Results for James Cook University


Data linkage & patient outcome study: Aeromedical services in Central Queensland

The development of linked data from aeromedical retrieval & health system databases will provide improved, value-added insights to patient care and outcome analysis. This first-of-its-kind study seeks to take the next step in patient-centered outcomes research and resource allocation planning by linking together existing, but independent emergency department, aeromedical, hospital and death databases. Our pilot study has linked databases, creating secure & robust infrastructure for future state-wide studies.

The aims of the study are:
a) Utilise the linked data infrastructure that we’ve created, allowing next phase state-wide replication; describe aeromedical patient outcomes (including length of stay and mortality); understand aeromedical service requirements for specific illness/ injury, those that require frequent flights, & identify steps within the patient journey.
b) Develop a better understanding of the aeromedical patient journey will help to develop appropriate health services delivery, in particular emergency departments whom most often are first point-of-service, thus ensuring better health outcomes.

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Cairns Base Hospital capacity building grant

Cairns Base Hospital Emergency Department is committed to attracting the best emergency physicians and trainees. Our research commitment over the years, particularly the ability to provide 4.10.70 direction and opportunities, has been recognised by our peers as significant, particularly in an environment of heavy clinical \workloads and limited funding opportunities. In the past two years the CBH executive has worked to balance this by increasing staff numbers and allowing more academic opportunities for Emergency Physician and trainees alike.

This Capacity building grant allows the Hospital to appoint, for three years, Associate Professor Jamie Seymour from the James Cook University, School of Medicine and Tropical Biology, as a Research Fellow. A/Prof Seymour has a history of involvement in research with the Hospital's ED -- primarily, but not restricted to, toxinology and advice in study design and analysis. This grant enabled the Hospital to considerably expand and formalise the collaboration.

In his role as Senior Research Fellow, A/Prof Seymour will provide the experience and expertise need to help the Department apply for successful grant applications and help attract and immerse Emergency Medicine trainees in a fertile research environment that actively encourages them with their 4:10:70 as well as research in thelr ongoing career. The department believes that this approach will also increase its attractiveness to emergency physicians in relation to job placement and has unanimous support from the consultants in the department.

The department envisages that the Research Fellow would conduct research training on a weekly basis as part of the present teaching protocol where research ideas and published studies are discussed and examined, where experimental design and statistical analysis of proposed research projects can be developed.

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First aid oxygen treatment of divers with decompression sickness

Decompression sickness (DCS), commonly called the bends, involves formation of gas bubbles in the body following scuba diving. These bubbles can cause a variety of problems, ranging from minor aches and pain, to severe stroke-like symptoms.

Providing pre-hospital oxygen therapy at the highest concentration possible provides needed oxygen to body tissues, reduces bubbles and can often relieve symptoms. Oxygen has been shown to reduce the number of hyperbaric treatments a diver with DCS will require so improving pre-hospital oxygen delivery will lead to decreased hospital costs. However, the ideal oxygen delivery system has not been determined.

Using new techniques and equipment, this research will identify the optimal device for delivering oxygen to divers with DCS leading to recommendations which will improve the health outcomes of injured divers. We will measure how effectively varied breathing devices deliver oxygen to the body tissues and remove bubbles from the diver’s blood while assessing innovative equipment. This study will assess a new commercially available oral mask to improve oxygen delivery with a demand system. A medical oxygen re-breather, which like an anaesthetic machine absorbs carbon dioxide and adds small amounts of oxygen to the breathing circuit, will be also assessed.

Assessing the use of these devices will not only determine their efficacy to deliver oxygen to injured divers but also provide guidance on appropriate systems to use for dive operators with limited medical oxygen. Assessing the change in bubble grade with oxygen delivery will add evidence for its use.

This research will provide information that can guide pre-hospital and emergency clinicians when choosing the type of oxygen delivery devices used for injured divers improving patient outcomes and decreasing costs.

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Is Helicopter Transport Safe for Divers with Decompression Illness?

Diving is a common recreational activity for both Queenslanders and tourists alike. It forms the basis for whole tourism industries based on the Great Barrier Reef. Unfortunately diving does have risks which includes decompression illness (DCI). DCI involves formation of gas bubbles and can be fatal. Treatment usually involves re-pressurisation in special chambers designed to ‘squash’ the bubbles and reduce symptoms. Affected divers can only receive this treatment in certain hospitals. They may need to be transported urgently by helicopters from the reef to hospital. However, some people believe that the vibration of the helicopter may increase the number of bubbles and make symptoms worse before divers can access treatment. This study will determine if this is true – will bubbles actually be increased by the vibration associated with helicopter flight? If vibration does increase bubble formation, then in the future alternative strategies for transporting DCI patients can be implemented to reduce the risk to these patients. To ensure safety the vibration record of helicopter flight will be recorded and reproduced using a vibrating basket model. Healthy volunteers accompanying divers in the recompression chamber will be assessed with a special ultrasound to detect bubbles following the ‘dive’ and then placed in the vibrating basket. The number of bubbles present after this will be measured again. This study will help ensure safe transport of injured divers not just in Queensland but internationally. This global importance is represented in the research team, which includes members from both Canada and other Australian states, which are collaborating in a Queensland based study.

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Noel Stevenson Research Scholarship – A/Prof Peter Aitken

Disasters have caused the loss of more than 12 million lives and affected more than 50 million people in the past 50 years alone. Disasters involve not just more patients, but a different type of patient in a system under extreme stress. Emergency Departments (ED), as the ‘front door’ to the health system are a key part of the disaster response and a well prepared ED is essential to save lives. Being prepared involves education and training however disaster health education is not well developed in Australia. The research program aim is the development of a disaster education framework for the health workforce in Australia. This framework will incorporate learning needs and identify strategies to meet them in a manner which is both cost and outcome effective. A key outcome will be development and evaluation of a post graduate qualification in disaster health consistent with this framework. The current state of education in disaster health in Australia will be reviewed including a comparison of strategies used, relative effectiveness and barriers to success. Common problems will be identified from literature and Australian experience to help target educational priorities. This will include ED and Australian teams deployed overseas, many of whom were ED staff. A secondary aim is development of a network to strengthen both emergency medicine response to disasters and disaster health research.

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Drugs for the treatment of nausea and vomiting in adult patients in the emergency department setting

Nausea and vomiting is a common and distressing presenting complaint in emergency departments. Nausea describes the unpleasant sensation of the imminent need to vomit, whereas vomiting refers to the forceful oral expulsion of gastric contents associated with contraction of the abdominal and chest wall musculature. The complications from nausea and vomiting can range from trivial to serious, such as dehydration and oesophageal rupture.

High level evidence supports the use of antiemetics in the management of nausea and vomiting in many settings and populations, however there is little guidance or consensus in recommendations for the management of nausea and vomiting in the adult emergency department setting. Recommendations are inconsistent and rarely evidence based. It is not possible to extrapolate this evidence from other treatment settings to the emergency department population because of differences in aetiologies, patient populations and other factors.

Using the strict methodology outlined by the Cochrane collaboration, we will conduct a systematic review of randomized controlled trials (RCTs) of antiemetic agents in the management of nausea and vomiting in the emergency department setting.

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Ketamine IntraNasally Delivered in the Emergency Room: KINDER

Sick and injured children in the Emergency Department (ED) often require procedures which can cause severe pain (like fracture reduction, stitching wounds, abscess drainage) or otherwise require the child to be still and cooperative (CT scans, lumbar punctures, removal of foreign bodies). Sedative drugs are given to these patients both to relieve pain/distress and to keep them still for the procedure.

ED sedation of children now has a well established body of evidence. Most of the literature relates to when the drug is given intravenously or intramuscularly. Drug delivery by these routes leads to reliable effects as the drug bypasses the liver without being broken down before it reaches the brain. However, both these routes require a needle which requires staff to hold down a young child against their will, frequently causing great distress along with the pain of the needle. Great efforts have gone into making EDs "Ouchless" where unnecessary pain for children is reduced or eliminated. Sedation is itself part of this effort. The intranasal route (injecting the medicine up the nose with a plastic syringe) could represent a needle-free alternative.

Ketamine is the most common drug used for paediatric sedation in Australian EDs and can be given intranasally. No studies have examined its use for ED sedation but many studies support its use in anaesthetics and dental clinics where it has been shown to be safe and effective.

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A randomised controlled trial of intravenous paracetamol and oral paracetamol to control acute pain

Pain is a common reason for presentation to the emergency department. In 78–86% of Australian emergency department presentations pain is a primary component and therefore represents a major clinical care issue. However, numerous studies have shown that pain is poorly managed in the emergency department.

This project aims to provide evidence that intravenous (IV) paracetamol produces superior analgesia than oral paracetamol in the emergency department setting and that IV paracetamol produces good patient satisfaction, few side-effects and reduced length of hospital stay. To date the majority of trials into the effectiveness of IV paracetamol have focused on specific disease states and, to the research teams’ knowledge, no trials have been conducted to assess the efficacy of IV paracetamol in the Australian emergency department setting.

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Envenomation, first aid and critical care of tropical jellyfish stings

Queensland is currently recognised as the leader in the field of jellyfish envenoming treatment. Many of the treatments for jellyfish stings are not evidence based and data is emerging that suggests that some of the treatments may do more harm to jellyfish sting victims than good.
This project will investigate three major areas of present contention:
• Is vinegar a suitable first aid for jellyfish stings?
• Can the survival rate of victims stung by big box jellyfish be increased by simply continuing CPR for extended periods?
• Can readily available and used drugs be the answer to the ever-increasing Irukandji Syndrome?

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ConSEPT: Convulsive Status Epilepticus Paediatric Trial

Convulsive Status Epilepticus (CSE) is the most common childhood neurological emergency, sometimes resulting in death or serious disability. CSE is managed with anticonvulsant medications in a step-wise approach until seizures stop. While some management strategies for CSE are well supported by evidence (e.g. initial administration of benzodiazepines), subsequent strategies are based on expert consensus and not evidence.

Phenytoin, the traditional second line agent for CSE has a high failure rate, causes adverse events and must be administered slowly. Levetiracetam, a newer anticonvulsant, has a favourable adverse events profile, can be administered quickly and has good efficacy for various seizure types.

This research project proposes to undertake a randomised controlled trial of the second line anticonvulsants phenytoin and levetiracetam for CSE in children. This multi-centre study will be a world first and have a profound impact on the management of CSE in children in New Zealand, Australia and worldwide, in either confirming the current second line medication used or recommending a newer second line medication.

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