Emergency Medicine Research

Emergency Medicine Research : How do I get started? A/Prof Marcus Ong Consultant, Senior Medical Scientist & Director of Research Department of Emergency Medicine Singapore General Hospital Adjunct Associate Professor Duke-NUS Graduate Medical School Office of Research

How do I get started?

Step 1:

Ask questions about your everyday practice

Review the current literature:

Pubmed/Medline

Cochrane database

Embase

Google scholar

Textbooks

Step 1a:

Frame the question in a way that the answer can be measured:

Is HAT better than T&S for scalp lacerations in terms of better wound healing, lower infection and lower wound breakdown?

Step 1b:

Choose an appropriate study design:

RCT

Pseudorandomised clinical trial

Cohort study

Case-control study

Observational/descriptive type

Step 1c:

Choose appropriate statistical tests:

Frequencies, mean, sd, se

Chi Square test/ Fisher’s exact test

T test

Correlation

Multivariate analysis, Logistic regression

Survival analysis

Results Table 1: Characteristics of patients

Results Complications by treatment

Step 1d:

Design and execute your data collection

Case record form

Survey

Computer based data collection

Case notes review

Warning: Clinicians hate form filling!

Patient information (Study no_______) Name________________________________________________ HRN__________________________ Age___________Sex 1)M 2)F Race 1)Chinese Patient’s sticker 2)Malay 3)Indian 4)Others ,State_________________ Attending Doctor____________________ Scalp injury (circle where appropriate) Medical history steroids 1)y 0)n DM 1)y 0)n Immunocompromise 1)y 0)n Others________________________ Technique used 1)hair apposition 2)T&S Unable to score pain 1)y 0)n Procedure painful? VISUAL SCALE: 0 1 2 3 4 5 6 7 8 9 10 NO PAIN UNBEARABLE PAIN Adhesive used 1)Dermabond 2)Histoacryl glue Hair shaved 1)y 0)n Antibiotics 1)y 0)n Duration of procedure______________ Problems encountered__________________ _________________________________ Multiple wounds 0)n 1)y Site 1) frontal 2)occipital 3)temporal 4)parietal 5)vertex Length ___________(Use longest wound only) Wound 1)Linear 2)complicated State 1)Clean 2)mild contamination 3)moderate contamination 4)severe contamination Underlying fracture 1)y 0)n Proven intracranial injury 1)y 0)n Bleeding 1)none 2)mild 3)moderate 4)severe Time to treatment __________

Step 1e:

Analyse, present and write up your data:

DIY vs consult a statistician

Get feedback from your presentation

The art of manuscript writing

Reader’s Digest 2003

Step 2:

Develop basic research skills

Biostatistics/Epidemiology

Clinical Trials Design

Good Clinical Practices (GCP) courses

Bioethics courses

Medical writing courses

University of Ottawa EM Research Fellowship incorporating MSc in Epidemiology (2 years)

Dept of Emergency Medicine /VCURES VCU Health System Research Fellowship Incorporates Phd (3 years) or Masters of Public Health (1.5 years) Dept of Epidemiology and Community Health Virginia Commonwealth University

Step 3:

Grow in your research experience and interest

Start with accessible data sources

Common clinical conditions

Develop your research question

Spontaneous Pneumothorax Outcome Study (SPOT Phase 1) : A 2 yr Review

Ong, MEH, Chan YH, Kee TYS, Chew HC, Koh MSY. Spontaneous Pneumothorax Outcome Study (SPOT phase I): a 2-year review.

European Journal of Emergency Medicine. April 2004, 11(2):89-94

Spontaneous Pneumothorax Outcome Trial II (SPOT II)

A randomised controlled trial comparing needle aspiration and mini-chest tube (20-24F) insertion with Heimlich valve attachment in the treatment of primary spontaneous pneumothorax (PSP).

Step 4:

Build a relationship with a research mentor

Step 5:

Develop your collaborations, research funding and portfolio

CARE Study

Cardiac Arrest and Resuscitation Epidemiology in Singapore: A Pre-hospital Study

Largest and most comprehensive OHCA study to date

Prospective, Observational study

Multi-center, covers whole of Singapore

CARE Study

Period of study:

CARE I: 1 Oct 2001 to 30 Apr 2002

CARE II: 1 Oct 2002 to 14 Oct 2004

CARE III: Ongoing

CARE IV: In planning

Number of Cases Recruited: >28, 000

‘ Public access defibrillation in Singapore: where should automated external defibrillators (AEDs) be placed? (PADS Phase I)’

CARE Study

Ong EHM, Chan YH, Anantharaman V, Lau ST, Lim SH, Seldrup J. Cardiac Arrest and Resuscitation Epidemiology in Singapore (CARE I study). Prehospital Emergency Care 2003; 7: 427-433

Ong ME, Chan YH, Srither DE, Lim YH. Asian Medical Staff Attitudes Towards Witnessed Resuscitation; Resuscitation; Jan 2004;60(1):45-50

Ong MEH, . Chan YH, Ang HY, Lim SH, Tan KL. Resuscitation of out-of-hospital cardiac arrest by Asian primary health care physicians. Resuscitation 2005, 65:191-195

Ong MEH, Chan YH, Anantharaman V. Improved response times with motorcycle based Fast Response Paramedics. SGH Proceedings 2003; 12(3): 114-119

Ong MEH, Chan YH, Yap YH, Ang HY. Intravenous access by paramedics in out-of-hospital cardiac arrest. Singapore Nursing Journal Apr 2003; 30 (2): 38-41

Ong MEH, Chan YH, Ang HY, Yap YH. Public attitudes to Emergency Medical Services (EMS) in Singapore: EMS day 2002. Singapore Med J 2004; 45(9): 419-422

Funding sources

Government research funding

Hospital funds

Charity funding: Singapore Heart Foundation, Cancer Society

Commercially funded (Drugs, devices)

Military/Security

Investors/ Business start ups

Funding sources

Capital items

Manpower

Expendables

Protected time?

Step 6:

Finding research ‘niches’

EM related

Emerging technologies

Inter-disciplinary collaborations

International collaborations

Early Defibrillation

“ Controlled Therapeutic Hypothermia Post-Cardiac Arrest Compared to Standard Intensive Care Unit Therapy  Marcus EH Ong, MD, FRCS (A&E), MPH Department of Emergency Medicine, Virginia Commonwealth University (VCU) Health System Mary Ann Peberdy MD, FACC Department of Medicine and Emergency Medicine, VCU Health System Renata Sampson, RN, MSN, BC, CPHQ Department of Performance Improvement, VCU Health System Joseph P. Ornato MD, FACP, FACC, FACEP Department of Emergency Medicine, VCU Health System

SGH Center for Resuscitation Science and Emergency Medicine Research

Multi-disciplinary approach :

Statisticians/Epidemiologists

Biomedical Engineering

Medical /Surgical/ Other disciplines

Para-medical disciplines: pharmacists, sociologists, public health. Psychology

Basic sciences

> $1 million in funding from NMRC, Singhealth Foundation, CTERU, commercial companies and Singapore Armed Forces etc.

SGH Center for Resuscitation Science and Emergency Medicine Research

5 full time researchers :

2 Research Co-ordinators (nurse/paramedic, psychologist

2 Research Engineers (Biomedical Engineering)

1 Research Assistant (IT)

Resuscitation Research at SGH

Measurement of Prehospital Heart Rate Variability as a Predictor of Hospital Outcomes

A Prospective Observational Study of Heart Rate Variability in Trauma Patients

Real-Time Measurement of Prehospital Heart Rate Variability as a Clinical Predictor of Hospital Outcomes in Acutely Ill Patients (Phase II)

Wireless Remote Detection of Heart Beat & Respiratory Rate

Wearable, Wireless Vital Signs Monitoring Devices in Critically Ill patients

Respiratory and Ventilation Characteristics in an Animal Model of Load Distributing Band Chest Compression

Preadmission Intravenous Vasopressin, adrenaline Outcome Trial

Measurement of Prehospital Heart Rate Variability as a Predictor of Hospital Outcomes

Measurement of Prehospital Heart Rate Variability as a Clinical Predictor of Hospital Outcomes in Acutely Ill Patients Pavitra Padmanabhan, Zhiping Lin, Marcus Eng Hock Ong, Wee Ser and Guang-Bin Huang. Automatic Extraction of HRV Sequences From Noisy ECG Data For Reliable Analysis And Telediagnosis. In print. Proceedings of the Third IASTED International Conference on Telehealth Wang Su Ho (265-317 AD) A Treatise on Qualities of the Pulse, “If the pattern of the heart beat becomes as regular as the tapping of a woodpecker or the dripping of rain from the roof, the patient will be dead in four days.”

Noise reduction & QRS detection Noise reduction QRS detection

Wireless Remote Detection of Heart Beat & Respiratory Rate

Portable Body Cooling System for Prehospital Management of Patients with Heat Stroke