Emergency Department Assessment of Suspected Acute Coronary Syndrome Using the IMPACT Pathway in Aboriginal and Torres Strait Islander People.

OBJECTIVES: The Improved Assessment of Chest pain Trial (IMPACT) pathway is an accelerated strategy for the assessment of emergency patients presenting with suspected acute coronary syndrome (ACS). The objective of this study was to report outcomes for Aboriginal and Torres Strait Islander patients deemed low-, intermediate-, or high-risk according to this pathway. DESIGN: This was a prospective observational trial conducted between November 2017 and December 2019. SETTING: Regional hospital in Far North Queensland. PARTICIPANTS: Aboriginal and Torres Strait Islander people presenting to the Emergency Department with suspected ACS were asked to participate. Participants were stratified as low-, intermediate- or high-risk of ACS according to the IMPACT pathway. High-and intermediate risk patients were managed according to the IMPACT pathway. Management of low-risk patients included additional inpatient cardiac testing, which was not part of the original IMPACT pathway. MAIN OUTCOME MEASURES: The primary outcome was acute coronary syndrome within 30-days. Secondary outcomes included length of stay and prevalence of objective testing. RESULTS: A total of 155 participants were classified as either at low-risk (n=18 11.6%), intermediate-risk (n=87 56.1%), or high-risk (n=50 32.3%) of ACS. Thirty-day (30-day) ACS occurred in 29 (18.6%) patients, which included 26 (52.0%) high-risk patients and three (3.4%) intermediate-risk patients. No patients in the low-risk group were diagnosed with ACS during their index presentation or by 30-days. Median hospital length-of-stay was 11.9 hours (interquartile range [IQR] 5.3-20.2 hrs) for low- and 15.5 hours (IQR 5.9-29.2 hrs) for intermediate-risk patients. CONCLUSION: The IMPACT pathway, which has been associated with reduced LOS in other settings, could be safely implemented for patients of Aboriginal and Torres Strait Islander origin, classifying two-thirds as low- or intermediate risk. However, a clinically significant proportion of Aboriginal and Torres Strait Islander patients experience cardiac events, which supports the need to provide early objective testing for coronary artery disease.

Clinical characteristics of Aboriginal and Torres Strait Islander emergency department patients with suspected acute coronary syndrome.

OBJECTIVES: To describe the demographics, presentation characteristics, clinical features and cardiac outcomes for Aboriginal and Torres Strait Islander patients who present to a regional cardiac referral centre ED with suspected acute coronary syndrome (ACS). METHODS: This was a single-centre observational study conducted at a regional referral hospital in Far North Queensland, Australia from November 2017 to September 2018 and January 2019 to December 2019. Study participants were 278 Aboriginal and Torres Strait Islander people presenting to an ED and investigated for suspected ACS. The main outcome measure was the proportion of patients with ACS at index presentation and differences in characteristics between those with and without ACS. RESULTS: ACS at presentation was diagnosed in 38.1% of patients (n = 106). The mean age of patients with ACS was 53.5 years (SD 9.5) compared with 48.7 years (SD 12.1) in those without ACS (P = 0.001). Patients with ACS were more likely to be male (63.2% vs 39.0%, P < 0.001), smokers (70.6% vs 52.3%, P = 0.002), have diabetes (56.6% vs 38.4%, P = 0.003) and have renal impairment (24.5% vs 10.5%, P = 0.002). CONCLUSIONS: Aboriginal and Torres Strait Islander patients with suspected ACS have a high burden of traditional cardiac risk factors, regardless of whether they are eventually diagnosed with ACS. These patients may benefit from assessment for coronary artery disease regardless of age at presentation.

'It definitely made a difference': A grounded theory study of yoga for pregnancy and women's self-efficacy for labour.

OBJECTIVE: To explore women's experience of attending yoga for pregnancy classes in order to generate a theory about which aspects, if any, are effective in enhancing self-efficacy for labour and birth. DESIGN: A longitudinal grounded theory study. METHODS: Semi-structured interviews were undertaken with women before they started yoga for pregnancy classes, after they had attended at least six classes, and finally, postnatally. Interview transcripts were analysed using constructive grounded theory and a self-efficacy framework. SETTING: Three yoga for pregnancy teachers' classes in England. PARTICIPANTS: Twenty two women attending yoga for pregnancy classes. FINDINGS: Analysis of interviews with women at three time points led to a propositional theory that yoga for pregnancy enhances women's self-efficacy for labour by building their confidence and competence through a combination of techniques. These include repeated practice of a variety of pain management strategies, use of affirming language and the telling of positive labour stories, underpinned by yoga practice to lower somatic response to stress.

A qualitative study exploring how the aims, language and actions of yoga for pregnancy teachers may impact upon women's self-efficacy for labour and birth.

BACKGROUND: As women's anxiety and the rate of medical intervention in labour and birth continue to increase, it is important to identify how antenatal education can increase women's confidence and their ability to manage the intense sensations of labour. AIM: To report a grounded theory study of how the aims, language and actions of yoga for pregnancy teachers may impact upon women's self-efficacy for labour and birth. METHODS: Yoga for pregnancy classes in three locations were filmed. Semi-structured interviews were undertaken with the teachers to explore what they were trying to achieve in their classes, and how. Interviews and classes were transcribed and analysed using grounded theory. FINDINGS: There was considerable consistency in the teachers' aims, the language they used in classes and in their thinking about class structure. Four main themes emerged: creating a sisterhood, modelling labour, building confidence and enhancing learning. Teachers see yoga for pregnancy as a multi-faceted, non-prescriptive intervention that enhances women's physical, emotional and social readiness for labour and birth, and supports women to make their own decisions across the transition to parenthood. CONCLUSION: Women's self-efficacy for labour is complex and multi-factorial. This study offers insights into the factors which may be involved in increasing it. These include not only traditional elements of yoga such as postures, breathing and meditation, but also the creation of safe, women-only groups where anxieties, experiences and stories can be shared, and pain-coping techniques for labour learned and practised.