Results for The University of Queensland


Rapid diagnosis of sepsis in acutely ill children

Life threatening bacterial infections such as sepsis are a leading cause of childhood mortality. International authorities recognise the urgent need for better recognition, diagnosis, and management of children with sepsis. Children in regional and remote settings are at particular risk for late or inaccurate diagnosis resulting in worse outcomes.

In this study, we are testing the feasibility, performance, time-to-diagnosis, and cost impact of applying the most advanced genomics-based sepsis diagnostic tools. This could lead to better treatment of infections, reduce unnecessary antibiotic use, shorten hospital length of stay, improve patient outcomes, and allow patients and families to be managed closer to home, with the aim to provide the same care for all children around the state. We are recruiting acutely ill children presenting with suspected sepsis to Emergency Departments, including regional and remote centres in Queensland.

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Randomised controlled trial of two antidote regimens for paracetamol overdose

Paracetamol is the commonest medications taken in overdose and is the leading cause of acute liver failure in the developed world. The antidote, acetylcysteine, which replenishes liver glutathione was developed in the 1970’s. However the regimen (20 hours duration) was never subjected to either a randomised controlled trial or any dose ranging studies. The regimen gives a large loading dose and the remainder of the infusion (20 hours) is given to mirror the time taken for paracetamol to be cleared by the liver. This time is only an average and depends on the degree of liver damage. For normal livers it is much shorter (12 hours).

The aim of the study is to compare acetylcysteine given over 20 hours compared to 12 hours for patients presenting early with paracetamol overdose to see if it provides the same protection against liver damage. The research design will be a multicentre non inferiority per protocol unblinded randomised controlled trial of a 20 hour versus a 12 hour regimen of acetylcysteine in paracetamol overdose. The study will be undertaken at the Princes Alexandra, Calvary Mater Newcastle and Prince of Wales hospitals. Eligible patients will be paracetamol overdoses less than 30g presenting within 8 hours of ingestion.

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A brief psychological intervention to promote recovery after mild traumatic brain injury

Mild traumatic brain injury (mTBI) is a common injury with potentially profound consequences. Although many patients recover within a few days to a few weeks, an estimated 15-40% develop post-concussion syndrome (PCS), which consists of an array of cognitive, emotional, and physical symptoms.(TBI symptoms that persist beyond three months often develop into a chronic, potentially life-long, health problem.)

PCS is associated with problems returning to work, social difficulties, higher healthcare utilisation, and poorer quality of life. The mitigation of PCS represents a significant clinical problem. An effective evidence-based early intervention to prevent PCS is sorely needed.

There is a growing consensus that differences in patient outcomes from mTBI are due to a range of biopsychosocial factors. For example, stress, anxiety, cognitive biases, sleep disturbance, and structural brain damage are among a number of factors that influence PCS symptom report. A focus on modifiable psychosocial factors (e.g., thoughts and behaviours) offers a promising solution: Cognitive Behavioural therapy (CBT) is well suited to altering the maladaptive beliefs, misattributions, cognitive biases and coping behaviours that promote chronicity in PCS.

The purpose of this study is to examine the feasibility and effectiveness of a Cognitive-behavioural psychotherapy (CBT)-based early intervention for patients at high-risk of developing PCS after mTBI. It is a two-site non-blinded, parallel group, randomised controlled trial comparing treatment-as-usual (TAU) and TAU+CBT intervention.

Developing an effective intervention for PCS is a critical and much-needed step in advancing our approach to the clinical management of mTBI. The outcomes of this research can inform the coordination of post-discharge care and treatment pathways, and reduce readmissions and new occasions of care.

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Too much of a good thing; Does fluid resuscitation worsen septic shock?

Patients with infections are a leading cause of presentations to the Emergency Department (ED), with severe sepsis and infection causing an estimated 20,000 deaths each day across the world. Treatment is aimed at eradicating the infection and supporting the patient while recovery can take place. Frequently patients develop low blood pressure as a result of immune response that can ultimately result in further organ injury (termed septic shock). Intravenous fluids are recommended by international guidelines as the first line therapy in the ED to treat low blood pressure of sepsis with the hope of preventing organ injury and death.

Despite 50 years of use in sepsis, the rationale for fluids remains based in theory rather than clear evidence it is effective in saving lives. Disconcertingly, there is now increasing evidence that fluids in sepsis are ineffective and may actually worsen patient survival. Despite this fluids continue to be recommended and used liberally in the ED resulting in conflict between our historical practice and the best evidence. We have developed an animal model of septic shock and resuscitation in order to test the effectiveness of fluid resuscitation. This will allow us to both understand the true effect but also investigate the underlying physiological mechanisms of any harms.

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The sepsis registry: A prospective database to characterise and facilitate improved outcome for admitted patients with community-acquired infection.

This study aims to improve our understanding of sepsis in Australian Emergency Departments. We will do this by analysing in great detail the spectrum of infection syndromes presenting to the Emergency Department of a typical large Australian hospital over a period of several years. This will allow us to:

1) Identify the number of patients presenting to hospitals each year with severe infections and the outcome of these presentations.
2) Analyse the factors and information available to doctors in the Emergency Department that are associated with overall prognosis in patients with infection.
3) Build a comprehensive picture of the spectrum of infective agents that cause patients to be admitted to Australian hospitals.
4) Identify the most appropriate combination of antibiotics which should be used in the early treatment of the most severely ill patients with infection.

The cornerstone of this project is a large database which will capture detailed information on all patients presenting to the Emergency Department of a typical large Australian hospital who are subsequently admitted with infection.

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Capacity Building Grant: Princess Alexandra Hospital

The Princess Alexandra Hospital (PAH) Emergency Department is a designated Level 6 Trauma Centre. In 2012, in excess of 50,000 patients presented to the PAH ED, of which more than 35 per cent were admitted.
Clinical expertise within the PAH ED is wide, with specific disease emphasis in toxicology, chronic disease, multi-system disease associated with the elderly population, cardiovascular disease, sepsis and septic shock, infectious diseases and critical care.
The PAH ED is a tertiary referral hospital for trainees of the Australasian College for Emergency Medicine and excels in service delivery and education; areas in which it has a national reputation for excellence.
The outcome from Phase 1 of the QEMRF funded three-year plan to increase research capacity within the PAH ED was successful with all key performance indicators being exceeded.
Phase 2 will build on the platform created in Phase 1 focusing on research promoting prevention or control of diseases.
The vision for research within the PAH ED is that the ED will be regarded as a leader in emergency medicine research attracting clinical and research staff and producing outcomes which will change clinical practice and improve the health and well-being of patients.

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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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Examining Sepsis in the Emergency Department

Infections, particularly serious infections leading to sepsis, cost the Australian healthcare system millions of dollars every year and impose a significant burden of illness on the Australian community. Serious infections also have the capacity to cause tragedy at a much more personal level, with lethal outcomes possible even in young healthy individuals. Despite the significant consequences of these illnesses, we have very limited information about the best way to identify and treat infection in Emergency Departments. Therefore, research that provides more information is vital.

We are conducting a ground breaking body of research to improve our understanding of infection in Australian Emergency Departments. We will conduct a group of studies focusing on early identification and treatment of infection. Specifically, four studies will be conducted across two hospitals. The first will identify the types of historical and clinical information available to doctors during the early stages of assessment that predicts whether an individual is likely to become very ill with infection. Identifying these patients at risk of progression to severe illness can be difficult, and is important because certain potentially life-saving treatments are most effective when given early. The second study will identify the types of bacteria that cause infection in our community. The third study will examine the potential beneficial effect of a commonly prescribed class of cholesterol-lowering drugs (“statins”) on patients admitted with infection. Finally, in the fourth study we will develop an antibiotic order set that covers the major bacteria causing severe infections. This will enable earlier effective treatment of seriously ill patients. These studies are the first of their kind conducted in Australia and will ultimately enable doctors to identify and treat severe infection earlier.

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Pilot project to assess measures of psychological impact of providing CPR on a related victim of cardiac arrest.

Cardiopulmonary resuscitation (CPR) provision by bystanders has a well recognized link to improved outcome in cardiac arrest sufferers. However, a victim of cardiac arrest is more likely to receive CPR from a non-related bystander than from a related witness. It is thought that there are psychological barriers to the provision of CPR by related persons.

The overall aim of the proposed pilot study is to examine the effects of CPR provision on persons who are related bystanders of a victim of cardiac arrest. The three key purposes for the proposed pilot study, therefore, are: (1) to assess the proposed recruitment strategy; (2) to evaluate the usefulness of the selected test instruments in the context of the larger study and its aims; and, (3) to establish whether or not participants will perceive subjective psychological distress (or possibly even psychological benefit) through the administration of the selected assessment tools.

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Prospective evaluation of an innovative system for online clinical assessment of practical skills (eCAPS) for Emergency Medicine residents and registrars.

The current project will involve the implementation and evaluation of a pioneering protocol for the online clinical assessment of practical skills (eCAPS) for medical residents and registrars training in Emergency Medicine. It will use a variety of web-based video technologies to facilitate the learning and innovative assessment of physical examinations of the musculoskeletal system initially targeting the knee and shoulder joints. Specifically, eCAPS includes three interdependent elements with a progressive (asynchronous to synchronous) organization of online instructor and learner-generated video resources to allow formative and summative assessments of practical competencies of Emergency Medicine residents and registrars performing selected physical examinations of the musculoskeletal system. This includes:

1. an integrated series of web-based video lectures and tailored clinical demonstrations of practical skill sets (musculoskeletal examinations) by experts in the field;

2. resident/registrar (“learner”) generated video demonstrations of selected, clinically relevant practical skills recorded with portable USB cameras (asynchronous) uploaded to a secure response and feedback online repository for personal and peer-community access; and

3. real time (synchronous) video assessment of residents/registrars completing practical skill sets for physical examination of the musculoskeletal system within a simulated OSCE (Objective Structured Clinical Examination) scenario using readily accessible web-based technologies (e.g. Skype).

The evaluation of the proposed implementation of the eCAPS protocol will provide important baseline information on aspects such as the flexibility, viability and generalizability of emerging online learning options for developing and assessing practical/procedural skills within an Emergency Medicine training program.
Furthermore, the current project will provide insights into the learning outcomes of the eCAPS protocol and the potential applications of this online approach for facilitating the standardization, validation and recording of clinical competence across a range of training levels and settings including rural and remote Emergency Medicine contexts.

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