Results for 2015


Point-of-care testing for better management of acutely ill remote patients.

Australians living in rural and remote areas experience a significantly higher burden of acute care episodes compared to those living in metropolitan and urban areas. A contributing factor is the effect of geographical isolation and its impact on access to health services including pathology testing. We aim to assess the benefits of using point-of-care testing at remotely located health centres of the Northern Territory. Point-of-care testing enables pathology testing to be performed on-site, with results available during the patient consultation. We will investigate the clinical benefits of using point-of-care testing to either rule-out a potential acute medical problem, stabilise an acutely ill patient, and/or to confirm an emergency medical evacuation is required for patient care. The project will also determine the cost savings associated with point-of-care testing preventing unnecessary emergency medical retrievals, which come at a high cost to the Northern Territory Government.

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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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Using a modified blood pressure cuff to prevent cell death for rural people suffering a heart attack or stroke.

Stroke and heart attacks (HA) are caused by blocked brain or heart blood vessels. The impact of stroke or HA depends in part on time taken to unblock occluded blood vessels. Rural people with stroke or HA receive treatment to unblock vessels later than city folk. The delay to re-perfusion causes damage and worse outcomes for country people experiencing stroke or HA. Late re-perfusion is associated with increased brain or heart injury. A treatment called "remote-ischaemic-conditioning" (RIC) involves a modified blood-pressure cuff that occludes limb blood flow for short periods, is known to protect against re-perfusion injury. The aims of this study are: investigate the feasibility, safety and efficacy of RIC in preventing re-perfusion injury for rural people experiencing a stroke or HA. The expected outcomes of RIC include: lower levels of brain or heart damage and disability following a stroke or HA amongst rural people.

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Capacity Building Grant: Royal Brisbane Hospital

The Royal Brisbane and Women’s Hospital (RBWH) Department of Emergency Medicine (DEM) is constantly looking for better ways to improve the care of the sick and injured. Patients are cared for by a team of professionals including doctors, nurses and other allied health professionals. Improvements in care come largely from high quality research.
Our medical specialists in Emergency work on a wide range of challenging, innovative emergency medicine research topics. Their results are reported in some of the top professional journals, including the Lancet. Research led by other team members including nurses, however, is scarce despite the fact that these clinicians play an integral part in emergency care. We believe one of the main reasons for this is the lack of senior research mentors accessible to all clinicians in our department.
We propose creation of a dedicated research position to enhance capacity, develop grants and opportunity for research among our multidisciplinary team. She/he will identify key research questions, design scientific studies, write and submit proposals for funding, supervise the collection and analysis of study data, and support the preparation of reports for presenting and publishing in medical, nursing, and other professional meetings and journals. He/she will also provide training, guidance and encouragement to all ED staff to participate in research; liaise with other investigators (external to DEM) to facilitate optimum conduct of all departmental interdisciplinary projects. Furthermore, she/he will establish collaboration and professional partnerships with academic institutions and other research bodies to attract funds, grants and research to the department.
This position will help to improve the quality of emergency medicine research outputs from the RWBH and boost multidisciplinary team focused research in the department. It will also help build the knowledge base and provide the evidence to guide interventions by all health care workers in the emergency department.

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Ketamine IntraNasally Delivered in the Emergency Room: KINDER

Sick and injured children in the Emergency Department (ED) often require procedures which can cause severe pain (like fracture reduction, stitching wounds, abscess drainage) or otherwise require the child to be still and cooperative (CT scans, lumbar punctures, removal of foreign bodies). Sedative drugs are given to these patients both to relieve pain/distress and to keep them still for the procedure.

ED sedation of children now has a well established body of evidence. Most of the literature relates to when the drug is given intravenously or intramuscularly. Drug delivery by these routes leads to reliable effects as the drug bypasses the liver without being broken down before it reaches the brain. However, both these routes require a needle which requires staff to hold down a young child against their will, frequently causing great distress along with the pain of the needle. Great efforts have gone into making EDs "Ouchless" where unnecessary pain for children is reduced or eliminated. Sedation is itself part of this effort. The intranasal route (injecting the medicine up the nose with a plastic syringe) could represent a needle-free alternative.

Ketamine is the most common drug used for paediatric sedation in Australian EDs and can be given intranasally. No studies have examined its use for ED sedation but many studies support its use in anaesthetics and dental clinics where it has been shown to be safe and effective.

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High Flow Nasal Cannula Treatment for Infants and Children with Acute Respiratory Failure – a Pilot Trial

Worldwide, the respiratory distress associated with pneumonia and other causes remains the leading cause of death in children. In Australia 39% of intensive care admissions for children are due to respiratory disease, with bronchiolitis/viral infection representing 17%, asthma 7% and pneumonia 7%. There is an emerging trend to support respiration with methods other than oxygen, particularly in the early stage of disease process aiming to prevent the progression of disease. In under resourced countries children presenting to hospitals with severe pneumonia have a mortality rate between 13-20% and most deaths occur with hypoxemia before therapeutic benefit of antimicrobials. High flow nasal cannula (HFNC) therapy is a new promising mode of respiratory support as an alternative to non-invasive ventilation, which is poorly tolerated by a sick child. HFNC therapy can be used very early in the disease process and requires little cooperation

This study aims to develop a multi-centre trial and to assess which infants and children with acute respiratory failure benefit using HFNC therapy. For this purpose we will perform a randomised controlled trial comparing current best practice (standard oxygen delivery via subnasal prongs, facemask, venturi mask) versus HFNC therapy. With the introduction of this simple to use respiratory system administered earlier in the disease process, we aim to investigate if HFNC therapy has a lower treatment failure rate in comparison to standard oxygen delivery, and to investigate if there is a reduction in the need for transfer of these patients to a tertiary hospital or admission to intensive care.

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REstricted Fluid REsuscitation in Sepsis-related Hypotension (REFRESH)

The REFRESH study is a multicentre, open-label, randomised, phase II clinical feasibility trial. This is the first randomised trial examining fluid volume for initial resuscitation in septic shock in an industrialised country. A pragmatic, open-label design will establish the feasibility of undertaking a large, international, multicentre trial with sufficient power to assess clinical outcomes. The embedded biomarker study aims to provide mechanistic plausibility for a larger trial by defining the effects of fluid volume on markers of systemic inflammation and the vascular endothelium.

Participants will be patients presenting to the emergency departments of Australian metropolitan hospitals with suspected sepsis and a systolic blood pressure of < 100 mmHg, persisting after a 1000-ml fluid bolus with isotonic crystalloid. Participants will be randomised to either a second 1000-ml fluid bolus (standard care) or maintenance rate fluid only, with the early commencement of a vasopressor infusion to maintain a mean arterial pressure of > 65 mmHg, if required (restricted fluid). All will receive further protocolised fluid boluses (500 ml or 250 ml, respectively), if required during the 6-h study period. The primary outcome measure is total volume administered in the first 6 h. Secondary outcomes include fluid volume at 24 h, organ support 'free days' to day 28, 90-day mortality, and a range of feasibility and process-of-care measures. Participants will also undergo serial measurement, over the first 24 h, of biomarkers of inflammation, endothelial cell activation and glycocalyx degradation for comparison between the groups.

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A Prospective Observational Cohort Study of Paediatric Status Epilepticus in Emergency Departments of Australia and New Zealand. The Status Epilepticus Australasian Registry for Children (SEARCh).

Convulsive status epilepticus (CSE) occurs when seizures do not stop spontaneously. It is the most severe form of epilepsy, and can result in long-term disabilities and rarely death. It can affect both adults and children, although the causes and outcomes are different in these groups of patients. Treatments of patients with CSE are largely based on expert opinion rather than strong evidence, due to the difficult nature of conducting quality trials in patients with this relatively infrequent condition in the emergency setting. We will determine the incidence and causes of CSE in children in Australia and New Zealand and collect information on the type of seizure, duration, treatment and outcome to determine ways to improve the management of children with CSE.

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Describing the experiences of social workers in a tertiary emergency department

The Royal Brisbane and Women’s Hospital Emergency and Trauma Centre is one of the largest emergency departments in Australia. It is the only one that includes an on-site team of social worker 24/7. This research project is the first conducted to explain the evolution of this service, its implications for the social work team, and for the department more broadly. This study involves a qualitative analysis of the experiences of this social work team, based on information provided during interviews. This is the proposed first phase of research, which will inform future research including measures such as compassion fatigue and burnout among this group.

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Development and validation of a psychometric tool to measure the risk propensity of junior emergency doctors.

This pilot project brings together experts from the fields of emergency medicine, medical education and organisational psychology. Its aim is to develop a tool which may be used to evaluate risk propensity in emergency doctors.

An individual’s propensity for risk and their decision making involving risk have both positive and negative consequences. It is most often revealed when faced with scenarios that involve a trade-off amongst competing demands. Risk-related behaviour may cause harm to self, staff and patients; however it can also be used positively when the potential benefit is high, e.g. when the risk associated with a procedure is considered acceptable to improve quality of life. Risk propensity is the measure of the balance between the perceived risk and the perceived benefit with the resultant action or behaviour. An individual’s knowledge of, and insight into, their own risk propensity will be of value to self-directed and learned behavioural change. The project will develop and evaluate a tool specifically aimed at junior emergency doctors who, owing to the nature of their patient contact (i.e. acute, trauma) are highly time critical in their decision making.

Resultant application of the tool will be the basis of an ARC application in 2016. Results will inform medical educators how to target support, counseling and training of junior doctors in emergency medicine to be self-aware of their own propensity for risk and use it to best advantage for their psychological well-being, their personal safety and importantly the well-being of their colleagues and patients.

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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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