National Health and Medical Research Council statement on electronic cigarettes: 2022 update.

INTRODUCTION: Electronic cigarette (e-cigarette) use in Australia has rapidly increased since the 2017 National Health and Medical Research Council (NHMRC) Chief Executive Officer (CEO) statement on e-cigarettes. The type of products available and the demographic characteristics of people using these products have changed. New evidence has been published and there is growing concern among public health professionals about the increased use, particularly among young people who do not currently smoke combustible cigarettes. The combination of these issues led NHMRC to review the current evidence and provide an updated statement on e-cigarettes. In this article, we describe the comprehensive process used to review the evidence and develop the 2022 NHMRC CEO statement on electronic cigarettes. MAIN RECOMMENDATIONS: E-cigarettes can be harmful; all e-cigarette users are exposed to chemicals and toxins that have the potential to cause adverse health effects. There are no health benefits of using e-cigarettes if you do not currently smoke tobacco cigarettes. Adolescents are more likely to try e-cigarettes if they are exposed to e-cigarettes on social media. Short term e-cigarette use may help some smokers to quit who have been previously unsuccessful with other smoking cessation aids. There are other proven safe and effective options available to help smokers to quit. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT: The evidence base for the harms of e-cigarette use has strengthened since the previous NHMRC statement. Significant gaps in the evidence base remain, especially about the longer term health harms of using e-cigarettes and the toxicity of many chemicals in e-cigarettes inhaled as an aerosol.

Medical Emergencies Requiring First Aid at Home: A Population-Based Survey Study.

BACKGROUND: Most medical emergencies requiring first-aid occur at home. Little is known about the prevalence of these medical emergencies. OBJECTIVE: The objective of this study is to describe medical emergencies occurring at people's homes requiring first aid; characteristics, burdens and impact on functional outcome, and to address the national public knowledge and practice of first aid. METHOD: A confidential, cross-sectional survey, primarily based on the 2015 American Heart Association (AHA) and American Red Cross first aid guidelines, was conducted among adults (>18 years) from 12 educational centers, under the Ministry of Awqaf and Islamic affairs, State of Kuwait. RESULTS: A total of 3000 self-administered questionnaires were distributed from September 16 2019 to November 30, 2019. The response rate was 34% (n = 1033 participants) of which 1% (n = 11) were partially answered questionnaires leaving 1022 questionnaires for valid statistical analysis. The prevalence of medical emergencies was 118.5 out of 100000 per year and the level of public knowledge was 19%. Medical emergencies were more likely to occur in Hawali province (49%, n = 149), women were more likely to encounter medical emergencies (78%, n = 238). Victims above 18 years of age were more likely to experience hypoglycemia (39%, n = 55) and children were more likely to suffer from hypoglycemia (19%, n = 22) or burns (17%, n = 20). Compliance with First aid guidelines was seen in hypoglycemia (31%, n = 44) but lacking in burn incidents (44%, n = 15). Participants called the ambulance in seizures (50%, n = 13), with 62% of medical emergencies requiring attendance at a health-care facility and 29% requiring hospital admission. Of the victims, 15% missed school or a day of work, and 25% had impaired functional outcomes. CONCLUSION: Medical emergencies occurring at home are relatively common in Kuwait, and public training on first aid is low. Kuwait has unique medical emergencies, with hypoglycemia, seizures and burns being the most frequent emergencies that occur at home. These emergencies cause a burden on the health-care system with a quarter of them having negative impact on the victim's functional outcome.

Violence against emergency medical services personnel: A systematic review of the literature.

BACKGROUND: Violence against emergency medical services (EMS) personnel is a growing concern. The aim of this systematic review is to synthesize the current literature on violence against EMS personnel. METHODS: We examined literature from 2000 to 2016. Eligibility criteria included English-language, peer-reviewed studies of EMS personnel that described violence or assaults. Sixteen searches identified 2655 studies; 25 studies from nine countries met the inclusion criteria. RESULTS: The evidence from this review demonstrates that violence is a common risk for EMS personnel. We identified three critical topic areas: changes in risk over time, economic impact of violence and, outcomes of risk-reduction interventions. There is a lack of peer reviewed research of interventions, with the result that current intervention programs have no reliable evidence base. CONCLUSIONS: EMS leaders and personnel should work together with researchers to design, implement, evaluate and publish intervention studies designed to mitigate risks of violence to EMS personnel.

Students' Attitudes Toward Interprofessional Learning: A Comparison Between Two Universities.

UNLABELLED: Because they will become health professionals of the future, it is important to assess the attitudes of students towards interprofessional education (IPE), as this will impact strongly on the development and delivery of teaching models that educators will use to facilitate IPE. The aim of this study was to examine attitudes towards, and readiness for, IPE of students from eight different undergraduate health disciplines at two Australian universities. METHODS: This cross-sectional study employed a convenience sample of first-, second-, third-, and fourth-year students enrolled in one of eight undergraduate courses from Monash University and Edith Cowan University. Student attitudes to IPE were measured using the Readiness for Interprofessional Learning Scale. RESULTS: A total of 1,111 students participated in the study, of whom 81% (n=907) were female. Most were aged 20-24 years (46%, n=518) and enrolled in first year (39%, n=440). Undergraduate paramedic students had the lowest mean scores for both teamwork and collaboration (M=37.41, SD=6.21) and positive-professional-identity (M=15.36, SD=3.10). Statistically significant differences were also noted between age groups and professions. CONCLUSIONS: This study adds to the emerging body of knowledge in interprofessional learning and provides important data on students' perceptions and readiness for interprofessional learning from an Australian context.

Long-term effect of respiratory training for chronic obstructive pulmonary disease patients at an outpatient clinic: a randomised controlled trial.

OBJECTIVE: To assess the effect of respiratory training (RT) on lung function, activity tolerance and acute exacerbation frequency with chronic obstructive pulmonary disease (COPD). DESIGN: A randomised controlled trial. SETTING: Outpatient clinic and home of the COPD patients, Zhengzhou City, China. SUBJECTS: Sixty participants with COPD were randomised into two groups: an intervention group (n = 30) which received the RT in self-management and a control group (n = 30) that received an education program during the study. INTERVENTION: Pulmonary function, activity tolerance and frequency of acute exacerbation of these COPD patients were evaluated before and after the program. The intervention and control programs were delivered at monthly outpatient clinic visits over a period of 12 months. The pulmonary rehabilitation (PR) program was conducted by a physiotherapist (who delivered RT to the participant over a minimum of 1 h per visit) for the intervention group, whereas the control group received routine health education provided by physiotherapists. The intervention group patients were then instructed to perform exercises at home as taught in the RT at least 5 days per week at home. RESULTS: After 12 months of RT, the lung function and the activity tolerance of the COPD patients in the intervention group were significantly improved and the exacerbation frequency was also decreased. CONCLUSION: Long-term RT can improve lung function and activity tolerance while decreasing the frequency of acute exacerbation for COPD patients.

Empathy levels among health professional students: a cross-sectional study at two universities in Australia.

BACKGROUND: Empathy is paramount in the health care setting, optimizing communication and rapport with patients. Recent empirical evidence suggests that empathy is associated with improved clinical outcomes. Therefore, given the importance of empathy in the health care setting, gaining a better understanding of students' attitudes and self-reported empathy is important. The objective of this study was to examine self-reported empathy levels of students enrolled in different health disciplines from two large Australian universities. MATERIALS AND METHODS: A total of 1,111 students from two different universities enrolled in eight different health professions were administered the Jefferson Scale of Physician Empathy - Health Profession Students version, a 20-item 7-point Likert scale questionnaire to evaluate self-reported empathy levels. RESULTS: A total of 1,111 students participated in this study. The majority of participants were from Monash University (n=771), with 340 students from Edith Cowan University. No statistically significant differences were found between universities: Monash University (mean 110.1, standard deviation [SD] 11.8); Edith Cowan University (mean 109.2, SD 13.3, P=0.306). The mean female empathy score (mean 110.8, SD 11.7) was significantly higher than the mean male score (mean 105.3, SD 13.5; P<0.0001; d=0.44). Paramedic students had significantly lower empathy scores (mean 106.3, SD 12.73) than all other participants except nursing students (P<0.0001). CONCLUSION: Results relating to sex are reflective of previous studies. There is some discrepancy in results relating to empathy and its incline/decline as students progress through a program. Further study is warranted to explore why there are variations in empathy levels in students of different health disciplines.

Occupational injury risk among Australian paramedics: an analysis of national data.

OBJECTIVE: To identify the occupational risks for Australian paramedics, by describing the rate of injuries and fatalities and comparing those rates with other reports. DESIGN AND PARTICIPANTS: Retrospective descriptive study using data provided by Safe Work Australia for the period 2000-2010. The subjects were paramedics who had been injured in the course of their duties and for whom a claim had been made for workers compensation payments. MAIN OUTCOME MEASURES: Rates of injury calculated from the data provided. RESULTS: The risk of serious injury among Australian paramedics was found to be more than seven times higher than the Australian national average. The fatality rate for paramedics was about six times higher than the national average [corrected].On average, every 2 years during the study period, one paramedic died and 30 were seriously injured in vehicle crashes. Ten Australian paramedics were seriously injured each year as a result of an assault. The injury rate for paramedics was more than two times higher than the rate for police officers. CONCLUSIONS: The high rate of occupational injuries and fatalities among paramedics is a serious public health issue. The risk of injury in Australia is similar to that in the United States. While it may be anticipated that injury rates would be higher as a result of the nature of the work and environment of paramedics, further research is necessary to identify and validate the strategies required to minimise the rates of occupational injury for paramedics.

A cross-sectional study of paramedics' readiness for interprofessional learning and cooperation: results from five universities.

INTRODUCTION: Healthcare systems are evolving to feature the promotion of interprofessional practice more prominently. The development of successful and functional interprofessional practice is best achieved through interprofessional learning. Given that most paramedic programmes take an isolative uni-professional educational approach to their healthcare undergraduate courses, serious questions must be raised as to whether students are being adequately prepared for the interprofessional healthcare workplace. The objective of this study was to assess the attitudes of paramedic students towards interprofessional learning across five Australian universities. METHODS: Using a convenience sample of paramedic student attitudes towards interprofessional learning and cooperation were measured using two standardised self-reporting instruments: Readiness for Interprofessional Learning Scale (RIPLS) and Interdisciplinary Education Perception Scale (IEPS). RESULTS: Students' readiness for interprofessional learning did not appear to be significantly influenced by their gender nor the type of paramedic degree they were undertaking. As students progressed through their degrees their appreciation for collaborative teamwork and their understanding of paramedic identity grew, however this appeared to negatively affect their willingness to engage in interprofessional learning with other healthcare students. The tertiary institute attended also appeared to influence students' preparedness and attitudes to shared learning. CONCLUSIONS: This study has found no compelling evidence that students' readiness for interprofessional learning is significantly affected by either their gender or the type of degree undertaken. By contrast it was seen that the tertiary institutions involved in this study produced students at different levels of preparedness for IPL and cooperation.

ParaMED Home: a protocol for a randomised controlled trial of paramedic assessment and referral to access medical care at home.

BACKGROUND: In Australia approximately 25% of Emergency Department (ED) attendances are via ambulance. ED overcrowding in Australia, as in many countries, is common. Measures to reduce overcrowding include the provision of enhanced timely primary care in the community for appropriate low risk injury and illness. Therefore paramedic assessment and referral to a community home hospital service, in preference to transfer to ED, may confer clinical and cost benefit. METHODS/DESIGN: A randomised controlled trial. Consenting adult patients that call an ambulance and are assessed by paramedics as having an eligible low risk problem will be randomised to referral to ED via ambulance transfer or referral to a rapid response service that will assess and treat the patient in their own residence. The primary outcome measure is requirement for unplanned medical attention (in or out of hospital) in the first 48 hours. Secondary outcomes will include a number of other clinical endpoints. A cost effectiveness analysis will be conducted. DISCUSSION: If this trial demonstrates clinical non-inferiority and cost savings associated with the primary assessment service, it will provide one means to safely address ED overcrowding. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry Number 12610001064099.

Inhaled methoxyflurane and intranasal fentanyl for prehospital management of visceral pain in an Australian ambulance service.

OBJECTIVE: This study analysed the analgesic effect and changes in vital signs associated with administration of inhaled Methoxyflurane (MTX) and/or intranasal Fentanyl (INF) for prehospital management of visceral pain. METHOD: A retrospective, observational study reviewing 1024 randomly selected records of patients with presumed visceral pain administered MTX (465), INF (397) or both (162) by the Western Australian Ambulance Service between January 2004 and February 2006. Clinical variables assessed included systolic blood pressure, pulse rate, respiration rate and Glasgow Coma Scale score. Pain was assessed utilising Visual/Verbal Analogue Scale pain scores. RESULTS: Overall effects on vital signs appeared favourable 5 min after use and at hospital arrival with either agent alone or in combination. As sole agents, MTX produced the greatest initial pain scores reduction (2.0 (1.7 to 2.2) vs 1.6 (1.4 to 1.8)) (mean (95% CI), and INF provided greater pain reduction by hospital arrival (3.2 (2.9 to 3.5) vs 2.5 (2.1 to 2.9)). While both agents were effective, INF provided a greater pain score reduction for cardiac (3.0 (2.6 to 3.4) vs 2.3 (1.8 to 2.8)), female (3.4 (2.9 to 4.0) v 2.5 (2.0 to 3.0)) and age 75+ patients (3.2 (2.5 to 3.8) vs 1.8 (1.0 to 2.5)). Combined use of agents was not advantageous. CONCLUSIONS: MTX and INF are effective agents for providing visceral pain analgesia in the prehospital setting. While MTX provided a more rapid onset of pain relief, INF provided superior analgesia after subsequent doses and in female, cardiac and older patients.