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?

Shutterstock/Nils Versemann

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.

yellow hard hat on ground. people are nearby sitting on ground after an accident
The right advice could tell you whether you need to visit hospital in person or not. 1st footage/Shutterstock

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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  • Rosehip’s Benefits, Inside & Out

    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.

    It’s In The Hips

    Rosehip (often also written: “rose hip”, “rosehips”, or “rose hips”, but we’ll use the singular compound here to cover its use as a supplement) is often found as an extra ingredient in various supplements, and also various herbal teas. But what is it and what does it actually do?

    What it is: it’s the fruiting body that appears on rose plants underneath where the petals appear. They are seasonal.

    As for what it does, read on…

    Anti-inflammatory

    Rosehip is widely sought for (and has been well-studied for) its anti-inflammatory powers.

    Because osteoarthritis is one of the most common inflammatory chronic diseases around, a lot of the studies are about OA, but the mechanism of action is well-established as being antioxidant and anti-inflammatory in general:

    ❝Potent antioxidant radical scavenging effects are well documented for numerous rose hip constituents besides Vitamin C.

    Furthermore, anti-inflammatory activities include the reduction of pro-inflammatory cytokines and chemokines, reduction of NF-kB signaling, inhibition of pro-inflammatory enzymes, including COX1/2, 5-LOX and iNOS, reduction of C-reactive protein levels, reduction of chemotaxis and chemoluminescence of PMNs, and an inhibition of pro-inflammatory metalloproteases.❞

    ~ Dr. Margret Moré et al.

    Source: Rosa canina – Rose hip pharmacological ingredients and molecular mechanics counteracting osteoarthritis – A systematic review

    Note that while rosehip significantly reduces inflammation, it doesn’t affect the range of movement in OA—further making clear its mechanism of action:

    Read: Rosa canina fruit (rosehip) for osteoarthritis: a cochrane review

    Anti-aging

    This is partly about its antioxidant effect, but when it comes to skin, also partly its high vitamin C content. In this 8-week study, for example, taking 3mg/day resulted in significant reductions of many measures of skin aging:

    The effectiveness of a standardized rose hip powder, containing seeds and shells of Rosa canina, on cell longevity, skin wrinkles, moisture, and elasticity

    Heart healthy

    The dose required to achieve this benefit is much higher, but nonetheless its effectiveness is clear, for example:

    ❝Daily consumption of 40 g of rose hip powder for 6 weeks can significantly reduce cardiovascular risk in obese people through lowering of systolic blood pressure and plasma cholesterol levels. ❞

    ~ Dr. Mona Landin-Olsson et al.

    Read in full: Effects of rose hip intake on risk markers of type 2 diabetes and cardiovascular disease: a randomized, double-blind, cross-over investigation in obese persons

    Want to try some?

    We don’t sell it, but here for your convenience is an example product on Amazon

    Enjoy!

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  • Pinch of Nom – by Kate Allinson & Kay Allinson

    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.

    “Home-style recipes”, because guess where most readers live!

    And: slimming, because trimming the waistline a little is a goal for many after holiday indulgences.

    The key idea here is healthy recipes that “don’t taste like diet food”—often by just switching out a couple of key ingredients, to give a significantly improved nutritional profile while remaining just as tasty, especially when flavors are enhanced with clever spicing and seasoning.

    The food is simple to prepare, while being “special” enough that it could be used very credibly for entertaining too. For that matter, a strength of the book is its potential for use as a creative springboard, if you’re so inclined—there are lots of good ideas in here.

    The recipes themselves are all you’d expect them to be, and presented clearly in an easy-to-follow manner.

    Bottom line: if you’ve ever wanted to cook healthily but you need dinner on the table in the very near future and are stuck for ideas, this book is exactly what you need.

    Click here to check out Pinch of Nom, and liven up your healthy cooking!

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  • How To Recover Quickly From A Stomach Bug

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    How To Recover Quickly From A Stomach Bug

    Is it norovirus, or did you just eat something questionable? We’re not doctors, let alone your doctors, and certainly will not try to diagnose from afar. And as ever, if unsure and/or symptoms don’t go away or do get worse, seek professional medical advice.

    That out of the way, we can give some very good general-purpose tips for this one…

    Help your immune system to help you

    So far as you can, you want a happy healthy immune system. For the most part, we’d recommend the following things:

    Beyond Supplements: The Real Immune-Boosters!

    …but you probably don’t want to be exercising with a stomach bug, so perhaps sit that one out. Exercise is the preventative; what you need right now is rest.

    Hydrate—but watch out

    Hydration is critical for recovery especially if you have diarrhea, but drinking too much water too quickly will just make things worse. Great options for getting good hydration more slowly are:

    • Peppermint tea
      • (peppermint also has digestion-settling properties)
    • Ginger tea
    • Broths
      • These will also help replenish your sodium and other nutrients, gently. Chicken soup for your stomach, and all that. A great plant-based option is sweetcorn soup.
      • By broths, we mean clear(ish) water-based soups. This is definitely not the time for creamier soups.

    ❝Milk and dairy products should be avoided for 24 to 48 hours as they can make diarrhea worse.

    Initial dietary choices when refeeding should begin with soups and broth.❞

    Source: American College of Gastroenterology

    Other things to avoid

    Caffeine stimulates the digestion in a way that can make things worse.

    Fat is more difficult to digest, and should also be avoided until feeling better.

    To medicate or not to medicate?

    Loperamide (also known by the brand name Imodium) is generally safe when used as directed.

    Click here to see its uses, dosage, side effects, and contraindications

    Antibiotics may be necessary for certain microbial infections, but should not be anyone’s first-choice treatment unless advised otherwise by your doctor/pharmacist.

    Note that if your stomach bug is not something that requires antibiotics, then taking antibiotics can actually make it worse as the antibiotics wipe out your gut bacteria that were busy helping fight whatever’s going wrong in there:

    A gentler helper

    If you want to give your “good bacteria” a hand while giving pathogens a harder time of it, then a much safer home remedy is a little (seriously, do not over do it; we are talking 1–2 tablespoons, or around 20ml) apple cider vinegar, taken diluted in a glass of water.

    ❝Several studies indicate apple cider vinegar (ACV)’s usefulness in lowering postprandial glycemic response, specifically by slowing of gastric motility❞

    (Slowing gastric motility is usually exactly what you want in the case of a stomach bug, and apple cider vinegar)

    Source: Effectiveness of Nutritional Ingredients on Upper Gastrointestinal Conditions and Symptoms: A Narrative Review

    See also:

    Take care!

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  • Sweet Potato vs Winter Squash – Which is Healthier?

    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.

    Our Verdict

    When comparing sweet potato to winter squash, we picked the sweet potato.

    Why?

    In terms of macros, the sweet potato has 2x the protein, 2x the carbs, and slightly more fiber. Because the protein numbers are small, the carb:fiber ratio is the deciding factor here, and has winter squash has the lower glycemic index (assuming cooking them both on a like-for-like basis), we’re going with that on macros, but it’s subjective.

    In the category of vitamins, sweet potato has more of vitamins A, B1, B2, B3, B5, B6, C, E, and choline, while winter squash has more of vitamins B9 and K. It’s interesting to note that while sweet potato is rightly famous for its vitamin A content, winter squash is actually very good for that too. Still, by the numbers, it’s a clear 9:2 victory for sweet potato here.

    When it comes to minerals, sweet potato has more calcium copper, iron, magnesium, manganese, phosphorus, potassium, and zinc, while winter squash has more selenium, meaning an 8:1 victory for sweet potato this time.

    In short, enjoy either or both, but sweet potato is the more nutritionally dense option for sure.

    Want to learn more?

    You might like to read:

    Carb-Strong or Carb-Wrong? Should You Go Light Or Heavy On Carbs?

    Enjoy!

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  • Uric Acid’s Extensive Health Impact (And How To Lower It)

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    Uric Acid’s Extensive Health Impact (And How To Lower It)

    This is Dr. David Perlmutter. He’s a medical doctor, and a Fellow of the American College of Nutrition. He’s a member of the Editorial Board for the Journal of Alzheimer’s Disease, and has been widely published in many other peer-reviewed journals.

    What does he want us to know?

    He wants us to know about the health risks of uric acid (not something popularly talked about so much!), and how to reduce it.

    First: what is it? Uric acid is a substance we make in our own body. However, unlike most substances we make in our body, we have negligible use for it—it’s largely a waste product, usually excreted in urine.

    However, if we get too much, it can build up (and crystallize), becoming such things as kidney stones, or causing painful inflammation if it shows up in the joints, as in gout.

    More seriously (unpleasant as kidney stones and gout may be), this inflammation can have a knock-on effect triggering (or worsening) other inflammatory conditions, ranging from non-alcoholic fatty liver disease, to arthritis, to dementia, and even heart problems. See for example:

    How can we reduce our uric acid levels?

    Uric acid is produced when we metabolize purine nucleotides, which are found in many kinds of food. We can therefore reduce our uric acid levels by reducing our purine intake, as well as things that mess up our liver’s ability to detoxify things. Offsetting the values for confounding variables (such as fiber content, or phytochemicals that mitigate the harm), the worst offenders include…

    Liver-debilitating things:

    • Alcohol (especially beer)
    • High-fructose corn syrup (and other fructose-containing things that aren’t actual fruit)
    • Other refined sugars
    • Wheat / white flour products (this is why beer is worse than wine, for example; it’s a double-vector hit)

    Purine-rich things:

    • Red meats and game
    • Organ meats
    • Oily fish, and seafood (great for some things; not great for this)

    Some beans and legumes are also high in purines, but much like real fruit has a neutral or positive effect on blood sugar health despite its fructose content, the beans and legumes that are high in purines, also contain phytochemicals that help lower uric acid levels, so have a beneficial effect.

    Eggs (consumed in moderation) and tart cherries have a uric-acid lowering effect.

    Water is important for all aspects of health, and doubly important for this.

    Hydrate well!

    Lifestyle matters beyond diet

    The main key here is metabolic health, so Dr. Perlmutter advises the uncontroversial lifestyle choices of moderate exercise and good sleep, as well as (more critically) intermittent fasting. We wrote previously on other things that can benefit liver health:

    How To Unfatty A Fatty Liver

    …in this case, that means the liver gets a break to recuperate (something it’s very good at, but does need to get a chance to do), which means that while you’re not giving it something new to do, it can quickly catch up on any backlog, and then tackle any new things fresh, next time you start eating.

    Want to know more about this from Dr. Perlmutter?

    You might like his article:

    An Integrated Plan for Lowering Uric Acid ← more than we had room for here; he also talks about extra things to include in your diet/supplementation regime for beneficial effects!

    And/or his book:

    Drop Acid: The Surprising New Science of Uric Acid―The Key to Losing Weight, Controlling Blood Sugar, and Achieving Extraordinary Health

    …on which much of today’s main feature was based.

    Take care!

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  • Macadamia Nuts vs Brazil Nuts – Which is Healthier?

    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.

    Our Verdict

    When comparing macadamia nuts to Brazil nuts, we picked the Brazil nuts.

    Why?

    They’re a lot more nutrient dense! But watch out…

    First, to do due diligence in terms of macros: Brazil nuts have twice as much protein and less fat, as well as being a little higher in fiber and slightly lower in carbs.

    In terms of vitamins, Brazil nuts are about 10x higher in vitamin E, while macadamias are somewhat higher in several B-vitamins.

    The category of minerals is where it gets interesting. Macadamia nuts are a little higher in iron and considerably higher in Manganese. But… Brazil nuts are a lot higher in calcium, copper, magnesium, phosphorus, potassium, selenium, and zinc.

    About that selenium… Specifically, it’s more than 5,000x higher, and a cup of Brazil nuts would give nearly 10,000x the recommended daily amount of selenium. Now, selenium is an essential mineral (needed for thyroid hormone production, for example), and at the RDA it’s good for good health. Your hair will be luscious and shiny. However, go much above that, and selenium toxicity becomes a thing, you may get sick, and it can cause your (luscious and shiny) hair to fall out. For this reason, it’s recommended to eat no more than 3–4 Brazil nuts per day.

    In short… Brazil nuts are much more nutrient dense in general, and thus come out on top here. But, they’re so nutrient dense in the case of selenium, that careful moderation is advised.

    Want to learn more?

    You might like to read:

    Why You Should Diversify Your Nuts

    Take care!

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