What is a virtual emergency department? And when should you ‘visit’ one?
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For many Australians the emergency department (ED) is the physical and emblematic front door to accessing urgent health-care services.
But health-care services are evolving rapidly to meet the population’s changing needs. In recent years, we’ve seen growing use of telephone, video, and online health services, including the national healthdirect helpline, 13YARN (a crisis support service for First Nations people), state-funded lines like 13 HEALTH, and bulk-billed telehealth services, which have helped millions of Australians to access health care on demand and from home.
The ED is similarly expanding into new telehealth models to improve access to emergency medical care. Virtual EDs allow people to access the expertise of a hospital ED through their phone, computer or tablet.
All Australian states and the Northern Territory have some form of virtual ED at least in development, although not all of these services are available to the general public at this stage.
So what is a virtual ED, and when is it appropriate to consider using one?
How does a virtual ED work?
A virtual ED is set up to mirror the way you would enter the physical ED front door. First you provide some basic information to administration staff, then you are triaged by a nurse (this means they categorise the level of urgency of your case), then you see the ED doctor. Generally, this all takes place in a single video call.
In some instances, virtual ED clinicians may consult with other specialists such as neurologists, cardiologists or trauma experts to make clinical decisions.
A virtual ED is not suitable for managing medical emergencies which would require immediate resuscitation, or potentially serious chest pains, difficulty breathing or severe injuries.
A virtual ED is best suited to conditions that require immediate attention but are not life-threatening. These could include wounds, sprains, respiratory illnesses, allergic reactions, rashes, bites, pain, infections, minor burns, children with fevers, gastroenteritis, vertigo, high blood pressure, and many more.
People with these sorts of conditions and concerns may not be able to get in to see a GP straight away and may feel they need emergency advice, care or treatment.
When attending the ED, they can be subject to long wait times and delayed specialist attention because more serious cases are naturally prioritised. Attending a virtual ED may mean they’re seen by a doctor more quickly, and can begin any relevant treatment sooner.
From the perspective of the health-care system, virtual EDs are about redirecting unnecessary presentations away from physical EDs, helping them be ready to respond to emergencies. The virtual ED will not hesitate in directing callers to come into the physical ED if staff believe it is an emergency.
The doctor in the virtual ED may also direct the patient to a GP or other health professional, for example if their condition can’t be assessed visually, or if they need physical treatment.
The results so far
Virtual EDs have developed significantly over the past three years, predominantly driven by the COVID pandemic. We are now starting to slowly see assessments of these services.
A recent evaluation my colleagues and I did of Queensland’s Metro North Virtual ED found roughly 30% of calls were directed to the physical ED. This suggests 70% of the time, cases could be managed effectively by the virtual ED.
Preliminary data from a Victorian virtual ED indicates it curbed a similar rate of avoidable ED presentations – 72% of patients were successfully managed by the virtual ED alone. A study on the cost-effectiveness of another Victorian virtual ED suggested it has the potential to generate savings in health-care costs if it prevents physical ED visits.
Only 1.2% of people assessed in Queensland’s Metro North Virtual ED required unexpected hospital admission within 48 hours of being “discharged” from the virtual ED. None of these cases were life-threatening. This indicates the virtual ED is very safe.
The service experienced an average growth rate of 65% each month over a two-year evaluation period, highlighting increasing demand and confidence in the service. Surveys suggested clinicians also view the virtual ED positively.
What now?
We need further research into patient outcomes and satisfaction, as well as the demographics of those using virtual EDs, and how these measures compare to the physical ED across different triage categories.
There are also challenges associated with virtual EDs, including around technology (connection and skills among patients and health professionals), training (for health professionals) and the importance of maintaining security and privacy.
Nonetheless, these services have the potential to reduce congestion in physical EDs, and offer greater convenience for patients.
Eligibility differs between different programs, so if you want to use a virtual ED, you may need to check you are eligible in your jurisdiction. Most virtual EDs can be accessed online, and some have direct phone numbers.
Jaimon Kelly, Senior Research Fellow in Telehealth delivered health services, The University of Queensland
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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A new government inquiry will examine women’s pain and treatment. How and why is it different?
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The Victorian government has announced an inquiry into women’s pain. Given women are disproportionately affected by pain, such a thorough investigation is long overdue.
The inquiry, the first of its kind in Australia and the first we’re aware of internationally, is expected to take a year. It aims to improve care and services for Victorian girls and women experiencing pain in the future.
The gender pain gap
Globally, more women report chronic pain than men do. A survey of over 1,750 Victorian women found 40% are living with chronic pain.
Approximately half of chronic pain conditions have a higher prevalence in women compared to men, including low back pain and osteoarthritis. And female-specific pain conditions, such as endometriosis, are much more common than male-specific pain conditions such as chronic prostatitis/chronic pelvic pain syndrome.
These statistics are seen across the lifespan, with higher rates of chronic pain being reported in females as young as two years old. This discrepancy increases with age, with 28% of Australian women aged over 85 experiencing chronic pain compared to 18% of men.
It feels worse
Women also experience pain differently to men. There is some evidence to suggest that when diagnosed with the same condition, women are more likely to report higher pain scores than men.
Similarly, there is some evidence to suggest women are also more likely to report higher pain scores during experimental trials where the same painful pressure stimulus is applied to both women and men.
Pain is also more burdensome for women. Depression is twice as prevalent in women with chronic pain than men with chronic pain. Women are also more likely to report more health care use and be hospitalised due to their pain than men.
Women seem to feel pain more acutely and often feel ignored by doctors.
ShutterstockMedical misogyny
Women in pain are viewed and treated differently to men. Women are more likely to be told their pain is psychological and dismissed as not being real or “all in their head”.
Hollywood actor Selma Blair recently shared her experience of having her symptoms repeatedly dismissed by doctors and put down to “menstrual issues”, before being diagnosed with multiple sclerosis in 2018.
It’s an experience familiar to many women in Australia, where medical misogyny still runs deep. Our research has repeatedly shown Australian women with pelvic pain are similarly dismissed, leading to lengthy diagnostic delays and serious impacts on their quality of life.
Misogyny exists in research too
Historically, misogyny has also run deep in medical research, including pain research. Women have been viewed as smaller bodied men with different reproductive functions. As a result, most pre-clinical pain research has used male rodents as the default research subject. Some researchers say the menstrual cycle in female rodents adds additional variability and therefore uncertainty to experiments. And while variability due to the menstrual cycle may be true, it may be no greater than male-specific sources of variability (such as within-cage aggression and dominance) that can also influence research findings.
The exclusion of female subjects in pre-clinical studies has hindered our understanding of sex differences in pain and of response to treatment. Only recently have we begun to understand various genetic, neurochemical, and neuroimmune factors contribute to sex differences in pain prevalence and sensitivity. And sex differences exist in pain processing itself. For instance, in the spinal cord, male and female rodents process potentially painful stimuli through entirely different immune cells.
These differences have relevance for how pain should be treated in women, yet many of the existing pharmacological treatments for pain, including opioids, are largely or solely based upon research completed on male rodents.
When women seek care, their pain is also treated differently. Studies show women receive less pain medication after surgery compared to men. In fact, one study found while men were prescribed opioids after joint surgery, women were more likely to be prescribed antidepressants. In another study, women were more likely to receive sedatives for pain relief following surgery, while men were more likely to receive pain medication.
So, women are disproportionately affected by pain in terms of how common it is and sensitivity, but also in how their pain is viewed, treated, and even researched. Women continue to be excluded, dismissed, and receive sub-optimal care, and the recently announced inquiry aims to improve this.
What will the inquiry involve?
Consumers, health-care professionals and health-care organisations will be invited to share their experiences of treatment services for women’s pain in Victoria as part of the year-long inquiry. These experiences will be used to describe the current service delivery system available to Victorian women with pain, and to plan more appropriate services to be delivered in the future.
Inquiry submissions are now open until March 12 2024. If you are a Victorian woman living with pain, or provide care to Victorian women with pain, we encourage you to submit.
The state has an excellent track record of improving women’s health in many areas, including heart, sexual, and reproductive health, but clearly, we have a way to go with women’s pain. We wait with bated breath to see the results of this much-needed investigation, and encourage other states and territories to take note of the findings.
Jane Chalmers, Senior Lecturer in Pain Sciences, University of South Australia and Amelia Mardon, PhD Candidate, University of South Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Can You Gain Muscle & Lose Fat At The Same Time?
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small 😎
❝Is it possible to lose fat and gain muscle at the same time, or do we need to focus on one and then the other, and if so, which order is best?❞
Contrary to popular belief, you can do both simultaneously! However, it’s not as easy as doing just one or the other, which is why most bodybuilders, for example, have a “building phase” and a “cutting phase”.
The reason it’s difficult is because of the diet. Growing muscle doesn’t just take protein and micronutrients; it takes energy as well, which must come from carbohydrates and/or fats. Therefore, it is tricky to eat enough to build muscle and to fuel the workouts that are required to build the muscle (you can’t hit the gym in a state of rabbit starvation* and expect to perform well at your workout), while at the same time not eating enough carbs/fats to have any excess to store as fat.
*So-called because rabbit-meat is very lean, such that when during times of famine, European peasants tried to subsist off mostly rabbits, their health quickly plummeted for lack of energy. It’s also been called “salmon starvation”, apparently, for the same reason:
In French it’s called “Mal de caribou” (caribou sickness), by the way. But you get the idea: eat too much lean protein without enough carbs/fats, and woe shall befall.
So, if you want to do both at once, you need to be incredibly on top of your macros, and the bad news is, only you (or a coach working directly with you) can work out what precise macros requirements your body has, because it depends on your body and your activities.
The easier “half-way house”
We will get to the “building phase” and “cutting phase” of bodybuilders, but first, here’s an option that’s very worthy of consideration, and it is: forget about your weight and just focus on health while incidentally doing regular resistance exercises and HIIT.
What will happen if you do this (assuming a healthy balanced diet, nothing special and without counting anything, but we’re talking at least mostly whole-foods, and at least mostly plants; the Mediterranean diet is great for this, as it is for most things) is:
- The dietary approach described will gradually improve your metabolic health if it wasn’t already good. If it was already good, it’ll likely just maintain it, rather than improve it.
- The resistance exercises will, if engaged with seriously (it has to be difficult to do, or your muscles won’t have any reason to grow), gradually build muscle. This will be very gradual, because you’re not eating for bodybuilding, nor optimizing your general lifestyle for same. Historically many women have feared lifting weights because they don’t want to “look like a weightlifter”, but the kinds of bodies that word brings to mind are not the kind that happen by accident (especially for women, with our different hormones guiding our bodies to a different composition); it takes a lot of single-minded dedication to specifically optimize size gains, for a long time.
- The high-intensity interval training (HIIT) will more rapidly improve your metabolic health, and unlike most forms of exercise, it will actually result in a gradual reduction of fat, if you have superfluous fat to lose. This is because whereas most forms of cardio exercise increase the heartrate for a while but then have a corresponding metabolic slump afterwards to make up for it, HIIT confuses the heart (in a good way) which results in it having to grow stronger, and not doing any compensatory metabolic slump:
How To Do HIIT (Without Wrecking Your Body) ← as well as the “how to”, this also gives some of the science behind it, too
This will, thus, result in gradual gain of muscle and loss of fat—or if you take it easier with the exercise, then you can easily settle into just maintaining your body composition as it is, but that wasn’t the question today.
So, there you have it, that’s how to do both at once! Now, if you want more dramatic results, then more dramatic methods are called for:
What bodybuilders (mostly) do
Matters of genetic predisposition and commonplace use of steroids aside, here’s how bodybuilders get that “lots of muscle, no fat” figure:
- First, get into “moderate” shape if not already there.
- Bulk up: eat amounts of food that will seem unreasonable to a non-bodybuilder; eating 2x or even 3x the “recommended” daily calorie amount is common; focus is typically on getting adequate (for bodybuilding purposes) protein while also carb-loading for workouts and getting at least enough fats for fat-soluble vitamins to work. In the gym, focus on doing sets of very few reps with the heaviest weights one can safely lift, while doing minimal cardio, and also sleeping a lot (9–12hrs per day), which is essential because this is putting a huge strain on the body and it needs a chance to recover and rebuild.
- Cut down: maintain protein intake (to at least mostly maintain muscles) while keeping carbs and fats low, doing cardio work (HIIT is still ideal) and running a calorie deficit for a short while (there is no use in trying to maintain a long-term calorie deficit; your body will try to save you from starvation by storing any fat it can and slowing your metabolism).
Phases 2 and 3 are then cycled, alternating every month, or every 6 weeks, or every 2 months or so, depending on personal preferences and scheduling considerations (bodybuilders will often have competitions they are working towards, so they need to time things to be at the end of a cutting phase to look their “best” by bodybuilder standards).
Disclaimer: bodybuilding is complex, and can be ruinous to the health if practised inexpertly, because of its extreme nature. We don’t recommend serious bodybuilding per se in general, but if you are going to do it, please consult with a professional bodybuilding coach, and do not rely on a few paragraphs from us that are intended only to give the most basic overview of how bodybuilders can approach the “gain muscle, lose fat” problem.
Want to know more?
We’ve written on some related topics previously; here’s a three-part series:
- How To Lose Weight (Healthily!)
- How To Build Muscle (Healthily!)
- How To Gain Weight (Healthily!) ← this one’s specifically about gaining healthy levels of fat, for any who want/need that
And also:
Can We Do Fat Redistribution? ← yes we can, but there are caveats
Take care!
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Okra vs Asparagus – Which is Healthier?
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Our Verdict
When comparing okra to asparagus, we picked the okra.
Why?
Both are great! But…
In terms of macros, okra has more fiber and carbs, making it the more nutrient dense option, for a similar glycemic index.
In the category of vitamins, okra has more of vitamins B1, B3, B6, B9, and C, while asparagus has more of vitamins B2, B5, E, K, and choline, making for a 5:5 tie, with similar margins of difference too. Thus, definitely a tie on vitamins.
When it comes to minerals, okra has more calcium, magnesium, manganese, phosphorus, potassium, and zinc, while asparagus has more copper, iron, and selenium. An easy 6:3 win for okra.
Both of these on-the-cusp-of-being-pungent vegetables have beneficial antioxidant polyphenols (especially various forms of quercetin), but okra has more.
Adding up the sections makes for an overall win for okra, but by all means enjoy either both; diversity is good!
Want to learn more?
You might like to read:
Enjoy Bitter/Astringent/Pungent Foods For Your Heart & Brain
Enjoy!
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The FIRST Program: Fighting Insulin Resistance with Strength Training – by Dr. William Shang
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
A lot of advice about fighting insulin resistance focuses on diet. And, that’s worthwhile! How we eat does make a huge difference to our insulin responses (as does fasting). But, we expect our regular 10almonds readers either know these things now, or can read one of several very good books we’ve already reviewed about such.
This one’s different: it focuses, as the title promises, on fighting insulin resistance with strength training. And why?
It’s because of the difference that our body composition makes to our metabolism. Now, our body fat percentage is often talked about (or, less usefully but more prevalently, even if woefully misleadingly, our BMI), but Dr. Shang makes the case for it being our musculature that has the biggest impact; because of how it hastens our metabolism, and because of how it is much healthier for the body to store glycogen in muscle tissue, than just cramming whatever it can into the liver and visceral fat. It becomes relevant, then, that there’s a limit to how much glycogen can be stored in muscle tissue, and that limit is how much muscle you have.
This is not, however, 243 pages to say “lift some weights, lazybones”. Rather, he explains the relevant pathophysiology (we will be more likely to adhere to things we understand, than things we do not), and gives practical advice on exercising the different kinds of muscle fibers, arguing that the whole is greater than the sum of its parts, as well as outlining an exercise program for the gym, plus a chapter on no-gym exercises too.
The style is quite dense, which may be offputting for some, but it suffices to take one’s time and read thoughtfully; the end result is worth it.
Bottom line: if you’d like to keep insulin resistance at bay, this book is an excellent extra tool for that.
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Protein Immune Support Salad
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How to get enough protein from a salad, without adding meat? Cashews and chickpeas have you more than covered! Along with the leafy greens and an impressive array of minor ingredients full of healthy phytochemicals, this one’s good for your muscles, bones, skin, immune health, and more.
You will need
- 1½ cups raw cashews (if allergic, omit; the chickpeas and coconut will still carry the dish for protein and healthy fats)
- 2 cans (2x 14oz) chickpeas, drained
- 1½ lbs baby spinach leaves
- 2 large onions, finely chopped
- 3 oz goji berries
- ½ bulb garlic, finely chopped
- 2 tbsp dessicated coconut
- 1 tbsp dried cumin
- 1 tbsp nutritional yeast
- 2 tsp chili flakes
- 1 tsp black pepper, coarse ground
- ½ tsp MSG, or 1 tsp low-sodium salt
- Extra virgin olive oil, for cooking
Method
(we suggest you read everything at least once before doing anything)
1) Heat a little oil in a pan; add the onions and cook for about 3 minutes.
2) Add the garlic and cook for a further 2 minutes.
3) Add the spinach, and cook until it wilts.
4) Add the remaining ingredients except the coconut, and cook for another three minutes.
5) Heat another pan (dry); add the coconut and toast for 1–2 minutes, until lightly golden. Add it to the main pan.
6) Serve hot as a main, or an attention-grabbing side:
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Cashew Nuts vs Coconut – Which is Healthier?
- What Matters Most For Your Heart?
- Beyond Supplements: The Real Immune-Boosters!
- Goji Berries: Which Benefits Do They Really Have?
- Our Top 5 Spices: How Much Is Enough For Benefits?
Take care!
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Calm Your Inflammation – by Dr. Brenda Tidwell
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The book starts with an overview of inflammation, both acute and chronic, before diving into how to reduce the latter kind (acute inflammation being usually necessary and helpful, usually fighting disease rather than creating it).
The advice in the book is not just dietary, and covers lifestyle interventions too, including exercise etc—and how to strike the right balance, since the wrong kind of exercise or too much of it can sabotage our efforts. Similarly, Dr. Tidwell doesn’t just say such things as “manage stress” but also provides 10 ways of doing so, and so forth for other vectors of inflammation-control. She does cover dietary things as well though, including supplements where applicable, and the role of gut health, sleep, and other factors.
The style of the book is quite entry-level pop-science, designed to be readable and comprehensible to all, without unduly dumbing-down. In terms of hard science or jargon, there are 6 pages of bibliography and 3 pages of glossary, so it’s neither devoid of such nor overwhelmed by it.
Bottom line: if fighting inflammation is a priority for you, then this book is an excellent primer.
Click here to check out Calm Your Inflammation, and indeed calm your inflammation!
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