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1.
Intern Med J ; 52(11): 2001-2004, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36404117

RESUMO

Formalised research opportunities offered to junior doctors in Australasia, and specifically New Zealand, are few and far in between. This is especially evident for interns in the first 2 years after graduation. Academic internships are positioned not only to fill this gap but also provide interns with long-lasting skills beyond the confines of academia.


Assuntos
Internato e Residência , Humanos , Nova Zelândia , Australásia
2.
ANZ J Surg ; 92(10): 2667-2671, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36221204

RESUMO

BACKGROUND: The role of patient educational materials for paediatric patients is increasing. A reading grade level of eighth-grade (USA) or year nine (Australia and New Zealand) is recommended as acceptable. The aim of this paper was to assess the reading grade levels of paediatric online patient educational materials, within Australasia. METHODS: The online Google® search engine was used with a variety of keyword combinations, filtered to the location of Australia and New Zealand. Suitable websites were explored for webpages related to slipped upper femoral epiphysis, septic arthritis, osteomyelitis, talipes equinovarus and developmental dysplasia of the hip. Readability was assessed using the online readability software WEB FX®. RESULTS: Seventy-six patient educational webpages were analysed: 66 from Australia and 10 from New Zealand. Only eight of the 76 webpages (10.5%) had reading grade levels below the recommended eighth-grade (US)/year nine (AUS/NZ) level. Webpages from private healthcare providers and pages related to septic arthritis had the significantly highest reading grades. CONCLUSIONS: Australasian families have limited online patient educational materials available to them, which are mostly set at reading grade levels above recommended standards. Healthcare providers should be incentivized to improve the readability of their patient educational materials to reduce health disparities and improve health literacy moving forward.


Assuntos
Artrite Infecciosa , Letramento em Saúde , Doenças Musculoesqueléticas , Ortopedia , Australásia , Criança , Compreensão , Humanos , Internet
3.
BMJ Open ; 12(9): e058107, 2022 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-36104135

RESUMO

INTRODUCTION: Glioblastoma (GBM) is the most common malignant primary central nervous system cancer in adults. The objective of the Multi-Arm GlioblastoMa Australasia (MAGMA) trial is to test hypotheses in real world setting to improve survival of people with GBM. Initial experimental arms are evaluating the effectiveness of interventions in newly diagnosed GBM (ndGBM). This study will compare maximal surgical resection followed by chemoradiotherapy plus adjuvant chemotherapy for 6 months with the addition of (1) 'neoadjuvant' chemotherapy beginning as soon as possible after surgery and/or (2) adjuvant chemotherapy continued until progression within the same study platform. METHODS AND ANALYSIS: MAGMA will establish a platform for open-label, multiarm, multicentre randomised controlled testing of treatments for GBM. The study began recruiting in September 2020 and recruitment to the initial two interventions in MAGMA is expected to continue until September 2023.Adults aged ≥18 years with ndGBM will be given the option of undergoing randomisation to each study intervention separately, thereby giving rise to a partial factorial design, with two separate randomisation time points, one for neoadjuvant therapy and one for extended therapy. Patients will have the option of being randomised at each time point or continuing on with standard treatment.The primary outcome for the study is overall survival from the date of initial surgery until death from any cause. Secondary outcomes include progression-free survival, time to first non-temozolomide treatment, overall survival from each treatment randomisation, clinically significant toxicity as measured by grade 3 or 4 adverse events and health-related quality-of-life measures. Tertiary outcomes are predictive/prognostic biomarkers and health utilities and incremental cost-effectiveness ratio.The primary analysis of overall survival will be performed separately for each study intervention according to the intention to treat principle on all patients randomised to each study intervention. ETHICS AND DISSEMINATION: The study (Protocol version 2.0 dated 23 November 2020) was approved by a lead Human Research Ethics Committee (Sydney Local Health District: 2019/ETH13297). The study will be conducted in accordance with the principles of the Declaration of Helsinki and Good Clinical Practice. TRIAL REGISTRATION NUMBER: ACTRN12620000048987.


Assuntos
Glioblastoma , Adolescente , Adulto , Australásia , Quimiorradioterapia , Quimioterapia Adjuvante , Glioblastoma/terapia , Humanos , Intervalo Livre de Progressão , Ensaios Clínicos Controlados Aleatórios como Assunto
4.
Clin Chem Lab Med ; 60(10): 1551-1561, 2022 09 27.
Artigo em Inglês | MEDLINE | ID: mdl-35998658

RESUMO

OBJECTIVES: Since its implementation 50 years ago in Quebec, Canada, newborn screening for congenital hypothyroidism has become one of the most successful public health measures worldwide. Screening programmes across Australia and New Zealand are characterised by significant commonalities in screening algorithms, and a high degree of regional cooperation in harmonisation efforts. We aimed to conduct a comprehensive survey of current performance and practices related to the total testing process for congenital hypothyroidism screening and provide recommendations for harmonisation priorities within our region. METHODS: A survey was conducted involving the six newborn screening laboratories which provide complete geographic coverage across Australasia. Approximately 360,000 newborns are screened annually. Survey questions incorporated pre-analytical, analytical, and post-analytical aspects of the screening programmes and an extensive 5-year (2016-2020) retrospective analysis of individual programme performance data. Responses from individual screening programmes were collated. RESULTS: The uptake of newborn screening was over 98% for the six major jurisdictions. All programmes have adopted a single-tier thyroid stimulating hormone (TSH) strategy using the Perkin Elmer GSP instrument. Significant similarities exist between programmes for recommended age of collection and recollection protocols for low birthweight newborns. The process for the determination of TSH cutoffs varies between programmes. TSH lower cut-offs for borderline-positive and positive notifications between 12-15 and 12-25 mIU/L blood, respectively. Recall rates vary between 0.08 and 0.20%. The case definition for congenital hypothyroidism generally includes biochemical and radiological parameters in addition to the commencement of thyroxine. All programmes reported collecting biochemical and clinical data on infants with positive screening tests, and positive predictive values vary between 23.6 and 77.3%. Variation in reported incidence (1:1,300-2,000) cannot be entirely explained by cutoff or recall rate (although one programme reporting fewer cases includes only permanent disease). CONCLUSIONS: Despite similarities between newborn screening algorithms for congenital hypothyroidism across Australia and New Zealand, differences in reported programme performance provide the basis for further harmonisation. Surveillance of a large population offers the potential for the ongoing development of evidence-based screening guidelines.


Assuntos
Hipotireoidismo Congênito , Australásia , Humanos , Lactente , Recém-Nascido , Triagem Neonatal , Estudos Retrospectivos , Tireotropina , Tiroxina
5.
J Antimicrob Chemother ; 77(11): 3064-3068, 2022 10 28.
Artigo em Inglês | MEDLINE | ID: mdl-35972404

RESUMO

OBJECTIVES: In 2016, The Royal College of Pathologists of Australasia (RCPA) initiated the formation of a working group comprising medical microbiologists to establish guidelines to assist Australian laboratories to implement selective and cascade reporting of antimicrobials-the first guidelines of this type in the world. METHODS: A 2017 audit of antimicrobial reporting in Australian and New Zealand laboratories identified significant opportunities for improvement and standardization of selective reporting. RESULTS: The first draft of the RCPA Selective Reporting Guidelines was circulated to all RCPA Microbiology fellows for feedback in August 2018 and the first version was published in February 2019. Subsequently, version two of the guidelines has recently been published in Australia, and New Zealand adapted these guidelines for formulation of their own national guidelines to accommodate local needs. CONCLUSIONS: Here we describe the processes, acceptance and challenges associated with the establishment of these guidelines and measurement of their impact.


Assuntos
Anti-Infecciosos , Patologistas , Humanos , Austrália , Australásia , Laboratórios , Anti-Infecciosos/uso terapêutico
6.
Cont Lens Anterior Eye ; 45(6): 101724, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-35753904

RESUMO

INTRODUCTION: The diagnosis of dry eye is challenging for eye health practitioners (EHP) and recently, a variety of new diagnostic tests have emerged. This study assesses the attitudes of EHP to dry eye and testing and compares these with attitudes in 2003. METHODS: An electronic questionnaire was disseminated to EHP in Australasia between December 2020 to March 2021. Participants rated the likelihood that presenting symptoms/signs were associated with dry eye, the utility of diagnostic tests, the value of test characteristics, and their satisfaction with dry eye diagnostics. Qualitative responses were categorised into positive, negative, or neutral themes. RESULTS: 144 responses were received, with 117 (81.3%) from Australia and 27 (18.7%) from New Zealand. Posterior blepharitis was significantly more likely to be associated with dry eye than other factors (p < 0.01). Clinical history, fluorescein staining and FBUT were judged significantly more useful in diagnosing dry eye compared to other tests (p < 0.01). Test validity was judged significantly more important in choosing a test than other qualities. Qualitative attitudes towards dry eye presentations and diagnostic tests were positive in 42.2% and 24.3%, negative in 32.4% and 41.9%, and neutral in 25.5% and 33.8% respectively. CONCLUSIONS: The opinions of EHP regarding dry eye tests were variable, but most favour history and corneal staining for diagnosis. Patterns of responses were similar to that reported by Turner et al 16-years ago, however, there is a higher satisfaction with available tests and therapeutic options. There is a need to develop a consensus amongst real-world clinicians regarding an optimum diagnostic pathway for dry eye, particularly in relation to newer diagnostic tests.


Assuntos
Testes Diagnósticos de Rotina , Síndromes do Olho Seco , Humanos , Técnicas de Diagnóstico Oftalmológico , Síndromes do Olho Seco/diagnóstico , Síndromes do Olho Seco/terapia , Australásia , Atitude , Lágrimas/fisiologia
7.
Aust Vet J ; 100(8): 367-376, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35560212

RESUMO

AIM: To develop a taxonomy of positive and negative occupational and organisational factors reported that impact the mental health of veterinary professionals. METHODS: Veterinary professionals working in Australasia were surveyed between February and June of 2021. The survey comprised two questions related to participants' perceptions of the positive and negative aspects of their job role that impact their mental health and wellbeing. Reflexive thematic analysis was employed to analyse the responses and generate two taxonomies of occupational and organisation stressors and protectors reported by participants. RESULTS: Fifty-three responses from veterinary professionals were analysed. The final stressor taxonomy generated contained 9 overarching themes and 36 subthemes. The most common of these were negative work conditions, challenging relationships with clients, and adverse events and patient outcomes. The taxonomy of protectors contained 11 overarching themes and 32 subthemes, with the most common including fulfillment and satisfaction, positive work conditions, and relationships with colleagues. CONCLUSION: This study is the first to examine both positive and negative factors in the veterinary industry reported by veterinary professionals in Australasia. The results highlighted stressors that can be addressed on both an individual and organisational level to promote the mental and health well-being of professionals working in the animal care industry.


Assuntos
Saúde Mental , Médicos Veterinários , Animais , Australásia , Humanos , Satisfação no Emprego , Inquéritos e Questionários , Médicos Veterinários/psicologia
8.
Zootaxa ; 5107(1): 1-119, 2022 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-35391393

RESUMO

This paper is the fifth monograph of the series that describes the global records of limno-terrestrial water bears (Tardigrada). Here, we provide a comprehensive list of non-marine tardigrades recorded from Australasia, providing an updated and revised taxonomy accompanied by geographic co-ordinates, habitat, and biogeographic comments. It is hoped this work will serve as a reference point and background for further zoogeographical and taxonomical studies.


Assuntos
Tardígrados , Animais , Australásia , Ecossistema
10.
Mol Phylogenet Evol ; 170: 107453, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35341964

RESUMO

The genus Nomada Scopoli (Hymenoptera: Apidae) is the largest genus of brood parasitic bees with nearly 800 species found across the globe and in nearly all biogeographic realms except Antarctica. There is no previous molecular phylogeny focused on Nomada despite their high species abundance nor is there an existing comprehensive biogeography for the genus. Using ultraconserved element (UCE) phylogenomic data, we constructed the first molecular phylogeny for the genus Nomada and tested the monophyly of 16 morphologically established species groups. We also estimated divergence dates using fossil calibration points and inferred the geographic origin of this genus. Our phylogeny recovered 14 of the 16 previously established species groups as monophyletic. The superba and ruficornis groups, however, were recovered as non-monophyletic and need to be re-evaluated using morphology. Divergence dating and historic biogeographic analyses performed on the phylogenetic reconstruction indicates that Nomada most likely originated in the Holarctic âˆ¼ 65 Mya. Geodispersal into the southern hemisphere occurred three times: once during the Eocene into the Afrotropics, once during the Oligocene into the Neotropics, and once during the Miocene into Australasia. Geodispersal across the Holarctic was most frequent and occurred repeatedly throughout the Cenozoic era, using the De Geer, Thulean, and the Bering Land Bridges. This is the first instance of a bee using both the Thulean and De Geer land bridges and has implications of how early bee species dispersed throughout the Palearctic in the late Cretaceous and early Paleogene.


Assuntos
Himenópteros , Parasitos , Animais , Australásia , Abelhas/genética , Fósseis , Filogenia , Filogeografia
11.
Cancer Rep (Hoboken) ; 5(5): e1501, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-34319008

RESUMO

BACKGROUND: Hematopoietic Stem Cell Transplant (HSCT) is an established treatment for malignant and non-malignant conditions and pulmonary disease is a leading cause of late term morbidity and mortality. Accurate and early detection of pulmonary complications is a critical step in improving long term outcomes. Existing guidelines for surveillance of pulmonary complications post-HSCT contain conflicting recommendations. AIM: To determine the breadth of current practice in monitoring for pulmonary complications of pediatric HSCT. METHODS: An institutional review board approved, online, anonymous multiple-choice survey was distributed to HSCT and pulmonary physicians from the United States of America and Australasia using the REDcap platform. The survey was developed by members of the American Thoracic Society Working Group on Complications of Childhood Cancer, and was designed to assess patient management and service design. RESULTS: A total of 40 (34.8%) responses were received. The majority (62.5%) were pulmonologists, and 82.5% were from the United States of America. In all, 67.5% reported having a protocol for monitoring pulmonary complications and 50.0% reported adhering "well" or "very well" to protocols. Pulmonary function tests (PFTs) most commonly involved spirometry and diffusion capacity for carbon monoxide. The frequency of PFTs varied depending on time post-HSCT and presence of complications. In all, 55.0% reported a set threshold for a clinically significant change in PFT. CONCLUSIONS: These results illustrate current variation in surveillance for pulmonary complications of pediatric HSCT. The results of this survey will inform development of future guidelines for monitoring of pulmonary complications after pediatric HSCT.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Pneumopatias , Australásia , Criança , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Pulmão , Pneumopatias/diagnóstico , Pneumopatias/epidemiologia , Pneumopatias/etiologia , Inquéritos e Questionários
12.
Nephrology (Carlton) ; 27(1): 35-43, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34392579

RESUMO

AIM: There is no clear consensus on how best to treat primary membranous nephropathy (PMN). This study aimed to ascertain prevailing views among nephrologists on their choice of immunosuppressive agents to treat this disease. METHODS: The Australasian Kidney Trials Network conducted a multinational online survey among nephrologists from the South Asia-Pacific region to identify prescribing practices to treat PMN. Survey questions focused on the types of immunosuppressive therapies used, preferred first-line and second-line therapies, indications for starting immunosuppressive therapy, the preferred mode of combining corticosteroid and cyclophosphamide, the use of serum phospholipase A2 receptor antibody testing in clinical practice, indications for anticoagulation, and interest in participating in future clinical trials in PMN. RESULTS: One hundered fifty-five nephrologists from eight countries responded to the online survey. The majority of them were senior nephrologists from Australia and India with significant experience managing patients with PMN. The combination of cyclophosphamide and corticosteroid was the preferred first-line therapy. Of those who used this combination, only 34.8% followed the Kidney Disease Improving Global Outcomes (KDIGO) 2012 guidelines by adding intravenous methylprednisolone. The combination of calcineurin inhibitor with corticosteroid was the most common second-line therapy. Most respondents considered prophylactic anticoagulation if serum albumin was less than 25 g/L. Most nephrologists were keen to participate in a clinical trial with a control arm consisting of cyclophosphamide and corticosteroids. CONCLUSION: The combination of corticosteroid with cyclophosphamide (without intravenous methylprednisolone) is the most commonly reported first-line immunosuppressive therapy for the management of PMN.


Assuntos
Inibidores de Calcineurina/uso terapêutico , Ciclofosfamida/uso terapêutico , Glomerulonefrite Membranosa/tratamento farmacológico , Metilprednisolona/uso terapêutico , Padrões de Prática Médica/estatística & dados numéricos , Anticoagulantes/uso terapêutico , Australásia/epidemiologia , Quimioprevenção/métodos , Consenso , Glomerulonefrite Membranosa/epidemiologia , Glomerulonefrite Membranosa/imunologia , Humanos , Imunossupressores/uso terapêutico , Nefrologistas/estatística & dados numéricos , Inquéritos e Questionários
13.
Cerebrovasc Dis ; 51(1): 125-130, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34265764

RESUMO

INTRODUCTION AND AIM: Internationally, women are underrepresented as leaders in major scientific organizations and conferences. We aimed to determine gender differences in leadership roles and annual scientific conferences of the Stroke Society of Australasia (SSA). METHODS: In a retrospective review of SSA data (2014-2019), committee members were obtained through the SSA Web site, and moderators, speakers, and award recipients were identified from SSA annual scientific conference programs. Gender was determined by name inspection and Web search. Absolute numbers and proportions of women and men were recorded for all roles examined, overall and per year. Associations between representation of women in conferences and percentage of women in speaking roles were tested using multinomial regression. RESULTS: Presidential leadership of the SSA was held by men in 2014-2016 and 2019 and women in 2017-2018. SSA committee membership was predominantly women (55%), being lowest (47%) in 2014 and 2019 and highest (65%) in 2017. There was a wide gender variation at scientific conferences, with 41% of keynote speakers being women overall, from 20% in 2016 to 75% in 2015. From 2014 to 2019, 55% of all speakers were women, ranging from 32% (in 2016) to 71% (in 2015). A higher percentage of women as speakers or moderators was associated with a program committee with over a third of its members composed of women (p ≤ 0.044). CONCLUSIONS: Representation of women varied from 2014 to 2019 in the SSA organization and its conferences, although men are more often elected president in the organization and women are less often keynote speakers. When more women were included in the program committee, the representation of women as speakers increased.


Assuntos
Médicas , Acidente Vascular Cerebral , Australásia , Feminino , Equidade de Gênero , Humanos , Liderança , Masculino , Sociedades Médicas , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia
14.
Emerg Med Australas ; 34(2): 288-290, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34873839

RESUMO

The challenge of addressing gender inequality was highlighted in the 2016 Trainee Focus of Emergency Medicine Australasia. Despite increasing numbers of female medical graduates, including increasing female trainees in emergency medicine (EM), this has not yet translated to equal representation in formal leadership roles. Five years later, as the Australasian College for Emergency Medicine (ACEM) welcomes the second female college president, this article explores the gendered leadership gap in EM from an organisational and intersectional feminist perspective and recommends high-level strategies for change. Notably, ACEM has demonstrated committed engagement with gender equity, such as the establishment of the Advancing Women in Emergency Section. It has also achieved gender parity in provisional trainees and improved women's representation on the ACEM Board. However, broader organisational processes that ensure work-life integration, transparent leadership development pathways and equitable recruitment, promotion, retention and evaluation remain critical. Creating a local evidence-base to support diversity in leadership development remains a priority.


Assuntos
Medicina de Emergência , Médicas , Australásia , Feminino , Equidade de Gênero , Humanos , Liderança , Universidades
15.
Int J Rheum Dis ; 25(1): 7-20, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34931463

RESUMO

BACKGROUND: Gout is the most prevalent inflammatory arthritis in the Asia-Pacific region and worldwide. This clinical practice guideline (CPG) aims to provide recommendations based on systematically obtained evidence and values and preferences tailored to the unique needs of patients with gout and hyperuricemia in Asia, Australasia, and the Middle East. The target users of these guidelines are general practitioners and specialists, including rheumatologists, in these regions. METHODS: Relevant clinical questions were formulated by the Steering Committee. Systematic reviews of evidence were done, and certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation methodology. A multi-sectoral consensus panel formulated the final recommendations. RESULTS: The Asia-Pacific League of Associations for Rheumatology Task Force developed this CPG for treatment of gout with 3 overarching principles and 22 recommendation statements that covered the treatment of asymptomatic hyperuricemia (2 statements), treatment of acute gout (4 statements), prophylaxis against gout flare when initiating urate-lowering therapy (3 statements), urate-lowering therapy (3 statements), treatment of chronic tophaceous gout (2 statements), treatment of complicated gout and non-responders (2 statements), treatment of gout with moderate to severe renal impairment (1 statement), and non-pharmacologic interventions (5 statements). CONCLUSION: Recommendations for clinically relevant scenarios in the management of gout were formulated to guide physicians in administering individualized care.


Assuntos
Gota/terapia , Reumatologia/normas , Ásia , Australásia , Progressão da Doença , Supressores da Gota/uso terapêutico , Humanos
16.
Nutrients ; 13(11)2021 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-34836442

RESUMO

BACKGROUND: Type 1 Diabetes (T1D) is associated with increased risk of eating disorders. This study aimed to (1) assess adherence of Australasian paediatric T1D clinics to international guidelines on screening for disordered eating and (2) identify barriers and enablers to the use of screening tools for the identification of disordered eating. METHODS: A 24-item survey covering five content domains: clinic characteristics, identification of disordered eating, screening tool use, training and competence, and pathways for referral, was sent to Australasian clinics caring for ≥150 children and adolescents with T1D. RESULTS: Of 13 eligible clinics, 10 participated. Two reported rates of disordered eating of >20%, while eight reported rates < 5%. All clinics used the routine clinical interview as the primary method of screening for disordered eating. Only one used screening tools; these were not diabetes-specific or routinely used. Barriers to use of screening tools included shortage of time and lack of staff confidence around use (n = 7, 70%). Enablers included staff training in disordered eating. CONCLUSIONS: Screening tools for disordered eating are not utilised by most Australasian paediatric T1D clinics. Overall, low reported rates of disordered eating suggest that it may be undetected, potentially missing an opportunity for early intervention.


Assuntos
Diabetes Mellitus Tipo 1/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Fidelidade a Diretrizes/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Australásia , Criança , Competência Clínica/estatística & dados numéricos , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Masculino , Programas de Rastreamento/normas , Pediatria/normas , Padrões de Prática Médica/estatística & dados numéricos
17.
Headache ; 61(10): 1539-1552, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34726783

RESUMO

OBJECTIVE: To describe the epidemiology of nontraumatic headache in adults presenting to emergency departments (EDs). BACKGROUND: Headache is a common reason for presentation to EDs. Little is known about the epidemiology, investigation, and treatment of nontraumatic headache in patients attending EDs internationally. METHODS: An international, multicenter, observational, cross-sectional study was conducted over one calendar month in 2019. Participants were adults (≥18 years) with nontraumatic headache as the main presenting complaint. Exclusion criteria were recent head trauma, missing records, interhospital transfers, re-presentation with same headache as a recent visit, and headache as an associated symptom. Data collected included demographics, clinical assessment, investigation, treatment, and outcome. RESULTS: We enrolled 4536 patients (67 hospitals, 10 countries). "Thunderclap" onset was noted in 14.2% of cases (644/4536). Headache was rated as severe in 27.2% (1235/4536). New neurological examination findings were uncommon (3.2%; 147/4536). Head computed tomography (CT) was performed in 36.6% of patients (1661/4536), of which 9.9% showed clinically important pathology (165/1661). There was substantial variation in CT scan utilization between countries (15.9%-75.0%). More than 30 different diagnoses were made. Presumed nonmigraine benign headache accounted for 45.4% of cases (2058/4536) with another 24.3% classified as migraine (1101/4536). A small subgroup of patients have a serious secondary cause for their headache (7.1%; 323/4536) with subarachnoid hemorrhage (SAH), stroke, neoplasm, non-SAH intracranial hemorrhage/hematoma, and meningitis accounting for about 1% each. Most patients were treated with simple analgesics (paracetamol, aspirin, or nonsteroidal anti-inflammatory agents). Most patients were discharged home (83.8%; 3792/4526). In-hospital mortality was 0.3% (11/4526). CONCLUSION: Diagnosis and management of headache in the ED is challenging. A small group of patients have a serious secondary cause for their symptoms. There is wide variation in the use of neuroimaging and treatments. Further work is needed to understand the variation in practice and to better inform international guidelines regarding emergent neuroimaging and treatment.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Cefaleia/epidemiologia , Adulto , Ásia/epidemiologia , Australásia/epidemiologia , Estudos Transversais , Diagnóstico Diferencial , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/epidemiologia , Neuroimagem , Exame Neurológico , Estudos Retrospectivos , Hemorragia Subaracnóidea/epidemiologia , Tomografia Computadorizada por Raios X
19.
World J Emerg Surg ; 16(1): 53, 2021 10 14.
Artigo em Inglês | MEDLINE | ID: mdl-34649583

RESUMO

BACKGROUND: It is unknown how frequently damage control (DC) laparotomy is used across trauma centers in different countries. We conducted a cross-sectional survey of trauma centers in the United States, Canada, and Australasia to study variations in use of the procedure and predictors of more frequent use of DC laparotomy. METHODS: A self-administered, electronic, cross-sectional survey of trauma centers in the United States, Canada, and Australasia was conducted. The survey collected information about trauma center and program characteristics. It also asked how often the trauma program director estimated DC laparotomy was performed on injured patients at that center on average over the last year. Multivariable logistic regression was used to identify predictors of a higher reported frequency of use of DC laparotomy. RESULTS: Of the 366 potentially eligible trauma centers sent the survey, 199 (51.8%) trauma program directors or leaders responded [United States = 156 (78.4%), Canada = 26 (13.1%), and Australasia = 17 (8.5%)]. The reported frequency of use of DC laparotomy was highly variable across trauma centers. DC laparotomy was used more frequently in level-1 than level-2 or -3 trauma centers. Further, high-volume level-1 centers used DC laparotomy significantly more often than lower volume level-1 centers (p = 0.02). Nearly half (48.4%) of high-volume volume level-1 trauma centers reported using the procedure at least once weekly. Significant adjusted predictors of more frequent use of DC laparotomy included country of origin [odds ratio (OR) for the United States vs. Canada = 7.49; 95% confidence interval (CI) 1.39-40.27], level-1 verification status (OR = 6.02; 95% CI 2.01-18.06), and the assessment of a higher number of severely injured (Injury Severity Scale score > 15) patients (OR per-100 patients = 1.62; 95% CI 1.20-2.18) and patients with penetrating injuries (OR per-5% increase = 1.27; 95% CI 1.01-1.58) in the last year. CONCLUSIONS: The reported frequency of use of DC laparotomy was highly variable across trauma centers. Those centers that most need to evaluate the benefit-to-risk ratio of using DC laparotomy in different scenarios may include high-volume, level-1 trauma centers, particularly those that often manage penetrating injuries.


Assuntos
Laparotomia , Centros de Traumatologia , Australásia/epidemiologia , Estudos Transversais , Humanos , Escala de Gravidade do Ferimento , Estados Unidos
20.
J Phys Act Health ; 18(11): 1321-1324, 2021 09 21.
Artigo em Inglês | MEDLINE | ID: mdl-34548424

RESUMO

The Australasian Society for Physical Activity aims to advance the science and practice of physical activity in Australia, New Zealand, the Pacific Islands, East Asia, South Asia, Southeast Asia, and Oceania. Fun, enjoyment, and cross-disciplinary discourse are important to ensure the network of physical activity professionals and our collective voice continues to grow. In May 2021, Australasian Society for Physical Activity's Early Career Network curated an engaging online Physical Activity Debate attended by 206 professionals. This commentary provides a synopsis of the debate and the central arguments presented by the affirmative and negatives teams. The authors describe the debate format and interactive design of the online Physical Activity Debate to provide insights for future online events that aim to boost interaction among physical activity professionals from various disciplines.


Assuntos
Exercício Físico , Comportamento Sedentário , Australásia , Austrália , Humanos , Oceania
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