scholarly journals Critical Illness and its Impact on the Aboriginal People of the Top End of the Northern Territory, Australia

2003 ◽  
Vol 31 (3) ◽  
pp. 294-299 ◽  
Author(s):  
D. Stephens
Keyword(s):  
Critical Illness ◽  
Aboriginal People ◽  
Survival Rates ◽  
Severity Of Illness ◽  
Northern Territory ◽  
Hospital Environment ◽  
Remote Communities ◽  
Aboriginal Population ◽  
Aboriginal Patient ◽  
Chronic Health Problems

The Royal Darwin Hospital (RDH) services a relatively large and geographically remote Aboriginal population who account for 45% of intensive care unit admissions. Critical illness in the Aboriginal population is different from the non-Aboriginal population of the “Top End” of the Northern Territory. The critically ill Aboriginal patient is younger, has more chronic health problems and a higher severity of illness at presentation. The city and the hospital environment are foreign to many Aboriginal patients retrieved from remote communities and this adds to the stress of the critical illness. English is a second, third or fourth language for many Aboriginal people from remote communities and strategies must be put in place to ensure informed consent and effective communication are achieved. Despite the increased severity of illness and complexity, the Royal Darwin Hospital ICU achieves the same survival rates for both Aboriginal and non-Aboriginal patients.

scholarly journals Acute myocardial infarction incidence and survival in Aboriginal and non-Aboriginal populations: an observational study in the Northern Territory of Australia, 1992–2014

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e036979
Author(s):  
Cushla Coffey ◽  
Yuejen Zhao ◽  
John R Condon ◽  
Shu Li ◽  
Steven Guthridge
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Aboriginal People ◽  
Age Groups ◽  
Northern Territory ◽  
Older Age ◽  
Aboriginal Population ◽  
Aboriginal Populations ◽  
National Trends ◽  
Over Time

ObjectivesTo examine long-term trends in acute myocardial infarction (AMI) incidence and survival among Aboriginal and non-Aboriginal people.DesignRetrospective cohort study.Setting, participantsAll first AMI hospital cases and deaths due to ischaemic heart disease in the Northern Territory of Australia (NT), 1992–2014.Main outcome measuresAge standardised incidence, survival and mortality.ResultsThe upward trend in Aboriginal AMI incidence plateaued around 2007 for males and 2001 for females. AMI incidence decreased for non-Aboriginal population, consistent with the national trends. AMI incidence was higher and survival lower for males, for Aboriginal people and in older age groups. In 2014, the age standardised incidence was 881 and 579 per 100 000 for Aboriginal males and females, respectively, compared with 290 and 187 per 100 000 for non-Aboriginal counterparts. The incidence disparity between Aboriginal and non-Aboriginal population was much greater in younger than older age groups. Survival after an AMI improved over time, and more so for Aboriginal than non-Aboriginal patients, because of a decrease in prehospital deaths and improved survival of hospitalised cases.ConclusionsThere was an important breakpoint in increasing trends of Aboriginal AMI incidence between 2001 and 2007. The disparity in AMI survival between the NT Aboriginal and non-Aboriginal populations reduced over time as survival improved for both populations.

scholarly journals Antimicrobial Use in COVID-19 Patients in the First Phase of the SARS-CoV-2 Pandemic: A Scoping Review

Antibiotics ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 745
Author(s):  
Wenjuan Cong ◽  
Ak Narayan Poudel ◽  
Nour Alhusein ◽  
Hexing Wang ◽  
Guiqing Yao ◽  
...  
Keyword(s):  
Critical Illness ◽  
Scoping Review ◽  
Clinical Evidence ◽  
Length Of Hospital Stay ◽  
Severity Of Illness ◽  
Antibiotic Prescribing ◽  
Antimicrobial Use ◽  
Clinical Scenarios ◽  
Scoping Reviews ◽  
The Impact

This scoping review provides new evidence on the prevalence and patterns of global antimicrobial use in the treatment of COVID-19 patients; identifies the most commonly used antibiotics and clinical scenarios associated with antibiotic prescribing in the first phase of the pandemic; and explores the impact of documented antibiotic prescribing on treatment outcomes in COVID-19 patients. The review complies with PRISMA guidelines for Scoping Reviews and the protocol is registered with the Open Science Framework. In the first six months of the pandemic, there was a similar mean antibiotic prescribing rate between patients with severe or critical illness (75.4%) and patients with mild or moderate illness (75.1%). The proportion of patients prescribed antibiotics without clinical justification was 51.5% vs. 41.9% for patients with mild or moderate illness and those with severe or critical illness. Comparison of patients who were provided antibiotics with a clinical justification with those who were given antibiotics without clinical justification showed lower mortality rates (9.5% vs. 13.1%), higher discharge rates (80.9% vs. 69.3%), and shorter length of hospital stay (9.3 days vs. 12.2 days). In the first 6 months of the pandemic, antibiotics were prescribed for COVID-19 patients regardless of severity of illness. A large proportion of antibiotic prescribing for mild and moderate COVID-19 patients did not have clinical evidence of a bacterial co-infection. Antibiotics may not be beneficial to COVID-19 patients without clinical evidence of a bacterial co-infection.

Empowerment is the Basis for Improving Education and Employment Outcomes for Aboriginal People in Remote Australia

2018 ◽  
Vol 48 (2) ◽  
pp. 153-161
Author(s):  
Byron Wilson ◽  
Tammy Abbott ◽  
Stephen J. Quinn ◽  
John Guenther ◽  
Eva McRae-Williams ◽  
...  
Keyword(s):  
Structural Equation ◽  
Aboriginal People ◽  
Positive Impact ◽  
Remote Communities ◽  
Aboriginal Communities ◽  
Aboriginal Community ◽  
Equation Modelling ◽  
Shared Space ◽  
English Literacy ◽  
Education And Employment

In Australia, Aboriginal and Torres Strait Islander people score poorly on national mainstream indicators of wellbeing, with the lowest outcomes recorded in remote communities. As part of a ‘shared space’ collaboration between remote Aboriginal communities, government and scientists, the holistic Interplay Wellbeing Framework and accompanying survey were designed bringing together Aboriginal priorities of culture, empowerment and community with government priorities of education, employment and health. Quantitative survey data were collected from a cohort of 841 Aboriginal people aged 15–34 years, from four different Aboriginal communities. Aboriginal community researchers designed and administered the survey. Structural equation modelling was used to identify the strongest interrelating pathways within the framework. Optimal pathways from education to employment were explored with the concept of empowerment playing a key role. Here, education was defined by self-reported English literacy and numeracy and empowerment was defined as identity, self-efficacy and resilience. Empowerment had a strong positive impact on education (β = 0.38, p < .001) and strong correlation with employment (β = 0.19, p < .001). Education has a strong direct effect on employment (β = 0.40, p < .001). This suggests that education and employment strategies that foster and build on a sense of empowerment are mostly likely to succeed, providing guidance for policy and programs.

Severity of Illness Influences the Efficacy of Enteral Feeding Route on Clinical Outcomes in Patients with Critical Illness

2012 ◽  
Vol 112 (8) ◽  
pp. 1138-1146 ◽  
Author(s):  
Hsiu-Hua Huang ◽  
Sue-Joan Chang ◽  
Chien-Wei Hsu ◽  
Tzu-Ming Chang ◽  
Shiu-Ping Kang ◽  
...  
Keyword(s):  
Critical Illness ◽  
Clinical Outcomes ◽  
Enteral Feeding ◽  
Severity Of Illness

scholarly journals Association Between Room Location and Adverse Outcomes in Hospitalized Patients

2018 ◽  
Vol 12 (2) ◽  
pp. 21-29 ◽  
Author(s):  
Anoop Mayampurath ◽  
Christopher Ward ◽  
John Fahrenbach ◽  
Cynthia LaFond ◽  
Michael Howell ◽  
...  
Keyword(s):  
Critical Illness ◽  
Severity Of Illness ◽  
Adverse Outcomes ◽  
Sensitivity Analyses ◽  
Additional Risk Factor ◽  
Inhospital Mortality ◽  
Additional Risk ◽  
Increased Risk ◽  
Euclidean Distances ◽  
Time Of Admission

Objective: To investigate whether a patient’s proximity to the nurse’s station or ward entrance at time of admission was associated with increased risk of adverse outcomes. Method: We conducted a retrospective cohort study of consecutive adult inpatients to 13 medical–surgical wards at an academic hospital from 2009 to 2013. Proximity of admission room to the nurse’s station and to the ward entrance was measured using Euclidean distances. Outcomes of interest include development of critical illness (defined as cardiac arrests or transfer to an intensive care unit), inhospital mortality, and increase in length of stay (LOS). Results: Of the 83,635 admissions, 4,129 developed critical illness and 1,316 died. The median LOS was 3 days. After adjusting for admission severity of illness, ward, shift, and year, we found no relationship between proximity at admission to nurse’s station our outcomes. However, patients admitted to end of the ward had higher risk of developing critical illness (odds ratio [ OR] = 1.15, 95% confidence interval [CI] = [1.08, 1.23]), mortality ( OR = 1.16, 95% CI [1.03, 1.33]), and a higher LOS (13-hr increase, 95% CI [10, 15] hours) compared to patients admitted closer to the ward entrance. Similar results were observed in sensitivity analyses adjusting for isolation room patients and considering patients without room transfers in the first 48 hr. Conclusions: Our study suggests that being away from the nurse’s station did not increase the risk of these adverse events in ward patients, but being farther from the ward entrance was associated with increase in risk of adverse outcomes. Patient safety can be improved by recognizing this additional risk factor.

‘Japan Fight. Aboriginal People Fight. European People Fight’: Yolngu Stories from World War II

2008 ◽  
Vol 37 (S1) ◽  
pp. 65-72
Author(s):  
Noah Riseman
Keyword(s):  
World War Ii ◽  
Aboriginal People ◽  
Northern Territory ◽  
Oral Histories ◽  
World War ◽  
Prisoner Of War ◽  
War Effort ◽  
History Of ◽  
The Rich ◽  
Australian Soil

Abstract Did you know that a Bathurst Islander captured the first Japanese prisoner of war on Australian soil? Or that a crucifix saved the life of a crashed American pilot in the Gulf of Carpentaria? These are excerpts from the rich array of oral histories of Aboriginal participation in World War II. This paper presents “highlights” from Yolngu oral histories of World War II in Arnhem Land, Northern Territory. Using these stories, the paper begins to explore some of the following questions: Why did Yolngu participate in the war effort? How did Yolngu see their role in relation to white Australia? In what ways did Yolngu contribute to the security of Australia? How integral was Yolngu assistance to defence of Australia? Although the answers to these questions are not finite, this paper aims to survey some of the Yolngu history of World War II.

scholarly journals Funding of Northern Territory public hospitals

2002 ◽  
Vol 25 (1) ◽  
pp. 189 ◽  
Author(s):  
Dale Fisher ◽  
Allen Ruben
Keyword(s):  
Clinical Data ◽  
Burden Of Disease ◽  
Aboriginal People ◽  
Northern Territory ◽  
Public Hospitals ◽  
Australian Population ◽  
Admission Rates ◽  
Lengths Of Stay ◽  
Land Mass

The Northern Territory is Australia's third largest jurisdiction by land mass but it is the smallest by population. By proportion it accommodates the largest number of Aboriginal people who suffer the greatest burden of disease with highmorbidity, mortality, admission rates and lengths of stay. Output based funding by DRG is based on the 'typical' Australian population which is not that of the Northern Territory. The NT has had to significantly modify its approach to funding to meet the needs of its population. The current funding method based on detailed analyses of clinical data with small numbers may be inappropriate where simpler methods tailored to the NT population could suffice.

Predictors of Delayed Recognition of Critical Illness in Emergency Department Patients and Its Effect on Morbidity and Mortality

2020 ◽  
pp. 088506662096790
Author(s):  
Neha N. Goel ◽  
Matthew S. Durst ◽  
Carmen Vargas-Torres ◽  
Lynne D. Richardson ◽  
Kusum S. Mathews
Keyword(s):  
Emergency Department ◽  
Critical Illness ◽  
Census Data ◽  
Severity Of Illness ◽  
Improved Outcomes ◽  
Chart Abstraction ◽  
System Factors ◽  
Delayed Recognition ◽  
Emergency Department Patients ◽  
Operational Metrics

Purpose: Timely recognition of critical illness is associated with improved outcomes, but is dependent on accurate triage, which is affected by system factors such as workload and staffing. We sought to first study the effect of delayed recognition on patient outcomes after controlling for system factors and then to identify potential predictors of delayed recognition. Methods: We conducted a retrospective cohort study of Emergency Department (ED) patients admitted to the Intensive Care Unit (ICU) directly from the ED or within 48 hours of ED departure. Cohort characteristics were obtained through electronic and standardized chart abstraction. Operational metrics to estimate ED workload and volume using census data were matched to patients’ ED stays. Delayed recognition of critical illness was defined as an absence of an ICU consult in the ED or declination of ICU admission by the ICU team. We employed entropy-balanced multivariate models to examine the association between delayed recognition and development of persistent organ dysfunction and/or death by hospitalization day 28 (POD+D), and multivariable regression modeling to identify factors associated with delayed recognition. Results: Increased POD+D was seen for those with delayed recognition (OR 1.82, 95% CI 1.13-2.92). When the delayed recognition was by the ICU team, the patient was 2.61 times more likely to experience POD+D compared to those for whom an ICU consult was requested and were accepted for admission. Lower initial severity of illness score (OR 0.26, 95% CI 0.12-0.53) was predictive of delayed recognition. The odds for delayed recognition decreased when ED workload is higher (OR 0.45, 95% CI 0.23-0.89) compared to times with lower ED workload. Conclusions: Increased POD+D is associated with delayed recognition. Patient and system factors such as severity of illness and ED workload influence the odds of delayed recognition of critical illness and need further exploration.

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