Congratulations to CCS NHMRC Investigator Grant recipients

L-R: Professor Paul Myles, Dr Shalini Arunogiri, Dr Andrew Neal, Dr Margaret Lam, Professor Mark Fitzgerald

Congratulations to our five successful National Health and Medical Research Council (NHMRC) Investigator Grant recipients! Commiserations to our many researchers whose grants were ranked highly, but nonetheless missed out. See detail below of CCS recipients. 

 

Overall, Monash University was awarded over $43 million to support 30+ researchers, and our Faculty of Medicine, Nursing and Health Sciences won 26 Investigator grant fellowships worth $37.4M. See Faculty and Monash lists here. See detail of NHMRC funding round outcomes released 14 September.

Rural emergency doctors lack confidence in trauma control, study finds

Emergency services are getting less traffic
in regional centres. Image: Caravan World

by Anne Crawford

In 2000 Victoria’s trauma services started to become more centralised, with increasingly more patients rushed to three major trauma hospitals in Melbourne for treatment.

Under the Victorian State Trauma System (VSTS) preventable road fatalities dropped considerably over time and trauma patient management was vastly improved. Emergency centres around the world now look to Victoria’s system as a model case.

But a study by critical care researchers has found that as the trauma cases drained from regional hospitals to The Alfred, Royal Children’s and Royal Melbourne hospitals, rural clinicians dealing with these patients have become ‘de-skilled’ and less confident in aspects related to care for injured patients.

Monash surgeon calls for new terrorist attack treatment measures

Professor Jeffrey Rosenfeld during his last military deployment

by Anne Crawford

A leading military surgeon says Australian hospitals should become familiar with US military trauma guidelines to better prepare them for terrorist attacks or other mass casualty events.

Professor Jeffrey Rosenfeld, a senior neurosurgeon at The Alfred Hospital, Professor of Surgery at the Monash University and a Major General in the Australian Defence Force, is also calling for civilians to be trained in haemorrhage control through the ‘HemCon’ course developed by the American College of Surgeons and the Hartford Consensus in the US, recommendations made after a US school shooting in late 2012 in which 20 children were fatally shot.

Video of the Week: A second Renaissance for trauma care

Professor Mark Fitzgerald is Director of the National Trauma Research Institute at Monash University and of Alfred Trauma Services. He is an internationally renowned expert in the field. On 12 October 2016, Mark gave Central Clinical School's annual public lecture. He presented on the history and development of trauma care, saying that we were now in a second Renaissance for innovations. See more:

• Video link: www.youtube.com/watch?v=Kc2rBPAd-bQ
• National Trauma Research Institute: www.ntri.org.au
• Public lecture information: med.monash.edu.au/cecs/events/2016-public-lecture-fitzgerald.html

Photo of the Week: Mark Fitzgerald giving CCS's fifth annual public lecture

Professor Mark Fitzgerald gave Central Clinical School's 5th annual lecture, on innovative systems of trauma care. Mark has had a lifetime's experience as an emergency physician working in what's known as a 'decision-rich' environment, where decisions have to be made rapidly on the basis of often incomplete and certainly dynamic information. Mark heads the Alfred's trauma service and also the joint Alfred-Monash National Trauma Research Centre, and has developed software to assist with that process. Professor Robyn O'Hehir, CCS's Deputy Head of School, MCed the event. The video will be released soon on the CCSMonash youtube channel.

Photo of the week: Trauma care at the Alfred

Professor Mark Fitzgerald and a team of trauma medical staff talking with a patient during ward rounds.

Prof Mark Fitzgerald is Director of both the Alfred Trauma Service and the National Trauma Research Centre. Mark will be giving CCS's public lecture on 12 October on innovative systems of trauma care. The Victorian State Trauma System has halved the odds of dying after serious injury since its inception in 2001! [Ref] All welcome. See more:

• Public lecture web page
• RSVP

Research highlight: The Australia-India Trauma Systems Collaboration

Professor Mark Fitzgerald (2nd from left) speaking at a recent AITSC forum hosted
by the National Trauma Research Institute. Prof Fitzgerald will be giving
Central Clinical School's public lecture on 12 Oct 2016, on trauma systems.

Commencing in 2013, the Australian and Indian governments invested over $2.6 million through their Australia-India Strategic Research Fund Grand Challenge Scheme, to find the best ways of delivering needed care to injured people.

The Australia-India Trauma Systems Collaboration (AITSC) brings together governments, industry, clinicians and researchers to improve information and resources, and to pilot new systems of care.

CCS Public Lecture: Innovative systems for improving trauma care 12 Oct 2016

The Alfred trauma team taking a patient.
Prof Mark Fitzgerald is to the right

2016 Central Clinical School Public Lecture:  Innovative systems for improving trauma care

Injury causes 5.8 million deaths per year with 90% in low- and middle-income countries. It also causes a significant amount of disability and economic loss. Much of this burden could be decreased by improvements in the care of the injured (trauma care).

Professor Mark Fitzgerald will give an overview of trauma system research and development, how we’re using it here, and how we’re helping other countries, both in the developed and developing world, to either build or improve their own systems of trauma care.

Details:

• Date: Wednesday, 12 October 2016
• Time: 6.00 pm for 6.30 pm start. Lecture for 45 minutes followed by Q&A session.
• Venue: AMREP Lecture Theatre, adjacent to the BakerIDI Institute at 75 Commercial Road, Melbourne 3004, 200 metres east of the main Alfred Hospital entrance. See map.
• Cost: Free
• RSVP: CLICK HERE. Please RSVP by Friday 7 October 2016 for catering purposes
• Enquiries: Julia.Veitch@monash.edu ph +61 3 9903 0026 or mob 0438 856 481; 
• Weblink: med.monash.edu.au/cecs/events/2016-public-lecture-fitzgerald.html

Returning to work after major trauma

By Dr Jodie Abramovitch

In high income countries, injury-related deaths have decreased between 1990 and 2013. This higher likelihood for survival following serious injury is attributed to effective prevention strategies and improved patient care. However there is still a limited understanding of the quality of patients’ recovery, how long recovery takes, and the proportion of injured patients who suffer lifelong disability.  

Professor Belinda Gabbe - Head of the Pre-Hospital,
Emergency and Trauma Research Unit in the
Department of Epidemiology and Preventive Medicine

The aim of a study conducted by Monash researchers from the Department of Epidemiology and Preventive Medicine (DEPM) and the Department of Surgery, alongside trauma services based at the Alfred hospital and collaborators from a number of different institutes, was to describe the long-term return to work and function of major trauma patients.

Adult major trauma survivors were assessed between 2007 and 2012 in Victoria at 6, 12 and 24 months after leaving hospital. Of the 8128 patients who were followed up, 23% had returned to their pre-injury condition by 24 months. Of those working or studying prior to injury, 70% had returned to work/study by 24 months. These outcomes were found to be influenced by multiple factors including age, socio-economic status and presence of pre-existing health conditions.

This study concluded that function and return to work improved with time following injury thus indicating that further improvements in health and quality of life may be expected after 24 months. However, ongoing disability was still prevalent at 24 months highlighting the need for future studies spanning longer than 24 months to fully assess the burden of major trauma on the lives of those affected.

The data collected in this study will assist with predicting the outcome of major trauma for individual patients and improve trauma services. This study also advocates for the improvement of rehabilitative and disability services to better the long-term health outcomes for patients.

Reference: Gabbe BJ, Simpson PM, Harrison JE, Lyons RA, Ameratunga S, Ponsford J, Fitzgerald M, Judson R, Collie A, Cameron PA. Return to Work and Functional Outcomes After Major Trauma: Who Recovers, When and How Well? Ann Surg. 2016 Jan.
doi: 10.1097/SLA.0000000000001564

Congratulations to Alfred researchers on MIME funding

The Monash Institute of Medical Engineering (MIME) has announced its 2015 Seed Funding Awardees, to which over $700,000 has been disbursed in research project support. The projects will be undertaken in collaboration with researchers in the Faculties of Engineering and IT.

The Central Clinical School recipients were:

Professor Mark Fitzgerald (National Trauma Research Institute)   

• Chest trauma: Develop semi-automated device for emergency drainage of blood in the chest cavity (pleural decompression device)    
• Trauma resuscitation: Develop wireless heads-up display for real-time decision support in trauma situations   

Professor Anton Peleg (Department of Infectious Diseases)

• Hospital-acquired infections: Develop surface coatings for medical devices that resist the attachment of organisms and establishment of biofilms, particularly antibiotic resistance biofilms

Adjunct Professor Bruce Thompson (Allergy, Immunology and Respiratory Medicine )

• Asthma treatment: Development and testing of a nebulizer with “dial up” particle size control that can target small airways, improving the treatment of asthma   

Professor Andrew Spencer (Australian Centre for Blood Diseases)

• Multiple myeloma diagnostic tool: Develop a diagnostic test for detecting circulating tumour DNA for use in primary healthcare

 

 

MIME PhD Scholarship support

MIME also funds PhD scholarships so students can be recruited to work with researchers. Successful researchers from CCS were: 

Dr Heather Cleland, Mr Stephen Goldie (Department of Surgery)

• Burn injuries: Develop a tissue engineered skin substitute, which will enable rapid and permanent wound closure, as well as functional and aesthetic reconstruction   

Dr Stephen Ting (Australian Centre for Blood Diseases)

• Leukemia stem cell detection: Single cell identification, separation, isolation and assay of bone marrow and leukemia stem cells     

 


Professor Mark Fitzgerald (National Trauma Research Institute)   

• Trauma resuscitation – develop wireless heads-up display for real-time decision support   

Professor David Kaye (Department of Medicine, Baker IDI)

• Heart attack: Develop 3D-printed muscle patch for heart repair

Predicting patients who require large blood transfusions

By Dr Jodie Abramovitch

Loss of large volumes of blood is responsible for a third of all deaths associated with trauma. The only way to treat a loss of blood, also known as haemorrhagic shock, is via transfusion of blood products. Some trauma patients require transfusion with incredibly large amounts of blood – a massive transfusion (MT) - and their survival may depend on the timely delivery of blood or blood products.  

Director of the National Trauma Research Institute
and senior author Professor Mark Fitzgerald

To create a robust system that allows for the prediction of patients who may require MT, researchers from Monash University and the Alfred Hospital (Trauma Centre, National Trauma Research Institute, Department of Epidemiology and Preventive Medicine and Ambulance Victoria) explored whether use of a ‘shock index’ (SI) calculated before and after arrival at hospital could predict MT. SI is calculated simply by measuring heart rate and dividing it by measured systolic blood pressure.

Of the 6990 major trauma patients who presented at the Alfred Hospital between 2006 - 2012, 5.2% (360 patients) received MT. By using a number of statistical models it was shown that a SI calculated before arrival at hospital was able to significantly improve prediction of MT. Combining the SIs calculated before and after arrival at hospital was only slightly better at predicting MT than the SI measured after arrival at hospital alone.

Considering these observations it was concluded that the SI is a simple option to assist with the prediction of MT. However further study is warranted to validate the SI prospectively. The development and implementation of computer-assisted data collection and prognostication may further enhance the utility of the SI in predicting MT.


Reference: Olaussen A, Peterson EL, Mitra B, O'Reilly G, Jennings PA, Fitzgerald M. Massive transfusion prediction with inclusion of the pre-hospital Shock Index. Injury  2015 May: 46;822-6. 
doi: 10.1016/j.injury.2014.12.009

Proposed improvement for Advanced Trauma Life Support care

Dr Mark Fitzgerald, one of the study authors, is a trauma surgeon
at the Alfred and Acting Director of the National Trauma Research
Institute

This article proposes a counter-argument to standard Advanced Trauma Life Support (ATLS) training - which advocates bladder catheterisation to be performed as an adjunct to the primary survey and resuscitation for early decompression of the bladder and urine output monitoring. We argue the case for delaying bladder catheterisation until after definitive truncal Computed Tomography (CT) imaging.
Reference: Huang, S., Vohora, A., Russ, M.K., Mathew, J.K., Johnny, C.S., Stevens, J., Fitzgerald, M.C. Delaying urinary catheter insertion in the reception and resuscitation of blunt multitrauma and using a full bladder to tamponade pelvic bleeding. Injury (2015) 46 (6) pp.1081 - 1083

Congratulations to our 2015 completed CCS postgraduate students!

So far in 2015, seven CCS postgraduate students have completed and passed their theses - well done!

Congratulations to :

• Sarah Charnaud (Burnet Institute): Mechanism of protein export in the malaria parasite
• Mark Fitzgerald (National Trauma Research Institute): Computer-aided decision support for trauma reception and resuscitation
• Matthew Kitson (Department of Medicine): Vitamin D status and chronic hepatitis C infection and nonalcoholic steatohepatitis
• Ying Ying Kong (Department of Immunology): Effects of cancer cells on the cells of the dendritic cell lineage
• Melissa Kirkovski (Monash Alfred Psychiatry Research Centre): The influence of biological sex on neurobiological mechanisms underlying autism spectrum disorder
• Michael Christopher (Baker IDI): Type 2 diabetes, obesity, insulin resistance and altered lipid metabolism
• Tanya Millard (Department of Infectious Diseases): Online self management program for men living with HIV in Australia