Results for Clinical


Implementation of Nasal High Flow: A Remote Context

In this study, the clinician-researchers are exploring whether nasal high flow (NHF) therapy can be safely and effectively used to improve health outcomes for infants with bronchiolitis in isolated remote communities, in particular for remote Indigenous Australians who have a higher incidence rate of bronchiolitis than non-Indigenous Australians. There is a desire by clinicians to implement NHF in remote areas, but this should undergo similar scientific scrutiny as previous published data.

NHF is a respiratory support system that provides support for people with respiratory conditions and is applied by high flow oxygen through nasal prongs. The therapy can avoid an escalation of care during hospitalisation. The safety of NHF has been widely studied in tertiary areas and regional hospitals, however, there is a lack of evidence to support safe use in remote settings.

In this study, the researchers are employing a two-phased approach: Firstly, an expert working party establishing agreed safe clinical boundaries for the NHF implementation and utilising expert viewpoints for implementation when managing infants with bronchiolitis. Secondly, a comparison of the outcomes before and after implementation to observe a reduction in escalation of care leading to reduced transfers. A community engagement process, with the focus to keep community members in their country/home environment, will be established to measure psychological, social-emotional and economic benefits of NHF.

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Paediatric Reduction in Emergency Cannula Accidental REmoval Trial – PRECARE trial

The aim of this study is to evaluate securement devices for peripheral intravenous catheters (PIVC) in the paediatric ED to determine which method is most effective for reducing PIVC failure, associated costs, acceptability and patient distress.

Infants and children depend on PIVCs for the provision of medical therapy within the emergency department and during hospitalisation. However, PIVC insertion and management is challenging and more than 25% of devices fail. PIVC failure is costly for both the patient and healthcare organisation. Failure may require the child to undergo traumatic reinsertion procedures, delay important medical treatment and prolong length of hospital stay. One way to reduce PIVC failure is with effective PIVC dressing and securement, by ensuring correct catheter position in the vein.

Our trial aims to test if new advances in catheter securement, medical grade superglue (Histoacryl) and an integrated dressing securement product (SorbaView SHIELD), are effective at preventing cannula failure and complications in paediatric patients. Using a three arm, randomised controlled trial, this study will recruit 460 paediatric patients at two regional emergency departments (Logan Hospital, Ipswich Hospital). Children will be randomised to receive PIVC securement by i) standard care, ii) advanced dressing or iii) medical grade superglue and advanced dressing. The main outcome of this trial is PIVC failure, with other important questions surrounding cost effectiveness and patient comfort also to be explored.

It is important for effective, improved cannula security to be explored as this is frequently a first line device choice for treatment, being highly effective in rapid treatment situations. A result in improved treatment delivery will benefit with cost savings in not only product but clinician time spent re-inserting, and a reduction in unnecessary, painful procedures for children.

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Improving the care of skin infections in the Torres Straits

This research project is looking at cellulitis in the Torres Straits. Cellulitis is a bacterial infection of the skin that requires antibiotics. People with cellulitis usually have an area of red and hot skin and sometimes can have fevers and become really unwell. Germs called Staphylococus aureus and Streptococcus pyogenes typically cause cellulitis. It potentially can cause serious infections and are a common presentation to emergency departments and admission to hospital.

In a tropical environment such as the Torres Strait cellulitis is extremely common and contributes to a significant burden on the healthcare system. Often patients present to health care facilities in the Torres Strait with cellulitis and are transported into Thursday Island Hospital for intravenous antibiotics. This is associated with significant retrieval, emergency and hospital costs. However the treatment of cellulitis in the community has been found to be practical, safe, and cost effective. We want to find out if cellulitis can be treated at home instead of in the hospital here in the Torres Straits.

The aim of this study is to validate outpatient intravenous antibiotic management of cellulitis in the Torres Straits. We anticipate that results from this study will improve preventable emergency and hospital admissions thus having significant health economic savings here in the Torres Straits.

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Can children be sedated effectively with only one needle?

Procedural sedation in emergency departments is performed on a daily basis. The current management plan arguably inflicts unnecessary pain and distress on children. This open label, multicenter, randomised control trial is investigating whether paediatric procedural sedation can be achieved with just one needle. The research team’s focus is the on determining the best outcome for the child in procedural sedation, prioritising psychological as well as medical consequences.

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Early resuscitation in paediatric sepsis

Sepsis is a leading cause of death and disability in children, globally accounting for more than one million childhood deaths per year. Recommended sepsis treatment currently consists of intravenous antibiotics and aggressive fluid boluses followed by inotropes and consideration for intravenous steroids. However, the evidence for interventions other than antibiotics is limited and aggressive fluid administration may be associated with harm. Therefore, fluid-sparing algorithms using early inotropes to treat shock have been proposed. Another strategy to hasten shock resolution consists in intravenous steroids, alone or in combination with thiamine and vitamin C, postulated to support metabolic dysfunction in recent studies.

In this project, the research team is conducting a randomised controlled pilot trial in children presenting with septic shock. They are assessing the feasibility of a fluid-sparing algorithm using early inotropes and early intravenous administration of Vitamin C, Thiamine and Hydrocortisone and the impact on survival free of organ dysfunction.

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Fibrinogen Early In Severe Trauma studY II (FEISTY II)

In a severe trauma, major bleeding or haemorrhaging is associated significant morbidity and mortality. Haemorrhage can be compounded by Trauma Induced Coagulopathy. It is postulated that early replacement of low fibrinogen levels may reduce haemorrhage and improve outcomes. Fibrinogen concentrate is an alternative way to replace fibrinogen.

In the FEISTY pilot trial, we demonstrated that a guided fibrinogen replacement strategy utilising either fibrinogen concentrate or cryoprecipitate is feasible. We found that fibrinogen concentrate was significantly faster to administer. The follow-on FEISTY II Trial will evaluate relevant patient-centred endpoints of a guided dose of FC Vs cryoprecipitate in traumatic haemorrhage. This larger study builds on the success of FEISTY to include multiple trauma centres in Australia and overseas.

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Fluid resuscitation in emergency patients with sepsis and hypotension (ARISE Fluids)

The question of fluid volume in resuscitation has been identified as the top priority in sepsis research by emergency physicians in the United Kingdom, Australia and New Zealand. Guidelines and sepsis pathways recommend an initial intravenous (IV) fluid bolus of 30ml/kg isotonic crystalloid for patients with sepsis and hypotension. However, there is a lack of evidence from clinical trials to support this strategy. Both observational data as well as randomised studies suggest there may be harm associated with injudicious use of fluids in sepsis. Since there is equipoise regarding a more liberal or restricted fluid volume resuscitation as first line treatment for sepsis-related hypotension, we conducted the pilot multicentre REstricted Fluid REsuscitation in Sepsis-associated Hypotension (REFRESH) trial comparing a restricted fluid protocol with early initiation of vasopressor support against standard guideline care.

The data from REFRESH will inform feasibility of a large, multicentre phase III study. However, further ground work is essential for the optimal design of a Phase III trial that will provide valuable information on feasibility (road test recruitment rate and screening processes) as well as refinement of the protocol (sample size estimation, processes of care, prevalence of the population of interest, real world clinical practice regarding fluid use).

In this ARISE Fluids study, we aim to provide more insight into current practice by conducting a bi-national multi-site prospective observational study of fluid administration in (suspected) sepsis and hypotension in the Emergency Departments of Australia and New Zealand hospitals. Sites have been selected on the basis of having expressed interest in participating in a phase III trial.

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Capacity Building Grant – third year: Royal Brisbane and Women’s Hospital

The Royal Brisbane and Women’s Hospital (RBWH) Emergency and Trauma Centre (E&TC) is committed to research as a way to improve both patient outcomes and the delivery of emergency care services. With the support of competitive grants from funding bodies, the E&TC has rapidly established a reputation for high quality, medically-oriented clinical and health services research. Our capacity and support for such work has resulted in international collaborations, publications in leading journals and translation of findings into clinical practice with tangible benefits to both patients and health services. Despite these successes, several years ago we recognised that there were still barriers to participation in research by emergency nursing and allied health clinicians.

It was evident that dedicated senior research support was required, which prompted our Capacity Building application to EMF in 2015. The resulting conjoint senior nurse research role was first occupied in 2017 and, in less than 18 months, has energized nursing and allied health clinicians to define key research questions, collaborate across disciplines and institutions, apply for funding, design and conduct research studies, publish manuscripts, present at professional meetings, and enrol in research higher degrees.

In applying to extend the funding for the conjoint senior nurse research fellow to a third year we acknowledge the essential contribution this position makes to our research capacity and to the development of individual nursing and allied health staff into effective clinician-researchers. Together with the commitments already received from RBWH and Queensland University of Technology, a third year of EMF funding will enable the full expectations of this conjoint position to be realized, thereby maximising the likelihood of attracting future recurrent funding.

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Examining the effectiveness of Brown snake antivenom

The amount of Brown snake antivenom required to properly neutralise the venom delivered in a brown snake bite remains controversial. Using appropriate amounts reduces the risks and side effects of antivenom, while optimising its positive effects. One of the major clinical symptoms of Brown snake bite is massive bleeding. We aim to use a novel method for analysis of blood clotting (the ROTEM analyser) to study the effects of Brown snake venom on blood clotting and how different doses of antivenom affect this. This information may enable us to develop a simple point of care test to determine the optimal dose of antivenom to be given, reducing the amount of antivenom needed, the length of hospital stay, and therefore overall cost of snake bite management.

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Single centre validation of the Canadian Syncope Risk Score

Syncope is a transient loss of consciousness with full recovery, and is a common presenting problem to the emergency department (ED). Most patients presenting with syncope have a benign cause, but others may be at risk for serious adverse outcomes. The problem is that there is currently no validated tool for knowing which patients are at risk and which can be safely discharged. Several clinical prediction rules have been developed over the years, however the sensitivity and specificity of these rules vary. This has led to an over-admission of patients who could otherwise be safely discharged, based on clinician discretion. These patients are subjected to multiple tests, including cardiac telemetry for monitoring which not only has low yield, but also results in significant costs to the healthcare system.

The Canadian Syncope Risk Score (CSRS) is the latest decision tool developed in an attempt to predict serious outcomes in patients presenting with syncope to the ED, but it has not yet been validated. This study aims to validate the CSRS at a single site, providing the first step in guiding clinicians to make better risk assessments and disposition decisions for patients with syncope. Furthermore, an innovative economic model will assess the impact of this decision tool on the healthcare system. This project is the first, critical phase toward better informed decision-making by clinicians for patients with syncope. Ultimately, this tool will enable a change to clinical practice that will result in improved patient outcomes and enhanced, targeted healthcare delivery.

Pictured to the right: Members of the Syncope research team from left to right: Ms Helena Cooney, Dr Alan Yan, Dr Jason Chan, Dr Emma Ballard (QIMR), Dr Jonathan Hunter and Dr David Brain (AusHSI)

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research projects

Improving jellyfish sting treatment

EMF funding is improving emergency care for the elderly

Trauma: better treatment for severe bleeding

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CONTACT US +61 7 3720 5700 info@emfoundation.org.au 2/15 Lang Parade Milton Qld 4064