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Objective: Improve documentation quality of end-of-life family meetings in a tertiary intensive care unit (ICU). Design: Before-and-after interventional quality improvement project between October 2018 and February 2020 utilising an electronic pro-forma record. Setting: Australian, University affiliated, mixed medical-surgical 22 bed adult ICU. Participants: Patients who were admitted to the ICU for active management and subsequently died during that ICU admission. We enrolled 50 patients who died before and 50 patients after the introduction of the electronic family meeting pro-forma record. Intervention: Through collaboration with ICU medical and nursing staff, End-of-life Special Interest Group and Clinical Documentation Committee we developed the ICU Family Meeting Discussion Note as an electronic pro-forma record with multiple key fields of entry. Main outcome measures: Patient records were examined for the presence of documented details around patient's admission, family meetings and specific elements surrounding the patient's death. Results: The introduction of a pro-forma record markedly improved the quality of documentation of end-of-life care related family meetings. Documentation increased in recording hospital admission date/time (6% vs 84%), meeting location (14% vs 70%), the reason patients were absent from the meeting (34% vs 72%), the Medical Treatment Decision Maker (MTDM) (10% vs 44%), the patient's resuscitation status (22% vs 54%), and treatment options discussed (78% vs 94%) (p ⩽ 0.005 for all). Conclusion: Introducing an electronic pro-forma record to facilitate family meeting documentation increased the frequency of important recorded information. Further studies are required to assess whether documentation quality improvements are sustainable and whether they affect patient- or relative-centred outcomes. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to identify the possible chain of events leading to fatal scuba diving incidents in Australia from 2001–2013 to inform appropriate countermeasures. Methods: The National Coronial Information System was searched to identify scuba diving-related deaths from 2001–2013, inclusive. Coronial findings, witness and police reports, medical histories and autopsies, toxicology and equipment reports were scrutinised. These were analysed for predisposing factors, triggers, disabling agents, disabling injuries and causes of death using a validated template. Results: There were 126 known scuba diving fatalities and 189 predisposing factors were identified, the major being health conditions (59; 47%), organisational/training/experience/skills issues (46; 37%), planning shortcomings (29; 23%) and equipment inadequacies (24; 19%). The 138 suspected triggers included environmental (68; 54%), exertion (23; 18%) and gas supply problems (15; 12%) among others. The 121 identified disabling agents included medical-related (48; 38%), ascent-related (21; 17%), poor buoyancy control (18; 14%), gas supply (17; 13%), environmental (13; 10%) and equipment (4; 3%). The main disabling injuries were asphyxia (37%), cardiac (25%) and cerebral arterial gas embolism/pulmonary barotrauma (15%). Conclusions: Chronic medical conditions, predominantly cardiac-related, are a major contributor to diving incidents. Divers with such conditions and/or older divers should undergo thorough fitness-to-dive assessments. Appropriate local knowledge, planning and monitoring are important to minimise the potential for incidents triggered by adverse environmental conditions, most of which involve inexperienced divers. Chain of events analysis should increase understanding of diving incidents and has the potential to reduce morbidity and mortality in divers. [ABSTRACT FROM AUTHOR]

Barbiturate-related deaths have increased in Australia in two major demographic groups: older people with physical health problems and younger people with mental health problems. The former are the intended beneficiaries of laws that allow euthanasia. The latter have been described as collateral damage from increased access to barbiturates, a class of drug often used for euthanasia, regardless of its legality or illegality. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to identify the number, location and characteristics associated with fatal shark attacks on divers in Australian waters from 1960 to 2017, inclusive. Methods: Searches were made of the Divers Alert Network Asia-Pacific Diving Mortality Database; the International Shark Attack File website; the Australian Shark Attack File and the Global Shark Attack File to identify cases of fatal shark attacks on divers in Australia. In addition, a systematic search of published medical and sporting literature was conducted to identify relevant reports. The data collected were scrutinised for relevance and duplication. Results: There were 187 recorded attacks on divers, comprising 112 snorkellers, 62 scuba divers and 13 on divers using surface-supplied breathing apparatus. These included 28 verified deaths: 13 involving snorkellers, eight involving scuba divers, and seven divers using surface-supply. The victims' ages ranged from 13-50 years (mean 31 years). All but three were males. The vast majority of attacks were by Carcharodon carcharias (Great White Shark). Conclusion: Spearfishing and other seafood collection, as well as diving near fishing activities and/or seals, were identified as major risk factors. However, shark attacks on divers are relatively rare and represent only 3% of diving-related fatalities in Australia over this 57-year period. [ABSTRACT FROM AUTHOR]

Heatwaves are a significant cause of adverse health outcomes and mortality in Australia, worsening with climate change. In Queensland, the northeastern-most state, little is known about the impact of heatwaves outside of the capital city of Brisbane. This study aims to explore the impact of heatwaves on mortality across various demographic and environmental conditions within Queensland from 2010 to 2019. The Excess Heat Factor was used to indicate heatwave periods at the Statistical Area 2 (SA2) level. Registered deaths data from the Australian Bureau of Statistics and heatwave data from the Bureau of Meteorology were matched using a case-crossover approach. Relative risk and 95% confidence intervals were calculated across years, regions, age, sex, rurality, socioeconomic status, and cause of death. Heatwaves were associated with a 5% increase in all-cause mortality compared to deaths on non-heatwave days, with variability across the state. The risk of death on a heatwave day versus a non-heatwave day varied by heatwave severity. Individuals living in urban centers, the elderly, and those living in regions of lower socioeconomic status were most impacted by heatwave mortality. The relative risk of dying from neoplasms, nervous system conditions, respiratory conditions, and mental and behavioral conditions increased during heatwaves. As heatwaves increase in Queensland due to climate change, understanding the impact of heatwaves on mortality across Queensland is important to tailor public health messages. There is considerable variability across communities, demographic groups, and medical conditions, and as such messages need to be tailored to risk., (© 2023. The Author(s).)

There has been a significant increase in the number of peer-reviewed publications, critical reviews and searchable web-based databases, since the first substantial tsunami database for Australia was published in 2007. This review represents a complete reorganization and restructuring of previous work coupled with the addition of new data that takes the number of events from 57 (including 2 erroneous events) to 145. Several significant errors have been corrected including mistaken run-up heights for the event of 19 August 1977, Sumba Island, Indonesia, that suggested it was the largest tsunami in Australia’s history. The largest historical event in the database is now the 17 July 2006, Java, Indonesia, tsunami that had a run-up height of 7.90 m at Steep Point, Western Australia. Although estimated wave heights of 40 ft (∼13 m) were noted for the 8 April 1911 event at Warrnambool, Victoria, no run-up data were provided. One of the more interesting findings has been the occurrence of at least 11 deaths, albeit for events that are generally poorly defined. Data gathered during the construction of this database were rigorously reviewed and as such several previous palaeotsunami entries have been removed and other potentially new ones discarded. The reasons for inclusion or exclusion of data are discussed, and it is acknowledged that while there has been an almost three-fold increase in the number of entries the database is still incomplete. With this in mind the database architecture has been brought in line with others in the region with the ultimate goal of merging them all in order to provide a larger, interrogatable and updatable data set. In essence, the goal is to enhance our understanding of the national and regional tsunami hazard (and risk) and to move towards an open-source database. [ABSTRACT FROM PUBLISHER]

Objective: Cardiovascular disease (CVD) is the leading cause of hospitalisations and deaths in Australia. This study estimates the excess CVD hospitalisations and deaths across seasons and during the December holidays in Queensland, Australia. Methods: The study uses retrospective, longitudinal, population-based cohort data from Queensland, Australia from January 2010 to December 2015. The outcomes were hospitalisations and deaths categorised as CVD-related. CVD events were grouped according to when they occurred in the calendar year. Excess hospitalisations and deaths were estimated using the multivariate ordinary least squares method after adjusting for confounding effects. Results: More CVD hospitalisations and deaths occurred in winter than in summer, with 7811 (CI: 1353, 14,270; p < 0.01) excess hospitalisations and 774 (CI: 35, 1513; p < 0.01) deaths compared to summer. During the coldest month (July), there was an excess of 42 hospitalisations and 7 deaths per 1000 patients. Fewer CVD hospitalisations (-20 (CI: -29, -9; p < 0.01)) occurred during the December holidays than any other period during the calendar year. Non-CVD events were mostly not statistically significant different between periods. Conclusion: Most CVD events in Queensland occurred in winter rather than during the December holidays. Potentially cost-effective initiatives should be explored such as encouraging patients with CVD conditions to wear warmer clothes during cold temperatures and/or insulating the homes of CVD patients who cannot otherwise afford to.

To investigate the spectrum of diseases seen in diabetes mellitus in a forensic context, all autopsy reports of diabetic individuals who presented to Forensic Science, South Australia (FSSA), over a 5-year period from 2005 to 2009 were studied. The leading cause of death was cardiovascular disease (55.0%), followed by unnatural deaths (15.4%) and infections (9.4%). In type 1 diabetics, principal causes of death included cardiovascular disease (44.7%), acute metabolic complications (18.7%), unnatural deaths (17.9%), and infections (8.9%). However, frequencies of these diseases differed in type 2 diabetics, with cardiovascular events responsible for 56.6% of cases, followed by unnatural deaths (15.0%) and infections (10.9%). A larger number of male deaths were seen in all disease categories, except respiratory and gastrointestinal where the frequencies were similar to females. Cardiovascular disease was the leading overall cause of death across all ages except in those under the age of 30 where metabolic complications were more common., (© 2017 American Academy of Forensic Sciences.)

Objective: The aim of the study was to estimate the maximum incidence of agranulocytosis which clozapine would have caused between 2006 and 2010 had there been no blood monitoring system; and to determine the number of clozapine-associated cases of agranulocytosis and related deaths recorded between 1993 and 2011., Method: Records associating clozapine use with white blood cell deficiency (WBCD), in the Therapeutic Goods Administration's Case Line Listing of adverse drug reactions, were examined. The figure of 11,000 was used as the population on clozapine each year from 2006-2010., Results: Between 2006 and 2010 there were 209 cases of clozapine-associated WBCD recorded, probably caused by clozapine in 141 cases. WBCD caused by clozapine could have progressed to agranulocytosis if clozapine had not been withdrawn. The risk of WBCD/agranulocytosis decreased with increasing duration of clozapine use. Between 1993 and 2011 there were 141 recorded cases of agranulocytosis, and four deaths, from clozapine-associated WBDC., Conclusions: During 2006-2010, without any monitoring system, the maximum annual incidence of agranulocytosis caused by clozapine would have been 0.26%. The risks of agranulocytosis, and related deaths, decreased with length of time on clozapine. During 1993-2011 141 cases of agranulocytosis, with four deaths, were recorded in association with clozapine use. The monitoring system could have successfully prevented relatively few deaths.