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Biomedical subjects

I R Rogers

Publications and source records attributed to I R Rogers.

8 recordsLinked to original sources
PubMed1999

Re-engineering an Australian emergency department: can we measure success?

In 1996, in response to perceived deficiencies of the Emergency Department, Sir Charles Gairdner Hospital made emergency medicine a key strategic initiative. Major staffing and functional changes occurred as a result, including creation of the first Chair in Emergency Medicine in Australasia. We present a before and after study, using a range of measured variables, including the accepted Australian Council on Healthcare Standards emergency medicine clinical indicators. Clinically, there were great improvements in waiting times, time to thrombolysis in acute myocardial infarction, complaint rate, and misdiagnosed fracture rate. Increased throughput of short stay patients in a re-opened observation ward greatly shortened average length of stay for patients with a range of acute conditions. Data also indicated significant improvements in teaching and research. We conclude that with firm commitment from hospital management, re-engineering an emergency department can be shown to improve the quality-of-care.

Australia↗
PubMed1999

Hyponatremia in ultradistance triathletes.

PURPOSE: Hyponatremia ([plasma sodium] <135 mmol x L(-1)) is a potentially serious complication of ultraendurance sports. However, the etiology of this condition is still uncertain. This observational cohort study aimed to determine prospectively the incidence and etiology of hyponatremia in an ultradistance triathlon. METHODS: The subjects consisted of 605 of the 660 athletes entered in the New Zealand Ironman triathlon (3.8-km swim, 180-km cycle, and 42.2-km run). Subjects were weighed before and after the race. A blood sample was drawn for measurement of plasma sodium concentration after the race. RESULTS: Complete data on pre- and postrace weights and plasma sodium concentrations were available in 330 race finishers. Postrace plasma sodium concentrations were inversely related to changes in body weight (P = 0.0001). Women (N = 38) had significantly lower plasma sodium concentrations (133.7 vs 137.4 mmol x L(-1); P = 0.0001) than men (N = 292) and lost significantly less relative weight (-2.7 vs -4.3%; P = 0.0002). Fifty-eight of 330 race finishers (18%) were hyponatremic; of these only 18 (31%) sought medical care for the symptoms of hyponatremia (symptomatic). Eleven of the 58 hyponatremic athletes had severe hyponatremia ([plasma sodium] < 130 mmol x L(-1)); seven of these 11 severely hyponatremic athletes were symptomatic. The relative body weight change of the 11 severely hyponatremic athletes ranged from 2.4% to +5%; eight (73%) of these athletes either maintained or gained weight during the race. In contrast, relative body weight changes in the 47 athletes with mild hyponatremia ([plasma sodium] 130-134 mmol x L(1)) were more variable, ranging from -9.25% to +2.2%. CONCLUSIONS: Hyponatremia is a common biochemical finding in ultradistance triathletes but is usually asymptomatic. Although mild hyponatremia was associated with variable body weight changes, fluid overload was the cause of most (73%) cases of severe, symptomatic hyponatremia.

Adult↗
PubMed1999

Using clinical indicators in emergency medicine: documenting performance improvements to justify increased resource allocation.

OBJECTIVES: To demonstrate how emergency department triage scale and thrombolysis indicator data can be used to document the impact of a substantial increase in resource allocation. METHODS: Descriptive study in an emergency department of an adult tertiary hospital in Perth, Australia during similar periods of the year both before and after a substantial increase in emergency department staff, equipment, and system resources. The study group comprised a total of 11,048 emergency department attendances and all cases of emergency department initiated thrombolysis or acute angioplasty. Outcome was measured using numbers seen and percentage seen within indicator threshold time together with admission rates in each of the five triage categories as well as by using time from presentation to initiation of reperfusion treatment in acute myocardial infarction. RESULTS: The proportion of patients seen within the prescribed indicator time increased by 16.4% (95% confidence interval 14.4% to 18.2%). The increase was most pronounced in triage category 2 (32.7%). Median time to thrombolysis fell by 30 minutes to 37 minutes (p = 0.0002). CONCLUSIONS: Use of the Australasian national triage scale and time to thrombolysis clinical indicator data allows a quantitative assessment of the impact of increased emergency department resource allocation.

Adult↗
PubMed1998

Severe multi-system failure following delayed presentation with tiger snake envenomation.

A 68 year-old-man presented some twelve hours after a presumed Tiger Snake bite with coagulopathy, paralysis and muscle necrosis. He suffered multi-system failure requiring prolonged ventilation, haemodialysis and supportive care, to be discharged after 26 days. Delays to antivenom therapy after tiger snake envenomation can result in significant morbidity. Australian snakes are the most venomous in the world.

Aged↗
PubMed1996

Roxithromycin-induced digoxin toxicity.

A 76-year-old women presented with digoxin toxicity four days after starting a course of roxithromycin. In 10%-15% of the population, digoxin is degraded extensively by bacteria in the gastrointestinal tract, and antibiotic-induced changes in the bacterial flora may lead to digoxin toxicity.

Aged↗
PubMed1993

Sternal fractures: a retrospective analysis of 272 cases.

OBJECTIVE: To determine the incidence, morbidity, and mortality associated with fractures of the sternum. DESIGN: A retrospective review of the medical records of all patients treated in an emergency department with the radiologic diagnosis of sternal fracture during a 6 1/2 year period between January 1, 1985 and June 30, 1991. SETTING: A level II trauma center in the eastern suburbs of Melbourne, Australia. PATIENTS: 272 patients were eligible for analysis. Only 6 patients of 251 involved in motor vehicle collisions were documented as not wearing seatbelts. RESULTS: The incidence of sternal fracture as a result of motor vehicle collisions was 3%. Sternal fracture is more common in female victims and the elderly and is associated with a very low incidence of cardiac arrhythmias requiring treatment. It has a mortality of 0.7%. CONCLUSIONS: Sternal fracture is a common injury in a population where restraints are frequently used. PATIENTS with an isolated sternal fracture do not require cardiac monitoring and those under 40 years of age may be cared for in a short stay ward.

Accidents, Traffic↗