Monash Emergency Research Collaborative (MERC)
The Monash Emergency Research Collaborative (MERC) is a multi-disciplinary collaborative network consisting of both clinical and research focused staff in emergency care.
MERC research is conducted across the three emergency departments (ED) of Monash Health at Clayton, Dandenong and Casey, where more than 200,000 emergency presentations are triaged each year. We focus on undertaking translational research that provides outcomes aimed at driving the implementation of best practise emergency care. We believe that the care of patients in the emergency department benefits from an evidence-based, problem-orientated and patient-centered approach. MERC is affiliated with Monash Health and Monash University (Department of Medicine within the School of Clinical Sciences at Monash Health) and collaborates with a broad range of organisations and services.
To know more about us, click on the links below:
- Key research areas
- Our team
- Information for external researchers
- Available research projects
- Current Postgraduate research projects
- Emergency Medicine education
- Research students
Key research areas
Research interests of MERC are wide-ranging and include clinical research in emergency medicine and toxicology. Our clinical research focuses on pragmatic patient-centric research that is aimed at driving innovation and change. Our key research areas are listed below:
The Monash Emergency Medicine Service supports one of only two specialised clinical toxicology units located in Melbourne.
The Monash Toxicology Unit provides clinical services for assessment, management and treatment of suspected poisonings presenting to the Monash Emergency network as well as provides teaching in clinical toxicology to a wide variety of clinical staff across Monash Health.
Toxicology and Therapeutics research encompass one of the pillars of MERC research goals.
Toxicology research encompasses both basic science and clinical translational research into the risk assessment, diagnosis and treatment of various poisoning scenarios. Specific toxicology research interests include; risk assessment and assessment of novel acetylcysteine treatment regimens for paracetamol poisoning, assessment of novel treatments for cardiovascular drug poisoning, adolescent poisoning epidemiology, assessment and recommendations for rational antidote use.
Therapeutic interests include the assessment of the utility of intranasal drug delivery in the emergency department, assessment of analgesic regimens for acute pain and development of evidence based guidelines for the assessment and use of antiemetics for emergency department nausea and vomiting. Meet the research area head, Professor Andis Graudins
The paediatric emergency medicine research is based at our tertiary paediatric ED (Monash Medical Centre in Clayton), and extends to our mixed adult-paediatric departments at Dandenong and Casey. Over 60,000 children are seen across the three Monash Health emergency departments each year.
Our paediatric emergency medicine has wide interests in all aspects of the emergency care of children, including critical care and resuscitation, common illnesses and clinical procedures, diagnostic testing, pain management and clinical decision rules. We have strong links with all Monash Children's inpatient units, as well as the Royal Children's Hospital ED and other paediatric EDs across Australia and New Zealand. Meet the research area head, Dr Simon Craig
Meet the research area head, Dr Diana Egerton-Warburton.
External researchers wishing to conduct emergency research at Monash Health, and/or include Monash Health EDs in multi-site research studies, should contact one of our MERC team members. They will offer advice and support to facilitate the required departmental, ethics and organisational authorisations for such research.
Current Postgraduate research projects
- Risk prediction and management of paracetamol overdose
- Outcomes for antiemetic efficacy trials in adult ED patients with nausea
- How are we managing acute asthma in children? A PREDICT study
Risk prediction and management of paracetamol overdose
Anselm is currently undertaking his PhD in the management and risk prediction of paracetamol overdose. Other aspects of his research include drug trials, biomarker research, drug pharmacokinetics in poisoning and epidemiological studies.
Outcomes for antiemetic efficacy trials in adult ED patients with nausea
People presenting to Emergency Departments (ED) commonly have nausea and vomiting as part of their presenting complaint. Antiemetic drugs have been used for ED patients for many decades but there is doubt about their efficacy in this setting. A recent Cochrane Systematic Review concluded that there was no convincing evidence to support the use of antiemetic drugs for adult ED patients with nausea and vomiting. This was largely based on the findings of three ED-based placebo controlled antiemetic trials. These studies all used the Visual Analog Scale change to rate nausea severity. The primary outcome was between group comparison of mean change in the VAS rating. No study has demonstrated a statistically significant difference between active drugs and placebo. However, group mean VAS change gives no information on the number of improved patients per group, so this cannot be directly compared and a Number Needed to Treat cannot be calculated. A binary outcome based on a VAS change cut-off level indicative of symptom improvement would be more clinically meaningful. A series of studies to investigate this outcome measure and its accuracy for detection of symptom improvement will be conducted. If performance is satisfactory, the new outcome measure will be trialled prospectively in an ED-based, therapeutic RCT.
How are we managing acute asthma in children? A PREDICT study
Acute severe childhood asthma is an infrequent, but potentially life-threatening emergency presentation. There is a wide range of different approaches to this condition, with very little supporting evidence. To improve knowledge in this area, there must first be consensus on how to conduct clinical trials, so that valid comparisons can be made between future studies.
We have formed an international working group comprising paediatricians and emergency physicians from North America, Europe, Asia, the Middle East, Africa, South America, Central America, Australasia and the United Kingdom.
We aim to develop a truly international consensus on the conduct and reporting of randomized controlled trials for children with acute severe exacerbations of asthma. This will involve the development of a shared understanding of what needs to be measured, and how it should be measured, leading to a core outcome set for research involving this group of children.
Planned projects include a systematic review of outcome measures used in RCTs of intravenous bronchodilators in children with asthma, a Cochrane overview of reviews relating to second-line therapy for acute paediatric asthma, retrospective cohort studies of children with severe acute asthma exacerbations, a review of the content and quality of current clinical guidelines for paediatric asthma, interviews with patients/families and clinicians, a systematic review of the characteristics of currently used clinical scoring systems for acute paediatric asthma, and a modified Delphi process for prioritizing outcome measures.
Additional work may include the prospective assessment of clinical scoring systems, and/or a pilot study based upon the planned consensus document.
Emergency Medicine Education
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