Impact of a structured intern education programme on clinical documentation in the emergency department.

OBJECTIVES: To evaluate the impact of More Learning for Interns in Emergency (MoLIE) on clinical documentation in the ED of a large regional hospital. METHODS: MoLIE was implemented at The Townsville Hospital (TTH) in 2010, and has since provided ED interns with structured off-floor teaching and a dedicated clinical supervisor. A pre- and post-intervention study was conducted using retrospective medical record review methodology. Charts were selected by identifying all TTH ED patients seen by interns in the period 2008-2011. Two hundred pre-intervention records (2008-2009) and 200 post-intervention records (2010-2011) were reviewed. These were randomly selected following an initial screen by an ED staff specialist. The quality of clinical documentation for five common ED presentations (asthma, chest pain, lacerations, abdominal pain and upper limb fractures) was assessed. For each presentation, documentation quality was scored out of 10 using predefined criteria. An improvement of two or more was thought to be clinically significant. Mean scores for each group were compared using a Student's t-test for independent samples. RESULTS: Mean documentation scores (and 95% confidence intervals) were 5.55 (5.17-5.93) in 2008, 5.42 (4.98-5.86) in 2009, 6.37 (5.99-6.75) in 2010 and 6.08 (5.71-6.45) in 2011. There was a statistically but not clinically significant improvement in scores pre- and post-intervention (P ≤ 0.001). CONCLUSION: The introduction of MoLIE was associated with a small but statistically significant improvement in documentation, despite an 80% increase in intern placements. These results suggest that structured training programmes have potential to improve intern performance while simultaneously enhancing training capacity. The impact on quality of care requires further evaluation.

Safety of interhospital transport of cardiac patients and the need for medical escorts.

OBJECTIVE: To review the safety of the current retrieval service procedures and identify factors associated with the need for a medical escort. METHODS: Detailed retrospective chart review of the records of patients with confirmed or presumed cardiac disorders transferred for acute care by the Townsville Hospital Emergency Department retrieval service between June 2003 and December 2004. RESULTS: A total of 555 charts were reviewed. During transport, 118 complications and 111 interventions occurred. In total, 414 patients required no intervention, 96 required nurse or paramedic care, and 45 needed a medical escort. Only one patient determined to need a doctor was not accompanied by one; however, 183 patients were accompanied by a doctor when no need was identified. A logistic regression model was applied to 463 patients after excluding intubated patients and those with any missing observation data. This found that the following variables were significantly predictive of events during transport requiring a doctor to be present: myocardial infarction (OR 2.48; P = 0.016; 95% CI 1.2-5.1), having received lysis (OR 3.54; P = 0.004; 95% CI 1.59-7.92), on an infusion (OR 5.06; P < 0.001; 95% CI 2.37-10.82) or history of cardiac arrest (OR 7.77; P < 0.001; 95% CI 2.9-20.77). CONCLUSION: Transport of cardiac patients by the Townsville Hospital Emergency Department retrieval service were safely staffed and performed, guided by the expert decision making and clinical support of the clinical coordinators. Patients with a provisional diagnosis at the time of referral of myocardial infarction, a history of receiving lysis or cardiac arrest, or on a drug infusion were more likely to require the expertise of a doctor during transport.

Quantitation of the main constituents of some authentic grape-seed oils of different origin.

This paper describes the composition of 30 grape-seed oils obtained from France, Italy, and Spain during 2002-2003. Oils were extracted from the seeds using small-scale industrial solvent extraction equipment and analyzed in their unrefined state using standard methods for fatty acids, fatty acids in the triacylglycerol 2-position, tocopherols and tocotrienols, triglycerides, sterols, steradienes, and iodine value. Values for the composition of the sterols, triglycerides, fatty acids, iodine value, and tocopherol composition were generally in good agreement with the results of previous similar surveys. Steradienes (stigmastadiene, campestadiene, stigmastatriene, and campestatriene) were detected in the oil and were probably formed from sterols during the extraction process.

Quantitation of the main constituents of some authentic sesame seed oils of different origin.

This paper describes the composition of sesame seed oils obtained from seeds collected from five countries that are major suppliers of traded sesame seed oil. Oils were extracted from the seeds using small-scale industry pressing equipment and analyzed using standard methods for fatty acids, fatty acids in the triglyceride 2-position, tocopherols and tocotrienols, triglycerides, sterols, steradienes, and iodine value. Values for the composition of the sterols, triglycerides, fatty acids, iodine value, and tocopherol composition were generally in good agreement with the results published elsewhere. All of the oils from roasted seeds contained low levels of the sterol degradation products stigmasta-3,5-diene and campesta-3,5-diene, which were probably formed by dehydration of the parent sterols during roasting.

Study of the main constituents of some authentic hazelnut oils.

This paper describes the composition of authentic hazelnut oils obtained from nuts collected from five countries that are major suppliers of hazelnut oil. Oils were analyzed using standard methods for fatty acids, fatty acids in the triacylglycerol 2-position, tocopherols and tocotrienols, triacylglycerols, sterols, steradienes, and iodine value. The results were generally in good agreement with those of other publications. Tocotrienols, previously unreported in hazelnut oil, were detected in one sample. There were no major differences in the composition of oils from different countries. Roasting the nuts prior to pressing had little effect on oil composition.

Study of the main constituents of some authentic walnut oils.

This paper describes the composition of walnut oils obtained from nuts collected from seven countries that are major suppliers of walnut oil. Oils were extracted from the nuts using small-scale industry pressing equipment and analyzed using standard methods for fatty acids, fatty acids in the triacylglycerol 2-position, tocopherols and tocotrienols, triacylglycerols, sterols, steradienes, and iodine value. Values for the composition of the sterols, triacylglycerols, fatty acids, iodine value, and tocopherol composition were generally in good agreement with the results of previous similar surveys. Tocotrienols were not detected in any sample. Steradienes (stigmastadiene, campestadiene, stigmastatriene, and campestatriene) were not detected in any oil.