
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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How gender-affirming care improves trans mental health
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In recent years, a growing number of states have passed laws restricting or banning gender-affirming care for transgender people, particularly minors. As conversations about gender-affirming care increase, so do false narratives about it, with some opponents falsely suggesting that it’s harmful to mental health.
Despite widespread attacks against gender-affirming care, research clearly shows that it improves mental health outcomes for transgender people.
Read on to learn more about what gender-affirming care is, how it benefits mental well-being, and how you can access it.
What is gender-affirming care?
Gender-affirming care describes a range of medical interventions that help align people’s bodies with their gender identities. While anyone can seek gender-affirming care in the form of laser hair removal, breast augmentation, erectile dysfunction medication, or hormone therapy, among other treatments, most conversations about gender-affirming care center around transgender people, whose gender identity or gender expression does not conform to their sex assigned at birth.
Gender-affirming care for trans people varies based on age. For example, some trans adults seek hormone replacement therapy (HRT) or gender-affirming surgeries that help their bodies match their internal sense of gender.
Trans kids entering adolescence might be prescribed puberty blockers, which temporarily delay the production of hormones that initiate puberty, to give them more time to figure out their gender identities before deciding on next steps. This is the same medication given to cisgender kids—whose gender identities match the sex they were assigned at birth—experiencing early puberty.
What is gender dysphoria?
Gender dysphoria describes a feeling of unease that some trans people experience when their perceived gender doesn’t match their gender identity. This can lead to a range of mental health conditions that affect their quality of life
Some trans people may manage gender dysphoria by wearing gender-affirming clothing, opting for a gender-affirming hairstyle, or asking others to refer to them by a name and pronouns that authentically represent them. Others may need gender-affirming care to feel at home in their bodies.
Trans people who desire gender-affirming care and have not been able to access it experience psychological distress, including depression, anxiety, self-harm, and suicidal ideation. The Trevor Project’s 2023 U.S. National Survey on the Mental Health of LGBTQ Young People found that roughly half of trans youth “seriously considered attempting suicide in the past year.”
How does gender-affirming care improve mental health?
For trans adults, gender-affirming care can alleviate gender dysphoria, which has been shown to improve both short-term and long-term mental health. A 2018 study found that trans adults who do not undergo HRT are four times more likely to experience depression than those who do, although not all trans people desire HRT.
Extensive research has shown that gender-affirming care also alleviates gender dysphoria and improves mental health outcomes in trans kids, teens, and young adults. A 2022 study found that access to HRT and puberty blockers lowered the odds of depression in trans people between the ages of 13 and 20 by 60 percent and reduced the risk of self-harm and suicidal thoughts by 73 percent.
Both the Endocrine Society—which aims to advance hormone research—and the American Academy of Pediatrics recommend that trans kids and teens have access to developmentally appropriate gender-affirming care.
How can I access gender-affirming care?
If you’re a trans adult seeking gender-affirming care or a guardian of a trans kid or teen who’s seeking gender-affirming care, talk to your health care provider about your options. You can find a trans-affirming provider by searching the World Professional Association for Transgender Health directory or visiting your local LGBTQ+ health center or Planned Parenthood.
Some gender-affirming care may not be covered by insurance. Learn how to make the most of your coverage from the National Center for Transgender Equality. Find insurance plans available through the Marketplace that cover gender-affirming care in some states through Out2Enroll.
Some states restrict or ban gender-affirming care. Learn about the laws in your state by visiting the Trans Legislation Tracker.
Where can trans people and their families find mental health support?
In addition to working with a trans-affirming therapist, trans people and their families can find mental health support through these free services:
- PFLAG offers resources for families and friends of LGBTQ+ people. Find a PFLAG chapter near you.
- The Trevor Project’s hotline has trained counselors who help LGBTQ+ youth in crisis. Call the TrevorLifeline 1-866-488-7386 or text START to 678-678.
- The Trans Lifeline was created by and for the trans community to support trans people in crisis. You can reach the Trans Lifeline hotline at 1-877-565-8860.
For more information, talk to your health care provider.
If you or anyone you know is considering suicide or self-harm or is anxious, depressed, upset, or needs to talk, call the Suicide & Crisis Lifeline at 988 or text the Crisis Text Line at 741-741. For international resources, here is a good place to begin.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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The Beautiful Cure – by Dr. Daniel Davis
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This one is not just a book about the history of immunology and a primer on how the immune system works. It is those things too, but it’s more:
Dr. Daniel Davis, a professor of immunology and celebrated researcher in his own right, bids us look at not just what we can do, but also what else we might.
This is not to say that the book is speculative; Dr. Davis deals in data rather than imaginings. He also cautions us against falling prey to sensationalization of the “beautiful cures” that the field of immunology is working towards. What, then, are these “beautiful cures”?
Just like our immune systems (in the plural; by Dr. Davis’ count, primarily talking about our innate and adaptive immune systems) can in principle deal with any biological threat, but in practice don’t always get it right, the same goes for our medicine.
He argues that in principle, we categorically can cure any immune-related disease (including autoimmune diseases, and tangentially, cancer). The theoretical existence of such cures is a mathematically known truth. The practical, contingent existence of them? That’s what takes the actual work.
The style of the book is accessible pop science, with a hard science backbone from start to finish.
Bottom line: if you’d like to know more about immunology, and be inspired with hope and wonder without getting carried away, this is the book for you.
Click here to check out The Beautiful Cure, and learn about these medical marvels!
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Spelt vs Bulgur – Which is Healthier?
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Our Verdict
When comparing spelt to bulgur, we picked the spelt.
Why?
An argument could be made for bulgur, but we say spelt comes out on top. Speaking of “sorting the wheat from the chaff”, be aware: spelt is a hulled wheat product and bulgur is a cracked wheat product.
Looking at macros first, it’s not surprising therefore that spelt has proportionally more carbs and bulgur has proportionally more fiber, resulting in a slightly lower glycemic index. That said, for the exact same reason, spelt is proportionally higher in protein. Still, fiber is usually the most health-relevant aspect in the macros category, so we’re going to call this a moderate win for bulgur.
When it comes to micronutrients, however, spelt is doing a lot better:
In the category of vitamins, spelt is higher in vitamins A, B1, B2, B3, and E (with the difference in E being 26x more!), while bulgur is higher only in vitamin B9 (and that, only slightly). A clear win for spelt here.
Nor are the mineral contents less polarized; spelt has more copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc, while bulgur is not higher in any minerals. Another easy win for spelt.
Adding these up makes a win for spelt, but again we’d urge to not underestimate the importance of fiber. Enjoy both in moderation, unless you are avoiding wheat/gluten in which case don’t, and for almost everyone, mixed whole grains are always going to be best.
Want to learn more?
You might like to read:
- Grains: Bread Of Life, Or Cereal Killer?
- Gluten: What’s The Truth?
- Why You’re Probably Not Getting Enough Fiber (And How To Fix It)
Take care!
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Slowing the Progression of Cataracts
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Understanding Cataracts
Cataracts are natural and impact everyone.
That’s a bit of a daunting opening line, but as Dr. Michele Lee, a board-certified ophthalmologist, explains, cataracts naturally develop with age, and can be accelerated by factors such as trauma, certain medications, and specific eye conditions.
We know how important your vision is to you (we’ve had great feedback about the book Vision for Life) as well as our articles on how glasses impact your eyesight and the effects of using eye drops.
While complete prevention isn’t possible, steps such as those mentioned below can be taken to slow their progression.
Here is an overview of the video’s first 3 takeaways. You can watch the whole video below.
Protect Your Eyes from Sunlight
Simply put, UV light damages lens proteins, which (significantly) contributes to cataracts. Wearing sunglasses can supposedly prevent up to 20% of cataracts caused by UV exposure.
Moderate Alcohol Consumption
We all, at some level, know that alcohol consumption doesn’t do us any good. Your eye health isn’t an exception to the rule; alcohol has been shown to contribute to cataract development.
If you’re looking at reducing your alcohol use, try reading this guide on lowering, or eradicating, alcohol consumption.
Avoid Smoking
Smokers are 2-3 times more likely to develop cataracts. Additionally, ensure good ventilation while cooking to avoid exposure to harmful indoor smoke.
See all 5 steps in the below video:
How was the video? If you’ve discovered any great videos yourself that you’d like to share with fellow 10almonds readers, then please do email them to us!
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Natural Remedies and Foods for Osteoarthritis
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
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
❝Natural solutions for osteoarthritis. Eg. Rosehip tea, dandelion root tea. Any others??? What foods should I absolutely leave alone?❞
We’ll do a main feature on arthritis (in both its main forms) someday soon, but meanwhile, we recommend eating for good bone/joint health and against inflammation. To that end, you might like these main features we did on those topics:
- We Are Such Stuff As Fish Are Made Of (collagen for bone and joint health)
- The Bare-Bones Truth About Osteoporosis (eating for bone health generally)
- Keep Inflammation At Bay (dietary tips for minimizing inflammation—also, our all-time most popular article to date!)
Of these, probably the last one is the most critical, and also will have the speediest effects if implemented.
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5 Ways To Beat Cancer (And Other Diseases)
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A Systematic Approach To Healthy Eating
This is Dr. William Li. He’s a physician, cancer researcher, and educator. He also founded the Angiogenesis Foundation back in 1994.
We recently reviewed one of his books, “Eat To Beat Disease”.
He has another book that we haven’t reviewed at time of writing, “Eat To Beat Your Diet“, which you might like to check out.
What does he want us to know?
He wants us to know how to eat to beat cancer and other diseases, by means of five specific angles:
Angiogenesis
This is about replacing blood vessels, which of course happens all the time, but it becomes a problem when it is feeding a cancer in the process.
Here, based on Dr. Li’s work, is what can be done about it:
A List of Anti-Angiogenic Foods for a Cancer-Fighting Diet
Regeneration
Generally speaking, we want to replace healthy cells early, because if we wait until they get damaged, then that damage will be copied forwards. As well as intermittent fasting, there are other things we can do to promote this—even, Dr. Li’s research shows, for stem cells:
Doctor’s Tip: Regeneration (stem cells)—one of your body’s five defense systems
Microbiome health
Healthy gut, healthy rest of the body. We’ve written about this before:
Making Friends With Your Gut (You Can Thank Us Later)
DNA protection
DNA gets unravelled and damaged with age, the telomere caps get shorter, and mistakes get copied forward. So there more we can protect our DNA, the longer we can live healthily. There are many ways to do this, but Dr. Li was one of the first to bring to light the DNA-protecting benefits of kiwi fruit:
Immunity
Paradoxically, what’s good for your immune system (making it stronger) also helps to protect against autoimmune diseases (for most people, for the most part).
In short: it’s good to have an immune system that’s powerful not just in its counterattacks, but also in its discerning nature. There are dietary and other lifestyle approaches to both, and they’re mostly the same things:
Beyond Supplements: The Real Immune-Boosters!
and thus see also:
Want to know more?
You might enjoy his blog or podcast, and here’s his TED talk:
Want to watch it, but not right now? Bookmark it for later
Enjoy!
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