Does adding an emergency medicine pharmacist improve acute stroke care?

Acute stroke callout team care is more rapid when an emergency pharmacist ia included: study.
Image: NTRI

Does adding an emergency medicine pharmacist improve acute stroke care? The answer is Yes, by an average of 12 minutes. A well known saying in the field of neurology is ‘time is brain’ and for this particular study it couldn’t be more true, as every minute a stroke sufferer isn't treated, more damage takes place.

Researchers from the Pharmacy Department (Faculty of Pharmacy and Pharmaceutical Sciences), the Department of Neuroscience (Central Clinical School) and Department of Epidemiology and Preventive Medicine (School of Public Health and Preventive Medicine) have found that by adding an emergency pharmacist to the acute stroke call-out team provided an improvement in the average time to administer treatment (thrombolysis with alteplase, or recombinant tissue plasminogen activator rtPA) to a patient by 12 minutes.

CCS Recent Publications 10th April - 29th April

Dr Be'eri Niego, ACBD, has a recent publication
STILfeatured in this week's article.

Recent publications for Central Clinical School feature affiliated authors in the following departments:

• Melbourne Sexual Health Centre
• Peninsula Clinical School
• ACBD
• MAPrc
• Gastroenterology
• Infectious Diseases
• Neuroscience
• Diabetes
• NTRI
• Anaesthesia and Perioperative Medicine
• Surgery

Symposium: Toward better detection and management of sports concussion

This symposium will discuss major results from an NHMRC funded project to determine whether current practice with regard to concussion detection and management in Australian Football would be augmented by the use of instrumented accelerometers. It's an opportunity to better detect and manage sports concussion, particularly at the junior and amateur level.

Speakers include Professor Biswadev Mitra, Professor Jeffery Rosenfeld, Dr Michael Makdissi, Professor Andrew McIntosh and Dr David Hughes.

Click here for event flyer.

When: Wednesday 13th February 2019, 12:30pm - 4:30pm
Where: A+ Lecture Theatre (formerly AMREP), 80 Commercial Rd, Melbourne VIC 3004
RSVP: annie.carter@monash.edu

Alfred trauma program hits home with teenagers; study

Prevent Alcohol and Risk-related Trauma in Youth (P.A.R.T.Y.)

program is a trauma prevention and health promotion initiative

by Anne Crawford

Research evaluating an injury awareness program run at The Alfred Hospital that uses vivid clinical reality has demonstrated the program’s effectiveness in changing perceptions of risk-taking in adolescents.

International trauma program to reduce burden of injury

Saudi Arabia records over half a million road accidents each year.
Video image

The Kingdom of Saudi Arabia records approximately 526,000 road accidents per annum - 7,900 people die each year due to road trauma and over 40,000 people are injured every year. The death rate from road accidents, per head of population, is five times higher than in Australia. This significant burden of injury endured by the Saudi people has been recognised by the Kingdom of Saudia Arabia as preventable.

Internationally, trauma is the leading cause of death in the first four decades of life and the second most frequent cause of deaths in all age groups. This has prompted the World Health Organisation (WHO) to declare the ‘Decade of Action’ (2011-2020) on road safety.

CCS Publications update: 24 – 31 March 2017

Prof Mark Fitzgerald is co-author on two

papers notified this week, on cardiac MRI

and coagulopathy & TBI. Image: UMN

Recent publications for Central Clinical School affiliated authors in the departments of Australian Centre for Blood Diseases (ACBD), Allergy, Immunology and Respiratory Medicine (AIRmed), Immunology and Pathology, Gastroenterology, Infectious Diseases, Medicine, Melbourne Sexual Health Centre (MSHC), Monash Alfred Psychiatry research centre (MAPrc), Trauma, and Surgery.

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: 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

Recent CCS publications: Week ending 19 Aug 2016

Dr Janine Trevillyan (right) is a co-author on a
paper on management of antimicrobial therapy.  Prof Jenny
Hoy (left) was one of Janine's supervisors of her PhD.

Recent publications (13) for Central Clinical School affiliated authors in the departments of ACBD, Anaesthesia & Perioperative Medicine, Gastroenterology, Immunology, Infectious Diseases, MAPrc, Medicine, MSHC, Surgery:

Anaesthesia & Perioperative Medicine

Wallace S, Myles PS, Zeps N, Zalcberg JR. Serious adverse event reporting in investigator-initiated clinical trials. Med J Aust. 2016 Apr 4;204(6):231-3.

Recent CCS publications: Week ending 12 Aug 2016

Dr Mark Shulman in the Ian Potter library at AMREP

Recent publications (28) for Central Clinical School affiliated authors in the departments of ACBD, Anaesthesia & Perioperative Medicine, Gastroenterology, Immunology, Infectious Diseases, MAPrc, Medicine, MSHC, Surgery:

Anaesthesia & Perioperative Medicine

Shulman M, Myles P. Measuring perioperative outcome Curr Opin Anaesthesiol. 2016 Jul 27. [Epub ahead of print]

Recent CCS publications: Week ending 22 July 2016

We have a bumper issue this week listing 43 new publications across all departments of the Central Clinical School, including:

• Anaesthesia and Perioperative Medicine (3)
• Australian Centre for Blood Diseases (8)
• Gastroenterology (6)
• Immunology & Pathology/AIRmed (7)
• Infectious Diseases (6)
• Melbourne Sexual Health Centre (7)
• Monash Alfred Psychiatry research centre (4)
• Surgery/NTRI (5)

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

Recent CCS publications: Week ending 25 March 2016

Heather Gilbert, MAPrc Women's Mental Health team,
taking blood pressure.

Recent publications with Central Clinical School affiliated authors:

Camuñas Palacín A, Grigg J, Gilbert H, Worsley R, Gavrilidis E, Kulkarni J. Safety of atypical antipsychotic drugs during pregnancy.  Psiquiatria Biologica. 2016 Jan (online). 
doi: 10.1016/j.psiq.2016.02.001

Choong JW, Ou R, Lim YW, Rosenfeldt FL. Cold Crystalloid Perfusion Provides Cardiac Preservation Superior to Cold Storage for Donation After Circulatory Death. Transplantation. 2016 Mar; 100:546-53.
doi: 10.1097/TP.0000000000000926.

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

Congratulations to Professor Russell Gruen on Singapore appointment

Congratulations to Professor Russell Gruen who has been appointed Professor of Surgery at the new Lee Kong Chian School of Medicine and Director of the Nanyang Institute of Technology in Health and Medicine at Nanyang Technological University in Singapore. For the past six years, Russell has made a significant contribution to trauma research in Australia and internationally as Director of the National Trauma Research Institute (NTRI) and as a Trauma Consultant at The Alfred Hospital. He will continue his affiliation with Monash University as Professor of Surgery and Public Health.As Chief Investigator of the PATCH study, Russell has advocated for greater understanding of the role of TXA for severely injured patients that are treated in advanced trauma systems. He will remain an integral part of the study. We wish him and his family all the best in their move to Singapore.

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

Centre of Excellence in Traumatic Brain Injury (CETBIR)

Dr Sarah Hellewell, CETBIR Fellow

Traumatic brain injuries in Australia, indeed around the world, create an enormous burden on individuals, families, communities and the economy.  Fortunately, there is a concerted effort being made by researchers around the world to decipher the derangements that occur at a cellular and molecular level in these injuries and in developing new therapies to improve the outcome from these injuries.  

A day in the life of a trauma surgeon

In a speech recently given by Prof Russell Gruen, outgoing Director of the National Trauma Research Institute, to GE Executives on the importance of industry and healthcare partnerships in developing technological solutions to improve patient care, he describes, not only a day in the life of a trauma surgeon,  but also how technology has an increasing role to play. See more: gereports.com.au/post/17-03-2015/a-day-in-the-life-of-a-trauma-surgeon

NTRI Forum report: Optimising support for informal carers of the long-term disabled

The National Trauma Research Institute Forum has released a report on how to help the helpers:

• What challenges are currently faced by informal (unpaid) carers of people with a long-term disability, and how are these challenges being met?
• How can knowledge of optimal strategies be applied locally to address these challenges over the lifetime of a person with a long-term disability?

See Executive summary or the full report