Paul M Middleton | The University of New South Wales (original) (raw)

Papers by Paul M Middleton

Research paper thumbnail of Diagnostic physiological scoring in a model of early haemorrhagic shock

The Journal of emergency medicine, Feb 1, 2006

... Diagnostic physiological scoring in a model of early haemorrhagic shock. Paul Middleton. No a... more ... Diagnostic physiological scoring in a model of early haemorrhagic shock. Paul Middleton. No abstract is available. To read the body of this article, please view the PDF online. Prince of Wales Hospital P, P University of New South Wales. PII: S0736-4679(06)00089-8. ...

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Research paper thumbnail of Understanding patient preferences for emergency care for lower triage acuity presentations during GP hours: a qualitative study in Australia

BMC Health Services Research

Background Low acuity presentations to Australian emergency departments drive long wait times, hi... more Background Low acuity presentations to Australian emergency departments drive long wait times, higher costs and may be better treated in primary care settings. This study sought to understand factors leading these patients to present to emergency departments. Methods Semi-structured interviews were carried out with patients at two tertiary emergency departments in Sydney during general practitioner opening hours. Nvivo was used to code the interviews and a thematic analysis was carried out to capture the main themes from the interviews. Results Forty-four interviews were included in the analysis across the two sites. They represented a diverse population in terms of ethnicity, education and socioeconomic background. Patient preferences for emergency care were organised into four main themes: (i) patients were referred (either by another health service, work, friend, or family), (ii) emergency department factors (convenience of investigations and severity of symptoms requiring emerge...

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Research paper thumbnail of Video head impulse testing to differentiate vestibular neuritis from posterior circulation stroke in the emergency department: a prospective observational study

BMJ Neurology Open

Background and aimsVertigo is a common presentation to the emergency department (ED) with 5% of p... more Background and aimsVertigo is a common presentation to the emergency department (ED) with 5% of presentations due to posterior circulation stroke (PCS). Bedside investigations such as the head impulse test (HIT) are used to risk stratify patients, but interpretation is operator dependent. The video HIT (v-HIT) provides objective measurement of the vestibular-ocular-reflex (VOR) and may improve diagnostic accuracy in acute vestibular syndrome (AVS). We aimed to evaluate the use of v-HIT as an adjunct to clinical assessment to acutely differentiate vestibular neuritis (VN) from PCS.Methods133 patients with AVS were consecutively enrolled from the ED of our comprehensive stroke centre between 2018 and 2021. Patient assessment included a targeted vestibular history, HINTs examination (Head Impulse, Nystagmus and Test of Skew), v-HIT and MRI>48 hours after symptom onset. The HINTS/v-HIT findings were analysed and compared between VN, PCS and other cause AVS. Clinical course, v-HIT and...

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Research paper thumbnail of Improving community-based first response to out of hospital cardiac arrest (FirstCPR): protocol for a cluster randomised controlled trial

BMJ Open

IntroductionOut-of-hospital cardiac arrest (OHCA) is associated with poor survival outcomes, but ... more IntroductionOut-of-hospital cardiac arrest (OHCA) is associated with poor survival outcomes, but prompt bystander action can more than double survival rates. Being trained, confident and willing-to-perform cardiopulmonary resuscitation (CPR) are known predictors of bystander action. This study aims to assess the effectiveness of a community organisation targeted multicomponent education and training initiative on being willing to respond to OHCAs. The study employs a novel approach to reaching community members via social and cultural groups, and the intervention aims to address commonly cited barriers to training including lack of availability, time and costs.Methods and analysisFirstCPR is a cluster randomised trial that will be conducted across 200 community groups in urban and regional Australia. It will target community groups where CPR training is not usual. Community groups (clusters) will be stratified by region, size and organisation type, and then randomly assigned to eith...

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Research paper thumbnail of Change in stroke presentations during COVID-19 pandemic in South-Western Sydney

BackgroundAustralia managed relatively well during the global COVID-19 pandemic owing to our swif... more BackgroundAustralia managed relatively well during the global COVID-19 pandemic owing to our swift mandated public health response. During the NSW lockdown restrictions, we noted a decrease in acute stroke presentations at our institution, similar to what was subsequently reported worldwide.AimsWe aimed to test our hypothesis that (i) the true numbers of ischaemic strokes did not change, however patients were presenting later and (ii) the proportion of TIAs decreased.MethodsWe conducted a retrospective audit of all stroke and TIA presentations in 2020 and compared these with data from 2019. We collected information about stroke subtype, severity, time from stroke/TIA onset to presentation and acute reperfusion therapies.ResultsBetween January-February and April-March 2020, there was a 15% drop in acute stroke presentations (128 vs. 109). In the same period “stroke mimic” presentations dropped by 22%. The proportion of patients attending the emergency department within 4.5hrs was onl...

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Research paper thumbnail of Part 8: Advanced Life Support

Circulation, 2010

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Research paper thumbnail of Part 7: CPR Techniques and Devices

Circulation, 2010

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Research paper thumbnail of A Global Survey of Emergency Department Responses to the COVID-19 Pandemic

Western Journal of Emergency Medicine, 2021

Introduction: Emergency departments (ED) globally are addressing the coronavirus disease 2019 (CO... more Introduction: Emergency departments (ED) globally are addressing the coronavirus disease 2019 (COVID-19) pandemic with varying degrees of success. We leveraged the 17-country, Emergency Medicine Education & Research by Global Experts (EMERGE) network and non-EMERGE ED contacts to understand ED emergency preparedness and practices globally when combating the COVID-19 pandemic. Methods: We electronically surveyed EMERGE and non-EMERGE EDs from April 3–June 1, 2020 on ED capacity, pandemic preparedness plans, triage methods, staffing, supplies, and communication practices. The survey was available in English, Mandarin Chinese, and Spanish to optimize participation. We analyzed survey responses using descriptive statistics. Results: 74/129 (57%) EDs from 28 countries in all six World Health Organization global regions responded. Most EDs were in Asia (49%), followed by North America (28%), and Europe (14%). Nearly all EDs (97%) developed and implemented protocols for screening, testing,...

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Research paper thumbnail of Multicultural presentation of chest pain at an emergency department in Australia

Emergency Medicine Australasia, 2020

To investigate differences in presenting patient characteristics, investigation, management and r... more To investigate differences in presenting patient characteristics, investigation, management and related outcomes between culturally and linguistically diverse (CALD) and non‐CALD chest pain (CP) patients presenting to the ED.

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Research paper thumbnail of A systematic review of the cost and benefit of helicopter emergency medical services

Injury, 2009

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Research paper thumbnail of The Methodology of the Australian Prehospital Outcomes Study of Longitudinal Epidemiology (APOStLE) Project

Prehospital Emergency Care, 2012

This paper describes the methodology of a large emergency medical services (EMS) data linkage res... more This paper describes the methodology of a large emergency medical services (EMS) data linkage research project currently under way in the statewide EMS system of New South Wales, Australia. The paper is intended to provide the reader with an understanding of how linkage techniques can be used to facilitate EMS research. This project, the Australian Prehospital Outcomes Study of Longitudinal Epidemiology (APOStLE) Project, links data from six statewide sources (computer-assisted dispatch, EMS patient health care reports, emergency department data, inpatient data, and two death registries) to enable researchers to examine the patient's entire journey through the health care system, from the emergency 0-0-0 call to the emergency department and inpatient setting, through to discharge or death, for approximately 2.6 million patients transported by the Ambulance Service of New South Wales to emergency departments between June 2006 and July 2009. Manual, deterministic, and probabilistic data linkages are described, and potential applications of linked data in EMS research are outlined.

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Research paper thumbnail of The pre-hospital epidemiology and management of spinal cord injuries in New South Wales: 2004–2008

Injury, 2012

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Research paper thumbnail of Right care, right time, right place: improving outcomes for people with spinal cord injury through early access to intervention and improved access to specialised care: study protocol

BMC Health Services Research, 2014

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Research paper thumbnail of Multicultural presentation of chest pain at an emergency department in Australia

Emergency Medicine Australasia, 2021

To investigate differences in presenting patient characteristics, investigation, management and r... more To investigate differences in presenting patient characteristics, investigation, management and related outcomes between culturally and linguistically diverse (CALD) and non-CALD chest pain (CP) patients presenting to the ED. A cohort study of 258 patients was enrolled on presentation to Liverpool Hospital ED with a complaint of CP over a 2-week period. Main outcomes included frequency and timeliness of diagnostic and radiological investigations, medication administered and ED length of stay. Both CALD and non-CALD ED CP patients had similar test ordering, medication administration and clinical outcomes, but this was in the context of CALD patients being 10 years older together with a small study sample size. A larger cohort, matched for age, would provide further insights into potentially important differences.

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Research paper thumbnail of Non invasive classification of severe sepsis using a nonlinear support vector machine

Physiological Measurement, 2010

Sepsis has been defined as the systemic response to infection in critically ill patients, with se... more Sepsis has been defined as the systemic response to infection in critically ill patients, with severe sepsis and septic shock representing increasingly
severe stages of the same disease. Based on the non-invasive cardiovascular spectrum analysis, this paper presents a pilot study on the potential use of the nonlinear support vector machine (SVM) in the classification of the sepsis continuum into severe sepsis and systemic inflammatory response syndrome (SIRS) groups. 28 consecutive eligible patients attending the emergency department with presumptive diagnoses of sepsis syndrome have participated in this study. Through principal component analysis (PCA), the first three principal components were used to construct the SVM feature space. The SVM classifier with a fourth-order polynomial kernel was found to have a better overall performance compared with the other SVM classifiers, showing the following classification results: sensitivity=94.44%, specificity=62.50%, positive predictive value = 85.00%, negative predictive value = 83.33% and accuracy = 84.62%. Our classification results suggested that the combinatory use of cardiovascular spectrum analysis and the proposed SVM classification of autonomic neural activity is a potentially useful clinical tool to classify the sepsis continuum into two distinct pathological groups of varying sepsis severity.

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Research paper thumbnail of Non-invasive Sepsis Patient Classification using Least Squares Support Vector Machine

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Research paper thumbnail of Are out-of-hospital cardiac arrest survival rates improving?

Resuscitation, Jan 19, 2015

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Research paper thumbnail of A comparison of survival following out-of-hospital cardiac arrest in Sydney, Australia, between 2004-2005 and 2009-2010

Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine, 2013

To determine whether survival following out-of- hospital cardiac arrest (OHCA) in Sydney, Austral... more To determine whether survival following out-of- hospital cardiac arrest (OHCA) in Sydney, Australia, improved between 2004-2005 and 2009-2010, and whether there was a change in incidence of OHCA. Retrospective study using the Ambulance Service of New South Wales and NSW Registry of Births, Deaths and Marriages databases. All patients who had an OHCA in the Sydney metropolitan area and who used the Ambulance Service of NSW between June 2009 and May 2010 (2009-2010), and between June 2004 and May 2005 (2004-2005). Survival to 90 days. Other outcome measures included the incidence of OHCA and survival to the day following OHCA, 28 days and 1 year following OHCA. Survival and incidence were also calculated according to initial electrocardiograph rhythm. Survival to 90 days was 12.3% in 2004-2005 and 10.2% in 2009-2010 (P = 0.015). In 2004-2005, the age standardised incidence of OHCA was 52.6 events per 100 000 person-years (95% CI, 51.6-53.6 events per 100 000 person-years), and in 2009...

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Research paper thumbnail of Near-drowning treated with therapeutic hypothermia

The Medical journal of Australia, Jan 21, 2005

... Shading indicates reference ranges. Jonathan P Williamson, MB BS, BSc(Med), Intensive Care an... more ... Shading indicates reference ranges. Jonathan P Williamson, MB BS, BSc(Med), Intensive Care and Respiratory Registrar1. Stan Braude, MD, FRACP, Intensivist, and Clinical Associate Professor, University of Sydney, NSW2. ...

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Research paper thumbnail of Paramedic-performed Fascia Iliaca Compartment Block for Femoral Fractures: A Controlled Trial

The Journal of Emergency Medicine, 2015

Femoral (thigh) fractures are an important clinical problem commonly encountered by paramedics. T... more Femoral (thigh) fractures are an important clinical problem commonly encountered by paramedics. These injuries are painful, and the need for extrication and transport adds complexity to the management of this condition. Whereas traditional analgesia involves parenteral opioids, regional nerve blockade for femoral fractures have been demonstrated to be effective when performed by physicians. Regional peripheral nerve blockade performed by paramedics may be suitable in the prehospital setting. To examine the efficacy and feasibility of paramedic-performed fascia iliaca compartment block (FICB) for patients with suspected hip or femur fractures in the prehospital setting compared to intravenous morphine alone. Prior to treatment allocation, all patients received a loading dose of morphine intravenously, then received either 1) FICB using lidocaine with epinephrine; or 2) standard care (further intravenous morphine only) in this nonblinded, randomized control trial. Participants rated their pain using a standard 11-point verbal numerical rating scale prior to and 15 min after receiving the allocated treatment. Secondary outcomes included effectiveness at other time points and incidence of adverse effects. We analyzed 11 and 13 patients in the FICB and standard care groups, respectively. Patients treated with FICB had a greater reduction in their median pain score than patients in the standard care group (50% vs. 22%, p = 0.025) after 15 min. In the FICB group, median pain scores decreased by 5 (interquartile range 4-6), compared to 2 (interquartile range 0-4) in the standard care group. The FICB procedure did not significantly impact on scene times. No immediately obvious adverse events were noted in the 11 participants who received FICB from paramedics. The study suggests that FICB can be performed by trained paramedics for patients with suspected femoral fractures.

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Research paper thumbnail of Diagnostic physiological scoring in a model of early haemorrhagic shock

The Journal of emergency medicine, Feb 1, 2006

... Diagnostic physiological scoring in a model of early haemorrhagic shock. Paul Middleton. No a... more ... Diagnostic physiological scoring in a model of early haemorrhagic shock. Paul Middleton. No abstract is available. To read the body of this article, please view the PDF online. Prince of Wales Hospital P, P University of New South Wales. PII: S0736-4679(06)00089-8. ...

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Research paper thumbnail of Understanding patient preferences for emergency care for lower triage acuity presentations during GP hours: a qualitative study in Australia

BMC Health Services Research

Background Low acuity presentations to Australian emergency departments drive long wait times, hi... more Background Low acuity presentations to Australian emergency departments drive long wait times, higher costs and may be better treated in primary care settings. This study sought to understand factors leading these patients to present to emergency departments. Methods Semi-structured interviews were carried out with patients at two tertiary emergency departments in Sydney during general practitioner opening hours. Nvivo was used to code the interviews and a thematic analysis was carried out to capture the main themes from the interviews. Results Forty-four interviews were included in the analysis across the two sites. They represented a diverse population in terms of ethnicity, education and socioeconomic background. Patient preferences for emergency care were organised into four main themes: (i) patients were referred (either by another health service, work, friend, or family), (ii) emergency department factors (convenience of investigations and severity of symptoms requiring emerge...

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Research paper thumbnail of Video head impulse testing to differentiate vestibular neuritis from posterior circulation stroke in the emergency department: a prospective observational study

BMJ Neurology Open

Background and aimsVertigo is a common presentation to the emergency department (ED) with 5% of p... more Background and aimsVertigo is a common presentation to the emergency department (ED) with 5% of presentations due to posterior circulation stroke (PCS). Bedside investigations such as the head impulse test (HIT) are used to risk stratify patients, but interpretation is operator dependent. The video HIT (v-HIT) provides objective measurement of the vestibular-ocular-reflex (VOR) and may improve diagnostic accuracy in acute vestibular syndrome (AVS). We aimed to evaluate the use of v-HIT as an adjunct to clinical assessment to acutely differentiate vestibular neuritis (VN) from PCS.Methods133 patients with AVS were consecutively enrolled from the ED of our comprehensive stroke centre between 2018 and 2021. Patient assessment included a targeted vestibular history, HINTs examination (Head Impulse, Nystagmus and Test of Skew), v-HIT and MRI>48 hours after symptom onset. The HINTS/v-HIT findings were analysed and compared between VN, PCS and other cause AVS. Clinical course, v-HIT and...

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Research paper thumbnail of Improving community-based first response to out of hospital cardiac arrest (FirstCPR): protocol for a cluster randomised controlled trial

BMJ Open

IntroductionOut-of-hospital cardiac arrest (OHCA) is associated with poor survival outcomes, but ... more IntroductionOut-of-hospital cardiac arrest (OHCA) is associated with poor survival outcomes, but prompt bystander action can more than double survival rates. Being trained, confident and willing-to-perform cardiopulmonary resuscitation (CPR) are known predictors of bystander action. This study aims to assess the effectiveness of a community organisation targeted multicomponent education and training initiative on being willing to respond to OHCAs. The study employs a novel approach to reaching community members via social and cultural groups, and the intervention aims to address commonly cited barriers to training including lack of availability, time and costs.Methods and analysisFirstCPR is a cluster randomised trial that will be conducted across 200 community groups in urban and regional Australia. It will target community groups where CPR training is not usual. Community groups (clusters) will be stratified by region, size and organisation type, and then randomly assigned to eith...

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Research paper thumbnail of Change in stroke presentations during COVID-19 pandemic in South-Western Sydney

BackgroundAustralia managed relatively well during the global COVID-19 pandemic owing to our swif... more BackgroundAustralia managed relatively well during the global COVID-19 pandemic owing to our swift mandated public health response. During the NSW lockdown restrictions, we noted a decrease in acute stroke presentations at our institution, similar to what was subsequently reported worldwide.AimsWe aimed to test our hypothesis that (i) the true numbers of ischaemic strokes did not change, however patients were presenting later and (ii) the proportion of TIAs decreased.MethodsWe conducted a retrospective audit of all stroke and TIA presentations in 2020 and compared these with data from 2019. We collected information about stroke subtype, severity, time from stroke/TIA onset to presentation and acute reperfusion therapies.ResultsBetween January-February and April-March 2020, there was a 15% drop in acute stroke presentations (128 vs. 109). In the same period “stroke mimic” presentations dropped by 22%. The proportion of patients attending the emergency department within 4.5hrs was onl...

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Research paper thumbnail of Part 8: Advanced Life Support

Circulation, 2010

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Research paper thumbnail of Part 7: CPR Techniques and Devices

Circulation, 2010

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Research paper thumbnail of A Global Survey of Emergency Department Responses to the COVID-19 Pandemic

Western Journal of Emergency Medicine, 2021

Introduction: Emergency departments (ED) globally are addressing the coronavirus disease 2019 (CO... more Introduction: Emergency departments (ED) globally are addressing the coronavirus disease 2019 (COVID-19) pandemic with varying degrees of success. We leveraged the 17-country, Emergency Medicine Education & Research by Global Experts (EMERGE) network and non-EMERGE ED contacts to understand ED emergency preparedness and practices globally when combating the COVID-19 pandemic. Methods: We electronically surveyed EMERGE and non-EMERGE EDs from April 3–June 1, 2020 on ED capacity, pandemic preparedness plans, triage methods, staffing, supplies, and communication practices. The survey was available in English, Mandarin Chinese, and Spanish to optimize participation. We analyzed survey responses using descriptive statistics. Results: 74/129 (57%) EDs from 28 countries in all six World Health Organization global regions responded. Most EDs were in Asia (49%), followed by North America (28%), and Europe (14%). Nearly all EDs (97%) developed and implemented protocols for screening, testing,...

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Research paper thumbnail of Multicultural presentation of chest pain at an emergency department in Australia

Emergency Medicine Australasia, 2020

To investigate differences in presenting patient characteristics, investigation, management and r... more To investigate differences in presenting patient characteristics, investigation, management and related outcomes between culturally and linguistically diverse (CALD) and non‐CALD chest pain (CP) patients presenting to the ED.

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Research paper thumbnail of A systematic review of the cost and benefit of helicopter emergency medical services

Injury, 2009

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Research paper thumbnail of The Methodology of the Australian Prehospital Outcomes Study of Longitudinal Epidemiology (APOStLE) Project

Prehospital Emergency Care, 2012

This paper describes the methodology of a large emergency medical services (EMS) data linkage res... more This paper describes the methodology of a large emergency medical services (EMS) data linkage research project currently under way in the statewide EMS system of New South Wales, Australia. The paper is intended to provide the reader with an understanding of how linkage techniques can be used to facilitate EMS research. This project, the Australian Prehospital Outcomes Study of Longitudinal Epidemiology (APOStLE) Project, links data from six statewide sources (computer-assisted dispatch, EMS patient health care reports, emergency department data, inpatient data, and two death registries) to enable researchers to examine the patient's entire journey through the health care system, from the emergency 0-0-0 call to the emergency department and inpatient setting, through to discharge or death, for approximately 2.6 million patients transported by the Ambulance Service of New South Wales to emergency departments between June 2006 and July 2009. Manual, deterministic, and probabilistic data linkages are described, and potential applications of linked data in EMS research are outlined.

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Research paper thumbnail of The pre-hospital epidemiology and management of spinal cord injuries in New South Wales: 2004–2008

Injury, 2012

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Research paper thumbnail of Right care, right time, right place: improving outcomes for people with spinal cord injury through early access to intervention and improved access to specialised care: study protocol

BMC Health Services Research, 2014

Bookmarks Related papers MentionsView impact

Research paper thumbnail of Multicultural presentation of chest pain at an emergency department in Australia

Emergency Medicine Australasia, 2021

To investigate differences in presenting patient characteristics, investigation, management and r... more To investigate differences in presenting patient characteristics, investigation, management and related outcomes between culturally and linguistically diverse (CALD) and non-CALD chest pain (CP) patients presenting to the ED. A cohort study of 258 patients was enrolled on presentation to Liverpool Hospital ED with a complaint of CP over a 2-week period. Main outcomes included frequency and timeliness of diagnostic and radiological investigations, medication administered and ED length of stay. Both CALD and non-CALD ED CP patients had similar test ordering, medication administration and clinical outcomes, but this was in the context of CALD patients being 10 years older together with a small study sample size. A larger cohort, matched for age, would provide further insights into potentially important differences.

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Research paper thumbnail of Non invasive classification of severe sepsis using a nonlinear support vector machine

Physiological Measurement, 2010

Sepsis has been defined as the systemic response to infection in critically ill patients, with se... more Sepsis has been defined as the systemic response to infection in critically ill patients, with severe sepsis and septic shock representing increasingly
severe stages of the same disease. Based on the non-invasive cardiovascular spectrum analysis, this paper presents a pilot study on the potential use of the nonlinear support vector machine (SVM) in the classification of the sepsis continuum into severe sepsis and systemic inflammatory response syndrome (SIRS) groups. 28 consecutive eligible patients attending the emergency department with presumptive diagnoses of sepsis syndrome have participated in this study. Through principal component analysis (PCA), the first three principal components were used to construct the SVM feature space. The SVM classifier with a fourth-order polynomial kernel was found to have a better overall performance compared with the other SVM classifiers, showing the following classification results: sensitivity=94.44%, specificity=62.50%, positive predictive value = 85.00%, negative predictive value = 83.33% and accuracy = 84.62%. Our classification results suggested that the combinatory use of cardiovascular spectrum analysis and the proposed SVM classification of autonomic neural activity is a potentially useful clinical tool to classify the sepsis continuum into two distinct pathological groups of varying sepsis severity.

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Research paper thumbnail of Non-invasive Sepsis Patient Classification using Least Squares Support Vector Machine

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Research paper thumbnail of Are out-of-hospital cardiac arrest survival rates improving?

Resuscitation, Jan 19, 2015

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Research paper thumbnail of A comparison of survival following out-of-hospital cardiac arrest in Sydney, Australia, between 2004-2005 and 2009-2010

Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine, 2013

To determine whether survival following out-of- hospital cardiac arrest (OHCA) in Sydney, Austral... more To determine whether survival following out-of- hospital cardiac arrest (OHCA) in Sydney, Australia, improved between 2004-2005 and 2009-2010, and whether there was a change in incidence of OHCA. Retrospective study using the Ambulance Service of New South Wales and NSW Registry of Births, Deaths and Marriages databases. All patients who had an OHCA in the Sydney metropolitan area and who used the Ambulance Service of NSW between June 2009 and May 2010 (2009-2010), and between June 2004 and May 2005 (2004-2005). Survival to 90 days. Other outcome measures included the incidence of OHCA and survival to the day following OHCA, 28 days and 1 year following OHCA. Survival and incidence were also calculated according to initial electrocardiograph rhythm. Survival to 90 days was 12.3% in 2004-2005 and 10.2% in 2009-2010 (P = 0.015). In 2004-2005, the age standardised incidence of OHCA was 52.6 events per 100 000 person-years (95% CI, 51.6-53.6 events per 100 000 person-years), and in 2009...

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Research paper thumbnail of Near-drowning treated with therapeutic hypothermia

The Medical journal of Australia, Jan 21, 2005

... Shading indicates reference ranges. Jonathan P Williamson, MB BS, BSc(Med), Intensive Care an... more ... Shading indicates reference ranges. Jonathan P Williamson, MB BS, BSc(Med), Intensive Care and Respiratory Registrar1. Stan Braude, MD, FRACP, Intensivist, and Clinical Associate Professor, University of Sydney, NSW2. ...

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Research paper thumbnail of Paramedic-performed Fascia Iliaca Compartment Block for Femoral Fractures: A Controlled Trial

The Journal of Emergency Medicine, 2015

Femoral (thigh) fractures are an important clinical problem commonly encountered by paramedics. T... more Femoral (thigh) fractures are an important clinical problem commonly encountered by paramedics. These injuries are painful, and the need for extrication and transport adds complexity to the management of this condition. Whereas traditional analgesia involves parenteral opioids, regional nerve blockade for femoral fractures have been demonstrated to be effective when performed by physicians. Regional peripheral nerve blockade performed by paramedics may be suitable in the prehospital setting. To examine the efficacy and feasibility of paramedic-performed fascia iliaca compartment block (FICB) for patients with suspected hip or femur fractures in the prehospital setting compared to intravenous morphine alone. Prior to treatment allocation, all patients received a loading dose of morphine intravenously, then received either 1) FICB using lidocaine with epinephrine; or 2) standard care (further intravenous morphine only) in this nonblinded, randomized control trial. Participants rated their pain using a standard 11-point verbal numerical rating scale prior to and 15 min after receiving the allocated treatment. Secondary outcomes included effectiveness at other time points and incidence of adverse effects. We analyzed 11 and 13 patients in the FICB and standard care groups, respectively. Patients treated with FICB had a greater reduction in their median pain score than patients in the standard care group (50% vs. 22%, p = 0.025) after 15 min. In the FICB group, median pain scores decreased by 5 (interquartile range 4-6), compared to 2 (interquartile range 0-4) in the standard care group. The FICB procedure did not significantly impact on scene times. No immediately obvious adverse events were noted in the 11 participants who received FICB from paramedics. The study suggests that FICB can be performed by trained paramedics for patients with suspected femoral fractures.

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