Emergency Medicine Research : How do I get started? A/Prof Marcus Ong Consultant, Senior Medical Scientist & Director of R...
How do I get started? <ul><li>Step 1: </li></ul><ul><li>Ask questions about your everyday practice </li></ul>
 
 
How do I get started? <ul><li>Review the current literature: </li></ul><ul><li>Pubmed/Medline </li></ul><ul><li>Cochrane d...
How do I get started? <ul><li>Step 1a: </li></ul><ul><li>Frame the question in a way that the answer can be measured: </li...
How do I get started? <ul><li>Step 1b: </li></ul><ul><li>Choose an appropriate study design: </li></ul><ul><li>RCT </li></...
 
How do I get started? <ul><li>Step 1c: </li></ul><ul><li>Choose appropriate statistical tests: </li></ul><ul><li>Frequenci...
Results Table 1: Characteristics of patients
Results Complications by treatment
How do I get started? <ul><li>Step 1d: </li></ul><ul><li>Design and execute your data collection </li></ul><ul><li>Case re...
Patient information (Study no_______)  Name________________________________________________ HRN__________________________ ...
How do I get started? <ul><li>Step 1e: </li></ul><ul><li>Analyse, present and write up your data: </li></ul><ul><li>DIY vs...
 
Reader’s Digest 2003
 
How do I get started? <ul><li>Step 2: </li></ul><ul><li>Develop basic research skills </li></ul><ul><li>Biostatistics/Epid...
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...
How do I get started? <ul><li>Step 3: </li></ul><ul><li>Grow in your research experience and interest </li></ul><ul><li>St...
Spontaneous Pneumothorax Outcome Study (SPOT Phase 1) : A 2 yr Review <ul><ul><li>Ong, MEH, Chan YH, Kee TYS, Chew HC, Koh...
Spontaneous Pneumothorax Outcome Trial II (SPOT II) <ul><li>A randomised controlled trial comparing needle aspiration and ...
How do I get started? <ul><li>Step 4: </li></ul><ul><li>Build a relationship with a research mentor </li></ul>
 
How do I get started? <ul><li>Step 5: </li></ul><ul><li>Develop your collaborations, research funding and portfolio </li><...
CARE Study <ul><li>Cardiac Arrest and Resuscitation Epidemiology in Singapore: A Pre-hospital Study </li></ul><ul><li>Larg...
CARE Study <ul><li>Period of study:  </li></ul><ul><li>CARE I:  1 Oct 2001 to 30 Apr 2002 </li></ul><ul><li>CARE II:  1 Oc...
‘ Public access defibrillation in Singapore: where should automated external defibrillators (AEDs) be placed? (PADS Phase ...
CARE Study <ul><ul><li>Ong EHM, Chan YH, Anantharaman V, Lau ST, Lim SH, Seldrup J. Cardiac Arrest and Resuscitation Epide...
Funding sources <ul><li>Government research funding </li></ul><ul><li>Hospital funds  </li></ul><ul><li>Charity funding: S...
Funding sources <ul><li>Capital items </li></ul><ul><li>Manpower </li></ul><ul><li>Expendables </li></ul><ul><li>Protected...
How do I get started? <ul><li>Step 6: </li></ul><ul><li>Finding research ‘niches’ </li></ul><ul><li>EM related  </li></ul>...
Early Defibrillation
 
“  Controlled Therapeutic Hypothermia Post-Cardiac Arrest Compared to Standard Intensive Care Unit Therapy    Marcus EH O...
 
 
 
SGH Center for Resuscitation Science and Emergency Medicine Research <ul><li>Multi-disciplinary approach  : </li></ul><ul>...
SGH Center for Resuscitation Science and Emergency Medicine Research <ul><li>5 full time researchers  : </li></ul><ul><li>...
Resuscitation Research at SGH <ul><li>Measurement of Prehospital Heart Rate Variability as a Predictor of Hospital Outcome...
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 Pav...
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 <ul><li>MEH Ong , Department of Emerg...
Schematic view of Body Cooling Unit and wireless vital signs monitoring system
How do I get started? <ul><li>Step 7: </li></ul><ul><li>Research career pathways? </li></ul><ul><li>Clinician-Scientist  <...
 
 
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Emergency Medicine Research

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A/Prof Marcus Ong
Consultant, Senior Medical Scientist
& Director of Research
Department of Emergency Medicine
Singapore General Hospital

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Emergency Medicine Research

  1. 1. 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
  2. 2. How do I get started? <ul><li>Step 1: </li></ul><ul><li>Ask questions about your everyday practice </li></ul>
  3. 5. How do I get started? <ul><li>Review the current literature: </li></ul><ul><li>Pubmed/Medline </li></ul><ul><li>Cochrane database </li></ul><ul><li>Embase </li></ul><ul><li>Google scholar </li></ul><ul><li>Textbooks </li></ul>
  4. 6. How do I get started? <ul><li>Step 1a: </li></ul><ul><li>Frame the question in a way that the answer can be measured: </li></ul><ul><li>Is HAT better than T&S for scalp lacerations in terms of better wound healing, lower infection and lower wound breakdown? </li></ul>
  5. 7. How do I get started? <ul><li>Step 1b: </li></ul><ul><li>Choose an appropriate study design: </li></ul><ul><li>RCT </li></ul><ul><li>Pseudorandomised clinical trial </li></ul><ul><li>Cohort study </li></ul><ul><li>Case-control study </li></ul><ul><li>Observational/descriptive type </li></ul>
  6. 9. How do I get started? <ul><li>Step 1c: </li></ul><ul><li>Choose appropriate statistical tests: </li></ul><ul><li>Frequencies, mean, sd, se </li></ul><ul><li>Chi Square test/ Fisher’s exact test </li></ul><ul><li>T test </li></ul><ul><li>Correlation </li></ul><ul><li>Multivariate analysis, Logistic regression </li></ul><ul><li>Survival analysis </li></ul>
  7. 10. Results Table 1: Characteristics of patients
  8. 11. Results Complications by treatment
  9. 12. How do I get started? <ul><li>Step 1d: </li></ul><ul><li>Design and execute your data collection </li></ul><ul><li>Case record form </li></ul><ul><li>Survey </li></ul><ul><li>Computer based data collection </li></ul><ul><li>Case notes review </li></ul><ul><li>Warning: Clinicians hate form filling! </li></ul>
  10. 13. 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 __________
  11. 14. How do I get started? <ul><li>Step 1e: </li></ul><ul><li>Analyse, present and write up your data: </li></ul><ul><li>DIY vs consult a statistician </li></ul><ul><li>Get feedback from your presentation </li></ul><ul><li>The art of manuscript writing </li></ul>
  12. 16. Reader’s Digest 2003
  13. 18. How do I get started? <ul><li>Step 2: </li></ul><ul><li>Develop basic research skills </li></ul><ul><li>Biostatistics/Epidemiology </li></ul><ul><li>Clinical Trials Design </li></ul><ul><li>Good Clinical Practices (GCP) courses </li></ul><ul><li>Bioethics courses </li></ul><ul><li>Medical writing courses </li></ul>
  14. 19. University of Ottawa EM Research Fellowship incorporating MSc in Epidemiology (2 years)
  15. 20. 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
  16. 21. How do I get started? <ul><li>Step 3: </li></ul><ul><li>Grow in your research experience and interest </li></ul><ul><li>Start with accessible data sources </li></ul><ul><li>Common clinical conditions </li></ul><ul><li>Develop your research question </li></ul>
  17. 22. Spontaneous Pneumothorax Outcome Study (SPOT Phase 1) : A 2 yr Review <ul><ul><li>Ong, MEH, Chan YH, Kee TYS, Chew HC, Koh MSY. Spontaneous Pneumothorax Outcome Study (SPOT phase I): a 2-year review. </li></ul></ul><ul><ul><li>European Journal of Emergency Medicine. April 2004, 11(2):89-94 </li></ul></ul>
  18. 23. Spontaneous Pneumothorax Outcome Trial II (SPOT II) <ul><li>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). </li></ul>
  19. 24. How do I get started? <ul><li>Step 4: </li></ul><ul><li>Build a relationship with a research mentor </li></ul>
  20. 26. How do I get started? <ul><li>Step 5: </li></ul><ul><li>Develop your collaborations, research funding and portfolio </li></ul>
  21. 27. CARE Study <ul><li>Cardiac Arrest and Resuscitation Epidemiology in Singapore: A Pre-hospital Study </li></ul><ul><li>Largest and most comprehensive OHCA study to date </li></ul><ul><li>Prospective, Observational study </li></ul><ul><li>Multi-center, covers whole of Singapore </li></ul>
  22. 28. CARE Study <ul><li>Period of study: </li></ul><ul><li>CARE I: 1 Oct 2001 to 30 Apr 2002 </li></ul><ul><li>CARE II: 1 Oct 2002 to 14 Oct 2004 </li></ul><ul><li>CARE III: Ongoing </li></ul><ul><li>CARE IV: In planning </li></ul><ul><li>Number of Cases Recruited: >28, 000 </li></ul>
  23. 29. ‘ Public access defibrillation in Singapore: where should automated external defibrillators (AEDs) be placed? (PADS Phase I)’
  24. 30. CARE Study <ul><ul><li>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 </li></ul></ul><ul><ul><li>Ong ME, Chan YH, Srither DE, Lim YH. Asian Medical Staff Attitudes Towards Witnessed Resuscitation; Resuscitation; Jan 2004;60(1):45-50 </li></ul></ul><ul><ul><li>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 </li></ul></ul><ul><ul><li>Ong MEH, Chan YH, Anantharaman V. Improved response times with motorcycle based Fast Response Paramedics. SGH Proceedings 2003; 12(3): 114-119 </li></ul></ul><ul><ul><li>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 </li></ul></ul><ul><ul><li>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 </li></ul></ul>
  25. 31. Funding sources <ul><li>Government research funding </li></ul><ul><li>Hospital funds </li></ul><ul><li>Charity funding: Singapore Heart Foundation, Cancer Society </li></ul><ul><li>Commercially funded (Drugs, devices) </li></ul><ul><li>Military/Security </li></ul><ul><li>Investors/ Business start ups </li></ul>
  26. 32. Funding sources <ul><li>Capital items </li></ul><ul><li>Manpower </li></ul><ul><li>Expendables </li></ul><ul><li>Protected time? </li></ul>
  27. 33. How do I get started? <ul><li>Step 6: </li></ul><ul><li>Finding research ‘niches’ </li></ul><ul><li>EM related </li></ul><ul><li>Emerging technologies </li></ul><ul><li>Inter-disciplinary collaborations </li></ul><ul><li>International collaborations </li></ul>
  28. 34. Early Defibrillation
  29. 36. “ 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
  30. 40. SGH Center for Resuscitation Science and Emergency Medicine Research <ul><li>Multi-disciplinary approach : </li></ul><ul><li>Statisticians/Epidemiologists </li></ul><ul><li>Biomedical Engineering </li></ul><ul><li>Medical /Surgical/ Other disciplines </li></ul><ul><li>Para-medical disciplines: pharmacists, sociologists, public health. Psychology </li></ul><ul><li>Basic sciences </li></ul><ul><li>> $1 million in funding from NMRC, Singhealth Foundation, CTERU, commercial companies and Singapore Armed Forces etc. </li></ul>
  31. 41. SGH Center for Resuscitation Science and Emergency Medicine Research <ul><li>5 full time researchers : </li></ul><ul><li>2 Research Co-ordinators (nurse/paramedic, psychologist </li></ul><ul><li>2 Research Engineers (Biomedical Engineering) </li></ul><ul><li>1 Research Assistant (IT) </li></ul>
  32. 42. Resuscitation Research at SGH <ul><li>Measurement of Prehospital Heart Rate Variability as a Predictor of Hospital Outcomes </li></ul><ul><li>A Prospective Observational Study of Heart Rate Variability in Trauma Patients </li></ul><ul><li>Real-Time Measurement of Prehospital Heart Rate Variability as a Clinical Predictor of Hospital Outcomes in Acutely Ill Patients (Phase II) </li></ul><ul><li>Wireless Remote Detection of Heart Beat & Respiratory Rate </li></ul><ul><li>Wearable, Wireless Vital Signs Monitoring Devices in Critically Ill patients </li></ul><ul><li>Respiratory and Ventilation Characteristics in an Animal Model of Load Distributing Band Chest Compression </li></ul><ul><li>Preadmission Intravenous Vasopressin, adrenaline Outcome Trial </li></ul>
  33. 43. Measurement of Prehospital Heart Rate Variability as a Predictor of Hospital Outcomes
  34. 44. 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.”
  35. 45. Noise reduction & QRS detection Noise reduction QRS detection
  36. 46. Wireless Remote Detection of Heart Beat & Respiratory Rate
  37. 47. Portable Body Cooling System for Prehospital Management of Patients with Heat Stroke <ul><li>MEH Ong , Department of Emergency Medicine, Singapore General Hospital </li></ul><ul><li>A/Prof Francis E.H. Tay, National University of Singapore Department of Mechanical Engineering </li></ul>
  38. 48. Schematic view of Body Cooling Unit and wireless vital signs monitoring system
  39. 49. How do I get started? <ul><li>Step 7: </li></ul><ul><li>Research career pathways? </li></ul><ul><li>Clinician-Scientist </li></ul><ul><li>Academic Emergency Medicine </li></ul><ul><li>Scientist-Clinician </li></ul>

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