Results for Leading Edge


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.

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LOVE-DIVA

Peripheral intravenous catheters (PIVCs) are small plastic tubes placed in a patient’s vein for the delivery of intravenous fluid and medications. In the emergency department, many patients present with difficult intravenous access and require multiple insertion attempts to successfully place a PIVC. This can be time consuming for clinical staff, costly for hospitals, and painful for patients. Correct device selection is a key strategy to ensure first-time insertion success.

This study will recruit 406 adult participants at two emergency departments in order to test if novel PIVCs with a retractable guidewire (AccuCath Ace™ Intravascular Cannula, BD), compared to standard care, are effective at increasing first-time insertion success for patients with difficult vascular access.

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An Occupational Therapy Pathway for Mild Traumatic Brain Injury ED presentations across the lifespan

Mild Traumatic Brain Injury (mTBI) is a significant burden to Queensland emergency departments (EDs) in adults and children. Between 2019-2020, there were 958 presentations of isolated mTBI to Gold Coast Hospital Health Service EDs, of these 73% presented outside of usual business hours and 26% re-presented within 3 weeks of their initial presentation, complaining of persistent symptoms.

The Occupational Therapy (OT) Outpatient Service identified an innovative medical substitution practice model involving specialist follow up for patients to facilitate recovery, link into appropriate specialty referrals where indicated, and prevent ED representations. It is anticipated that the implementation of the OT pathway will lead to enhanced clinical outcomes (including quality of life and return to work/school), decreased ED length of stay for monitoring of symptoms and decreased ED readmission.

The primary aim of this research is to evaluate the impact of this Occupational Therapy (OT) intervention pathway for patients presenting to ED with a mTBI outside of business hours compared to pre-implementation care. The study also aims to evaluate the feasibility of implementing the pathway in relation to adherence, patient and staff acceptability and satisfaction.

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Coronary Artery Disease in Aboriginal and Torres Strait Islander People

The current assessment for emergency department (ED) patients with chest pain focuses on the short-term risk of heart attack, to differentiate low risk patients from those at high risk and requiring further treatment. This has been shown to be safe and effective for non-Indigenous patients, however, deaths from heart attack in Indigenous Australians occur, on average, at younger ages than non-Indigenous Australians.

Due to the high lifetime prevalence of heart attack in Indigenous Australians, ED investigations that focus on both short- and long-term risks may improve outcomes. Understanding rates of, and the types of patients who have coronary artery disease in this cohort would provide additional information about who requires further testing.

The aim of this study is to measure the rate of coronary artery disease in Aboriginal and Torres Strait Islander people who present to the ED with chest pain. By identifying how many Indigenous patients with chest pain in the ED have coronary artery disease, researchers aim to establish foundational knowledge to develop a heart attack risk assessment that is specific to Indigenous patients.

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Exploring Cultural and Linguistic Diversity in the Emergency Department (CALD ED) study

Providing equitable and appropriate care to populations with cultural and linguistic diversity (CALD) can be a challenge for Emergency Department (ED) providers.

This qualitative study aims to explore cultural and linguistic diversity in the ED, to inform evidence-based strategies to support patients from CALD backgrounds and guide subsequent research directions.

Researchers will consider individual patients, and their affiliation to people, organisations, their community and culture to explore barriers and facilitators to care delivery from the perspective of clinicians (doctors and nurses) and patients from CALD backgrounds.

The study involves collaboration with health and community partners, and a research team largely from CALD backgrounds whose language skill set will be utilised in a novel way (i.e. with translating information forms and supporting patient interviews).

The project is co-funded by a grant from the Gold Coast Health Collaborative Research Grant Scheme. Gold Coast Health is funding the quantitative arm of the study describing ED use by patients from CALD backgrounds.

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EEG in TRaumatic brAin INjury (EnTRAIN)

Head injury results in a high degree of ongoing disability. Risk of Traumatic Brain Injury (TBI) is higher in the 15-19 and 75+ age groups with older Australians having a three times greater incidence compared to the general population (Pozzato, Tate, Rosenkoetter, & Cameron, 2019).

There are two distinct aspects to a severe head injury - the primary injury and the secondary injury that occurs as a result of deranged brain functioning. Treatments are targeted at minimising the damage occurring during the secondary stage and to protect damaged brain tissue by optimising blood flow, oxygen delivery and reducing the metabolic needs of the brain.

There is currently no way to closely monitor the 'real-time' physiologic changes beyond clinical symptoms such as changes in pupil size, heart rate, blood pressure etc. and, in the case of rising pressure in the brain, treatment is initiated on clinical suspicion alone. Electroencephalograms (brain wave monitors) have shown promise in their ability to detect brain oxygen starvation, seizure presence and increased pressure in the brain.

This pilot of Quantitative EEG (qEEG) will measure these changes during prehospital care of TBI, the results of this research would be used to guide larger studies into the use of this technology.

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From Big Data to the Bedside: answering big questions in emergency department pain care using artificial intelligence and patient-reported outcomes

One of the main reasons that acute pain is not well treated in the emergency department (ED) setting is that pain is difficult to measure. While patient-reported outcome measures (PROMS) are commonly used to help guide treatment of pain in settings such as chronic pain care, cancer care and migraine care, there are no similar tools available for patients with acute pain in the ED. Further hampering efforts to provide better ED pain care is poor overall understanding of the numbers and types of patients that experience pain.

Since it is a symptom rather than a diagnosis, information about pain is not systematically collected and is often obscured within free-text clinical notes. The lack of readily-available data makes it difficult to determine who exactly has experienced pain, and to design research studies to evaluate new and existing treatments.

Researchers aim to validate a PROM for pain care in the ED by administering to 400 patients who present with pain to one of two large hospital EDs. The aim is to find out the incidence and characteristics of patients who present with pain to the Royal Brisbane and Women’s Hospital ED, by using novel machine- and deep-learning techniques to process free-text information from clinical notes. This study will provide new knowledge and techniques that are essential for clinician-researchers to design and conduct studies that will ultimately improve pain care in the ED.

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How long can a clinician wearing personal protective equipment (PPE) safely work in a high-risk isolation area during one continuous shift?

Patients with COVID-19 symptoms are isolated and treated in a high-risk zone (HRZ) within the emergency department. Entry is restricted to essential staff wearing personal protective equipment (PPE).

HRZ doctors and nurses typically work 5-10 hour shifts, during which meal and toilet breaks must be taken outside the HRZ. Doffing (taking off PPE) and repeated donning (putting on PPE) are discouraged to conserve PPE. Doctors and nurses often work continuously with minimum breaks because they must doff before exiting and don before entering the HRZ. PPE traps body heat generated by physical activity, adding to mental and physical fatigue, and potential breaches in infection control precautions.

This study will investigate the length-of-time doctors or nurses can safely work in HRZ in one continuous shift.

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Interaction of hyperdynamic septic shock and sepsis endotypes: a new paradigm

Sepsis is an emergency medical condition that is caused by an abnormal response of the body to the presence of harmful microorganisms in the blood. It can lead to injury of body organs, shock and loss of life. Every year, 11 million people worldwide die due to sepsis.

Despite advances in the treatment of infections, management strategies for sepsis remain suboptimal. Inadequate understanding of immune system response to severe infection is partly to blame. Patients present to hospital with different signs that may include having warm peripheries and low blood pressure (hyperdynamic shock). Critically ill patients with sepsis who present with these signs, commonly receive medications to support blood pressure (vasopressors) but it is unclear whether starting vasopressor early, will result in better patient response or outcomes.

This study will investigate whether starting early vasopressor is better compared to delayed initiation. As clinicians working in the emergency department and intensive care, researchers will be able use study findings to develop better ways of treating septic patients.

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Emergency department treatment of the drowning victim

Drowning has a major global impact, with approximately 300,000 deaths each year. Yet the treatment of drowning victims has received limited investigation. This lack of evidence means that guidelines for the treatment of drowning victims are largely based on case reports or on other conditions such as acute respiratory distress syndrome (ARDS), on the premise that there may be similarities between the two conditions.

We are proposing to create a comprehensive database of information on drowning patients presenting to the emergency departments at the Sunshine Coast Hospital and Health Service. We will utilise a standardised list of data (Utstein-style guidelines for Drowning) to explore the treatment and outcomes for drowning patients over an eight-year period 2015-2022 inclusive. This will allow us to answer questions on the best ways to assist the breathing of drowning patients, if the treatment and outcomes in female drowning differ from males and why (there is some evidence females have better survival outcomes after being admitted to hospital), and to determine if the classification of drowning severity in common use around the world is useful in an Australian population.

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Improving jellyfish sting treatment

EMF funding is improving emergency care for the elderly

Trauma: better treatment for severe bleeding

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