http://hdl.handle.net/2440/5868 Search the Channel search http://digital.library.adelaide.edu.au/dspace/simple-search http://hdl.handle.net/2440/52013 Title: Outcomes of patients admitted to tertiary intensive care units after interhospital transfer: comparison with patients admitted from emergency departments.<br/><br/>Author: Flabouris, Athanasios; Hart, Gabrielle; George, Carol<br/><br/>Abstract: OBJECTIVES: To compare outcomes of patients admitted to tertiary-level intensive care units after interhospital transfer (IHT) with those of similar patients admitted from the emergency department (ED). DESIGN: Historical case-control study using data from the Australian and New Zealand Intensive Care Society Adult Patient Database (ANZICS APD), a quality-assurance dataset. PARTICIPANTS AND SETTING: 28882 patients aged 16 years or older admitted to an adult tertiary ICU in Australia or New Zealand between 1 January 1994 and 31 December 2003 with one of the eight most common diagnoses for IHT patients. Patients admitted directly to the ICU from another hospital (DIHT group) (n=9203) were matched by age, sex, APACHE II score and diagnosis with non-IHT patients admitted from the ED (ED group). RESULTS: Hospital mortality was higher in the DIHT group than in the ED group for patients with a diagnosis of multiple trauma (11.0% v 5.1%; odds ratio [OR], 2.3; 95% CI, 1.6- 3.34), respiratory infection (28.1% v 19.1%; OR, 1.66; 95% CI, 1.34-2.05), sepsis (38.7% v 28.7%; OR, 1.57; 95% CI, 1.34-1.83), intracranial haemorrhage (49.9% v 42.6%; OR, 1.34; 95% CI, 1.14-1.58), head injury alone (16.9% v 13.7%; OR, 1.28; 95% CI, 1.01-1.62), and cardiac arrest (59.3% v 53.2%; OR, 1.28; 95% CI, 1.06-1.56), but not overdose (3.9% v 3.6%; OR, 1.09; 95% CI, 0.72-1.67) or chronic obstructive pulmonary disease (19.8% v 22.5%; OR, 0.85; 95% CI, 0.63-1.15). Overall, the DIHT group had a higher intubation rate, longer ICU stay and higher rate of discharge to another hospital. CONCLUSIONS: Patients admitted to an ICU from another hospital have higher hospital mortality and longer stay than those admitted from the ED, with the differences varying between diagnoses. These differences are important considerations for resource allocation and triage, and as a measure of quality. Tue, 01 Jan 2008 00:00:00 GMT http://hdl.handle.net/2440/51699 Title: Psychological predictors of substantial pain reduction after minimally invasive radiofrequency and injection treatments for chronic low back pain<br/><br/>Author: van Wijk, Roelof Markus Antonius Wihelmus; Geurts, Jos W. M.; Lousberg, Richel; Wynne, Herman J.; Hammink, Edwin; Knape, Johannes T. A.; Groen, Gerbrand J.<br/><br/>Abstract: Objective. In this post hoc observational study, we investigated psychological predictors of outcome after radiofrequency and injection treatments, commonly performed in the management of chronic low back pain (CLBP).Design & Setting. Data, comprising 161 patients (29 eventually lost to follow-up), were obtained from two randomized controlled trials on efficacy of radiofrequency treatment for back pain and sciatica. Subsequently patients were additionally treated in an open prospective follow-up period. Although all groups presented a significant visual analog scale reduction after 3 and 12 months, no additional pain relief after radiofrequency compared with injection treatment was found. Both trial populations showed sufficient similarities. A principal component (factor) analysis was performed on baseline psychometric tests, SF-36, and physical activity variables. We constructed five clinically relevant psychological profiles: "psychologically negative,""adaptive manager,""rigid qualities,""supporting partner," and "strong ego." These were examined as possible predictors of significant pain relief using logistic regression analysis.Results. The "psychologically negative" dimension showed a negative and the "adaptive manager" dimension a positive prognostic effect on outcome.Conclusions. Minimally invasive treatment for CLBP leads to significant pain reduction, including potential placebo effects. However, psychologically vulnerable patients, characterized by, among others, reduced life control, disturbed mood, negative self-efficacy, catastrophizing, high anxiety levels, inadequacy, and poor mental health, tend not to respond to this treatment. Patients characterized by a.o. reduced pain and interference levels, positive expectations, and reasonable physical and social functioning, react more favorably. From both a clinical and a financial perspective, psychosocial evaluation and selection of patients seems appropriate, before applying minimally invasive procedures for CLBP.<br/><br/>Description: © 2008 American Academy of Pain Medicine Tue, 01 Jan 2008 00:00:00 GMT http://hdl.handle.net/2440/51572 Title: Towards safer, better healthcare: harnessing the natural properties of complex sociotechnical systems<br/><br/>Author: Braithwaite, J.; Runciman, William Ben; Merry, Alan F.<br/><br/>Abstract: Objectives: To sustain an argument that harnessing the natural properties of sociotechnical systems is necessary to promote safer, better healthcare. Methods: Triangulated analyses of discrete literature sources, particularly drawing on those from mathematics, sociology, marketing science and psychology. Results: Progress involves the use of natural networks and exploiting features such as their scale-free and small world nature, as well as characteristics of group dynamics like natural appeal (stickiness) and propagation (tipping points). The agenda for change should be set by prioritising problems in natural categories, addressed by groups who self select on the basis of their natural interest in the areas in question, and who set clinical standards and develop tools, the use of which should be monitored by peers. This approach will facilitate the evidence-based practice that most agree is now overdue, but which has not yet been realised by the application of conventional methods. Conclusion: A key to health system transformation may lie under-recognised under our noses, and involves exploiting the naturally-occurring characteristics of complex systems. Current strategies to address healthcare problems are insufficient. Clinicians work best when their expertise is mobilised, and they flourish in groupings of their own interests and preference. Being invited, empowered and nurtured rather than directed, micro-managed and controlled through a hierarchy is preferable. Thu, 01 Jan 2009 00:00:00 GMT http://hdl.handle.net/2440/51380 Title: Doctor displacement: a political agenda or a health care imperative?<br/><br/>Author: Ludbrook, Guy Lawrence; Maddern, Guy John<br/><br/>Description: © 2009 The Medical Journal of Australia Thu, 01 Jan 2009 00:00:00 GMT