Results for 2009


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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Blind Prescribing and the prescribing preparedness of doctors in Emergency Departments.

“Blind Prescribing” describes the situation where a medical practitioner prescribes a medication they know little about.
Theoretically, ‘blind prescribing’ could lead to higher rates of medication error and unsafe medical practice. The project aims to determine if Blind Prescribing occurs in emergency medicine, to identify the prevalence of the practice, and propose situational and contextual factors pertinent to Emergency medicine that are thought to enable this practice.

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Development of a human cardiac myocyte assay for the production of lethal dose response curves for box jellyfish venoms: Can heat and intralipids be used as a treatment for cubozoan envenomings?

The problem of box jellyfish stings is an issue of medical and commercial importance to tropical Australia, notably in Queensland, Northern Territory and Western Australian coastal communities, threatening the perception of Australia as a safe destination. For example, approximately 160 people from Queensland resorts, including many international visitors, were hospitalized following envenoming during the summer of 2001-02 closing much of the frequented north Queensland coastline.
Fatalities from Irukandji and Chironex box jellyfish stings and the loss of tourism to affected areas present both a medical and economic challenge. Although cubozoan envenoming in Australia may be seen as a minor "medical" concern (compared to other tropical diseases), it represents a major cost to northern Australian communities in terms of public health, leisure and tourism
We aim to
i) produce dose response curves for various concentrations of cubozoan venoms (namely Chironex fleckeri and the irukandji jellyfish, Carukia barnesi) on human cardiac myocytes.
ii) to determine the lipid solubility of Chironex and Irukandji venom in ILE and its effectiveness in decreasing the lethality of these venoms in human cardiac myocytes assays.
iii) to test the hypothesis that irukandji venom is heat labile and can be de-activated at thermal loads that do not cause permanent damage to the tissues of envenomed victims.
These aims will be achieved by testing jellyfish venoms on human heart cells, to determine the relationship between the concentration of jellyfish venoms to death rate of the cells. Using this data we will then be able to determine if new and novel approaches to treatment, i.e. the use of heat and intralipids, may benefit jellyfish envenomed patients.

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A randomised, un-blinded trial of continuous infusion versus bolus dosing of flucloxacilin in the management of uncomplicated cellulitis in an Emergency Department Short Stay Ward.

Skin infections are common in the Emergency Department. Currently, such infections are treated by admitting the patient to hospital for 24 hours and giving them four injections of an antibiotic called flucloxacillin. However, an alternative way to administer antibiotics is to attach a device to the patient’s arm which infuses the flucloxacillin over a 24 hour period. We anticipate that this device will reduce the time that nurses spend giving injections and also reduce the cost to the hospital associated with giving patients multiple injections.

The overall aim of this study is to trial the antibiotic device to determine whether it saves nursing time and health care costs without reducing the quality of care provided to patients. To achieve this aim, we will conduct a randomized controlled trial where half of the patients who present to our department with skin infections will be given a continuous infusion of antibiotics while the other half will be given the traditional treatment. We will then compare the time taken to administer the antibiotic in the two groups and consider the costs associated with each type of treatment. It is anticipated that the study will change the way that skin infections are treated in the Emergency Department and will result in considerable cost savings for the hospital.

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Ketamine alone versus propofol added to ketamine versus ketamine mixed in propofol for pediatric procedural sedation in emergency departments.

Children present to emergency departments (EDs) with injuries that require painful procedures such as straightening broken bones and suturing cuts. Medicines used for these procedures include midazolam (a sleeping medicine), nitrous oxide (laughing gas), and morphine (pain killer) as well as many others. Ketamine is one medicine that combines pain relief and sedation. Ketamine is very safe and has been used in millions of procedures around the world. Children when they wake up after ketamine may be agitated or feel like vomiting. Ketamine can raise blood pressure and some situations it should not be used. Ketamine is Australia’s preferred sedative for children in EDs. Perhaps we can improve on ketamine by using different dosing methods or mixing with other medicines.
Propofol is another medicine used to deeply sedate children. In large amounts it will interfere with breathing and lower blood pressure, so it needs to be given in the right place and at the right time. Propofol’s main advantage is that it is much faster to work than ketamine and its effects wear off very fast. Interestingly when propofol is given with ketamine they may balance each other’s side effects; keeping blood pressure even, providing relaxation, reducing vomiting. Since propofol recovery is faster than ketamine, children may wake up sooner.
Emergency doctors have been mixing ketamine and propofol together and calling this combination “ketofol” and find it very effective in adults. Some give ketamine and then propofol, although how much is required is not clear. A number of emergency doctors prefer to give ketamine alone and treat side effects if they occur.

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Comparison of the Implementation of Interventions for Controlling Laboratory Blood Tests Ordering in Four Queensland Teaching Hospital Emergency Departments.

Doctors frequently need to order blood tests in the Emergency Department when patients come to hospital with a medical or surgical emergency. In all but the most trivial cases, laboratory blood tests are requested as part of the diagnostic workup. Doctors and even the patient are often concerned about missing a diagnosis if enough blood tests are not done. However, medical research worldwide has revealed that test ordering is excessive and often unnecessary.

The growth in test ordering places an enormous financial strain on our health care system, and includes unnecessary investigations or treatment. Thus, reducing the number of unnecessary tests is important for patients to avoid undue discomfort and worry, and for the hospital to improve work efficiency and reduce costs.

Health care professionals have, therefore, worked out various ways to ensure tests are ordered only when needed. These have included education of junior medical staff, protocols for ordering tests, audits of tests ordered, and feedback of audits to staff. These methods have been successful in reducing test ordering in the short-term, but sustaining a long-term reduction is more difficult.

Queensland Hospital Emergency Departments have implemented methods to reduce excessive test ordering, but it is not known which method is most effective. The aim of this study is to determine maximum efficacy, by comparing the number of tests ordered in four of the busiest Emergency Departments in the state. Specifically we will compare the average number of blood tests ordered per patient treated in the Emergency Department taking into account their age, severity of their illness, and whether or not they were admitted to hospital.

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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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Will a mandatory clinical debriefing program affect levels of psychological distress in Emergency Registrars.

Emergency doctors have been shown to exhibit higher levels of psychological distress and burnout than both their medical colleagues and the general population. This study will measure levels of burnout and psychological distress amongst Emergency Registrars before and after the implementation of a clinical debriefing program. It will be ascertained whether there is a difference in the before and after scores and whether the change is statistically significant.

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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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