Results for Gold Coast University Hospital


Preventing chronic pain after whiplash injury

After whiplash injury, half of patients never fully recover. The human and economic cost is enormous, and current mainstay treatments are ineffective. Most recovery, if it occurs, takes place in the first two to three months. This early time period offers a ‘window of opportunity’ to pro-actively intervene and prevent the chronic pain. The Emergency Department (ED) is ideally placed to provide very early intervention. We have shown that upregulation of pain in the central nervous system occurs soon after whiplash injury and predicts poor recovery. We aim to target these central nervous system processes with pregabalin in conjunction with evidence based physiotherapy advice/exercise in the ED. The results have potential to fundamentally change the treatment of acute whiplash injury.

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Fibrinogen Early In Severe Trauma in children studY (FEISTY Junior)

Traumatic injuries in children are a leading cause of death and disability in Australia. In high income countries, 40% of child deaths are because of traumatic injuries. Fibrinogen is one of the key clotting factors that need to be replaced in severe traumatic bleeding.

Currently, fibrinogen is replaced using cryoprecipitate; a blood product obtained from healthy volunteer donors. This is a precious resource that is stored frozen in the blood bank; it can take a long time to administer and place significant strain on blood banks. Fibrinogen concentrate (FC) is an alternative product used to assist in blood clotting. It is a product that is derived from blood plasma but stored in powder form and can be reconstituted at the bedside and given quickly. The study will investigate whether it is quicker to administer FC than cryoprecipitate, which may reduce haemorrhage and improve outcomes.

This study will enrol 30 children from three major paediatric trauma centres in Queensland admitted with severe traumatic bleeding. Time to administration of fibrinogen replacement and the effect of fibrinogen levels will be measured.

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Domestic and family violence screening in the emergency department

Domestic and family violence (DFV) against women is the number one cause of hospitalisations in Australian girls and women aged 15-54 years. It is also the number one cause of death and disability in women aged 15 to 44. Although most victims of fatal DFV access health services in the 24 months prior to their deaths, many victims living with DFV go unnoticed in the community. Health care providers are well placed to identify DFV victims and refer them to appropriate services. The ED has been described as a good place to undertake identification of DFV victims in several published research papers. Yet, how to do this remains controversial, and there are no standard protocols in place in our EDs. In this project, we aim to describe the current DFV health practice culture in five Queensland EDs. Knowledge, beliefs, and attitudes, as well as what’s actually happening to detect cases of DFV, will be assessed among our front-line ED social workers, nurses, and doctors. We aim to determine how many presentations to ED are identified and referred to social worker services for DFV. Ultimately, this research will both raise awareness about the potential of the ED to detect DFV, and will help pave the way forward to a well-informed and structured ED DFV screening program for Queensland, with applicability internationally.

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Antibiotics in the Emergency Department

In the Emergency Department (ED) deciding who does and who does not need antibiotics can be difficult. There is no quick test that an Emergency doctor can perform that accurately tells them who needs antibiotics or what type of antibiotic to prescribe. Our study aims to find out how many patients are given antibiotics in the ED and what proportion of those antibiotics are not required or have been given incorrectly (incorrect type or dose). Our study also aims to identify factors that are associated with poor antibiotic choices, including doctor experience and time of antibiotic prescription.

The results of this study will allow us to: (1) accurately estimate the proportion of ED patients who receive antibiotics; (2) determine if there is problem with when and how ED in a busy Australian ED give antibiotics; and (3) help to identify possible reasons why a wrong antibiotic choice is made.

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Is prednisolone an effective treatment for Bell’s Palsy in children?

Bell’s palsy or acute idiopathic lower motor neurone facial paralysis is characterised by sudden onset paralysis or weakness of the muscles to one side of the face controlled by the facial nerve. It is the third most common neurological reason for children to present acutely to hospital.

In adults, there is conclusive evidence from two major recent trials that a short course of prednisolone, a cheap, widely available and safe steroid, can significantly increase the number of Bell’s palsy patients who completely recover. While the medical problems associated with Bell’s palsy are similar, in children there is no good evidence that prednisolone is an effective treatment.

Many neurological conditions progress differently in children and treatment methods sometimes vary. Children may react differently to prednisolone and without paediatric evidence; treatment guidelines for children with Bell’s palsy remain absent or vague, with variable and overall low rates of steroid use in children by physicians.

The lack of evidence and clinical uncertainty in the treatment of Bell’s palsy in children warrants a definitive trial to determine the efficacy of prednisolone as a treatment for this condition in children. The aim of this study is to assess the utility of steroids in Bell’s palsy in children in a large multicentre randomised, placebo-controlled, trial. The trial will take place in at least 10 hospitals within Australia and New Zealand, involving more than 500 children.

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Will a replicable ultrasound training intervention improve intravenous cannulation processes?

Most patients need intravenous access in the emergency department, but many suffer multiple attempts before the health provider is successful. This can cause patient distress and delays the time to potentially life-saving treatments.

We believe an ultrasound-guided cannulation training program will enable better recognition of patients with difficult intravenous access and increase use of ultrasound during cannulation, hence decreasing time to cannulation, increasing success rates, and reducing the number of punctures required

In this study, we are examining the current practice of inserting intravenous (IV) cannulas in the Emergency Department at the Gold Coast University Hospital. We will consider how many people get cannulas, number of attempts required, who inserts them, how successful we are, how often ultrasound is used to guide this insertion, time to successful cannulation, who uses ultrasound and how successful is ultrasound-guided placement.

We will then run a year long intervention program for doctors and nurses to improve knowledge and skills in identifying patients with difficult IV access and to learn ultrasound-guided cannulation.

Following this, the initial observational study will be repeated looking for an improvement in the number of attempts required, the time to achieve successful cannulation, and the overall success of IV cannula insertion.

We expect that our well described and professionally videotaped training module will improve cannulation processes and impact a large number of patients by reducing the number of cannulation attempts.

The study also aims to develop the materials (visual and written) needed such that the USS training program can be replicated at other Australian sites.

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Kids THRIVE

Children may present to an emergency department with life threatening conditions that require immediate treatment to support their breathing to allow enough oxygen to be supplied to the body. In these circumstances a child is given medication to put them to sleep and the airway is secured with the insertion of a tube into the windpipe. This transition from spontaneous breathing awake to controlled respiration under anaesthetic via a breathing tube is called intubation and is associated with a high risk for low oxygen levels in the body or low blood pressure.

Newer methods to avoid these risks are currently the subject of many trials. In our study we investigate a new approach to prevent a drop in oxygen levels during intubation using high flow oxygen delivery. We have tested this method in children with healthy lungs undergoing anaesthesia for elective surgery and we found that we can maintain oxygen levels more than twice as long as using standard intubation methods. These findings would allow the operator in emergency settings more time and a safer condition to secure the airway in a sick child.

Therefore, we aim to compare this new oxygenation method with the current standard practice to intubate a child in an emergency situation. We aim to demonstrate that the new method will reduce the risk for low oxygen levels in the blood and also prevents low blood pressure associated with intubation.

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FEISTY – Fibrinogen Early In Severe Trauma study

This clinical trial aims to improve the quality of the resuscitation of patients with traumatic haemorrhage. We are enrolling 100 patients from four major trauma centres in Queensland. Patients admitted with severe traumatic bleeding will be given either Fibrinogen concentrate or cryoprecipitate. Time to administration of these products and effects on blood fibrinogen levels will be measured. We are using innovative technology to identify hypofibrinogenaemia; we will provide data to define the optimal method of replacement and monitoring of the end points of resuscitation; and provide data on the role of fibrinogen concentrate and its use in traumatic haemorrhage. We are also exposing a broad range of ED physicians to potential practice changing research that may be translated to use in other patient groups with critical bleeding.

More than 7000 Australians are treated for severe trauma every year. Major bleeding in the setting of trauma is associated with poor outcomes and increased rates of death. Severe trauma causes a decrease in the factors within the blood that helps clots to form and stop bleeding. This loss of clotting factors is associated with worse outcomes and it is proposed that early replacement of these factors may reduce bleeding and improve outcomes. Fibrinogen is one of the key clotting factors that needs to be replaced in severe traumatic bleeding. Currently fibrinogen is replaced using cryoprecipitate; a blood product obtained from healthy volunteer donors. This is a precious resource that is stored frozen in the blood bank; it can take a long time to administer and place significant strain on blood banks. Fibrinogen concentrate (FC) is an alternative product used to assist in blood clotting. It is stored in powder form, can be reconstituted at the bedside and given quickly. The study will investigate whether it is quicker to administer FC than cryoprecipitate, which will reduce haemorrhage and improve outcomes. With positive impact for both large urban metropolitan areas and remote isolated communities.

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Effect of Buddy Taping vs Plaster in Boxer’s Fractures (5thMC) –Buddy Study.

Fractures of the metacarpal bones are the most common hand injuries. Fractures through the neck of the 5th metacarpal (little finger hand bone) account for the majority of these. They are known as Boxer’s Fractures, as they are often sustained during a punch. Boxer’s fractures are traditionally managed in plaster, but in recent years there has been some suggestion that to simply ‘tape’ the little and ring fingers together will allow similar recovery with the advantage of full mobilisation. Currently there is not enough evidence to recommend one treatment over another. Potential benefits of buddy taping include: earlier return to work, less time spent in emergency, simple community follow up at the patient’s discretion. There is an economic benefit for the patient (they don’t miss work through being in a cast) and for the hospital (less time in ED and no need for orthopaedic follow up).

Our study is randomised and prospective. We enrol patients in the EDs of Robina and Gold Coast University Hospitals and randomise the patient to either receive a cast or buddy strapping. The patients are followed up in the orthopaedic fracture clinic at 1, 3 and 6 weeks, with phone follow up at 12 weeks. We are measuring hand function (using the quickDASH score of function), pain, satisfaction, economic analysis of return to work and sports, as well as objective strength and movement in the affected hand.

The study will improve the way that we manage a common injury. Patients who previously had to attend multiple busy outpatient clinics will potentially follow up with their GP at their discretion. Where patients would previously have spent 4 weeks in a cast, if buddy taping is effective, they can return to work immediately. This will result in time and resources saved in both the ED (assessment and application of plaster) as well as in orthopaedic outpatients (fewer follow up appointments and no need to replace plasters). Our aim is to optimise the care of our patients in a busy and time-pressured environment, and if the functional outcome is the same in both arms, we can choose the arm that most benefits the long-term economic, and social outcomes.

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