Tasman Medical Journal

ISSN:  2652-1881

Category: Research

Simulation exercises increase staff confidence, knowledge and skills in managing mass casualty incidents: a pretest-posttest study

Introduction Emergency hospital systems are expected to respond effectively to intentional or accidental mass casualty incidents (MCI). Such incidents are largely unpredictable, and increasing worldwide.1-3  Mitigation of the harms associated with these disasters often requires appropriate high-quality healthcare processes to be enacted rapidly, safely and without duplication or error.4 To prepare clinicians and health systems, effective training and rehearsal using the multi-systems involved in an actual response is necessary. Response frameworks (for example, Homeland Security Exercise and Evaluation Program,5 Disaster Management Indicator Model,6 Hospital Incident Command System7 and disaster preparedness courses such as the Major Incident Medical Management Support (MIMMS) courses offered by MIMMS Australia8 have been created to address this need. Simulation exercises also aim to model surge capacity response,9 and test application of frameworks, plans and learnings. Some systems such as the Emergo Train System® (ETS) are designed to enable testing, but reviews of the literature reveal surprisingly

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The role of ultrasound in scleroderma skin disease

The authors have measured skin thickness in patients with scleroderma and compared the results with the current standard clinical measure, the modified Rodnan Skin Score (mRSS). Though US had satisfactory reliability and reproducibility, and detected changes in skin thickness over time, it did not correlate well with the mRSS, for reasons that remain uncertain.

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Assessing the accuracy of discharge coding for gout, using the International Classification of Disease, at two tertiary teaching hospitals in Perth

Clinical and epidemiological research is often conducted using data from hospital discharge coding. The authors have studied the accuracy of a discharge coding diagnosis of gout, compared to clinical diagnoses based on ACR/EULAR 2015 gout classification criteria and case note review. The coding diagnosis was not supported by the former in over half the cases, or by the latter in almost one third.

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Impact of ‘Can’t Intubate Can’t Oxygenate’ (CICO) kit ergonomic design on the timed responses of participants in simulated CICO crises: A randomised, crossover pilot study

IntroductionThe ‘Can’t Intubate Can’t Oxygenate’ (CICO) situation is a life-threatening, time-critical airway emergency.1 Although a rare event, it is associated with significant patient morbidity and mortality.1 The 4th National Audit Project by the Royal College of Anaesthetists (RCOA) and Difficult Airway Society (DAS) highlighted multiple factors influencing CICO outcome.2 A major modifiable factor included the availability and accessibility of essential equipment.2 The purported ergonomic utility of pre-packaged CICO equipment into kits has also been recently described in literature.3 However, there remains a lack of evidence in current literature to support the superiority of any one packaged design or inferences as to its impact on task performance. At Fiona Stanley Hospital, the Vortex approach and Vortex CICO status tool are used for in-theatre emergency airway and CICO crisis management, respectively. As part of the Vortex CICO status tool, there exists a recommendation for the use of a CICO ‘kit’ as part

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Outcomes from the first five years of allogeneic haemopoietic progenitor cell transplantation at Fiona Stanley Hospital

INTRODUCTIONAllogeneic haemopoietic progenitor cell transplantation (alloHPCT) involves the infusion of third party-derived haemopoietic precursor cells into a recipient who has undergone sufficient chemotherapy or radiotherapy conditioning treatment to allow engraftment of these cells and eventually full haemopoietic and immunological reconstitution.  The treatment is effective as replacement of haemopoiesis in bone marrow failure syndromes, and allows high doses of chemotherapy as well as life-long immunological surveillance against relapse to treat malignant conditions.  Donors are preferentially siblings who are human leukocyte antigen (HLA) matched at both class I and II loci, HLA-matched unrelated donors, or alternative donors such as partially matched unrelated adult, related adult or cryopreserved umbilical cord blood products.  In usual circumstances, donor cells are infused ‘fresh’, immediately after collection, into a recipient who has just received conditioning therapy.  Risks to recipients include toxicity of chemotherapy or radiotherapy, infection during aplasia or immunological reconstitution, relapse and graft-versus-host disease.  Western Australia

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Virtual Fracture Clinic pilot in an orthopaedic tertiary hospital setting: patient characteristics, clinical contact metrics and operational challenges

IntroductionVirtual fracture clinics (VFC) are established in the United Kingdom as a cost-effective conservative management pathway for patients with uncomplicated fractures.1,2  In a VFC, such patients are streamed to clinics staffed with advanced scope physiotherapists (ASP) and experienced nurses working in collaboration with orthopaedic surgeons. Many injuries that can be managed in boots, splints and slings are streamed to discharge with information or telephone follow up clinic.3  The primary rationale of establishing a VFC is to free up surgeons to review patients with more complex injuries who may require surgery.4  Secondary benefits to patients and the orthopaedic service include reducing the time to specialist review, reducing the number of plain radiographs, convenience and satisfaction for the patients and reduced cost of fracture management.3 The efficacy of a VFC has been well demonstrated in adult populations5 and there is emerging evidence for including paediatric injuries.6  A UK audit of paediatric fracture

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