Vivienne Tippett

Bio: Vivienne Tippett is an academic researcher from Queensland University of Technology. The author has contributed to research in topics: Emergency department & Emergency medical services. The author has an hindex of 19, co-authored 93 publications receiving 1004 citations. Previous affiliations of Vivienne Tippett include Queensland Health & The Joanna Briggs Institute.

The impact of heatwaves on mortality and emergency hospital admissions from non-external causes in Brisbane, Australia

Abstract: Objectives Heatwaves can have significant health consequences resulting in increased mortality and morbidity. However, their impact on people living in tropical/subtropical regions remains largely unknown. This study assessed the impact of heatwaves on mortality and emergency hospital admissions (EHAs) from non-external causes (NEC) in Brisbane, a subtropical city in Australia. Methods We acquired daily data on weather, air pollution and EHAs for patients aged 15 years and over in Brisbane between January 1996 and December 2005, and on mortality between January 1996 and November 2004. A locally derived definition of heatwave (daily maximum ≥37°C for 2 or more consecutive days) was adopted. Case–crossover analyses were used to assess the impact of heatwaves on cause-specific mortality and EHAs. Results During heatwaves, there was a statistically significant increase in NEC mortality (OR 1.46; 95% CI 1.21 to 1.77), cardiovascular mortality (OR 1.89; 95% CI 1.44 to 2.48), diabetes mortality in those aged 75+ (OR 9.96; 95% CI 1.02 to 96.85), NEC EHAs (OR 1.15; 95% CI 1.07 to 1.23) and EHAs from renal diseases (OR 1.41; 95% CI 1.09 to 1.83). The elderly were found to be particularly vulnerable to heatwaves (eg, for NEC EHAs, OR 1.24 for 65–74-year-olds and 1.39 for those aged 75+). Conclusions Significant increases in NEC mortality and EHAs were observed during heatwaves in Brisbane where people are well accustomed to hot summer weather. The most vulnerable were the elderly and people with cardiovascular, renal or diabetic disease.

Do biometeorological indices improve modeling outcomes of heat-related mortality?

Abstract: Various biometeorological indices and temperature measures have been used to assess heat-related health risks. Composite indices are expected to assess human comfort more accurately than do temperature measures alone. The performances of several common biometeorological indices and temperature measures in evaluating the heat-related mortality in Brisbane, Australia—a city with a subtropical climate—were compared. Daily counts of deaths from organic causes [International Statistical Classification of Diseases and Related Health Problems, 9th Revision, (ICD9) codes 001–799 and ICD, 10th Revision, (ICD10) codes A00–R99] during the period from 1 January 1996 to 30 November 2004 were used. Several composite biometeorological indices were considered, such as apparent temperature, relative strain index, Thom discomfort index, the humidex, and wet-bulb globe temperature. Hot days were defined as those days falling into the 95th percentile of each thermal stress indicator. Case-crossover analysis was applied to estimate the relationship between exposure to heat and mortality. The performances of various biometeorological indices and temperature measures were compared using the jackknife resampling method. The results show that more deaths were likely to occur on hot days than on other (i.e., control) days regardless of the temperature measure or biometeorological index that is considered. The magnitude of the odds ratios varied with temperature indicators, between 1.08 [95% confidence interval (CI): 1.02–1.14] and 1.41 (95% CI: 1.22–1.64) after adjusting for air pollutants (particulate matter with aerodynamic diameter less than 10 μm and ozone). Average temperature performed similarly to the composite indices, but minimum and maximum temperatures performed relatively poorer. Thus, average temperature may be suitable for the development of weather–health warning systems if the findings presented herein are confirmed in different locations.

Defining pharmacists' roles in disasters: A Delphi study.

Abstract: Introduction Pharmacists are uniquely placed in the community to be of assistance to disaster-affected patients. However, the roles undertaken by pharmacists in disasters are identified based on their own experiences and networks. There is currently no definition or acknowledgment of pharmacists’ roles in disasters. Objective To acquire consensus from an expert panel of key opinion leaders within the field of disaster health on pharmacists’ roles in disasters throughout the four disaster phases—prevention, preparedness, response, and recovery. Methods A Delphi study consisting of three rounds of online surveys was utilised. Twenty-four key opinion leaders were contacted, with 15 completing all three rounds. The 15 expert panellists were presented with 46 roles identified in the literature and asked to rank their opinions on a 5-point Likert scale. This study used an international, all-hazard, and multijurisdictional approach. Consensus was benchmarked at 80% and any role which did not reach consensus was re-queried in the subsequent round. The third round provided the results of the Delphi study and sought commentary on the acceptance or rejection of the roles. Results Of the 46 roles provided to the expert panel, 43 roles were accepted as roles pharmacists are capable of undertaking in a disaster. There were five roles for the prevention phase, nine for the preparedness phase, 21 for the response phase, and eight for the recovery phase. The experts were asked to prioritise the top five roles for each of the disaster phases. The three roles which did not make consensus were deemed to be specialised roles for disaster pharmacists and not generalisable to the broader pharmacy profession. Conclusion This study identifies pharmacists’ roles in disasters which have been accepted by the international disaster health community. The international key opinion leaders recommended that pharmacists could be undertaking 43 roles in a disaster, however, this is dependent on individual jurisdiction considerations. Pharmacy professional associations need to advocate to policymakers for legislative support and to ensure pharmacists are equipped with the training and education required to undertake these roles within specific jurisdictions.

Demand for public hospital emergency department services in Australia: 2000–2001 to 2009–2010

Abstract: Objective: Hospital EDs are a significant and high-profile component of Australia’s health-care system, which in recent years have experienced considerable crowding. This crowding is caused by the combination of increasing demand, throughput and output factors. The aim of the present article is to clarify trends in the use of public ED services across Australia with a view to providing an evidence basis for future policy analysis and discussion. Methods: The data for the present article have been extracted, compiled and analysed from publicly available sources for a 10 year period between 2000–2001 and 2009–2010. Results: Demand for public ED care increased by 37% over the decade, an average annual increase of 1.8% in the utilization rate per 1000 persons. There were significant differences in utilization rates and in trends in growth among states and territories that do not easily relate to general population trends alone. Conclusions: This growth in demand exceeds general population growth, and the variability between states both in utilization rates and overall trends defies immediate explanation. The growth in demand for ED services is a partial contributor to the crowding being experienced in EDs across Australia. There is a need for more detailed study, including qualitative analysis of patient motivations in order to identify the factors driving this growth in demand.

Impact of advanced cardiac life support-skilled paramedics on survival from out-of-hospital cardiac arrest in a statewide emergency medical service.

Abstract: Background: Prehospital research has found little evidence in support of advanced cardiac life support (ACLS) for out-of-hospital cardiac arrest. However, these studies generally examine city-based emergency medical services (EMS) systems. The training and experience of ACLS-skilled paramedics differs internationally, and this may also contribute to negative findings. Additionally, the frequency of negative outcome in out-of-hospital cardiac arrest suggests that it is difficult to establish sufficient numbers to detect an effect. Purpose: To examine the effect of ACLS on cardiac arrest in Queensland, Australia. Queensland has a population of 3.8 million and an area of over 1.7 million km2, and is served by a statewide EMS system, which deploys resources using a two-tier model. Advanced treatments such as intubation and cardioactive drug administration are provided by extensively trained intensive care paramedics. Methods: An observational, retrospective design was used to examine all cases of cardiac arrest attended by the Queensland Ambulance Service from January 2000 to December 2002. Logistic regression was used to examine the effect of the presence of an intensive care paramedic on survival to hospital discharge, adjusting for age, sex, initial rhythm, the presence of a witness and bystander cardiopulmonary resuscitation. Results: The presence of an intensive care paramedic had a significant effect on survival (OR = 1.43, 95% CI = 1.02 to 1.99). Conclusions: Highly trained ACLS-skilled paramedics provide added survival benefit in EMS systems not optimised for early defibrillation. The reasons for this benefit are multifactorial, but may be the result of greater skill level and more informed use of the full range of prehospital interventions.

Medscape

Abstract: Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Predictors of Survival From Out-of-Hospital Cardiac Arrest A Systematic Review and Meta-Analysis

Abstract: Background— Prior studies have identified key predictors of out-of-hospital cardiac arrest (OHCA), but differences exist in the magnitude of these findings In this meta-analysis, we evaluated the strength of associations between OHCA and key factors (event witnessed by a bystander or emergency medical services [EMS], provision of bystander cardiopulmonary resuscitation [CPR], initial cardiac rhythm, or the return of spontaneous circulation) We also examined trends in OHCA survival over time Methods and Results— An electronic search of PubMed, EMBASE, Web of Science, CINAHL, Cochrane DSR, DARE, ACP Journal Club, and CCTR was conducted (January 1, 1950 to August 21, 2008) for studies reporting OHCA of presumed cardiac etiology in adults Data were extracted from 79 studies involving 142 740 patients The pooled survival rate to hospital admission was 238% (95% CI, 211 to 266) and to hospital discharge was 76% (95% CI, 67 to 84) Stratified by baseline rates, survival to hospital discharge was more

Part 8: Advanced Life Support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Abstract: Part 8 : Advanced life support : 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations