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Article: Fishing for Trouble: A Novel Surgical Technique for Penetrating Fishhook Injuries of the Eyelid.

Brown, Nathan J / Legocki, Alex T / Tam, Emily K / Baran, Francine M

2023 Volume 15, Issue 3, Page(s) e36478

Abstract: Fishhook injuries commonly occur and may present as ophthalmic surgical emergencies. Choosing the appropriate removal technique is critical and depends on the involved extra- and intra-ocular structures and hook characteristics. We describe the case of a ...

Abstract	Fishhook injuries commonly occur and may present as ophthalmic surgical emergencies. Choosing the appropriate removal technique is critical and depends on the involved extra- and intra-ocular structures and hook characteristics. We describe the case of a challenging fishhook removal where a novel surgical technique was developed. An eight-year-old boy presented with a full-thickness fishhook injury to the eyelid. During removal surgery, the thickness and density of the fishhook prevented surgical tools from transecting the shank. A novel approach was deemed necessary for safe removal, termed the clamp and retract technique. To our knowledge, this is its first documented use in the literature.
Language	English
Publishing date	2023-03-21
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.36478
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Article ; Online: Bilateral vision loss as initial presentation of chronic myeloid leukemia in a young adult: A case report and review of the literature.

Brown, Nathan J / Kaya, Erin A / Haymore, Jonathan G / Gioia, Lauren V

American journal of ophthalmology case reports

2022 Volume 26, Page(s) 101579

Abstract: Purpose: To report a case of bilateral vision loss as the primary presenting symptom of chronic myeloid leukemia in a young adult.: Observations: The 28-year-old male patient presented to clinic with visual acuity of 20/200 in both eyes after several ...

Abstract	Purpose: To report a case of bilateral vision loss as the primary presenting symptom of chronic myeloid leukemia in a young adult. Observations: The 28-year-old male patient presented to clinic with visual acuity of 20/200 in both eyes after several months of episodic bilateral vision loss. Intraretinal and pre-retinal hemorrhages were appreciated, as well as Roth spots and peripheral neovascularization. Initial lab findings were consistent with a diagnosis of acute myeloid leukemia, later, upon bone marrow examination, the diagnosis was edited to chronic myeloid leukemia. Dasatinib therapy resulted in a complete hematologic resolution after six weeks. After intravitreal injections of bevacizumab in both eyes, visual acuity improved to 20/25 in the right eye and 20/20 in the left eye. Conclusion and importance: After review, this is one of only a few reported cases of bilateral blurry vision as the primary presenting symptom of chronic myeloid leukemia in a young adult. Because visual disturbances occur more frequently in acute myeloid leukemia, and lab results may be inconclusive, careful consideration should be given to differentiate myelogenous leukemias, as the acute and chronic subtypes may present similarly.
Language	English
Publishing date	2022-05-09
Publishing country	United States
Document type	Case Reports
ISSN	2451-9936
ISSN (online)	2451-9936
DOI	10.1016/j.ajoc.2022.101579
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Article ; Online: Enhancing pain care with the American Pain Society Patient Outcome Questionnaire for use in the emergency department (APS-POQ-RED): validating a patient-reported outcome measure.

Hughes, James A / Hazelwood, Sarah / Lyrstedt, Anna-Lisa / Jones, Lee / Brown, Nathan J / Jarugula, Rajeev / Douglas, Clint / Chu, Kevin

BMJ open quality

2024 Volume 13, Issue 1

Abstract: Background: In general, the quality of pain care in emergency departments (ED) is poor, despite up to 80% of all ED patients presenting with pain. This may be due to the lack of well-validated patient-reported outcome measures (PROMs) of pain care in ... ...

Abstract	Background: In general, the quality of pain care in emergency departments (ED) is poor, despite up to 80% of all ED patients presenting with pain. This may be due to the lack of well-validated patient-reported outcome measures (PROMs) of pain care in the ED setting. The American Pain Society-Patient Outcome Questionnaire-Revised Edition (APS-POQ-R), with slight modification for ED patients, is a potentially useful PROM for the adult ED, however it is yet to be completely validated. Methods: Adult patients, who had presented with moderate to severe acute pain, were recruited at two large inner-city EDs in Australia. A modified version of the APS-POQ-R was administered at the completion of their ED care. Responses were randomly split into three groups and underwent multiple rounds of exploratory and confirmatory factor analysis with testing for construct, convergent, divergent validity and internal consistency. Results: A total of 646 ED patients (55.6% female), with a median age of 48.3 years, and moderate to severe pain on arrival, completed the ED-modified APS-POQ-R. Psychometric evaluation resulted in a reduced nine-question tool, which measures three constructs (pain relief and satisfaction (α=0.891), affective distress (α=0.823) and pain interference (α=0.908)) and demonstrated construct, convergent, divergent validity, and internal consistency. Conclusions: This new tool, which we refer to as the American Pain Society-Patient Outcome Questionnaire-Revised for the ED (APS-POQ-RED), should form the basis for reporting patient-reported outcomes of ED pain care in future quality improvement and research.
MeSH term(s)	Adult ; Humans ; Female ; Middle Aged ; Male ; Pain ; Pain Management ; Australia ; Emergency Service, Hospital ; Patient Reported Outcome Measures
Language	English
Publishing date	2024-03-05
Publishing country	England
Document type	Journal Article
ISSN	2399-6641
ISSN (online)	2399-6641
DOI	10.1136/bmjoq-2023-002295
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Article: The Importance of Research Experience With a Scoreless Step 1: A Student Survey at a Community-Based Medical School.

Radulovich, Nicholas P / Burke, Skyler / Brown, Nathan J / Jones, Brett / Antongiovanni, James / Nanu, Douglas / Roll, John

Cureus

2023 Volume 15, Issue 8, Page(s) e43476

Abstract: Purpose: As of January 26, 2022, the United States Medical Licensing Examination (USLME) step 1 exam went from a scored test to pass-fail step 1 (PFS1). The authors were interested in surveying medical students at a community-based medical school to ... ...

Abstract	Purpose: As of January 26, 2022, the United States Medical Licensing Examination (USLME) step 1 exam went from a scored test to pass-fail step 1 (PFS1). The authors were interested in surveying medical students at a community-based medical school to observe their perceptions of the importance of student research given this recent change. Method: A Qualtrics survey was disseminated to medical students (years 1-4) via school emails. Data were analyzed using the Mann-Whitney test to assess Likert scale scores, and narrative comments were grouped as qualitative feedback. Survey dissemination and analysis of data were both conducted at a large community-based medical school. Results: The survey sampled 104 students categorized into pre-clerkship (PC) and clerkship (CL) years, with a response rate of 33%. A contradiction was found, as indicated by the higher number ( Conclusions: Efforts to make the step 1 exam pass/fail may have alleviated some stress related to performance but may have increased the perception of the importance of other components in a student's residency application. Our survey highlights how medical students at a community-based medical school perceive this change and how it has affected their research efforts.
Language	English
Publishing date	2023-08-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.43476
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Article ; Online: Determinants of fatigue in emergency department clinicians who wear personal protective equipment.

Bodnar, Daniel / Brown, Nathan J / Mitchell, Gary / Hughes, James A / Lourensen, Darren / Hawkins, Tracey / Chu, Kevin

Emergency medicine Australasia : EMA

2023 Volume 36, Issue 1, Page(s) 39–46

Abstract: Objective: To determine the independent predictors for clinician fatigue and decline in cognitive function following a shift in the ED during early stages of the COVID-19 pandemic.: Methods: This was a prospective, quasi-experimental study conducted ... ...

Abstract	Objective: To determine the independent predictors for clinician fatigue and decline in cognitive function following a shift in the ED during early stages of the COVID-19 pandemic. Methods: This was a prospective, quasi-experimental study conducted in a metropolitan adult tertiary-referral hospital ED over 20 weeks in 2021. The participants were ED doctors and nurses working clinical shifts in an ED isolation area or high-risk zone (HRZ) with stringent personal protective equipment (PPE). The participants' objective and subjective fatigue was measured by the Samn-Perelli fatigue score and a psychomotor vigilance 'smart game' score, respectively. Postural signs/symptoms and urine specific gravity (SG) were measured as markers of dehydration. Results: Sixty-three participants provided data for 263 shifts. Median (interquartile range) age was 33 (28-38) years, 73% were female. Worsening fatigue score was associated with working afternoon shifts (afternoon vs day, adjusted odds ratio [aOR] 5.16 [95% confidence interval (CI) 1.32-20.02]) and in non-HRZ locations (HRZ vs non-HRZ, aOR 0.23 [95% CI 0.06-0.87]). Worsening cognitive function (game score) was associated with new onset postural symptoms (new vs no symptoms, aOR 4.14 [95% CI 1.34-12.51]) and afternoon shifts (afternoon vs day, aOR 3.13 [95% CI 1.16-8.44]). Working in the HRZ was not associated with declining cognitive function. Thirty-four (37%) of the 92 participants had an end of shift urine SG >1.030. Conclusion: Working afternoon shifts was associated with fatigue. There was no association between HRZ allocation and fatigue, but our study was limited by a low COVID workload and fluctuating PPE requirements in the non-HRZs. Workplace interventions that target the prevention of fatigue in ED clinicians working afternoon shifts should be prioritised.
MeSH term(s)	Adult ; Humans ; Female ; Male ; Work Schedule Tolerance ; Prospective Studies ; Pandemics ; Fatigue/etiology ; Fatigue/diagnosis ; Personal Protective Equipment
Language	English
Publishing date	2023-08-15
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2161824-0
ISSN	1742-6723 ; 1742-6731 ; 1035-6851
ISSN (online)	1742-6723
ISSN	1742-6731 ; 1035-6851
DOI	10.1111/1742-6723.14291
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Article ; Online: Developing Robust Clinical Text Deep Learning Models - A "Painless" Approach.

Wu, Yutong / Hughes, James A / Lyrstedt, Anna-Lisa / Hazelwood, Sarah / Brown, Nathan J / Jones, Lee / Douglas, Clint / Jarugula, Rajeev / Chu, Kevin / Nguyen, Anthony

Studies in health technology and informatics

2024 Volume 310, Page(s) 705–709

Abstract: The success of deep learning in natural language processing relies on ample labelled training data. However, models in the health domain often face data inadequacy due to the high cost and difficulty of acquiring training data. Developing such models ... ...

Abstract	The success of deep learning in natural language processing relies on ample labelled training data. However, models in the health domain often face data inadequacy due to the high cost and difficulty of acquiring training data. Developing such models thus requires robustness and performance on new data. A generalised incremental multiphase framework is proposed for developing robust and performant clinical text deep learning classifiers. It incorporates incremental multiphases for training data size assessments, cross-validation setup to avoid test data bias, and robustness testing through inter/intra-model significance analysis. The framework's effectiveness and generalisation were confirmed by the task of identifying patients presenting in 'pain' to the emergency department.
MeSH term(s)	Humans ; Deep Learning ; Emergency Service, Hospital ; Natural Language Processing ; Pain ; Research Design
Language	English
Publishing date	2024-01-25
Publishing country	Netherlands
Document type	Journal Article
ISSN	1879-8365
ISSN (online)	1879-8365
DOI	10.3233/SHTI231056
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Article ; Online: Helical side chain chemistry of a peptoid-based SP-C analogue: Balancing structural rigidity and biomimicry.

Brown, Nathan J / Lin, Jennifer S / Barron, Annelise E

Biopolymers

2019 Volume 110, Issue 6, Page(s) e23277

Abstract: Surfactant protein C (SP-C) is an important constituent of lung surfactant (LS) and, along with SP-B, is included in exogenous surfactant replacement therapies for treating respiratory distress syndrome (RDS). SP-C's biophysical activity depends upon the ...

Abstract	Surfactant protein C (SP-C) is an important constituent of lung surfactant (LS) and, along with SP-B, is included in exogenous surfactant replacement therapies for treating respiratory distress syndrome (RDS). SP-C's biophysical activity depends upon the presence of a rigid C-terminal helix, of which the secondary structure is more crucial to functionality than precise side-chain chemistry. SP-C is highly sequence-conserved, suggesting that the β-branched, aliphatic side chains of the helix are also important. Nonnatural mimics of SP-C were created using a poly-N-substituted glycine, or "peptoid," backbone. The mimics included varying amounts of α-chiral, aliphatic side chains and α-chiral, aromatic side chains in the helical region, imparting either biomimicry or structural rigidity. Biophysical studies confirmed that the peptoids mimicked SP-C's secondary structure and replicated many of its surface-active characteristics. Surface activity was optimized by incorporating both structurally rigid and biomimetic side chain chemistries in the helical region indicating that both characteristics are important for activity. By balancing these features in one mimic, a novel analogue was created that emulates SP-C's in vitro surface activity while overcoming many of the challenges related to natural SP-C. Peptoid-based analogues hold great potential for use in a synthetic, biomimetic LS formulation for treating RDS.
MeSH term(s)	Biomimetic Materials/chemical synthesis ; Biomimetic Materials/chemistry ; Biomimetic Materials/metabolism ; Circular Dichroism ; Drug Design ; Lipid Bilayers/chemistry ; Lipid Bilayers/metabolism ; Microscopy, Fluorescence ; Peptoids/chemical synthesis ; Peptoids/chemistry ; Peptoids/metabolism ; Protein Conformation, alpha-Helical ; Protein Precursors/chemistry ; Proteolipids/chemistry ; Surface Properties
Chemical Substances	Lipid Bilayers ; Peptoids ; Protein Precursors ; Proteolipids ; surfactant protein B propeptide
Language	English
Publishing date	2019-04-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	1123-x
ISSN	1097-0282 ; 0006-3525
ISSN (online)	1097-0282
ISSN	0006-3525
DOI	10.1002/bip.23277
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Article ; Online: Hypofibrinogenaemia and hypocalcaemia in adult trauma patients receiving pre-hospital packed red blood cell transfusions: Potential for supplementary pre-hospital therapeutic interventions.

Bodnar, Daniel / Stevens, Zoe / Williams, Sue / Handy, Michael / Rashford, Steven / Brown, Nathan J

Emergency medicine Australasia : EMA

2021 Volume 34, Issue 3, Page(s) 333–340

Abstract: Objective: To report the arrival ionised calcium (iCa) and fibrinogen concentrations in trauma patients treated with packed red blood cells by the road-based high-acuity response units of a metropolitan ambulance service.: Methods: A retrospective ... ...

Abstract	Objective: To report the arrival ionised calcium (iCa) and fibrinogen concentrations in trauma patients treated with packed red blood cells by the road-based high-acuity response units of a metropolitan ambulance service. Methods: A retrospective review of trauma patients treated with packed red blood cells by high-acuity response units between January 2012 and December 2016. Patients were identified from databases at southeast Queensland adult trauma centres, Pathology Queensland Central Transfusion Laboratory, Gold Coast University Hospital blood bank and the Queensland Ambulance Service. Patient characteristics, results of laboratory tests within 30 min of ED arrival were analysed. Results: A total of 164 cases were analysed. The median injury severity score was 33.5 (interquartile range 22-41), with blunt trauma the commonest mechanism of injury (n = 128, 78.0%). Fifty-eight of the 117 patients (24.4%) with fibrinogen measured had a fibrinogen concentration ≤1.5 g/L; 79 of the 123 patients (64.2%) with an international normalised ratio (INR) measurement had an INR >1.2; 97 of 148 patients (63.8%) with an iCa measured, had an iCa below the Pathology Queensland reference range of 1.15-1.32 mmol/L. Arrival fibrinogen concentration ≤1.5 g/L and arrival iCa ≤1.00 were associated with in-hospital mortality with odds ratio 11.90 (95% confidence interval 4.50-31.65) and odds ratio 4.97 (95% confidence interval 1.42-17.47), respectively. Conclusions: Hypocalcaemia and hypofibrinogenaemia on ED arrival were common in this cohort. Future work should evaluate whether outcomes improve by correction of these deficits during the pre-hospital phase of trauma care.
MeSH term(s)	Adult ; Afibrinogenemia/therapy ; Erythrocyte Transfusion ; Fibrinogen/therapeutic use ; Hospitals ; Humans ; Hypocalcemia ; Injury Severity Score ; Retrospective Studies ; Trauma Centers ; Wounds and Injuries
Chemical Substances	Fibrinogen (9001-32-5)
Language	English
Publishing date	2021-10-27
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2161824-0
ISSN	1742-6723 ; 1742-6731 ; 1035-6851
ISSN (online)	1742-6723
ISSN	1742-6731 ; 1035-6851
DOI	10.1111/1742-6723.13887
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Article ; Online: An initial psychometric evaluation of the APS-POQ-R in acute pain presenting to the emergency department.

Hughes, James A / Jones, Lee / Potter, Joseph / Wong, Alixandra / Brown, Nathan J / Chu, Kevin

Australasian emergency care

2021 Volume 24, Issue 4, Page(s) 287–295

Abstract: Aim: The purpose of this study was to examine the psychometric properties of a modified version of the American Pain Societies - Patient Outcome Questionnaire - Revised edition in adult patients presenting with acute pain to the emergency department.: ...

Abstract	Aim: The purpose of this study was to examine the psychometric properties of a modified version of the American Pain Societies - Patient Outcome Questionnaire - Revised edition in adult patients presenting with acute pain to the emergency department. Background: There is a lack of validation and use of patient-reported outcome measures of pain care in the adult emergency setting. Design: Prospective psychometric evaluation. Methods: Adult patients who had presented with acute pain were invited to participate in the study after their emergency department care. The Questionnaire was administered by one of the investigators. Exploratory factor analysis (principal axis factoring) was used to explore items mapping to constructs. The number of constructs with an Eigenvalue closest to 1 was considered the correct fit for the data. Assessment of the analysis was conducted using the Kaiser-Meier-Olkin test of sampling adequacy, and the fit was assessed using Bartlett's test of sphericity. Results: The Questionnaire demonstrated construct validity in these patients. Exploratory factor analysis demonstrated five constructs. The tool demonstrated discriminatory ability based on patient urgency, and subscale measurement was associated with patient satisfaction with care CONCLUSIONS: The Questionnaire has demonstrable construct validity in adult patients presenting with acute pain to the ED.
MeSH term(s)	Acute Pain/diagnosis ; Adult ; Emergency Service, Hospital ; Humans ; Prospective Studies ; Psychometrics ; Surveys and Questionnaires ; United States
Language	English
Publishing date	2021-01-13
Publishing country	Australia
Document type	Journal Article
ISSN	2588-994X
ISSN (online)	2588-994X
DOI	10.1016/j.auec.2020.12.001
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Article ; Online: The documentation of pain intensity and its influences on care in the emergency department.

Hughes, James A / Chiu, Jacqui / Brown, Nathan J / Hills, Angela / Allwood, Brandon / Chu, Kevin

International emergency nursing

2021 Volume 57, Page(s) 101015

Abstract: Background: Assessment and reassessment of self reported pain intensity scores form the basis of acute pain care in the emergency deprtment (ED), however are frequently undocumented. The effects of not documenting pain assessments on time to first ... ...

Abstract	Background: Assessment and reassessment of self reported pain intensity scores form the basis of acute pain care in the emergency deprtment (ED), however are frequently undocumented. The effects of not documenting pain assessments on time to first analgesic medication (TTA) and ED length of stay (EDLOS) are unknown. Methods: This is a retrospective cross-sectional study to investigate the association between documented evidence of pain intensity scores, TTA and EDLOS in the ED. It also examined the factors associated with the documentation of pain intensity scores. Univariate and multivariable modelling was used on a random sample of presentations. Results: There were no statistically significant associations between the documented evidence of pain intensity scores and TTA or EDLOS. Modelling suggests that patients were less likely to have documented evidence of pain intensity scores if they were male, were streamed to the fast-track treatment area, had a lower burden of co-morbidities, or when the general departmental workload was increased. Conclusions: The documentation of pain intensity scores was not associated with TTA or EDLOS. Some demographic, illness and workload factors are associated with the lack of pain intensity score documentation, however, the effect on patients outcomes needs further investigation.
MeSH term(s)	Cross-Sectional Studies ; Documentation ; Emergency Service, Hospital ; Humans ; Male ; Pain/drug therapy ; Retrospective Studies
Language	English
Publishing date	2021-06-21
Publishing country	England
Document type	Journal Article
ZDB-ID	2420747-0
ISSN	1878-013X ; 1755-599X
ISSN (online)	1878-013X
ISSN	1755-599X
DOI	10.1016/j.ienj.2021.101015
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