Evaluation of older patients with minor blunt head trauma to identify those who do not have clinically important Traumatic Brain Injury and can be safely managed without cranial Computed Tomography

Older patients with minor head injury routinely get a head scan in emergency departments due to the risk of a brain bleed. Recent studies have suggested that some of these patients may not need a head scan. However, doctors do not currently have an accurate method to identify those patients who do not need a scan.

This research aims to identify a subgroup of older patients with minor head injury who do not have a brain bleed and can be safely managed without a head scan. As there are no known Australian studies in this area, this innovative project addresses a common problem in a vulnerable group of patients with several potential benefits.

The study will inform emergency doctors about the feasibility of larger Australian studies to develop a reliable and accurate method to identify older patients who do not have a brain bleed and do not need a head scan. Such a method could benefit patients by reducing transfer from rural and remote communities to bigger hospitals for a head scan, reducing waiting times in emergency departments and reducing exposure to radiation. Such a method could also have significant cost savings to the Australian healthcare system by reducing costs associated with patient transfers, head scans and prolonged emergency department wait times.

Staff experiences of wellness activities at a major regional Queensland ED

Healthcare in general and Emergency Departments (ED) in particular are stressful environments associated with excessive work demands, long hours and often limited support.

These pressures are compounded by staff shortages, fiscal constraints and increased ED presentations and patient acuity. Against this background where resources are so stretched, the COVID-19 pandemic poses intense and prolonged pressure.

The cumulative impact of chronic stress adversely affects the physical, mental, and social wellbeing of ED staff, leading to burn-out and to difficulties with staff recruitment and retention, decreased morale and job satisfaction.

Promoting staff wellness may enhance their ability to cope with occupational stress through support systems, development of resilience and building social connection. However engaging staff who are chronically stressed is a challenge.

It has never been timelier to identify effective evidenced based strategies that promote wellness and can be rigorously evaluated for the ED context. This project aims to qualitatively assess ED staff perceptions of Workplace Wellbeing activities, their views on measures to improve engagement, and perceptions of how to improve staff engagement with these interventions, especially in the context of chronic workplace stress.

Identifying RNA-based blood markers in ED patients with suspected acute ischaemic stroke arising from large vessel occlusion

Each year 40,000 Australians suffer a stroke, most of which arise from interruptions in the blood supply to the brain. Treatments for stroke focus on restoring the brain’s blood supply to limit the number of brain cells which die. Patients who suffer stroke due to a blockage of the arteries supplying the brain (LVO-stroke), benefit from surgical restoration of the blood supply (known as endovascular clot retrieval, ECR), but this is only effective if performed within 24 hours of stroke onset.

Rapid detection of patients with LVO-stroke is key, however many unrelated conditions can mimic stroke symptoms. Patients suspected of suffering a stroke therefore require intensive examination and brain scans to confirm diagnosis before treatment can begin. This delays care provision, particularly for patients in regional areas who must travel to access specialist equipment. Furthermore, the sensitivity of brain scans during the early stages of stroke is poor, increasing the potential for misdiagnosis.

Researchers propose developing a blood test to rapidly screen patients for stroke. Previous research identified 11 new markers in the blood of stroke patients, suggesting diagnostic potential. In this study, researchers we will screen blood samples collected from patients with LVO-stroke to discover markers specifically associated with ECR requirement. The study will also compare the diagnostic performance of identified markers to the screening tool currently used by emergency teams to assess clinical usefulness.

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.

Is Helicopter Transport Safe for Divers with Decompression Illness?

Diving is a common recreational activity for both Queenslanders and tourists alike. It forms the basis for whole tourism industries based on the Great Barrier Reef. Unfortunately diving does have risks which includes decompression illness (DCI). DCI involves formation of gas bubbles and can be fatal. Treatment usually involves re-pressurisation in special chambers designed to ‘squash’ the bubbles and reduce symptoms. Affected divers can only receive this treatment in certain hospitals. They may need to be transported urgently by helicopters from the reef to hospital. However, some people believe that the vibration of the helicopter may increase the number of bubbles and make symptoms worse before divers can access treatment. This study will determine if this is true – will bubbles actually be increased by the vibration associated with helicopter flight? If vibration does increase bubble formation, then in the future alternative strategies for transporting DCI patients can be implemented to reduce the risk to these patients. To ensure safety the vibration record of helicopter flight will be recorded and reproduced using a vibrating basket model. Healthy volunteers accompanying divers in the recompression chamber will be assessed with a special ultrasound to detect bubbles following the ‘dive’ and then placed in the vibrating basket. The number of bubbles present after this will be measured again. This study will help ensure safe transport of injured divers not just in Queensland but internationally. This global importance is represented in the research team, which includes members from both Canada and other Australian states, which are collaborating in a Queensland based study.

Tamsulosin for the treatment of Distal Ureteric Calculi: A Double Blinded, Placebo-Controlled, Randomized, Multi-Centre trial

Ureteric colic (or Kidney stones) is a significant public health concern within Australia, affecting as many as 5-15% of adults. As a result, a significant number of Australians experience significant pain, hospital and outpatient visits, and the potential for more significant complications such as infection, kidney damage and the need for surgical treatments.

Although several methods of medical treatments to improve care of such patients have been studied overseas, some of which appear promising, the practice of “medical expulsive therapy” for ureteric colic is not widely practiced in Australia. One such medication is Tamsulosin, which seems to have an effect on the ureter (tube from kidney to bladder) and helps stones pass. It is already in use for other urological conditions already in Australia, and studies overseas seem to show benefit for patients with Ureteric colic.

Within Queensland Health there is substantial variation with regard to access to specialist urologist services. Benefits of medical therapies for ureteric colic may be even greater in geographically isolated areas without full time urology services.

Patients who present to the participating emergency departments with Ureteric calculi, that fit the inclusion criteria will be randomly allocated to either the study medication (Tamsulosin 0.4mg daily) or placebo. The patients will then be closely monitored for four weeks, to determine if the stones pass spontaneously, or if any complications occur. At four weeks the study will be complete, patients who are yet to have passed the stone, would be referred to Urology for consideration of a procedure.