) hours. Patients was discharged from the ED or admitted to the ED short-stay unit prior to discharge in 57 and 23% of cases, respectively. CONCLUSIONS: The majority of patients had a benign diagnosis, with intracranial hemorrhage and bacterial meningitis accounting for only 3% of the diagnoses. There are variations in the proportion of patients receiving CT head scans between city-regional and principal-referral hospitals. As 38% of headache presentations overall underwent CT scanning, there is scope to rationalize diagnostic testing to rule out life-threatening conditions.

Review article: Potential of medical scribes to allay the burden of documentation and enhance efficiency in Australian emergency departments.

The increasing burden of documentation experienced by doctors threatens the efficiency in EDs and increases the likelihood of documentation errors. Medical scribes afford the opportunity to allay this burden by removing a large component of the doctors' documentation task. Scribes have been embedded successfully in US EDs, and the effects have been mostly advantageous. The present paper provides a brief overview of the function of scribes and their potential contribution to Australian EDs.

The top eight issues Queensland Australia's aged-care nurses and assistants-in-nursing worried about outside their workplace: a qualitative snapshot.

The attainment of a work-life balance is an important issue for recruitment, retention and workforce planning. This paper aims to report on the free text data provided by the aged-care sector nurses around perceptions of important work-life issues. Data were written responses of aged-care nurses to the open-ended request at the end of a survey, which asked them to list up to five political/social/environmental issues concerning them outside of their work. For aged-care nurses, when asked to list political/social/environmental issues they were concerned about outside of work in late 2007, there emerged considered issues around work and life. Among the top eight themes there is an intriguing balance between the themes work, industrial relations, aged care/elder care and health-care services compared with the themes environment, water, societal values and housing. Qualitative insights into the political/social/environmental issues aged-care nurses are concerned about outside of your work suggest their desire for a labour/life or work/life harmony. Aged-care nurses place an equal importance on the nature of labour and the basics of life. The findings provide information for aged-care sector managers and workforce planners on areas in need of consideration to recruit and retain a workforce within aged care.

Personality traits of Australian nurses and doctors: challenging stereotypes?

This study compared temperament and character traits of Australian registered nurses and general practitioners. A cross-sectional quantitative design used the Temperament and Character Inventory. Total sample size was 426. Only main effects were detected. Nurses were higher in the temperament traits of Novelty Seeking and Reward Dependence, lower in the character traits of Self-Directedness and Cooperativeness but higher in Self-Transcendence compared with the sample of doctors. Differences in personality profiles between registered nurses and general practitioners might challenge existing stereotypes between these professions. Further exploration of traits exclusive to and shared among health professions would supplement a broad conceptualization of specialities and support the enhancement of appropriate training and career counselling. Awareness of one's temperament and character can lead to a clearer understanding of how they function in the workplace and might encourage reflection on and insight into the implications of their personality and career plans.

Workplace violence: differences in perceptions of nursing work between those exposed and those not exposed: a cross-sector analysis.

Nurses are at high risk of incurring workplace violence during their working life. This paper reports the findings on a cross-sectional, descriptive, self-report, postal survey in 2007. A stratified random sample of 3000 of the 29 789 members of the Queensland Nurses Union employed in the public, private and aged care sectors resulted in 1192 responses (39.7%). This paper reports the differences: between those nurses who experienced workplace violence and those who did not; across employment sectors. The incidence of workplace violence is highest in public sector nursing. Patients/clients/residents were the major perpetrators of workplace violence and the existence of a workplace policy did not decrease levels of workplace violence. Nurses providing clinical care in the private and aged care sectors experienced more workplace violence than more senior nurses. Although workplace violence was associated with high work stress, teamwork and a supportive workplace mitigated workplace violence. The perception of workplace safety was inversely related to workplace violence. With the exception of public sector nursing, nurses reported an inverse relationship with workplace violence and morale.

How do rural GPs manage their inactive and overweight patients?--A pilot study of rural GPs in Queensland.

BACKGROUND: Overweight and obesity are major risk factors for chronic disease. Physical activity plays an important role in increasing wellbeing and reducing weight. General practitioners' advice and intervention can help patients increase their physical activity. This pilot study is part of a larger study investigating physical activity opportunities in rural Queensland. METHOD: A survey was sent to a random sample of 40 general practices in rural Queensland. The survey asked GPs about strategies they use when dealing with patients who would benefit from exercise, their use of Lifescripts, the main perceived barriers to exercise in their location, perceptions on change in exercise patterns over 5 years, and local resources and referral networks available in their location. The data was analysed using a five stage framework and coded into themes. RESULTS: A total of 67.5% of practices responded. The primary strategy GP respondents used to address overweight was discussion and advice. Fifteen of the 27 respondents referred patients to allied health professionals and local sport/recreation organisations. Lack of physical and human resources to encourage and support weight loss was the main perceived barrier to helping patients achieve physical activity and weight loss goals. DISCUSSION: Behavioural factors are globally acknowledged as the biggest barriers to exercise. The GPs surveyed recognise that, for most people, external support is essential for ongoing exercise compliance and motivation. This can be in the form of discussion with, and advice from, the GP, or referral to gyms or other services. Respondents identified limited facilities and support in rural areas as barriers. Formalisation of referral pathways and follow up is currently lacking and could assist rural GPs in helping their patients to exercise and lose weight.

'I love nursing, but..'- qualitative findings from Australian aged-care nurses about their intrinsic, extrinsic and social work values.

Aim. The aim of this qualitative analysis - a component of a larger survey study, was to provide insights and understandings about intrinsic and extrinsic work values for nurses in aged-care. Background. Intrinsic and extrinsic work values impact on nurses' job satisfaction and ultimately nursing retention. This study contributes further to knowledge development in this area by building on a previous work values study in aged-care nursing. Methods. This paper presents the qualitative research findings from the final open-ended question from a survey of nurses employed in the aged-care sector in the State of Queensland, Australia in 2007. Data from a cohort of 105 aged care sector nurses was analysed relying on deductive content analysis. Findings. Two intrinsic work values emerged - low morale and images of nursing and two extrinsic work values emerged - remuneration and working conditions. The work value 'working conditions' comprised four aspects of aged-care work, specifically staff turnover, workplace violence, care team membership specifically the Assistants-in-Nursing and paperwork. A single social workplace value 'support by management' is discussed as identified as important to these nurses. Conclusion. Qualitative insights into aged-care nurses' intrinsic and extrinsic work values suggest that work satisfaction is low. Workforce policy makers and employers of nurses in aged-care need to comprehend the relationship between job satisfaction, retention and work values. Relevance to clinical practice. These findings have implications for recruitment, retention and workforce planning within the aged-care environment.

The value of a breast care nurse in supporting rural and remote cancer patients in Queensland.

The role of the breast care nurse (BCN) in the Queensland's Supporting Rural Women With Breast Cancer Project was evaluated by mixed methodology. Through questionnaire and interview, patients provided views about the nurse's role under the categories of awareness, access, coordination, information, and psychosocial, emotional, and practical support. Of the 51 participants, 37 resided in rural and remote areas. Eighteen lived between 100 and 500 miles from specialized breast care services. The BCN met patients at their regular hospital visits and was available by telephone at any time. There was overwhelming agreement among the participants that the timing of contact, ease of accessibility, information provided, and support offered were extremely valuable in making their treatment and recovery easier. Most participants would recommend hospitals with a BCN to their friends. Members of the multidisciplinary care team provided views on awareness of the BCN, influence on care management, communication, and patient outcomes. They recognized the benefits of the BCN to patients and to coordination and liaison of the team. The findings concur with unpublished Australian reports that demonstrate the success of BCNs. The BCN model of care could be used to support other medical conditions in rural and remote Australia.

Informing rural and remote students about careers in health: factors influencing career decisions.

OBJECTIVE: Since 1994 a state-wide program has been operating in Queensland to provide non-metropolitan secondary school students with information about health careers. Determination of the factors influencing the career decisions of rural and remote students was one objective of the evaluation of that program. DESIGN: Telephone interviews. SETTING: Secondary schools. SUBJECTS: People who had previously attended Year 10 residential health career workshops run by Queensland Health. Ninety-four of 277 past participants to Year 10 Health Careers Workshops responded to a postal questionnaire and were invited to take part in a telephone questionnaire to collect further information related to the course and career choices. MAIN OUTCOME MEASURES: Self-reported factors affecting career decisions of students from rural and remote areas. RESULTS: Of the 94 past workshop participants, interviews were held with 70. All participants had left secondary education and had either undertaken or were undertaking some form of tertiary study. The most influential of nine factors to both undergraduate and postgraduate course choices was self-interest. Various other factors differentially contributed to undergraduate and postgraduate course choices among them were the health careers workshops, which played a major influence on undergraduate course decisions of students. CONCLUSION: Self-interest is the largest self-reported factor to career decision making among students from rural and remote areas. Finance and career advice from school are not considered to be highly influential. However, these independent decisions can be substantially influenced by external information provided through health career workshops.

Informing rural and remote students about careers in health: the effect of Health Careers Workshops on course selection.

OBJECTIVE: Since 1994, as part of the Health Careers in the Bush program, Queensland Health has run residential workshops to provide secondary school students from rural and remote areas with information about health careers. This study reports on the influence of the program on tertiary course selection. DESIGN: Self-administered mail survey and telephone interviews. SETTING: Secondary schools. PARTICIPANTS: Past students who had in year 10 attended residential career workshops run by Queensland Health. MAIN OUTCOME MEASURES: Tertiary courses; self-reported influence of the workshop program on raising awareness and course selection. RESULTS: Over 90% of participants reported that the workshops had a major impact on their course and career selection. The workshops provided exposure to a wide variety of health-related disciplines, enabling students to be better informed about their course and career plans within the industry. Half of the students changed their course as a result of attending a workshop, and 83% enrolled in a health-related course. The 17% who did not enrol in a health-related course also recognised the value of the workshop program. CONCLUSION: The workshop program raised awareness of health professions and offered valuable information to rural students about a wide range of health careers. Results suggest that provision of such information in a residential-workshop format contributed significantly to tertiary course selection of rural and remote students. The benefit to the health industry from these workshops has been substantial in relation to the small amount of funds invested.

Reproductive biology of Sykes and blue monkeys (Cercopithecus mitis).

Thirty-five live births were recorded over a 5-year period from three subspecies of the mitis (Sykes and blue) monkey (Cercopithecus mitis) maintained outdoors in single-male harem breeding groups. There was no indication of birth seasonality. Females of one subspecies, C. m. kolbi, were individually caged, and basic reproductive parameters were monitored. A menstrual cycle length of 31.9 ± 6.0 days was recorded, and there were a large number of irregular cycles. Within individuals, mean progesterone and estrogen concentrations during the luteal phase of the cycle ranged from 5.5 to 10.7 nmol/liter and from 542 to 829 pmol/liter, respectively. Attempts at timed matings were unsuccessful. It is concluded that the mitis monkey is slow to adapt reproductively to captivity and is, therefore, not especially well-suited for routine reproductive studies. However, it may prove valuable to elucidate some of the more complex factors controlling guenon reproduction.