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1.
Emerg Med Australas ; 35(3): 442-449, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-36410371

RESUMO

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.


Assuntos
Síndrome Coronariana Aguda , Povos Aborígenes Australianos e Ilhéus do Estreito de Torres , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Síndrome Coronariana Aguda/diagnóstico , Austrália , Queensland/epidemiologia , Encaminhamento e Consulta
3.
Heart Lung Circ ; 31(7): 1029-1036, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35337734

RESUMO

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.


Assuntos
Síndrome Coronariana Aguda , Havaiano Nativo ou Outro Ilhéu do Pacífico , Síndrome Coronariana Aguda/diagnóstico , Serviço Hospitalar de Emergência , Humanos , Prevalência , Queensland/epidemiologia
5.
Emerg Med Australas ; 25(2): 147-53, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23560965

RESUMO

OBJECTIVES: The present study examined junior residents' and registrars' preparedness to prescribe in an Australian ED. It measured the medication knowledge of participants and identified antecedent factors relevant to prescribing practice. METHODS: This is a prospective, exploratory study of the prescribing practices of 40 junior doctors. Data collection consisted of a participant questionnaire with three parts. Part A comprised demographic information; Part B comprised questions regarding prescribing practices; and Part C was an objective assessment of the doctor's knowledge of the most recently and most commonly prescribed medications. RESULTS: One hundred percent (n = 40) of doctors in the study had inadequate knowledge about at least one medication when an accuracy threshold of <80% correct was used. Seventy percent (n = 28) of the participants had inadequate knowledge of at least one medication when the lower accuracy threshold of <50% correct was used. Comparisons between medication knowledge score and Likert confidence scales showed that even though a doctor reported being completely sure about an individual medication, they most commonly only answered between four and six of the eight questions correctly for that medication. Their use of reference materials was also lacking in relation to their knowledge and level of confidence. The reported reasons for this included instructions by senior staff and time constraints. CONCLUSIONS: The majority of participants in the study had inadequate knowledge on medications they had most recently prescribed and medications most commonly prescribed in the ED. Junior doctors' perceptions of their medication knowledge were inflated in relation to their actual knowledge.


Assuntos
Competência Clínica/estatística & dados numéricos , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Médicos/psicologia , Padrões de Prática Médica/normas , Adulto , Competência Clínica/normas , Feminino , Humanos , Prescrição Inadequada/prevenção & controle , Prescrição Inadequada/estatística & dados numéricos , Entrevistas como Assunto , Masculino , Erros de Medicação/prevenção & controle , Erros de Medicação/estatística & dados numéricos , Projetos Piloto , Estudos Prospectivos , Queensland , Fatores Socioeconômicos , Inquéritos e Questionários , Centros de Atenção Terciária , Adulto Jovem
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