Results for Public Health


Evaluating rates of skin colonisation with MRSA or Group A Streptococci

Group A Streptococcal (GAS) is known to be the cause of Acute Rheumatic Fever (ARF) and Chronic Rheumatic Heart Disease (CRHD).

Worldwide Community acquired (CA) Methicillin Resistant Staphylococcus Aureus (MRSA) is an increasing problem which has also been identified in Australia since the 1990s. At times, the rates in North West HHS have been as high as 30%. This has implications for both the local HHS and the health system more broadly for patients that then require transfer to other facilities.

The purpose of this research is to conduct a snapshot study for the evaluation of rate of skin colonisation or infection with MRSA and/or Group A Streptococci (SCIMAG).

The aim of this study is to establish the percentage of patients with skin colonisation and/or infection with GAS and/or MRSA. It will assess the utility of point of care (non-culture) methods to detect colonisation and/or infection. This is of relevance not only for the Mount Isa Hospital Emergency Department (MIH ED), but both State-wide and nation-wide.

Findings from this research will contribute to the development and implementation of a guideline for diagnosis and antibiotic treatment (antibiotic stewardship) for Mount Isa and the North West. This guideline would be applicable to other States.

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Outcomes in Transfers of Head and Neck Trauma Patients for Neuroimaging to Toowoomba Base Hospital Emergency Department.

Patients from Dalby and Kingaroy Hospitals are transferred to Toowoomba Hospital, for CT Scanning and advanced Radiology, when CT and Advanced Radiology services are not available locally. Dalby and Kingaroy Hospitals only have these services during business hours, Monday to Friday, and advanced Radiology when the trained Radiologist is working. This means on weekends and after-hours, patients need to be transferred to Toowoomba for these services.

It is hypothesised that a percentage of transfers from rural hospitals for head and neck imaging following minor trauma do not meet ACEM guidelines. Our aim is to investigate the reasons for transfer for CT Head and Neck scanning or advanced radiology, to see if any identifiable patterns or concerns emerge around decision making which led to the transfer. The secondary aim is to evaluate adherence to evidence based clinical practice guidelines on diagnostic imaging by ACEM.

Results of this research will include identification of transfers that were not made according to current guidelines. These results would allow education opportunities to better facilitate evidence-based decision making in transferring head or neck trauma patients for diagnostic imaging when services are not available.

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Ketamine vs Propofol in Sedation of Psychiatric/Psychotic Patients requiring Retrieval.

The research aim is to conduct as a randomised clinical trial comparing the use of Ketamine and Propofol in sedating acute psychiatric patients for safe aeromedical retrieval.
The inherent dangers of the aviation environment combined with the potential and unpredictable behaviour of acute psychiatric patients presents a challenge to even the most experienced aeromedical retrieval clinician. An efficacious sedation drug is vital in this environment to ensure patient and crew safety and to minimise patient distress.
The outcomes of this research will highlight the potential complications, the safety profile and efficacy of different sedation agent utilised in the sedation of acute psychiatric patients in the aeromedical retrieval setting. This research has the potential to establish sedation guidelines in the aeromedical retrieval of acute psychiatric patients for Australia and internationally.

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Research Scholarship Grant Dr Jeremy Furyk

The importance of good quality clinical trials in health care is being increasingly recognized worldwide. The London School of Hygiene & Tropical Medicine (LSHTM) is the leading postgraduate medical institution in Europe in the subjects of public health and tropical medicine.
The Master of Science in Clinical Trials, conducted online, aims to provide those with some experience in the area of clinical trials to broaden their role in design, management, analysis and reporting of clinical trials.

The first year of the course covers the core topics of; fundamentals of clinical trials, basic statistics for clinical trials, clinical trials in practice and reporting and reviewing clinical trials. Techniques, and methods learnt from the course will directly benefit the Emergency Department at Townsville and with emergency medicine research activities at the hospital and within the region.

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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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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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Placement of antiseptic solution and hand lotion as a factor influencing hand hygiene compliance in the emergency department.

Effective hand washing and hand hygiene are universally recognized as the simplest ways to prevent the spread of infection. As well as limiting the spread of disease, hand washing is one of the few effective ways to reduce the development of antibiotic resistant infections. Despite this, many studies have shown that hand hygiene and compliance best-practice standards is universally poor amongst doctors and nurses working in hospitals. Previous studies have identified many factors reported to affect hand washing compliance. The time to undertake hand hygiene, the individual’s knowledge of hand hygiene techniques, their attitudes towards its importance, workloads, and the context in which they work are all known to influence hand hygiene practices.

One important factor known to influence hand hygiene factors is the availability and accessibility of equipment to carry out effective hand hygiene, such as antiseptic solutions. It is well-documented that compliance with hand hygiene is directly proportional to the accessibility and availability of products to decontaminate hands. In the context of the emergency department, where there are significant time and resource pressures, the time it takes to undertake hand hygiene and the accessibility of products to do so are important. Despite this, little evidence exists that examines the relationship between the positioning of hand hygiene solutions relative to the sink and its effect on hand hygiene compliance.

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Cost effectiveness and Clinical outcomes of B-type Natriuretic Peptide (BNP) Point of Care Testing versus BNP Laboratory testing for Adults with Dyspnoea in the Department of Emergency Medicine at Nambour General Hospital.

Patient flow and access block will be evaluated through comparing time to decision making in the Emergency Department (ED) and Emergency Department length of stay (ED LOS) between patients who have POC and Laboratory BNP testing. Cost effectiveness will be evaluated by reviewing treatment type given, admission rate, ICU admission rate, inpatient length of stay (IP LOS), Emergency Department Length of Stay and 30day readmission rate.

This study will build upon the findings of a similar concurrent study. Both studies demonstrate a poor utility in BNP testing in patients presenting with shortness of breath in reducing Emergency Department length of stay. While this limits the potential for BNP Point of care testing within the ED, the validated Abbott Point of Care BNP cartridge will have the good potential for improving patient care in rural and remote cardiac outpatient locations where current BNP testing results take several days to obtain.

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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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Comparison of the quality and completeness of the medical record and the proportion of appropriate referrals for suspected abusive injury of young children.

This study examines the data gathered and documented in patient charts with respect to the possibility of abusive injury in presentations by injured children under 3 years of age, as well as conclusions made by the treating doctor with respect to the possibility of abusive injury, and whether or not a consultation with an emergency or child protection specialist was made in reference to this issue.

These data are compared:
1/ Between two sample periods at the Mater Children’s Hospital before and after the introduction of an electronically generated proforma to prompt such data collection
2/ Between these samples and a matched sample from Royal Children’s Hospital which uses the prompting proforma but generates this manually.

Outcomes may include an increased likelihood of early detection of intentional trauma to children, and a clearer understanding of the context (benefits, challenges, impediments and opportunities) related to the application of an early detection surveillance referral tool.

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