To determine if COVID-19 State of Emergency (SOE) restrictions were associated with a reduction in presentations to two urban EDs in Melbourne, Victoria.
This retrospective observational study ...included adult patients presenting to The Alfred and Sandringham Hospital EDs during the first month of stage 2 and 3 SOE restrictions (26 March-25 April 2020). Patients transferred from other hospitals or diagnosed with COVID-19 were excluded. The primary outcome was the average number of presentations per day. Secondary outcomes included the average daily number of presentations for pre-specified subgroups defined by triage category and diagnosis. The independent impact of SOE restrictions, adjusted for underlying trends in attendance, was determined using negative binomial regression and reported as an incident rate ratio (IRR) with a 95% confidence interval (CI).
Average daily attendance during the exposure period was 174.7. In the absence of SOE restrictions, 278.8 presentations per day were predicted, a reduction of 37.3% (IRR 0.63, 95% CI 0.59-0.67). Attendance was lower than anticipated for all triage categories (especially category 5 IRR 0.51, 95% CI 0.44-0.59) and diagnostic groups (including circulatory problems IRR 0.62, 95% CI 0.50-0.76 and injury IRR 0.58, 95% CI 0.53-0.63). There were fewer than predicted presentations for several sentinel diagnoses, including gastroenteritis (IRR 0.27, 95% CI 0.17-0.42) and renal colic (IRR 0.55, 95% CI 0.33-0.92).
SOE restrictions were associated with a significant reduction in ED presentations across a range of triage categories and diagnoses. Public health messaging should emphasise the importance of timely ED attendance for acute illness and injury.
To report the incidence of fever among patients who tested positive for SARS-CoV-2.
Retrospective cohort study of patients who tested positive for SARS-CoV-2 at a single centre. Temperature at time ...of testing and on repeat testing within 24 h were collected.
At the time of testing, fever was detected (sensitivity) in 16 of 86 (19%; 95% confidence interval 11-28) episodes of positive tests for SARS-CoV-2. With repeat testing, fever was detected in 18 of 75 (24%; 95% confidence interval 15-35) episodes.
In an Australian hospital, screening for fever lacked sensitivity for detection of patients with SARS-CoV-2.
While the control of soil-borne phytopathogenic fungi becomes increasingly difficult without using chemicals, concern over the intensive use of pesticides in agriculture is driving more ...environmentally sound crop protection managements. Among these approaches, the use of compost to suppress fungal diseases could have great potential. In this study, a multidisciplinary approach has been applied to characterize microbiota composition of two on-farm composts and assess their suppress and biostimulant activities. The on-farm composting system used in this study was able to produce two composts characterized by an antagonistic microbiota community able to suppress plant pathogens and biostimulate plant growth. Our results suggest a potential role for Nocardiopsis and Pseudomonas genera in suppression, while Flavobacterium and Streptomyces genera seem to be potentially involved in plant biostimulation. In conclusion, this study combines different techniques to characterize composts, giving a unique overview on the microbial communities and their role in suppressiveness, helping to unravel their complexity.
Objective
To identify behavioural drivers and barriers that may have contributed to changes in ED attendance during the first 10 months of the coronavirus disease 2019 (COVID‐19) pandemic in ...Victoria.
Methods
We conducted a mixed methods analysis of patients who attended one of eight participating EDs between 1 November 2019 and 31 December 2020. A random sample of patients were chosen after their visit and invited to participate in an online survey assessing behavioural drivers and barriers to attendance. The study timespan was divided into four periods based on local and world events to assess changes in attitudes and behaviours over this period.
Results
A total of 5600 patients were invited to complete the survey and 606 (11%) submitted sufficient information for analysis. There were significant differences in participants' attitudes towards healthcare and EDs, levels of concern about contracting and spreading COVID‐19 and the influence of mask wearing. Patients expressed more concern about the safety of an ED during the largest outbreak of COVID‐19 infections than they did pre‐COVID, but this difference was not sustained once community infection numbers dropped. General concerns about hospital attendance were higher after COVID than they were pre‐COVID. A total of 27% of patients specifically stated that they had delayed their ED attendance.
Conclusion
Patients expressed increased concerns around attending ED during the first 10 months of the 2020 COVID‐19 pandemic and frequently cited COVID‐19 as a reason for delaying their presentation. These factors would be amenable to mitigation via focussed public health messaging.
A mixed methods study to identify behavioural drivers and barriers that may have contributed to changes in ED attendance during the first 10 months of the coronavirus disease 2019 (COVID‐19) pandemic in Victoria. Patients expressed increased concerns around attending ED during the first 10 months of the 2020 COVID‐19 pandemic and frequently cited COVID‐19 as a reason for delaying their presentation.
The number of patients with suspected COVID-19 presenting to Australian EDs continues to impose a burden on healthcare services. Isolation is an important aspect of infection prevention and control, ...but has been associated with undesirable consequences among hospital inpatients. The aim of the present study was to determine if isolation is associated with an increased length of stay (LOS) in the ED.
The Registry for Emergency Care Project is a prospective cohort study with a series of nested sub-studies. The present study was a retrospective analysis of adult patients allocated an Australasian Triage Scale category of 1 or 2 who presented to a tertiary ED between 18 and 31 May 2020. The primary outcome was ED LOS. Regression methods were used to determine the independent association between ED isolation and LOS.
There were 447 patients who met inclusion criteria, of which 123 (28%) were managed in isolation. The median (interquartile range) ED LOS was 259 (210-377) min for the isolation group and 204 (126-297) min for the non-isolation group, a difference in median ED LOS of 55 min (P < 0.001). Isolation was independently associated with a 23% increase in ED LOS (P = 0.002) and doubled the odds of an ED stay of more than 4 h (adjusted odds ratio 2.2 1.4-3.4, P = 0.001).
Consistent with the anecdotal experience of Australian ED clinicians, the present study demonstrated an increased ED LOS for patients managed in isolation. Enhanced infection prevention and control precautions will be required during and beyond the current pandemic, creating significant ongoing challenges for emergency care systems.
Global health (GH) training is well established overseas (particularly in North America) and reflects an increasing focus on social accountability in medical education. Despite significant interest ...among trainees, GH is poorly integrated with specialty training programs in Australia. While there are numerous benefits from international rotations in resource-poor settings, there are also risks to the host community, trainee and training provider. Safe and effective placements rely on firm ethical foundations as well as strong and durable partnerships between Australian and overseas health services, educational institutions and GH agencies. More formal systems of GH training in Australia have the potential to produce fellows with the skills and knowledge necessary to engage in regional health challenges in a global context.
Objective
To assess the feasibility of an ED presenting complaint (PC) tool that categorised all ED PCs into 10 categories.
Methods
A retrospective analysis of 1445 consecutive patient encounters was ...conducted. The primary outcome was the frequency of use of the 10 PC categories.
Results
Of the 1203 patient encounters meeting inclusion criteria, the PC tool was completed by clinicians in 574 (47.7%). When completed, the tool's 10 options were selected for most presentations (72.3%).
Conclusion
The PC tool captured the majority of presenting complaints in 10 categories. External validation is recommended.
The COVID-19 Emergency Department (COVED) Quality Improvement Project aims to provide regular and real-time clinical information to ED clinicians caring for patients with suspected and confirmed ...COVID-19. The present study summarises data from the first 2 weeks of the study.
COVED is an ongoing prospective cohort study that commenced on 1 April 2020. It includes all adult patients presenting to a participating ED who undergo testing for SARS-CoV-2. Data are collected prospectively and entered into a bespoke registry. Outcomes include a positive SARS-CoV-2 polymerase chain reaction test result and requirement for intensive respiratory support.
In the period 1-14 April 2020, 240 (16%) of 1508 patients presenting to The Alfred Emergency and Trauma Centre met inclusion criteria. Of these, 11 (5%) tested positive for SARS-CoV-2. The mean age of patients was 60 years and the commonest symptoms were acute shortness of breath (n = 122 67%), cough (n = 108 56%) or fever (n = 98 51%). Overseas travel or known contact with a confirmed case was reported by 24 (14%) and 16 (10%) patients, respectively. Fever or hypoxia was recorded in 23 (10%) and 11 (5%) patients, respectively. Eleven (5%) patients received mechanical ventilation in the ED, of whom none tested positive for SARS-CoV-2.
Among patients presenting to a tertiary ED with suspected COVID-19, only a small proportion tested positive for SARS-CoV-2. Although the low incidence of positive cases currently precludes the development of predictive tools, the COVED Project demonstrates that the rapid establishment of an agile clinical registry for emergency care is feasible.
PDF
