Results for Clinical


Research capacity building: Redcliffe Hospital

Redcliffe Hospital Emergency Department (ED) has a growing research track record and an increasing number of clinical staff engaging in research-related activities. To capitalise on this burgeoning interest, we will funding a dedicated Clinical Research Coordinator to provide active support, coordination and promotion of both current and future research activities. The aim of our endeavour is to establish research as a core element of ED activity, together with education & training, provision of clinical care and maintenance of standards in healthcare. We intend to conduct our future research under the auspices of leaders and champions representing four thematic headings: 1. Clinical Care, 2. National Standards, 3. Systems and Process Design, 4. Education and Training.

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Assessing Children’s Head Injury: Variation in CT scan use (APHIRST-Gap)

This study will collect information from the records of 3000 children from 30 hospitals presenting after a head injury in 2016 and will interview staff to look at different factors influencing the care provided. APHIRST-Gap is expected to provided crucial information on scan rates and inform strategies, including national guideline development to standardise and improve the care of children with head injury across Australia and New Zealand.

Head injury is a common reason children present to Emergency Departments in Australia and New Zealand. While most are minor the important issue for emergency clinicians is to determine whether a particular child is at risk of a serious head injury such as a bleed on the brain. A computerised tomography(CT) scan is the investigation of choice to look for these injuries. Its use is not without risks though, including those of sedation, and radiation induced cancer.

Several “rules” have been designed to guide doctors in the decision between risk of injury and risk of scan. The recently published Australasian APHIRST study examined three of these rules in our context. It found that all three rules performed well, clinicians made good judgements on who to scan, and the overall rate of CT scan use was low(10%). APHIRST was limited to 10 large metropolitan, and predominately children specific hospitals. Most children in Australia are not seen in these hospitals. Further research is required to determine whether there is a large variation in scan use between different hospitals and how best to apply these findings to a broader range of hospitals.

This trial is being run by the PREDICT network and the Principal Investigator is A/Prof Franz Babl.

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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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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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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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How are we treating severe childhood asthma in Australasia?

Most children with asthma presenting to an emergency department (ED) are managed with inhaled medications and oral steroids. Infrequently, some children are very unwell, and require assistance with their breathing, or intravenous medication Currently, there is minimal information to guide clinicians on which treatment to choose for severe acute asthma. All have side-effects, and we do not know which is most effective. Studies from the UK and Australasia demonstrate significant variation in practice, although Australasian data is nearly 10 years out of date. When comparing treatments, it is important to determine whether or not they can reduce the risk of severe complications, or whether they make a difference in important treatment outcomes.

This project will allow us to determine current management practices for children with severe acute asthma and/or wheeze; how common severe acute asthma is and also how frequently complications of severe asthma occur; and understand where differences in therapy exist between states/regions. We will be looking at sites across Australia and New Zealand. Once complete, this project will provide important data to allow us to design future research to establish the best treatments for severe asthma.

EMF is funding the Queensland sites taking part in this Australasian trial. This study is being run by the PREDICT network. The Chief Investigatory is A/Prof Simon Craig. The study will include 18,000 children aged 1 – 18 years treated for asthma in the ED.

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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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Point of care lung ultrasound in paediatric respiratory presentations

Emergency department physicians with no prior specialised ultrasound training can be taught to reliably identify bronchiolitis, pleural effusions, pneumothorax and pneumonia, in children presenting with cough, shortness of breath and hypoxia through the use of lung ultrasound after a brief training. In this study, we are assessing the effectiveness of trainees performing a lung ultrasound examination of children, capturing their images and recording their findings. No clinical decisions will be made based on these findings without consultation with the consultant on duty. We will consider to what extent the teaching was successful and try to determine whether the teaching resulted in a objectively verifiable benefit to the emergency department. We anticipate a reduction in the amount of time the child spends in the department. It is also anticipated that there will be decline in x-rays relative to the number of presenting patients.

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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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Propofol on trial for headaches in the Emergency Department setting

Headache is a common and frequently disabling clinical disorder that accounts for nearly 2% of all emergency department presentations. Often patients are experiencing a headache that is not responding to commonly available medications. However, there is no good evidence to support which available hospital medications consistently offer effective pain relief to individuals with these types of refractory headache. Understandably this is a challenging scenario in the emergency department setting for both the patient and physician that often leads to inadequate or unsatisfactory symptom relief.

In a few small trials, there has been promising evidence that the medication propofol is potentially an effective, safe and quick treatment alternative for stubborn headaches. It is important to note that propofol is not a new medication and is routinely used on a daily basis throughout hospitals for both general anaesthesia and procedural sedation.

It is the intention of this research project to demonstrate that infusing a low dose of this medication over a relatively short period of time is an effective new use for a familiar and already commonly utilised medication. This treatment is aimed at a specific cohort of patients who present with acute or subacute migraine-like headache in whom the standard available treatment options have failed.

This study has the potential to introduce a new safe and effective treatment option for stubborn headaches that can significantly reduce treatment times by rapidly restoring patients to baseline levels of function and comfort. Furthermore it reduces overall lengths of stay in the emergency department and contributes to overall improved emergency department patient flow.

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