scholarly journals Primary care presentations at emergency departments: rates and reasons by age and sex

2008 ◽  
Vol 32 (4) ◽  
pp. 700 ◽  
Author(s):  
Peter Siminski ◽  
Andrew J Bezzina ◽  
Luise P Lago ◽  
Kathy Eagar
Keyword(s):  
Primary Care ◽  
Emergency Departments ◽  
New South ◽  
Age Groups ◽  
Demographic Analysis ◽  
South Wales ◽  
Primary Care Patients ◽  
The Subject ◽  
Using Data ◽  
Age And Sex

Primary care presentations at emergency departments (EDs) have been the subject of much attention in recent years. This paper is a demographic analysis using administrative data from the Emergency Department Information System (EDIS) for 2005 of such presentations in New South Wales EDs and of self-reported reasons for presentation. Age and sex differences in the reasons given by patients for such presentations are analysed using data from a survey of patients conducted in a subset of EDs in 2004. The rate of ?potential primary care? presentations varies greatly with age and to a lesser extent with sex. Almost half (47%) of these presentations are made by people under 25 years of age. Children aged 0?4 years account for 14% of the total. The pattern is distinctly different to the corresponding rate of ED presentations that do not fit the ?potential primary care? definition. Reasons given for ?potential primary care? presentations are consistent across all age groups, reflecting self-assessed urgency, access to diagnostics and self-assessed complexity. Older ?primary care? patients are particularly unlikely to give reasons associated with GP affordability or availability for their presentations. Young adults? responses are consistent with the overall population, and children under the age of five seem most susceptible to availability issues.

scholarly journals Trends in Primary Care Presentations at Emergency Departments in New South Wales (1999–2006)

2008 ◽  
Vol 14 (3) ◽  
pp. 35 ◽  
Author(s):  
Peter Siminski ◽  
Kathy Eagar ◽  
Luise Lago ◽  
Andrew Bezzina
Keyword(s):  
Primary Care ◽  
Emergency Departments ◽  
New South ◽  
New South Wales ◽  
Future Research ◽  
Subsequent Period ◽  
South Wales ◽  
Ed Overcrowding ◽  
Trends Over Time ◽  
New Guidelines

This paper examines trends in potential 'primary care' presentations at emergency departments (ED), comparing these with other ED presentations and to primary care attendances in the community. The study draws on EDIS data (Emergency Department Information System), which, at December 2005, covered 76% of attendances in New South Wales, and from Medicare Australia MBS data. Annual counts of potential primary care presentations to EDs are compared with those of other ED presentations and to primary care presentations in the community. Changes in the percentage of ED presentations that are potentially for primary care are examined, as are changes in the percentage of total primary care presentations seen in EDs. Trends in age standardised presentation rates are also calculated for each of the three series. Primary care presentations at EDs increased marginally in the period under consideration, as did primary care presentations in the community. There was a substantial increase in other ED presentations. The proportion of ED presentations potentially for primary care decreased over the period. The proportion of primary care presentations seen in EDs and the proportion seen in the community changed little. Decline in the proportion of potential primary care presentations to EDs may have been impacted by new guidelines for the application of triage categories in 2001. However, trends over time do not show acute alterations and they continue to hold for the subsequent period after introduction of new guidelines. Primary care presentations at EDs are not responsible for recent changes to ED overcrowding in New South Wales, at least not for hospitals covered in the EDIS database. Future research might consider more specific trends in rural EDs.

scholarly journals Quit Experiences among Primary Care Patients Enrolled in a Smoking Cessation Pilot RCT Early in the COVID-19 Pandemic

2021 ◽  
Vol 18 (3) ◽  
pp. 1011
Author(s):  
Andrea A. Joyce ◽  
Grace M. Styklunas ◽  
Nancy A. Rigotti ◽  
Jordan M. Neil ◽  
Elyse R. Park ◽  
...  
Keyword(s):  
Primary Care ◽  
Text Messaging ◽  
Risk Perceptions ◽  
Environmental Changes ◽  
Age Groups ◽  
Text Messages ◽  
Increased Risk ◽  
Primary Care Patients ◽  
The Impact ◽  
At Home

The impact of the COVID-19 pandemic on US adults’ smoking and quitting behaviors is unclear. We explored the impact of COVID-19 on smoking behaviors, risk perceptions, and reactions to text messages during a statewide stay-at-home advisory among primary care patients who were trying to quit. From May–June 2020, we interviewed smokers enrolled in a 12-week, pilot cessation trial providing text messaging and mailed nicotine replacement medication (NCT04020718). Twenty-two individuals (82% white, mean age 55 years), representing 88% of trial participants during the stay-at-home advisory, completed exit interviews; four (18%) of them reported abstinence. Interviews were thematically analyzed by two coders. COVID-19-induced environmental changes had mixed effects, facilitating quitting for some and impeding quitting for others. While stress increased for many, those who quit found ways to cope with stress. Generally, participants felt at risk for COVID-19 complications but not at increased risk of becoming infected. Reactions to COVID-19 and quitting behaviors differed across age groups, older participants reported difficulties coping with isolation (e.g., feeling disappointed when a text message came from the study and not a live person). Findings suggest that cessation interventions addressing stress and boredom are needed during COVID-19, while smokers experiencing isolation may benefit from live-person supports.

scholarly journals 140. Symptoms and Situations Predispose Patients to Use Antibiotics Without Medical Advice

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S200-S200
Author(s):  
Michael Hansen ◽  
Barbara Trautner ◽  
Roger Zoorob ◽  
George Germanos ◽  
Osvaldo Alquicira ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Emergency Departments ◽  
Primary Care Clinic ◽  
Antibiotic Use ◽  
Safety Net ◽  
Care Clinic ◽  
Primary Care Clinics ◽  
Primary Care Patients ◽  
Emergency Department Patients

Abstract Background Use of antibiotics without a prescription (non-prescription use) contributes to antimicrobial resistance. Non-prescription use includes obtaining and taking antibiotics without a prescription, taking another person’s antibiotics, or taking one’s own stored antibiotics. We conducted a quantitative survey focusing on the factors that impact patients’ decisions to use non-prescription antibiotics. Methods We surveyed patients visiting public safety net primary care clinics and private emergency departments in a racially/ethnically diverse urban area. Surveys were read aloud to patients in Spanish and English. Survey domains included patients’ perspectives on which syndromes require antibiotic treatment, their perceptions of health care, and their access to antibiotics without a prescription. Results We interviewed 190 patients, 122 from emergency departments (64%), and 68 from primary care clinics (36%). Overall, 44% reported non-prescription antibiotic use within the past 12 months. Non-prescription use was higher among primary care clinic patients (63%) than the emergency department patients (39%, p = 0.002). The majority felt that antibiotics would be needed for bronchitis (78%) while few felt antibiotics would be needed for diarrhea (30%) (Figure 1). The most common situation identified “in which respondents would consider taking antibiotics without contacting a healthcare provider was “got better by taking this antibiotic before” (Figure 2). Primary care patients were more likely to obtain antibiotics without prescription from another country than emergency department patients (27% vs. 13%, P=0.03). Also, primary care patients were more likely to report obstacles to seeking a doctor’s care, such as the inability to take time off from work or transportation difficulties, but these comparisons were not statistically significant. Figure 1. Patients’ agreement that antibiotics would be needed varied by symptom/syndrome. Figure 2. Situations that lead to non-prescription antibiotic use impacted the two clinical populations differently Conclusion Non-prescription antibiotic use is a widespread problem in the two very different healthcare systems we included in this study, although factors underlying this practice differ by patient population. Better understanding of the factors driving non-prescription antibiotic use is essential to designing patient-focused interventions to decrease this unsafe practice. Disclosures All Authors: No reported disclosures

Cumulative reproductive performance effect on overall lifetime productivity in Merino sheep

2018 ◽  
Vol 58 (8) ◽  
pp. 1470
Author(s):  
J. S. Richards ◽  
M. A. Sladek ◽  
G. J. Lee
Keyword(s):  
Reproductive Performance ◽  
New South ◽  
Dental Health ◽  
Age Groups ◽  
The South ◽  
Performance Effect ◽  
South West ◽  
South Wales ◽  
The Impact ◽  
Effect Of Age

Reproduction is an important driver of profitability in commercial sheep flocks. Historically, Merino flocks have been run with a fixed age structure, ignoring individual merit and casting for age at a specific age. More recently, research has focussed on utilising the variation within age groups by keeping productive older ewes longer and culling less productive ewes earlier. Previous studies have also examined the effect of age on reproduction and the impact of reproduction status on productivity, but little research has been conducted on cumulative effects of reproductive performance on later productivity, reproduction and health. The present study examined the impact of higher lifetime reproduction on other key production and fitness traits in older ewes run under commercial conditions. Data were collected from two commercial wool-producing properties in the South West Slopes and the Central West Plains of New South Wales during 2009–2011. Reproduction, fleece measurements, bodyweight and condition and dental health were recorded during the study. The results showed that age had a bigger effect on productivity and dental health than did cumulative lifetime reproduction. Environment and genetics determined the level of impact, with minimal loss in productivity from increased age of animals occurring in the South West Slopes flock, whereas the Central West Plains flock would appear to require closer monitoring of productivity as ewes aged. The data collected did not allow separation of the genetic and environmental influences within the study. Retaining animals with a higher reproductive performance past normal culling age does not necessarily result in reduction of productivity or ewe health, but this must be monitored.

A Quick Test of Cognitive Speed: norm-referenced criteria for 121 Italian adults aged 45 to 90 years

2014 ◽  
Vol 26 (9) ◽  
pp. 1493-1500 ◽  
Author(s):  
Ferdinando Petrazzuoli ◽  
Sebastian Palmqvist ◽  
Hans Thulesius ◽  
Nicola Buono ◽  
Enzo Pirrotta ◽  
...  
Keyword(s):  
Primary Care ◽  
Mmse Score ◽  
Age Groups ◽  
Quick Test ◽  
Dementia Screening ◽  
Primary Care Patients ◽  
Cognitive Speed ◽  
Color Form ◽  
Criterion Referenced ◽  
Age Range

ABSTRACTBackground:A Quick Test of Cognitive Speed (AQT) is a brief test that can identify cognitive impairment. AQT has been validated in Arabic, English, Greek, Japanese, Norwegian, Spanish, and Swedish. The aim of this study was to develop Italian criterion-referenced norms for AQT.Methods:AQT consists of three test plates where the patient shall rapidly name (1) the color of 40 blue, red, yellow, or black squares (AQT color), (2) the form of 40 black figures (circles, squares, triangles, or rectangles; AQT form), (3) the color and form of 40 figures (consisting of previous colors and forms; AQT color–form). The AQT test was administered to 121 Italian cognitively healthy primary care patients (age range: 45–90 years). Their mean Mini-Mental State Examination (MMSE) score was 28.8 ± 0.9 points (range 26–30 points). AQT naming times in seconds were used for developing preliminary criterion cut-off times for different age groups.Results:Age was found to have a significant moderate positive correlation with AQT naming times color (r = 0.65, p < 0.001), form (r = 0.53, p < 0.001), color–form (r = 0.63, p < 0.001) and a moderate negative correlation with MMSE score (r = –0.44, p < 0.001) and AQT naming times differed significantly between younger (45–55 years old), older (56–70 years old), and the oldest (71–90 years old) participants. Years of education correlated positively but weakly with MMSE score (r = 0.27, p = 0.003) and negatively but weakly with AQT color (r = –0.16, p = ns), form (r = –0.24, p = 0.007), and color–form (r = –0.19, p = 0.005). We established preliminary cut-off times for the AQT test based on +1 and +2 standard deviations according to the approach in other languages and settings.Conclusions:This is the first Italian normative AQT study. Future studies of AQT – a test useful for dementia screening in primary care – will eventually refine cut-off times for normality balancing sensitivity and specificity in cognitive diagnostics.

Drysdale, Russell (1912–1981)

2018 ◽  
Author(s):  
Anne Gray
Keyword(s):  
World War Ii ◽  
Indigenous People ◽  
Subject Matter ◽  
New South ◽  
New South Wales ◽  
World War ◽  
Railway Stations ◽  
South Wales ◽  
The Subject ◽  
The 1960S

Russell Drysdale was an Australian artist who created an original vision of the Australian landscape from the 1940s to the 1960s, portraying the emptiness and loneliness of the Australian outback and country townships in his paintings, drawings, and photographs. During World War II, he depicted everyday subjects, including groups of servicemen waiting at railway stations. He traveled numerous times to the interior of Australia, including a trip to record the drought devastation in South Western New South Wales in 1944, where he created images that convey the environmental degradation of the landscape. In 1947, he explored the Bathurst region with Donald Friend where he discovered Sofala and Hill End, an area that served as the subject matter for his art for a number of years. Drysdale painted many images of deserted country towns as well as brooding landscapes peopled with stockmen and station hands. In his paintings of Aborigines, Drysdale expressed a deep concern for the Indigenous people, often placing them within his paintings in a manner that conveys a sense of dispossession. His work was singled out by Kenneth Clark in 1949 as being among the most original in Australian art, and his exhibition at the Leicester Galleries, London, in 1950 convinced British critics that Australian artists had an original vision.

The influence of various factors on survival rate to weaning of Merino lambs. I. Sex, strain, location, and age of ewe for single-born lambs

1965 ◽  
Vol 16 (6) ◽  
pp. 981 ◽  
Author(s):  
J Lax ◽  
Turner H Newton
Keyword(s):  
Survival Rate ◽  
New South ◽  
Strong Association ◽  
New South Wales ◽  
Survival Rates ◽  
Age Groups ◽  
Strain Differences ◽  
Marked Rise ◽  
South Wales ◽  
Improved Pasture

The influence of sex, strain, location, and age of ewe on survival rate to weaning of single-born Merino lambs has been examined in two sets of data: the strain trial, involving five strains run without selection at each of three locations (Cunnamulla, Qld.; Armidale, on the northern tablelands of New South Wales; Deniliquin, in the Riverina area of New South Wales), with six age groups of ewes; and the same five strains later included in selection groups at Armidale with seven age groups of ewes. The strain trial at Armidale ran mainly on native, and the selection groups mainly on improved pastures. Female lambs had a higher survival rate than either castrated or entire males, the differences in lambs weaned per lamb born being 0.03 and 0.04 respectively. No strain differences could be regarded as statistically significant, and neither could the strain x location interaction in the strain trial. Mean survival rates for the strains ranged from 0.673 to 0.786 on the Armidale native and from 0.802 to 0.850 on the Armidale improved pasture, from 0.746 to 0.859 at Cunnamulla, and from 0.838 to 0.894 at Deniliquin. The strains did not rank consistently in the same order. Location had a marked effect on survival rate, the means being 0.744 for the native and 0.824 for the improved pasture at Armidale, 0.810 at Cunnamulla, and 0.868 at Deniliquin. Age of ewe had a marked influence in the poorest environment (Armidale native pasture), survival rate rising with age and later falling sharply. The effect was less marked in the intermediate environments (Armidale improved pasture and Cunnamulla) and negligible at Deniliquin. The patterns at Cunnamulla and Deniliquin are confirmed by data from other experiments on these stations. Survival rate is one component of number of lambs weaned. The other component, number of lambs born, has a higher mean value at Deniliquin than Cunnamulla, but shows a strong association with age of ewe in both environments. Number of lambs born responds rapidly to selection, but no information is yet available concerning the likely response in survival rate. If improvement in environment can raise the survival rate, particularly in the youngest and oldest ewes, then selection for number of lambs born, combined with improved environment, should lead to a marked rise in the number of lambs weaned.

Physician don't heal thyself: a descriptive study of impaired older doctors

2007 ◽  
Vol 19 (5) ◽  
pp. 974-984 ◽  
Author(s):  
C. Peisah ◽  
K. Wilhelm
Keyword(s):  
New South ◽  
Poor Performance ◽  
Work Patterns ◽  
South Wales ◽  
Age Related ◽  
Psychiatric Conditions ◽  
The Subject ◽  
Sense Of Obligation ◽  
Medical Morbidity ◽  
Aging Medical

Background: The growing and welcome interest in the issues leading to distress and impairment in younger doctors has not been mirrored by a focus on the similar issues in older doctors which is surprising given the aging medical workforce.Objectives: To improve understanding of impairment in older doctors and to facilitate the planning of primary prevention strategies.Method: Consecutive case records of notifications to the Impaired Registrants Program of the New South Wales Medical Board, Australia, of doctors over 60 years from January 2000 to January 2006 (N = 41) were examined. Details of demographics, type of practice, nature of referral, medical morbidity, cognitive examination, psychiatric diagnosis and outcome of assessment were recorded.Results: Impaired older doctors suffered cognitive impairment (54%), substance abuse (29%) and depression (22%) and 17% had two comorbid psychiatric conditions. Twelve percent had frank dementia. Two work patterns – the “workhorse” and the “dabbler” – were observed, as was a culture of postponed retirement due to a sense of obligation and working “until you drop.” Impaired older doctors were found to have higher chronic illness burden compared with community norms. Almost half were the subject of patient complaints or of poor performance within ten years of presentation.Conclusion: To our knowledge there has been no other comprehensive examination of patterns of impairment in older doctors. Older doctors are prone to suffer “the four Ds”: dementia, drugs, drink and depression. We need to encourage mature doctors to adapt to age-related changes and illness and validate their right to timely and appropriate retirement.

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