Intergenerational and lifelong chronic pain starting in early life

2nd year PhD students Jennaya Christensen (left)
and Sabrina Salberg (right)

Chronic pain is a costly public health issue that is highly prevalent and causes a great burden to people who are affected, their families, their workplaces and the health system. 

New research from the Monash Trauma Group at the Department of Neuroscience, Central Clinical School, Monash University shows that there is a difference both in gender and type of adverse childhood experience in the expression of specific biomarkers linked to chronic pain. 

Additionally, early life stress such as maternal separation, and a high-fat, high-sugar diet lead to higher pain sensitivity, increased anxiety-like behaviour and changes in the neurobiology (structural and functional level) of the brain.

Chronic pain often occurs during childhood, with 1 in 5 children or adolescents having reported it and it being more prevalent in females than males. 

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.

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.

Researchers urge greater hospital security to curb patient violence

Security personnel needed in EDs. 
Image: Daily Telegraph

by Anne Crawford

Australian hospital emergency departments should employ security personnel to counter the increasing number of violent incidents occurring there, a Monash University and Alfred Hospital study recommends.

Researchers from The Alfred’s Emergency and Trauma Centre have also called for a register to be established to alert emergency department (ED) staff across hospitals about repeat perpetrators of workplace violence to try to prevent future incidents.

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.

Laws needed to protect drunk pedestrians on roads: study

The Pedestrian Council of Australia run an active
education campaign for drunk pedestrian safety.

by Anne Crawford

Trauma researchers at The Alfred Hospital and Monash University have recommended improving public education campaigns and introducing new legislation after a study showed that almost one in four pedestrians seriously injured on the roads was intoxicated.

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.

Recent CCS publications: Week ending 14 October 2016

Dr Be'eri Niego with Mr Felix Lee in Prof
Rob Mecalf's lab. See the recent research
on reducing thrombosis formation

Bumper list this issue of recent publications for Central Clinical School affiliated authors in the departments of ACBD, AIRmed, Gastroenterology, Immunology, Infectious Diseases, MAPrc, Medicine, Surgery, Obesity, Trauma. Read more »

Australian Centre for Blood Diseases (ACBD)

Gaspari T, Brdar M, Lee HW, Spizzo I, Hu Y, Widdop RE, Simpson RW, Dear AE. Molecular and cellular mechanisms of glucagon-like peptide-1 receptor agonist-mediated attenuation of cardiac fibrosis. Diab Vasc Dis Res. 2016 Jan;13(1):56-68. doi: 10.1177/1479164115605000. Epub 2015 Sep 25.

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

Is previous trauma adequately documented for female psychiatric inpatients?

By Dr Jodie Abramovitch 

Traumatic events can lead to long-lasting psychological changes in an affected person. Patients presenting with serious mental health issues are more likely to have experienced emotional or physical trauma in the past than healthy individuals.

Professor Jayashri Kulkarni - Director of MAPrc
and senior author of this study

Researchers from the Monash Alfred Psychiatry Research Centre (MAPrc) aimed to investigate the extent to which clinicians record previous trauma events. They then analysed this information to identify if it was incorporated into diagnosis and treatment of female psychiatric inpatients.

One hundred inpatients were selected for the study, with psychotic illnesses being the most prevalent primary diagnosis. For just over half these participants, there was no record of whether or not there was a history of trauma. Of the 49 patients asked about trauma history, 84% (41 patients) responded positively though only 3% of these documented cases had a specific description of the trauma. For 34 (of the 41 with trauma history) subjects, no mention was made of potentially trauma-associated psychiatric symptoms such as flashbacks or emotional numbing. This study also found that current drug use and/or a diagnosis of borderline personality disorder were associated with a higher likelihood of documented trauma.

As such, this study concluded that clinicians dealing with patients with mental illnesses need to be more proactive about documenting a comprehensive history of trauma to better inform patient management.

Reference: Xiao CL, Gavrilidis E, Lee S, Kulkarni J. Do mental health clinicians elicit a history of previous trauma in female psychiatric inpatients? J Ment Health. 2016 Feb (online)

doi:

10.3109/09638237.2016.1139074

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

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.

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

Australian-first report shines spotlight on trauma care

The inaugural Australian Trauma Registry Report was released on Saturday 4 October 2014, at the Australian Trauma Society Conference. The collective effort of the nation’s 27 designated trauma centres has been revealed in the first report of the Australian Trauma Registry. The report quantifies the actual extent of the nation’s collective response to the 20,000 critically injured individuals who required treatment in an Australian trauma centre between 2010 and 2012. Australian Trauma Quality Improvement Program (AusTQIP) Co-Chair, Professor Russell Gruen, said the report offers us some vital national data for the first time. Download full report.  Also see media release and follow the hashtag #AusTrauma on Twitter.

Video: Russell Gruen on the National Trauma Research Institute work & research

Professor Russell Gruen, Director of the National Trauma Research Institute and Professor of Surgery (Central Clinical School) and Public Health (School of Public Health and Preventive Medicine) speaks on a number of topics. Youtube links:

• Research collaboration improving trauma care in India
• 2012 Lancet review of trauma surgery (series editor and lead author for one section)
• PATCH trial (Pre-Hospital Treatment of Acute Traumatic Coagulopathy and Haemorrhage)
• Overview of the National Trauma Research Institute

India, Australia team up for trauma care system

With over five million deaths reported each year due to injuries, a collaboration was announced between India and Australia to develop world class trauma care system. Both countries are investing over $2.6 million in the Australia-India Trauma Systems Collaboration (AITSC). Australian High Commissioner Patrick Suckling inaugurated the AITSC on Friday 8 November. Led by the National Trauma Research Institute, a partnership between the Alfred Hospital and Monash University in Melbourne, and the JPN Apex Trauma Centre at AIIMS, the program brings together some of the world’s leaders in trauma care. Story link. Video link. See also AITSC page, NTRI page and http://news.webindia123.com/news/Articles/India/20131109/2280839.html