MEDICAL EARLY RESPONSE INTERVENTION AND THERAPY (MERIT): A RANDOMISED CLINICAL TRIAL
Funder
National Health and Medical Research Council
Funding Amount
$530,500.00
Summary
Every year, between 12,000 and 23,000 deaths are associated with in-hospital adverse events, making them one of the leading causes of death in the general population. These adverse events lost Australia over three million bed-days per year, and cost the country up to $4.7 billion every year. Among the adverse events, death, cardiac arrest and unplanned admissions to intensive care unit (ICU) are the most serious occurrences. The majority of the events were preceded by serious clinical deteriorat ....Every year, between 12,000 and 23,000 deaths are associated with in-hospital adverse events, making them one of the leading causes of death in the general population. These adverse events lost Australia over three million bed-days per year, and cost the country up to $4.7 billion every year. Among the adverse events, death, cardiac arrest and unplanned admissions to intensive care unit (ICU) are the most serious occurrences. The majority of the events were preceded by serious clinical deterioration, which can be easily identified. Recognising these problems, a hospital-wide intervention system called the Medical Emergency Team (MET) has been developed in Australia over the last 10 years. Under this system, when a patient's clinical condition is unstable, a call is immediately placed to the MET for intervention. Preliminary data have shown that the MET can reduce in-hospital deaths, cardiac arrests and unplanned ICU admissions. However, past studies have been based on observational design and their results lack scientific credence due to uncontrolled confounders and biases. It is proposed to conduct a multi-centre randomised clinical trial to test the hypothesis that the implementation of the hospital-wide MET system will reduce the aggregate incidence of the following three adverse events: unplanned admissions to intensive care units, cardiopulmonary arrest, and in-hospital death. The study will involve 20 Australian and New Zealand hospitals, each with at least 20,000 admissions per year. This study will provide crucial scientific evidence for health managers and governments to make decision on the implementation of MET in Australian and New Zealand hospitals. If the MET system is shown to reduce adverse events as observed in preliminary studies, then the introduction of MET could save approximately 4000 lives, avoid 1500 cardiac arrests, and prevent 2500 unplanned ICU admissions every year.Read moreRead less
Assessing Naltrexone Implant Or Methadone Maintenance Treatment On Mental And Physical Health Outcomes In Heroin Users
Funder
National Health and Medical Research Council
Funding Amount
$216,200.00
Summary
The WA hospital data linkage system (DLS) will be used to assess differences in the mental and physical health of dependent heroin users prior to and post naltrexone implant or methadone maintenance treatment (MMT). MMT is the best established pharmacotherapy for the management of heroin dependence but oral naltrexone is gaining some acceptance. Currently funded by NHMRC, we are looking at outcomes with oral naltrexone using DLS data. Although effective in blocking heroin, management via oral na ....The WA hospital data linkage system (DLS) will be used to assess differences in the mental and physical health of dependent heroin users prior to and post naltrexone implant or methadone maintenance treatment (MMT). MMT is the best established pharmacotherapy for the management of heroin dependence but oral naltrexone is gaining some acceptance. Currently funded by NHMRC, we are looking at outcomes with oral naltrexone using DLS data. Although effective in blocking heroin, management via oral naltrexone has proved problematic, with medicine non compliance and relapse common. Surgical insertion of subcutaneous implants is an alternative method of naltrexone delivery. 441 heroin users have received naltrexone implants (3.4g) under Special Access in WA. Although naltrexone implants have yet to be comprehensively assessed, early results are encouraging. Pilot study data has shown a significant reduction in hospital emergency department (ED) attendance for accidental overdose, and mental health events following implant. The aim of this study is to more rigorously assess outcomes associated with implants compared to heroin dependent persons treated by MMT . The DLS collates general hospital and mental health admissions plus mortality data for individuals. This allows the health of an individual to be monitored over time. An electronic version of hospital ED data has recently become available. The study will validate these records by comparing the electronic data against hospital ED records for the implant group. We will then combine the electronic ED and DLS data. Morbidity and mortality rates for heroin users are significantly greater than those for the general population. If the preliminary findings are replicated, naltrexone implants may offer significant benefits over current pharmacotherapies in reducing general and psychiatric morbidity in dependent heroin users.Read moreRead less
Understanding And Preventing Avoidable Readmissions: Development Of A Patient Centered And Disease Specific Screening Tool
Funder
National Health and Medical Research Council
Funding Amount
$100,000.00
Summary
This study aims to develop a screenings tool to prevent unplanned re-admissions, based on specific patient centred and disease specific factors. We will include index admission data (367,782 in 2015) of five MACH hospitals. The cohort will be divided into a group for index derivation and a group for internal validation. Variables on patient and admission characteristics are based on literature. After internal validation we will validate the tool externally and implement it in clinical practice
A Randomised Trial Of Core Cooling Versus Surface Cooling In Comatose Survivors Of Prehospital Cardiac Arrest
Funder
National Health and Medical Research Council
Funding Amount
$309,000.00
Summary
Pre-hospital sudden cardiac arrest (SCA) is a major public health problem that is estimated to cause around one death per thousand adults per year. The aetiology of SCA is usually ischaemic heart disease causing ventricular fibrillation (VF). The current medical response to this condition involves a Chain of Survival, including early call to 000, bystander CPR, early defibrillation and early advanced cardiac life support. Following successful cardiac resuscitation, patients are transported to ho ....Pre-hospital sudden cardiac arrest (SCA) is a major public health problem that is estimated to cause around one death per thousand adults per year. The aetiology of SCA is usually ischaemic heart disease causing ventricular fibrillation (VF). The current medical response to this condition involves a Chain of Survival, including early call to 000, bystander CPR, early defibrillation and early advanced cardiac life support. Following successful cardiac resuscitation, patients are transported to hospital for further care. Despite this approach and recent improvements such as decreased ambulance response times, outcome remains poor and there are very few survivors who make a good recovery. This proposal is for funding to conduct a randomised, controlled trial, which compares two different techniques of induction of hypothermia in patients who are resuscitated from pre-hospital sudden cardiac arrest. Recently available data suggests that the outcome from SCA is significantly improved if moderate hypothermia is used as a treatment of neurological injury. However, the technique of induction of hypothermia requires further research. This study compares core-cooling using large-volume ice-cold intravenous fluid with the current technique of using ice packs for surface cooling, initiated in the field by ambulance paramedics and continued in hospital for a total of 12 hours. This study has the potential to demonstrate a significant improvement in outcome in a common clinical condition, which currently carries a very high mortality rate. This will be the first trial internationally which assess core versus surface cooling initiated pre-hospital, in SCA patients. It is highly likely that with the successful results from this trial that induced hypothermia in SCA patients will become standard care. The use of induced hypothermia could lead to over 500 lives saved per year accross Australia.Read moreRead less