News Article | April 20, 2017
Researchers hope to reduce unnecessary CT scans and radiation exposure in children with head injuries, following the results from a large-scale, multicentre validation study to assess the diagnostic accuracy of three clinical decision rules used by emergency doctors. Head injuries are one of the most common reasons children are taken to emergency departments. To rule out a serious brain injury, a percentage of these children require a CT scan and while this process is obvious for serious head injuries, it's more challenging to determine whether CT scans are necessary for children with milder injuries. The results from the Australasian clinical trial will help inform the use of the clinical decision rules for head injuries, which in turn could minimise CT scans, according to Lead investigator, Murdoch Children's Research Institute's Associate Professor Franz Babl. "The aim of this study was to determine which children need CT scans to detect brain injury," said A/Prof Babl. "Most head injuries are mild and don't require neurosurgical management, however, a small proportion of patients might present as having mild injuries, but have clinically significant intracranial injuries," he said. "This can be a vexed issue because physicians need to balance the importance of diagnosing an injury with reducing radiation exposure as much as possible. "The preferred course of treatment is to avoid a CT scan in minor head injuries if it is unnecessary. In particular, there is concern about the high radiation dose associated with CT scans of the head which can lead to cancer." In these cases, clinicians can turn to clinical decision rules, which have been developed to identify children at high risk of intracranial injuries, aiming to assist clinicians to minimise CT scans while still identifying all relevant injuries. In a prospective observational study, run across 10 Australian and New Zealand tertiary hospitals and involving, 20,137 children under the age of 18 years with head injuries, the research team compared three clinical decision rules: The goal was to determine which of these three decision rules provided the best option when it came to identifying children at very low risk of a traumatic brain injury. The researchers found that all three rules were good options, but only one, the PECARN from the US, did not miss a single patient requiring neurosurgery. Based on the research findings, the next step is for the group of emergency physicians to develop national approaches to optimise the management of children with head injuries in Australia and New Zealand. Internationally, the findings will provide a useful starting point for individual clinicians as well as hospitals or regional bodies contemplating the introduction or modification of one of the clinical decision rules, according to A/Prof Babl. "However, it will be important to relate the findings to a number of other factors before implementation, such as the baseline CT use, the effect of the rules on the projected CT rate, the baseline clinician diagnostic accuracy and experience, parental expectations, the medico-legal climate and economic considerations." The outcomes from the clinical trial were recently published in The Lancet. In The Lancet article, the researchers commented that patients reflected an Australia and New Zealand cohort from tertiary children's hospitals, which had much lower neuro-imaging rates than those reported from the USA and Canada. The study was run by clinicians involved in the PREDICT network (Paediatric Research in Emergency Departments International Collaborative). They received grants totalling AU$1.391 million from the NHMRC, the Emergency Medicine Foundation of Australia (EMF), Perpetual Philanthropic Services, Murdoch Children's Research Institute, Auckland Medical Research Foundation, A+ Trust, Auckland District Health Board, Townsville Hospital and Health Service Private Practice Research and Education Trust fund and the WA Health Targeted Research Fund. The $298,000 EMF grant, funded by Queensland Health, enabled the study to run at the Lady Cilento Children's Hospital, Brisbane and The Townsville Hospital. Other hospitals participating in the study included: Royal Children's Hospital, Melbourne; Princess Margaret Hospital, Perth; Monash Children's Hospital, Melbourne; Kidzfirst Middlemore Hospital, New Zealand; Starship Hospital, Auckland; Women's and Children's Hospital, Adelaide; and The Children's Hospital at Westmead, Sydney.
News Article | November 10, 2016
Australian emergency medicine researchers have successfully trialled an alternative deep sedative for patients in the emergency department. In a large, randomised trial, it was found that patients responded well to a combination of the commonly used sedative propofol and another drug ketamine, which has both sedative and pain relieving properties. The findings supported outcomes from earlier smaller trials and debunked the popular theory that ketamine causes frequent adverse psychological reactions in adults. Dr Anthony Bell, Director of Emergency Medicine at the Royal Brisbane and Women's Hospital said the trial was important because it showed that a combination of propofol and ketamine, known as 'ketofol', was as effective as propofol alone for sedating adults for procedures in the emergency department. "Historically, many emergency department clinicians were reluctant to use ketofol in adults due to concerns that the ketamine in the mixture would trigger a significant negative psychological reaction," said Dr Bell. "However, in this 573 patient trial, we compared the two sedative regimens and found that ketofol didn't cause any more adverse reactions than propofol alone," he said. "While ketofol was not shown to be superior to propofol, the two sedative regimens delivered similar outcomes and were both associated with high levels of patient satisfaction. "Finding that ketofol is a viable alternative to propofol will give us more sedation options in the future, especially considering the pain relieving properties of ketamine, which may reduce the need for other opiate type medications." The trial was led by Dr Bell, Dr Greg Treston, Dr Ian Ferguson, and Associate Professor Anna Holdgate and run across two Queensland hospitals -- Queen Elizabeth II Jubilee Hospital and Bundaberg Hospital -- as well as Liverpool Hospital in Sydney. The researchers found that some patients receiving propofol were more likely to have slightly lower blood pressure (8%), with a small number of patients experiencing some form of hallucination (5% for ketafol compared with 2% for propofol). In the majority of cases, with both regimens, these were rated as pleasant by patients. Overall, the ketofol group had lower pain scores 30 minutes post-procedure. The research was published in the November 2016 issue of the Annals of Emergency Medicine. The research team was awarded an $115,000 Emergency Medicine Foundation (EMF) of Australia research grant, which was fully funded by Queensland Health.
News Article | February 17, 2017
A novel, effective, more targeted approach for the surveillance and control of dengue fever Contact tracing, combined with targeted, indoor residual spraying of insecticide, can greatly reduce the spread of the mosquito-borne dengue virus, finds a study led by Emory University. In fact, this novel approach for the surveillance and control of dengue fever -- spread by the same mosquito species that infects people with the Zika virus -- was between 86 and 96 percent effective during one outbreak, the research shows. By comparison, vaccines for the dengue virus are only 30-to-70-percent effective, depending on the serotype of the virus. Science Advances published the findings, which were based on analyses from a 2009 outbreak of dengue in Cairns, Australia. "We've provided evidence for a method that is highly effective at preventing transmission of diseases carried by the Aedes aegypti mosquito in a developed, urban setting," says the study's lead author, Gonzalo Vazquez-Prokopec, a disease ecologist in Emory's Department of Environmental Sciences. "We've also shown the importance of human movement when conducting surveillance of these diseases." "The United States is facing continual threats from dengue, chikungunya and Zika viruses," says Sam Scheiner, director of the National Science Foundation's Ecology and Evolution of Infectious Diseases Program, which funded the research. "For now, the response is to intensively spray insecticides. This research shows that a more targeted approach can be more effective." While the method would likely not be applicable everywhere, Vazquez-Prokopec says that it may be viable to control Aedes-borne diseases in places with established health systems and similar environmental characteristics to Cairns, such as South Florida or other U.S. states at risk of virus introduction. "The widespread transmission of dengue viruses, coupled with the birth defects associated with Zika virus, shows the dire need for as many weapons as possible in our arsenal to fight diseases spread by these mosquitos," he says. "Interventions need to be context dependent and evaluated carefully and periodically." During the dengue outbreak in Cairns, public health officials traced recent contacts of people with a confirmed infection - a surveillance method known as contact tracing. This method is commonly used for directly transmitted pathogens like Ebola or HIV, but rarely for outbreaks spread by mosquitos or other vectors. Using mobility data from the known cases, public health workers targeted residences for indoor residual spraying, or IRS. Walls of the homes -- from top to bottom -- and dark, humid places were Aedes mosquitos might rest, were sprayed with an insecticide that lasts for months. The method is time-consuming and labor intensive, and health officials were not able to reach all of the residences that were connected to the infected persons. The researchers found that performing IRS in potential exposure locations reduced the probability of dengue transmission by at least 86 percent in those areas, in comparison to areas of potential exposures that did not have indoor spraying. "The findings are important," Vazquez-Prokopec says, "because they demonstrate one of the few measures that we have for the effectiveness of an intervention to reduce the transmission of dengue." Many times, he says, in the face of a dengue outbreak public health officials end up using trucks to spray insecticide -- despite the lack of scientific evidence for the effectiveness of fogging from the streets to control Aedes aegypti mosquitos. Quantifying the effectiveness of existing methods, and the context within which they work, can strengthen the vector-control arsenal. "We need to develop plans for outbreak containment that are context-specific," Vazquez-Prokopec says. He is researching ways to scale up this intervention. While it now takes approximately half-an-hour to conduct indoor residual spraying in a single house, he would like to cut that time to as little as 10 minutes. "We are evaluating how we can scale up and improve IRS for 21st-century urban areas," Vazquez-Prokopec says. Co-authors of the study include researchers from Queensland Health, the Rollins School of Public Health and James Cook University, Cairns. In addition to the NSF, the research was funded by the Emory Global Health Institute, the Marcus Foundation and the National Health and Medical Research Council.
News Article | December 6, 2016
Aussie researchers have found a new way to make one of the most common medical procedures in the world - placing drips or intravenous (IV) lines - safer, less painful and potentially more cost effective. The researchers, who were funded by the Emergency Medicine Foundation of Australia (EMF), found that using medical skin glue to hold hospital drips in place significantly reduced the need to replace them due to infection, pain, blockage or falling out. Caboolture Hospital Emergency physician and lead researcher, Dr Simon Bugden, said the failure rate for IV lines in the first 48 hours was 29-40 per cent in Australia and as high as 90 per cent internationally. "We found that by using medical skin glue, we could reduce the failure rate to below 17 per cent," Dr Bugden said. "The glue made IV lines harder to unintentionally remove and was also shown to kill the bacteria that most commonly cause infections. "The other major benefit was patient comfort, with patients in the trial reporting that the glue caused less irritation and they were less worried about the lines falling out. "Doctors place more than 10 million IV lines in Australia each year - and more than 300 million in the US - so reducing the need to replace IV lines will save staff time and free up valuable healthcare resources." With funding from Queensland Health, EMF awarded a $50,000 grant for the research and patient trials, which ran over several months at Caboolture Hospital in Queensland. The research is currently undergoing a cost-benefit analysis by health economists at Griffith University, with a view to rolling out the new procedure on a wide scale. EMF Chair, Associate Professor Sally McCarthy, said the discovery was an example of how significant healthcare benefits could be achieved by funding front line emergency medicine research. "There has been no improvement to the current procedure of inserting and securing IV lines in several decades, despite the rate of failure," A/Prof. McCarthy said. "Dr Bugden's method could be simply and cost-effectively introduced in hospitals worldwide. "EMF is committed to ensuring Australia continues to stay at the forefront of emergency medicine care by funding to dedicated research in this field." Dr Bugden's research was recently published in the Annals of Emergency Medicine.
Leggett B.,Royal Brisbane and Womens Hospital Research Foundation |
Leggett B.,Royal Brisbane and Womens Hospital |
Whitehall V.,Royal Brisbane and Womens Hospital Research Foundation |
Whitehall V.,Queensland Health
Gastroenterology | Year: 2010
The "serrated neoplastic pathway" describes the progression of serrated polyps, including sessile serrated adenomas and traditional serrated adenomas, to colorectal cancer. The recognition of this pathway during the last 15 years has led to a paradigm shift in our understanding of the molecular basis of colorectal cancer and significant changes in clinical practice. These findings are particularly relevant to prevention of interval cancers through colonoscopy surveillance programs-an important issue for colonoscopists. In the past, all serrated polyps were classified simply as hyperplastic polyps and were considered to have no malignant potential. Reappraisal of this view was largely driven by increasing recognition of the malignant potential of hyperplastic polyposis. © 2010 AGA Institute.
News Article | October 29, 2016
Despite having the same fitness level as everybody else at school, Gary Barber was never able to run as far as the other kids could because, at the age of four, he was diagnosed with a heart defect. The impact the heart defect had on Barber progressively worsened in his adult life. At one point, Barber, who is now 48, was unable to walk from the lounge room to the bathroom without having to stop halfway down the hallway to take a breath. "Imagine having somebody's hands around your throat, or you've got a really bad flu where there's pressure on your chest and you can't breathe properly. You're taking a quarter of your breath and you're trying to walk," Barber said. Toward the end of October 2015, Barber underwent emergency heart failure surgery after being admitted into Ipswich Hospital in Queensland, Australia. Barber's need for surgery came after frequently passing out and being told by his doctor the issue was his lungs and being overweight—not his heart. "My surgeon said I should have been on his [operating] table a minimum of four years ago," Barber said. Post-surgery, patients such as Barber are advised to undertake cardiac rehabilitation (CR) to reduce the risk of a second heart attack. As part of CR, patients are required to make regular visits to the hospital. But, according to Simon McBride, co-founder and CTO of Cardihab, the average cardiac rehab completion rate is only 30%. In hopes of increasing the completion rate, McBride introduced Cardihab, a smartphone application currently in pilot phase, designed to help patients recover from heart surgery remotely. Cardihab is a spin-off company from the Commonwealth Science and Industrial Research Organisation (CSIRO), and is also a participant of the HCF Catalyst accelerator program. He explained a key problem behind why people do not complete their CR program is due to accessibility and convenience. "The way normal cardiac rehab works is it's usually a 6-8 week long program where the person has to go to a clinic once or twice a week and that can really be inconvenient, especially for patients who have returned to work, or for rural remote patients," McBride said. Cardihab has been designed to collect data about a patient including how many steps a patient has taken, and their blood pressure and sugar levels, via Bluetooth-enabled monitors. The information is then uploaded to the cloud and shared with the patient's clinician, who can access it through an online portal. SEE: Healthcare IT's battle to keep sensitive data safe (TechRepublic) Based on research by the CSIRO, and through initial trials with Queensland Health, Cardihab has been able to reduce clinical hospital visits by 89% and improve cardiac rehab completion rates by 70%. While Barber said Cardihab has raised his personal awareness, it was not something he was initially open to trying. His initial thoughts about the program was that it was a " damn waste of time," but after completing the six-week Cardihab program with encouragement from one of the nurses, he said anyone who does not do the program would be a fool. "It made me more aware about what I was doing...I had a machine to be accountable to, I had a set of scales I had to be accountable to, and I had a blood pressure machine I had to be accountable to," Barber said. There were also conversational check-ups over the phone with the nurses, which would often involve discussions about why he was unable to take as many steps during certain days, Barber said, pointing out he's also a sufferer of gout and that restricted his movements. McBride said the application gives the opportunity to "empower" patients. "I think it's true to say getting patients more engaged is a big trend and something healthcare systems are trying to do. With [Cardihab], it gives people the ability to engage more with their care, and drive that feedback loop to the clinician and that's still the most important thing: The conversation between the patient and clinician is the heart of the cardiac rehab program; the technology just helps the clinician deliver that program in another way," Mcbride said. Although it has been a physical recovery, it has equally been an emotional one, too, Barber said. "When recovery is mentioned, what people don't understand is the emotional trauma. They don't understand the ongoing after affects," Barber said. While Barber believes there's still a long road ahead to full recovery, the results are already showing. He said it's now only taking him 10 minutes to feed the horses on his property, when it used to take 45 minutes.
Sugiyama T.,Baker IDI Heart and Diabetes Institute |
Neuhaus M.,University of Queensland |
Cole R.,Queensland Health |
Giles-Corti B.,University of Melbourne |
And 2 more authors.
Medicine and Science in Sports and Exercise | Year: 2012
Background: Increasing adults' physical activity through environmental initiatives that promote walking as a public health priority. To this end, evidence relevant to the urban planning and transport sectors is required. This review synthesized findings on destination and route attributes associated with utilitarian and recreational walking. Methods: A literature search was conducted in April 2011 using Web of Science, PubMed, Transport Research Information Services, GEOBASE, and SPORTDiscus. Environmental attributes were classified into the domains of utilitarian and recreational destinations (presence, proximity, quality) and route (sidewalks, connectivity, aesthetics, traffic, safety). Forty-six studies examining associations of these attributes with utilitarian and/or recreational walking were identified. Specific destination and route attributes associated with each type of walking were summarized. Results: Adults' utilitarian walking was consistently associated with presence and proximity of retail and service destinations (in 80% of the studies reviewed). It was also associated with functional aspects of routes (sidewalks and street connectivity) in 50% of studies. Recreational walking was associated with presence, proximity, and quality of recreational destinations (35% of studies) and route aesthetic (35% of studies). Both types of walking were found unrelated to route safety and traffic in most studies. Conclusions: There is consistent evidence that better access to relevant neighborhood destinations (e.g., local stores, services, transit stops) can be conducive to adults' utilitarian walking. Some evidence also suggests that availability of sidewalks and well-connected streets can facilitate utilitarian walking. To better inform initiatives to promote adults' walking in the planning and transport sectors, future studies need to examine how accessible such destinations should be, as well as the effect of the quality of recreational destinations. © 2012 by the American College of Sports Medicine.
Davis C.A.,Queensland Health
Communicable diseases intelligence | Year: 2011
Outbreaks of viral gastroenteritis occur regularly in residential care facilities (RCFs), with norovirus being the most common agent. Notification of outbreaks to public health authorities is encouraged in Australia, although there is limited evidence that this results in public health benefit. The aim of this study was to investigate if prompt notification of suspected norovirus outbreaks to public health authorities is associated with a reduction in either the duration or attack rate of outbreaks. Viral gastroenteritis outbreaks notified from Queensland RCFs between 2004 and 2007 were analysed. Foodborne outbreaks were excluded, along with 6 outbreaks where viruses other than norovirus were identified as the causative agent. Of the 264 remaining outbreaks, 70.8% were laboratory-confirmed as being due to norovirus. The average time to notification was 4 days and the average duration of outbreaks was 12 days. Outbreaks notified promptly (within 1 day) were of significantly shorter duration compared with outbreaks notified within 2-3 days (P < 0.02) or 4 or more days (P < 0.001). Early notification of outbreaks was not significantly associated with a reduced attack rate, however there was a significantly higher attack rate in facilities with less than 150 individuals at risk compared with facilities with 150 or more individuals at risk (30% versus 18%, respectively; P < 0.001). The shorter duration of promptly notified outbreaks provides some evidence to support recommendations from best practice guidelines for prompt notification of outbreaks by RCFs. However, further research is needed to unravel the interplay of factors that may influence the severity of viral gastroenteritis outbreaks in RCFs.
Maier B.J.,Queensland Health
Women and Birth | Year: 2013
The following article describes a midwife's experience in the adaption of the CenteringPregnancy model into her own group practice to provide education and support to the women in her care. Using personal experience and feedback from women and midwifery students the author describes not only the process of group care in her work context but the apparent benefits to women, families', midwifery students and herself. Antenatal group care was so successful for the author that it extended to postnatal group care and student group care, all well attended and sought after groups. This is an exciting and innovative way to provide care for women and families and the author encourages other midwives and group practices to consider how they can adapt and progress similar group care into their own practice. © 2012.
Sutton G.,Queensland Health
Journal for healthcare quality : official publication of the National Association for Healthcare Quality | Year: 2013
The team functioning assessment tool (TFAT) has been shown to be a reliable behavioral marker tool for assessing nontechnical skills that are critical to the success of ward-based healthcare teams. This paper aims to refine and shorten the length of the TFAT to improve usability, and establish its reliability and construct validity. Psychometric testing based on 110 multidisciplinary healthcare teams demonstrated that the TFAT is a reliable and valid tool for measuring team members' nontechnical skills in regards to Clinical Planning, Executive Tasks, and Team Functioning. Providing support for concurrent validity, high TFAT ratings were predicted by low levels of organizational constraints and high levels of group potency. There was also partial support for the negative relationships between time pressure, leadership ambiguity, and TFAT ratings. The paper provides a discussion on the applicability of the tool for assessing multidisciplinary healthcare team functioning in the context of improving team effectiveness and patient safety for ward-based hospital teams. © 2013 National Association for Healthcare Quality.