Network Five Emergency Medicine Journal Club

Pramod Chandru, Shreyas Iyer, Kit Rowe, Caroline Tyers & Samoda Wilegoda

This is a podcast designed to bring exciting emergency research to you!

Episode 18 - Environmental Medicine - Part 2: Diving & Otology
Jul 30 2022
Episode 18 - Environmental Medicine - Part 2: Diving & Otology
Theme: Environmental Medicine. Participants: Dr Scott Squires, A/Prof. Andrew Coggins (emergency physician), Tim Selvaraj, Yelise Foon, Mariez Gorgi, Shreyas Iyer, Kit Rowe, and Harry Hong. Discussion:Livingstone, D., Smith, K., & Lange, B. (2017). Scuba diving and otology: a systematic review with recommendations on diagnosis, treatment and post-operative care. Diving And Hyperbaric Medicine Journal, 47(2), 97-109.  - Yelise Foon - emergency medicine trainee at Westmead Hospital.Music/Sound Effects:Ascension by Keys of Moon | Music promoted by 4.0 International (CC BY 4.0), by LiQWYD | Music promoted by Creative Commons Attribution 3.0 Unported License, Going by Jay Someday | Music promoted by Commons Attribution 3.0 Unported License, Marshmallows by Arthur Vyncke | Music promoted by Creative Commons Attribution-ShareAlike 3.0 Unported, effects from  The Times by Jay Someday | Music promoted by Commons Attribution 3.0 Unported License,  Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~
Episode 15 - Paediatrics: Part 3 - Mental Health & Challenges
Apr 17 2022
Episode 15 - Paediatrics: Part 3 - Mental Health & Challenges
Theme: Paediatrics. Participants: Dr Kerf Tan (emergency physician), Dr Karl Pobre (paediatric emergency physician and paediatrician), Mariez Gorgi, Amanda De Silva, Shreyas Iyer, Harry Hong, and Samoda WilegodaDiscussion:Bourke, E., Say, D., Carison, A., Hill, A., Craig, S., & Hiscock, H. et al. (2021). Emergency mental health presentations in children with autism spectrum disorder and attention deficit hyperactivity disorder. Journal Of Paediatrics And Child Health, 57(10), 1572-1579. Shreyas Iyer.Summary:This was a retrospective cross-sectional study which aimed to explore the issues faced by young people with a known diagnosis of autism spectrum disorder (ASD) or attention deficit hyperactivity disorder (ADHD) presenting to the emergency department with a mental health complaint.This study found 374 mental health presentations to the Royal Children’s Hospital in Melbourne in 2018 in which patients had a background of ASD and/or ADHD (in the age group of 7 to 17 years).This represented 28% of mental health presentations for this specified age group.Those with a diagnosis of both ADHD and ASD were more likely to require ambulance or police transport to hospital (RR 1.5). Children with ADHD (with or without ASD) were at a higher risk of being brought to hospital under section. The most common presentation for both the ADHD and ASD cohorts was acute severe behavioural disturbance. Patients with ASD had a significantly increased risk of physical restraint (RR 2.8), chemical restraint (RR 2.8) and of seclusion (RR 3.3).It is important to understand what ASD and ADHD are and what the perspective of the child might be so that we can approach these patients with empathy and try and avoid potential triggers for behavioural escalation.   Take-Home Points:This study gives numbers to support what we already know; that patients with ASD and ADHD are both at structural risk of suffering secondary trauma in the emergency department because of the environment. When assessing these patients, involve senior and experienced clinicians early to try and expedite their journey through the emergency department. There needs to be systemic change with regards to the design of our emergency departments to better manage these patients; this will require input from an executive level.  Credits:This episode is produced with help of HETI's Emergency Medicine Training Network 5.Music/Sound EffectsEnergetic Electronic Vlog Music | Breeze by Alex-Productions | Music promoted by Creative Commons Attribution 3.0 Unported License, Way by Artegon | Music promoted by Creative Commons Attribution 3.0 Unported License, by Scandinavianz | Music promoted by Creative Commons Attribution 3.0 Unported License, Goodbye by Sapajou | Music promoted by Commons Attribution 3.0 Unported License, (audio logo) by tubebackr | Music promoted by effects from  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~
Episode 15 - Paediatrics: Part 2 - Family Presence During Cardiac Arrest
Apr 16 2022
Episode 15 - Paediatrics: Part 2 - Family Presence During Cardiac Arrest
Theme: Paediatrics. Participants: Dr Kerf Tan (emergency physician), Dr Karl Pobre (paediatric emergency physician and paediatrician), Mariez Gorgi, Shreyas Iyer, Harry Hong, and Samoda WilegodaDiscussion:Dainty, K., Atkins, D., Breckwoldt, J., Maconochie, I., Schexnayder, S., & Skrifvars, M. et al. (2021). Family presence during resuscitation in paediatric and neonatal cardiac arrest: A systematic review. Resuscitation, 162, 20-34. Mariez Gorgi (emergency medicine advanced trainee).Summary:This systematic review set out to determine the impact of family presence during resuscitation (specifically in cardiac arrest) on patient outcomes, family-centered outcomes and healthcare-provider outcomes.A total of 38 papers were included in the review; consisting of observational studies, qualitative interviews or surveys, spanning from 1999 to 2019 in 11 different countries.No papers explored the impact of family presence on patient outcome.Most parents wished to be offered the opportunity to be present in the resuscitation in order to provide comfort to their child, as well as assisting in accepting the outcome and knowing that everything that could be done had been done for their child. The opinion of healthcare providers was more widely varied, citing the concern of psychological trauma to the parents, interference with management of the patient and stress on the treating team (performance-related anxiety). However, the more experienced a healthcare worker with having family presence in a resuscitation, the more agreeable they were to this. However, the evidence provided in all papers was of very low quality, and there is an urgent need for better quality data surrounding this topic. Important things to consider with family presence is to flag that you may need them to leave the room during the resuscitation, and having a dedicated support person for the family present. Hot and cold debriefs involving all relevant staff (paramedics, nursing staff, allied health, doctors) are also incredibly important following a resuscitation such as this.  Take-Home Points: It would be great to have better studies looking into family presence in resuscitation (looking into outcomes for the patients themselves as well as better qualitative data looking into what happens to families and healthcare workers afterwards). If there is family around, they should be asked whether they want to be present in the resuscitation. There should be a resource allocated to families to prevent their presence taking away from the resuscitation itself. If you are struggling following a resuscitation, seek support. Resources (to support doctor well-being) - Applications: Shift (Black Dog Institute app for healthcare workers), Calm, Headspace, Feeling Good, Smiling Minds, Insight Timer.  JMO support line (NSW): 1300 566 321.Employee Assistance Program (free confidential service for all NSW Health employees) - 1300  687 327. Doctors for doctors: www.drs4drs.com.au.Beyond Blue: 1300 224 636.Lifeline: 13 11 14. Suicide call-back service: 1300 659 467. Credits:This episode is produced with help of HETI's Emergency Medicine Training Network 5.Music/Sound EffectsBreathe by Roa Music | Music promoted by Creative Commons Attribution 3.0 Unported License, Piano Improvisation by Alexander Nakarada | Music promoted by Attribution 4.0 International (CC BY 4.0), by MaxKoMusic | Music promoted by Creative Commons Attribution-ShareAlike 3.0 Unported,  Sound effects from  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~
Episode 15 - Paediatrics: Part 1 - Racial Disparities In Healthcare
Apr 13 2022
Episode 15 - Paediatrics: Part 1 - Racial Disparities In Healthcare
Theme: Paediatrics. Participants: Dr Kerf Tan (emergency physician), Dr Karl Pobre (paediatric emergency physician and paediatrician), Yelise Foon, Mariez Gorgi, Shreyas Iyer, Harry Hong, and Samoda WilegodaDiscussion:Goyal, M., Chamberlain, J., Webb, M., Grundmeier, R., Johnson, T., & Lorch, S. et al. (2020). Racial and ethnic disparities in the delayed diagnosis of appendicitis among children. Academic Emergency Medicine, 28(9), 949-956. Yelise Foon.Summary:Delay in the diagnosis of appendicitis is associated with perforation and significant subsequent morbidity. Currently the pre-operative perforation rate for appendicitis is 30%. Some known risk factors for a delayed diagnosis for appendicitis include a young age, female gender, African-American race, non-English speaking backgrounds and government insurance factors (predominantly in the US). This was a multi-centre retrospective cohort study conducted over 3 years utilizing the PECARN registry, which aimed to compare the rate of appendiceal perforation, delayed diagnosis of appendicitis and diagnostic imaging use among different ethnicities.Of the 7298 children diagnosed with appendicitis where race/ethnicity data was collected, 34.9% of non-Hispanic white children had a perforated appendix, compared with 36.5% of non-Hispanic black children. Non-Hispanic black children also had higher rates of delayed diagnosis (defined as having a relevant emergency visit in the week prior to diagnosis): at 4.7% compared with 2.0% for non-Hispanic white children. Further non-Hispanic black children with a delayed diagnosis of appendicitis were less likely to undergo definite imaging (including MRI, ultrasound, or CT) compared with their non-Hispanic white counterparts (with 28.2% versus 46.2% undergoing imaging). However, given that this study came out of the US, the generalisability of this study to Australian emergency departments is unclear. Health literacy is likely to be a large contributor to delayed presentation of appendicitis and something to be carefully considered when treating any child (and their family). There are tools such as the Paediatric Appendicitis Score (PAS) and the Alvarado Score which may assist in objectively quantifying the possibility of appendicitis (particularly for junior staff).  Take-Home Points:It is important for us to consider how we can minimise racial and ethnic disparities and make sure we are conscious of them. Credits:This episode is produced with help of HETI's Emergency Medicine Training Network 5.Music/Sound EffectsFeel Me by LiQWYD | Music promoted by Creative Commons Attribution 3.0 Unported License, The Eyes by Peyruis | Music promoted by Creative Commons Attribution 3.0 Unported License, All Good by Roa Music | Music promoted by Commons Attribution 3.0 Unported License, Trip by Sarah Jansen Music | Music promoted by Creative Commons Attribution 3.0 Unported License, by Mike Leite | Music promoted by Commons Attribution 3.0 Unported License, (audio logo) by tubebackr | Music promoted by effects from  Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~
Episode 13 - Workplace Violence: Part 3
Feb 20 2022
Episode 13 - Workplace Violence: Part 3
Theme: Workplace Violence. Participants: Dr Margaret Murphy, Dr Lex Narushevich, Arvind Karthikeyan, Adamina Drazkiewicz, Aran Sandrasegaran, Amanda De Silva, Pramod Chandru, Harry Hong, Shreyas Iyer, and Caroline Tyers. Discussion:Davids J, Murphy M, Moore N, Wand T, Brown M. Exploring staff experiences: A case for redesigning the response to aggression and violence in the emergency department. Int Emerg Nurs. 2021 Jul;57:101017. doi: 10.1016/j.ienj.2021.101017. Epub 2021 Jun 24. PMID: 34174545.  Presenter:Amanda De Silva (emergency medicine trainee at Westmead Hospital). Summary: It is widely recognized that emergency departments (EDs) are a high-risk environment when it comes to violence towards healthcare workers. A big contributor to this is the environment in the ED – it is chaotic, messy, busy, and sees a large turnover of patients. Compounded by access block and understaffing, this often exacerbates tense and potentially volatile situations. The Australian College of Emergency Medicine has created a policy regarding violence in emergency departments to provide a guideline by which departments can maintain a safe working environment. They examine the Code Black response and identify important elements of ED design to encourage a positive patient journey through the ED. This observational study was conducted in the Western Sydney Local Health district across four hospitals, one of which is Westmead Hospital. It involved interviewing 20 staff members from across the four sites to gauge their personal experience with violence in the emergency department. The data was analyzed and codes were created to capture concepts in the data. The study identified several points of interest when it comes to Code Blacks. Perpetrators of these events tended to be patients who had presented with drug or alcohol-related illness, as well as mental illness. There are several common triggers of violence, including extensive wait times, frustration/fear/anxiety, and being involuntarily detained for psychiatric care. Staff members feel undertrained when it comes to responding to violence in the ED – 6/20 staff reported not being given formal training when starting their job in ED, while many others reported learning through on-the-job training and observation. Good communication was identified as crucial to managing an escalating situation. Staff members were unsure when to activate a Code Black, and also reported feeling reluctant to call one for fear of interrupting other busy colleagues. There is no culture of formal debriefing after a Code Black, and staff members are often left to manage their own stress.  Take-Home Points Communication and de-escalation skills are vital to the Code Black response and in preventing violence in the ED. Early escalation of concerns about agitated patients is important, to allow for these communication skills to be utilized and to diffuse escalating situations before they reach a point of physical violence. More education is required around the Code Black response, with particular attention paid to the specific roles of each member of the response team and how they can assist in managing violent situations. Credits:This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta. Music/Sound EffectsBeach by Limujii | Music promoted by Creative Commons Attribution 3.0 Unported License,  Eternal Sunshine by LiQWYD & Luke Bergs | promoted by Creative Commons Attribution-ShareAlike 3.0 Unported,  Lie 2 You by Leonell Cassio ft. Dylan Emmet | Music promoted by Creative Commons Attribution-ShareAlike 3.0 Unported,  Sound effects from  Sittin’ Throwin’ Rocks by Leonell Cassio ft. Lily Hain | Music promoted by Creative Commons Attribution-ShareAlike 3.0 Unported, you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~
Episode 13 - Workplace Violence: Part 2
Jan 29 2022
Episode 13 - Workplace Violence: Part 2
Theme: Workplace Violence. Participants: Dr Margaret Murphy, Dr Lex Narushevich, Arvind Karthikeyan, Adamina Drazkiewicz, Amanda De Silva, Pramod Chandru, Harry Hong, Shreyas Iyer, and Caroline Tyers. Discussion:Jeong, I., & Kim, J. (2018). The relationship between intention to leave the hospital and coping methods of emergency nurses after workplace violence. Journal Of Clinical Nursing, 27(7-8), 1692-1701. Presenter:Dr Arvind Karthikeyan - ED Trainee at Tweed Hospital.Summary:The main aim of this study was to identify the relationship between emergency nurses’ intention to leave the hospital and their coping methods following workplace violence.The coping methods were split into emotion-focused and problem-focused mechanisms. The study was a cross-sectional study in which surveys were sent out to 7 hospitals in 7 different cities around Korea (completed by nursing staff working in the emergency department).They received 246 returned surveys, and 32 were incomplete, leaving 214 questionnaires to derive their results from.Verbal abuse was the most frequent violence experience. Of those who experienced violence, 61% considered leaving the hospital.Emotion-focused coping appeared to have a stronger association with nurses’ intention to leave following workplace violence. This highlights the need for resources and processes in place within the emergency department to support staff and encourage healthy coping mechanisms in response to incidents of violence. Take-Home Points: This article highlights the importance of healthy coping strategies.Having a more formalised, standardised counselling service for healthcare providers would be extremely beneficial (ideally an ‘opt-out’ service).  Credits:This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta. Music/Sound EffectsParadise by MBB | Music promoted by Creative Commons Attribution-ShareAlike 3.0 Unported,  Sound effects from  Youth by JayJen & Krishi Sarma | Music promoted by Commons Attribution 3.0 Unported License, you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~
Episode 13 - Workplace Violence: Part  1
Jan 28 2022
Episode 13 - Workplace Violence: Part 1
Theme: Workplace Violence. Participants: Dr Margaret Murphy, Dr Lex Narushevich, Arvind Karthikeyan, Adamina Drazkiewicz, Aran Sandrasegaran, Amanda De Silva, Pramod Chandru, Harry Hong, Shreyas Iyer, and Caroline Tyers. Discussion:Nikathil, S., Olaussen, A., Symons, E., Gocentas, R., and Mitra, B., 2017. Review article: Workplace violence in the emergency department: A systematic review and meta-analysis. Emergency medicine Australasia : EMA. 29. 10.1111/1742-6723.12761. (Nikathil et al., 2017). Presenter: Aran Sandrasegaran - ED SRMO at Westmead Hospital.Summary:Workplace violence in the emergency department is a systematic review and meta-analysis published in 2017 in EMA by Nikathil, et al.From 7235 abstracts, 22 studies were deemed relevant.A meta-analysis was conducted on the primary outcome variable-proportion of violent patients among total ED presentations.A secondary meta-analysis used studies reporting on the proportion of drug and alcohol-affected patients occurring within the violent population.It reported the prevalence of violence in Australian Emergency Departments (EDs) as at least 36 events per 10 000 patients, with about 45 in every 100 violent presentations estimated to be associated with alcohol and/or other drugs. These findings had good confidence intervals.The study reported that young males were the young (aged between 28-42 years) males were the primary demonstrators of violence.Due to statistical heterogeneity in study methodology, definitions and rates, and under-reporting the results are not a full reflection of the incidence of WPV in EDs.   Take-Home Points:Studies examining violence in the ED consistently report a high prevalence of workplace violence (WPV). Nikithil et al. is the only recent study to confirm a high proportion of violence in terms of patient presentation.Drugs and alcohol were commonly associated with violent episodes, often in the absence of an underlying psychiatric diagnosis.The findings of this study are likely an underrepresentation due to statistical heterogeneity and under-reporting and analysts and future studies must consider this.Public health and legal interventions are urgently required to curb workplace violence in EDs.References: International Labour Office/International Council of Nurses/World Health Organization/Public Services International. Framework Guidelines for Addressing Workplace Violence in the Health Sector. Geneva: International Labour Office, 2002.Nikathil, S., Olaussen, A., Symons, E., Gocentas, R., O'Reilly, G. and Mitra, B., 2017. Increasing workplace violence in an Australian adult emergency department. Emergency Medicine Australasia, 30(2), pp.181-186.Credits:This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney and, Deepa Dasgupta. Music/Sound EffectsCinematic Epic Music | Story by Alex-Productions | promoted by Creative Commons Attribution 3.0 Unported License,   Eternal Sunshine by LiQWYD & Luke Bergs | Music promoted by Creative Commons Attribution-ShareAlike 3.0 Unported,  Medical Examination by MaxKoMusic | Music promoted by Creative Commons Attribution-ShareAlike 3.0 Unported,  Sound effects from  Vacations by Mehul ShaRma | Music promoted by Creative Commons Attribution 3.0 Unported License, you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.~