Reinforcing informed medication prescription for low back pain in the emergency department (RIME): a controlled interrupted time series implementation study protocol.

INTRODUCTION: Management guidelines for low back pain (LBP) recommend exclusion of serious pathology, followed by simple analgesics, superficial heat therapy, early mobilisation and patient education. An audit in a large metropolitan hospital emergency department (ED) revealed high rates of non-recommended medication prescription for LBP (65% of patients prescribed opioids, 17% prescribed benzodiazepines), high inpatient admission rates (20% of ED LBP patients), delayed patient mobilisation (on average 6 hours) and inadequate patient education (48% of patients). This study aims to improve medication prescription for LBP in this ED by implementing an intervention shown previously to improve guideline-based management of LBP in other Australian EDs. METHODS AND ANALYSIS: A controlled interrupted time series study will evaluate the intervention in the ED before (24 weeks; 20 March 2023-3 September 2023) and after (24 weeks; 27 November 2024-12 May 2024) implementation (12 weeks; 4 September 2023-26 November 2023), additionally comparing findings with another ED in the same health service. The multicomponent implementation strategy uses a formalised clinical flow chart to support clinical decision-making and aims to change clinician behaviour, through clinician education, provision of alternative treatments, educational resources, audit and feedback, supported by implementation champions. The primary outcome is the percentage of LBP patients prescribed non-recommended medications (opioids, benzodiazepines and/or gabapentinoids), assessed via routinely collected ED data. Anticipated sample size is 2000 patients (n=1000 intervention, n=1000 control) based on average monthly admissions of LBP presentations in the EDs. Secondary outcomes include inpatient admission rate, time to mobilisation, provision of patient education, imaging requests, representation to the ED within 6 months and healthcare costs. In nested qualitative research, we will study ED clinicians' perceptions of the implementation and identify how benefits can be sustained over time. ETHICS AND DISSEMINATION: This study received ethical approval from the Metro North Human Research Ethics Committee (HREC/2022/MNHA/87995). Study findings will be published in peer-reviewed journals and presented at international conferences and educational workshops. TRIAL REGISTRATION NUMBER: ACTRN12622001536752.

The epidemiology of sports and leisure-related injury hospitalisations in Queensland: A five-year review.

OBJECTIVE: To describe the epidemiology of sports and leisure-related injury hospitalisations in Queensland DESIGN, SETTING, AND PATIENTS: Retrospective analysis of routinely collected hospital admissions data from all Queensland hospitals (public and private) between 2012 and 2016 for injury-related admissions where the activity engaged in when injured was coded as sports or leisure activity. MAIN OUTCOME MEASURES: Number of hospitalisations; rate of hospitalisation per 100,000 population and demographic, injury, treatment, and outcome details of hospitalised injury patients. RESULTS: Between 01 January 2012 and 31 December 2016, 76,982 people were hospitalised for a sports or leisure-related injury in Queensland. More people were hospitalised in public hospitals than private. Rates were highest for those under 14 years (601.5/100,000 population) and were higher in males (130.6/100,000 population) than females (28.9/100,000 population). A total of 18,734 injuries (24.3%; 79.5/100,000 population) were sustained while playing team ball sports, with rugby codes (rugby union, rugby league and rugby unspecified) representing the single largest source of injuries with 6,592. The extremities were the most likely body location of injury (46,644; 198/100,000 population), and the most common injury type was a fracture (35,018; 148.6/100,000 population). CONCLUSIONS: The findings highlight the significant burden of sport and leisure-related injury hospitalisations in Queensland. This information is important for injury prevention and trauma system planning.

DINED (Delivery-related INjuries in the Emergency Department) part 2: A chart review of risk factors and injuries affecting food delivery riders.

OBJECTIVE: This study aimed to examine patterns of injury, the impact of these injuries on patients and identification of potentially modifiable contributing factors through industry regulation reforms and education. METHODS: Food delivery rider (FDR)-related presentations to the Royal Brisbane and Women's Hospital Emergency and Trauma Centre for a year from September 2020 were identified. Data collected included patient and incident demographics: time, type and location of injuries, investigations and care required, length of stay, admission requirements and follow up. RESULTS: The cohort included 81.8% male with a mean age of 25.2 years. Most injuries occurred on the road from a collision with a vehicle. The most common injury was fractures. Incidence increased on weekends and during the evening. More than half the cohort were admitted to hospital. Only 22.7% of patients were eligible for workers compensation and less than half were covered by Medicare. The majority (72.7%) of cases involved non-resident riders from other countries. CONCLUSION: The majority of FDRs presenting with injuries are not Australian citizens and less than half were Medicare eligible potentially contributing to inadequate access to care especially fracture follow up. There were spikes in injuries occurring at night, weekends and during periods of pandemic associated lockdowns demonstrating an increased usage of delivery services during these times. Results highlight injury patterns experienced by delivery riders and potentially modifiable risk factors for this rapidly growing area of employment within the gig economy.

Community Opioid Dispensing After Injury (CODI): Protocol for a Population-Based Data Linkage Study.

BACKGROUND: There is an urgent need to reduce preventable deaths and hospitalizations from prescription opioid harms and minimize the negative effect opioid misuse can have on injured individuals, families, and the wider community. Data linkage between administrative hospitalization records for injured patients and community opioid dispensing can improve our understanding of the health and surgical trajectories of injured persons and generate insights into corresponding opioid dispensing patterns. OBJECTIVE: The Community Opioid Dispensing after Injury (CODI) study aims to link inpatient hospitalization data with opioid dispensing data to examine the distribution and predictive factors associated with high or prolonged community opioid dispensing among adults, for 2 years following an injury-related hospital admission. METHODS: This is a retrospective population-based cohort study of adults aged 18 years or older hospitalized with an injury in Queensland, Australia. The study involves the linkage of statewide hospital admissions, opioid prescription dispensing, and mortality data collections. All adults hospitalized for an injury between January 1, 2014, and December 31, 2015, will be included in the cohort. Demographics and injury factors are recorded at the time of the injury admission. Opioid dispensing data will be linked and extracted for 3 months prior to the injury admission date to 2 years after the injury separation date (last date December 31, 2017). Deaths data will be extracted for the 2-year follow-up period. The primary outcome measure will be opioid dispensing (frequency and quantity) in the 2 years following the injury admission. Patterns and factors associated with community opioid dispensing will be examined for different injury types, mechanisms, and population subgroups. Appropriate descriptive statistics will be used to describe the cohort. Regression models will be used to examine factors predictive of levels and duration of opioid use. Nonparametric methods will be applied when the data are not normally distributed. RESULTS: The project is funded by the Royal Brisbane and Women's Hospital Foundation. As of November 2021, all ethics and data custodian approvals have been granted. Data extraction and linkage has been completed. Data management and analysis is underway with results relating to an analysis for blunt chest trauma patients expected to be published in 2022. CONCLUSIONS: Little is currently known of the true prevalence or patterns of opioid dispensing following injury across Queensland. This study will provide new insights about factors associated with high and long-term opioid dispensing at a population level. This information is essential to inform targeted public policy and interventions to reduce the risk of prolonged opioid use and dependence for those injured. The novel work undertaken for this project will be vital to planning, delivering, monitoring, and evaluating health care services for those injured. The findings of this study will be used to inform key stakeholders as well as clinicians and pain management services. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/36357.

Effects of globally obtained informative priors on bayesian safety performance functions developed for Australian crash data.

The precision and bias of Safety Performance Functions (SPFs) heavily rely on the data upon which they are estimated. When local (spatially and temporally representative) data are not sufficiently available, the estimated parameters in SPFs are likely to be biased and inefficient. Estimating SPFs using Bayesian inference may moderate the effects of local data insufficiency in that local data can be combined with prior information obtained from other parts of the world to incorporate additional evidence into the SPFs. In past applications of Bayesian models, non-informative priors have routinely been used because incorporating prior information in SPFs is not straightforward. The previous few attempts to employ informative priors in estimating SPFs are mostly based on local prior knowledge and assuming normally distributed priors. Moreover, the unobserved heterogeneity in local data has not been taken into account. As such, the effects of globally derived informative priors on the precision and bias of locally developed SPFs are essentially unknown. This study aims to examine the effects of globally informative priors and their distribution types on the precision and bias of SPFs developed for Australian crash data. To formulate and develop global informative priors, the means and variances of parameter estimates from previous research were critically reviewed. Informative priors were generated using three methods: 1) distribution fitting, 2) endogenous specification of dispersion parameters, and 3) hypothetically increasing the strength of priors obtained from distribution fitting. In so doing, the mean effects of crash contributing factors across the world are significantly different than those same effects in Australia. A total of 25 Bayesian Random Parameters Negative Binomial SPFs were estimated for different types of informative priors across five sample sizes. The means and standard deviations of posterior parameter estimates as well as SPFs goodness of fit were compared between the models across different sample sizes. Globally informative prior for the dispersion parameter substantially increases the precision of a local estimate, even when the variance of local data likelihood is small. In comparison with the conventional use of Normal distribution, Logistic, Weibull and Lognormal distributions yield more accurate parameter estimates for average annual daily traffic, segment length and number of lanes, particularly when sample size is relatively small.

Pharmacists' perceptions and communication of risk for alertness impairing medications.

BACKGROUND: A core role of the pharmacist is to ensure safe and effective medication use. Therapeutic classes that impair alertness (e.g. sedatives or hypnotics) can pose safety concerns for the consumer when undertaking activities requiring psychomotor vigilance (e.g. driving). OBJECTIVE: To explore pharmacists' perceptions and communication strategy of the risks related to alertness impairing medications in clinical practice. METHODS: In-depth semi-structured interviews explored community pharmacists' perceptions of medication-related risks, current medication provision and the feasibility of new practice tools. Interviews were digitally recorded, transcribed verbatim and analysed using Framework Analysis to identify emergent themes. A Psychometric Risk Perception Questionnaire was also used to evaluate pharmacists' perceptions across 7 common psychotropic drug classes. RESULTS: Synthesis of the qualitative dataset of 30 pharmacist interviews revealed three key themes: 'Safety and Consequences of AIMs', 'Factors that Influence Risk Communication' and 'Refining Risk Communication'. Participating pharmacists were generally aware of the therapeutic classes associated with medication-related risks but were concerned about patients' level of understanding. Counselling approaches were largely dictated by perceived patient interest/experience with a medication. Concerns were centred on inter-individual pharmacokinetic differences, which could make the precise risk assignment difficult. Pharmacists also highlighted workflow limitations and the need to bring patients' attention to these resources during the clinical interaction to maximise impact. CONCLUSIONS: Medication-related risk communication is a complex clinical phenomenon dictated by patients' prior experiences and the pharmacists' practice environment. Extending the evidence base in this therapeutic area and refining clinical resources are key steps towards optimising patient medication safety.

Patient attitudes towards change in adapted motivational interviewing for substance abuse: a systematic review.

Adapted motivational interviewing (AMI) represents a category of effective, directive and client-centered psychosocial treatments for substance abuse. In AMI, patients' attitudes towards change are considered critical elements for treatment outcome as well as therapeutic targets for alteration. Despite being a major focus in AMI, the role of attitudes towards change in AMI's action has yet to be systematically reviewed in substance abuse research. A search of PsycINFO, PUBMED/MEDLINE, and Science Direct databases and a manual search of related article reference lists identified 416 published randomized controlled trials that evaluated AMI's impact on the reduction of alcohol and drug use. Of those, 54 met the initial inclusion criterion by evaluating AMI's impact on attitudes towards change and/or testing hypotheses about attitudes towards change as moderators or mediators of outcome. Finally, 19 studies met the methodological quality inclusion criterion based upon a Newcastle-Ottawa Quality Assessment Scale score ≥ 7. Despite the conceptual importance of attitudes towards change in AMI, the empirical support for their role in AMI is inconclusive. Future research is warranted to investigate both the contextual factors (ie, population studied) as well as deployment characteristics of AMI (ie, counselor characteristics) likely responsible for equivocal findings.