ED Research & Development Governance Group

Purpose statement

Christchurch Hospital Emergency Department (ED) has a strong academic core, and research has been a significant part of that. Research is recognised as both a formal requirement for some staff and an anticipated academic and professional strategy for all.  The Christchurch Hospital ED Research and Development Governance Group (ED R&DG Group) [formerly EMNRG - Emergency Medicine and Nursing Research Group] has been established to:

• Facilitate the ongoing research endeavours of individuals and groups, which relate to the provision of emergency care
• Promote and educate staff regarding evidence based medicine (EBM) and evidence based nursing (EBN)
• Guide and support staff in their research efforts
• Co-ordinate research activities in the ED
• Monitor and audit the progress of research in the ED
• Maintain appropriate professional practice with regard to research

The aim of the group is to facilitate the establishment and recognition of the Christchurch Hospital's ED as a centre of excellence for emergency research.

The members of EMNRG seek to identify research strands to help focus the use of the available resources.  It is envisaged that these strands will encompass the existing interests of the department, while aligning to reflect government priority health objectives and to relate to funding priority objectives.  This is not to imply that these guidelines will necessarily be exclusionary, as worthwhile research that falls outside these boundaries will still be considered by the research committee.

Areas of research interest of ED R&DG Group

Areas of research interest can be grouped into four main categories:

• 'Access' research - explores issues related to ED attendance, appropriateness, overcrowding and access block
• 'Accuracy' research - explores clinical predictors of disease, and the development of clinical decision-making tools.  Projects in this regard include acute coronary syndrome (ACS), pulmonary embolism (PE), deep venous thrombosis (DVT) and abdominal pain
• 'Ethics' research
• 'Other' research - includes poisoning and trauma imaging

Research guidelines

Given the fluctuating workload for staff in the department, it is necessary to limit the number of projects that can be accepted at any one time. Priority will go to those necessary for ED staff training and education requirements.  Examples of this prioritising include the ED Registrar research requirements and emergency nurses studying at Masters Level or above for qualifications in emergency nursing. 

In this context, research needs to be carefully planned and implemented so that it has minimal impact on the provision of services, and recruitment needs to be smooth and efficient.  As a result, a formal protocol has been developed, to provide a guide for those individuals or organisations wishing to undertake research that involves the staff, facilities or recruitment of patients in the ED.

Studies and trials occurring in ED

Toxicology of synthetic recreational drugs

We are continuing to conduct research into the toxicology of synthetic recreational drugs as part of a multicentre collaborative.  This area of research has produced many important publications in the Emergency and Toxicology literature. 

ARISE: Australasian Resuscitation in Sepsis Evaluation – Sepsis

The ARISE-RCT is a multi-centre, un-blinded, randomised, controlled trial of Early Goal-Directed Therapy (EGDT®) versus standard care in patients with severe sepsis presenting to the Emergency Departments (EDs) of hospitals in Australia, New Zealand, Finland and Hong Kong. The study will test the hypothesis that EGDT®, compared to standard care, reduces 90-day mortality in patients presenting to the ED with severe sepsis. The null hypothesis is that there is no difference in the risk of death between patients assigned to either EGDT® or standard care. The ARISE-RCT, along with the NIH-funded PROCESS trial, will look to validate the findings of the single-centre Rivers et al. study.

Rationale: Severe sepsis is a major public health problem. In 2004, the Australian and New Zealand Intensive Care Society Clinical Trials Group (ANZICS CTG) reported that the adult incidence of severe sepsis (a complication of severe infection) is 77 cases per 100,000 of population per year in Australia and New Zealand; representing over 15,000 patient episodes per year. Similar population incidence rates have been reported elsewhere. Importantly, 11.8% of all admissions to Australian and New Zealand ICUs are associated with severe sepsis and in-hospital mortality is 37.5%. In patients with septic shock, mortality approaches 60%. The burden of death is approximately 3 times the annual national road toll. The death rate also exceeds other diseases which significantly impact on the Australian community such as breast and colorectal cancer. Given the pressing need to reduce the mortality from severe sepsis and the class II evidence that EGDT may be an effective treatment that is not currently used in the majority of Australian and New Zealand hospitals, a phase III study to examine the effectiveness of EGDT in Australasian patients is imperative. Unless a trial specifically comparing EGDT and Australasian standard care is performed, ED and ICU specialists will remain uncertain about the benefits of EGDT to our patients and will be unlikely to adopt this potentially life-saving strategy.

Collaboration: The ARISE-RCT is being conducted in collaboration with the Australasian College for Emergency Medicine (ACEM) Clinical Trials Group. The ARISE-RCT is endorsed by the ANZICS CTG.

Contact: For further information about this study, please contact the ANZIC-RC ARISE-RCT Project Manager, Belinda Howe, on email: belinda.howe@monash.edu / http://www.anzicrc.monash.org/process.html

EDAKI: Early Detection of Acute Kidney Injury

EDAKI is a prospective observational study of urinary and plasma biomarkers in the ED, Intensive Care Unit (ICU), and at a 30 day follow up with the primary aim to reduce the false negative rate for prediction of Acute Kidney Injury (AKI) by sampling on entry to the ED compared with on entry to the ICU.

Urinary biomarkers are taken from urine collected from catheterised patients in the ED, on entry to the ICU, then 4, 8, 16 hours, and 2, 4, 7 days later. Plasma biomarkers are taken from blood sampled at the same time points, with the exception of the 4 and 8 hour samples, these samples are taken along with routine clinical blood collections. Mortality will be assessed at one year.

For further information about this study, please see http://www.anzctr.org.au/ACTRN12610001012066.aspx  

Can a new 'Australasian Risk Score' reduce chest pain admissions in New Zealand?

This research investigates an innovative and workable change to the medical decision making process for patients presenting to Emergency Departments with chest pain that is possibly due to a heart attack. This randomised trial aims to prove the effectiveness of a new 'fast-track' (2-hour) pathway compared with current, standard care. It uses a specially developed Australasian Low Risk Score to identify a low-risk group of patients, doubling the number that might have heart attack ruled out up to 10 hours earlier than is currently possible. This would make a tangible contribution to health care by preventing unnecessary hospital admission and facilitating early discharge home in a large group of patients. This outcome is beneficial to both patients and the health service, by reassuring patients earlier that heart attack has been ruled-out and by avoiding unnecessary admissions, duplication of staff activities, and reducing pressure upon urgent care services.

The RHISE Group: Researching the Health Implications of Seismic Events

Mission

To facilitate understanding of the health impact of the Canterbury earthquakes through the coordination and collaboration of research.

Roles and activities

The roles of the RHISE group are oversight and facilitation of research related to the health implications of the Canterbury earthquakes and, specifically, to enable collaboration and sharing of resources where appropriate. An initial task has been the establishment of RHISE as a central reference point for activities of the group and its members, the introduction of a web-based resource for sharing information, resources and providing a list of research projects and contact details for primary investigators.  A core activity has been to establish a rich database of information regarding patients injured as a result of the earthquake events.

Participants

RHISE is a large, inclusive group with a membership identified by its mailing list. Membership is open to any person or persons undertaking, or intending to undertake research regarding the health implications of the Christchurch earthquakes since September 2010. The members have access to the shared web-based resources of the group. This website encourages collaboration through communication and sharing of resources and information. Membership of the RHISE Group, and access to this website, is tacit agreement to the group's mission – in particular to the commitment to collaboration. To administer the activities of RHISE there is a working group consisting of Professor Mike Ardagh (Chair), Viki Robinson (Coordinator) and others as required.

Relationships

The RHISE group is housed by the Canterbury District Health Board (CDHB) and has membership from many parts of CDHB, and a number of other organisations including University of Otago, University of Canterbury, and Pegasus Health (among others).  The relationship with these organisations is informal, but collaborative, through its members.

The part time coordinator position has been a result of funding received from the Emergency Care Foundation (ECF), with support from the Emergency Care Co-ordination Team (ECCT) and the Canterbury District Health Board (CDHB). The subscription to the web-based resource (Basecamp) has also been funded by the ECF. This resource acts as a hub for sharing resources, providing general information, updates, and has the capacity to allow individual researchers and groups to establish project support and organisational sites.

• The Emergency Care Coordination Teams (ECCT) were established by the Ministry of Health to coordinate the Acute Management System for New Zealand aiming to support the "Right Care at the Right Time in the Right Place and from the Right Person" principles. The Canterbury regional ECCT has provided financial support for the RHISE group and its coordination.

The establishment of the database of information regarding patients injured as a result of the earthquake events has been made by possible following a grant from the Health Research Council of New Zealand (HRC) and the Canterbury Medical Research Foundation (CMRF).

• The Health Research Council (HRC) is a national body funding health research through contestable grant monies.
• The Canterbury Medical Research Foundation (CMRF) is a Canterbury body funding health research. The HRC and the CMRF have provided a funding grant to establish a database of earthquake injuries.

Contacts

For further information on conducting research in the ED please contact: emnrg.research@cdhb.health.nz

For further information on the RHISE Group or to register with the RHISE Group Basecamp website, please contact: emnrg.research@cdhb.health.nz

Publications 2002 to 2012

Books

• National Ethics Advisory Committee, including Moore, A., Fougere, G., Ardagh, M., Findlay, M., Paul, C., Richardson, A., McDonald, G. (2009). Ethical guidelines for intervention studies. Wellington, New Zealand: Ministry of Health, 37p.
• National Ethics Advisory Committee, including Moore, A., Ardagh, M., & Paul, C. (2008). Ethics of intervention studies: Discussion document and draft ethical guidelines for intervention studies. Wellington, New Zealand: Ministry of Health, 91p.
• National Ethics Advisory Committee, including Moore, A., Ardagh, M., & Paul, C. (2007). Getting through together: Ethical values for a pandemic. Wellington, New Zealand: Ministry of Health, 61p.
• National Ethics Advisory Committee, including Moore, A., Paul, C., & Ardagh, M. (2006). Ethical guidelines for observational studies: Observational research, audits and related activities. Wellington, New Zealand: Ministry of Health, 29p.

Peer reviewed books, book chapters, books edited

• Attenburrow, T. (2013) Burns (Chapter 11). In B. Dolan & L. Holt (Eds.), Accident and Emergency, Theory into Practice. (3rd Ed.) (pp. 165-183) London: Elsevier.
• Grainger, P. (2013). Pain and Pain Management. (Chapter 25) In B. Dolan & L. Holt (Eds.), Accident and Emergency, Theory into Practice. (3rd Ed.)  (pp. 353-362) London: Elsevier.
• Grainger, P. (2013). Local and Regional Anaesthesia. (Chapter 26) In B. Dolan & L. Holt (Eds.), Accident and Emergency, Theory into Practice. (3rd Ed.)  (pp. 363-374) London: Elsevier.
• Hamilton, R., Dolan, B. & Ardagh M. (2013) Creating patient flow (Chapter 42). In B. Dolan & L. Holt (Eds.), Accident and Emergency, Theory into Practice.  (3rd Ed.) (pp. 577-586) London: Elsevier.
• Richardson, S. & Williams, T. (2013). Managing issues of culture and power in the ED. (Chapter 41) In B. Dolan & L. Holt (Eds.), Accident and Emergency, Theory into Practice. (3rd Ed.)  (pp. 571-576) London: Elsevier.
• Ardagh, M. (2012). Ethical Considerations in Emergency Medicine. In Textbook of Emergency Medicine - Vol. 1 & 2. (1st Edition). David, Brown, Nelson, Banerjee, Anantharaman, et al. (Eds). Wolters Kluwer Health (Lippincott, Williams and Wilkins). Delhi, India.  
• Than, M. (2010). Acute Coronary Syndrome: Biomarkers: Past, present and future. Elsevier Cardiology Advisory Board - Cardiology Update  
• Grainger, P. (2008). Local and Regional Anaesthesia. (Chapter 25) In B. Dolan & L. Holt (Eds.), Accident and Emergency, Theory into Practice.  (2nd Ed.)   London: Elsevier
• Ardagh, MW. (2007) Resuscitation Ethics. In Textbook of Adult Emergency Medicine. (3rd Edition). Cameron, P., Jelinek, G., Kelly, AM., Murray, L., Heyworth, J. (Eds.) London, Churchill Livingston. 
• Ardagh MW. (2004) Resuscitation Ethics. In Textbook of Adult Emergency Medicine. (2nd Edition). Cameron, P., Jelinek, G., Kelly, AM., Murray, L., Heyworth, J. (Eds.)  (pp. 33-37) London, Churchill Livingston.
• Ardagh, M. W., & Gee, P. (2004). Lacerations and minor emergency department surgery. In G. W. O. Fulde (Ed.), Emergency medicine: The principles of practice (4th ed.) (pp. 222-228). Sydney, Australia: Churchill Livingstone.

Refereed Journal Articles

• Campbell R., Ardagh MW., Than M., (July 2012) Validation of the pulse rate over pressure evaluation index as a detector of early occult hemorrhage: A prospective observational study. Journal of Trauma and Acute Care Surgery 73(1) 286–288 doi: 10.1097/TA.0b013e318253b52e
• Than, M., Cullen, L., Aldous, S., Parsonage, W.A., Reid, C. M., Greenslade, J., Ardagh, M. W., Troughton, R., Richards, A. M. (2012). 2-Hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker: The ADAPT trial. Journal of the American College of Cardiology 59(23), 2091-2098. doi: 10.1016/j.jacc.2012.02.035
• Cowan, I., Cresswell, C., Liu, H., Siew, T., Ardagh, M., & Than, M. (2012). Selective versus mandatory whole-body computed tomography scanning in the multiply injured patient [Letter to the editor]. Emergency Medicine Australasia 24(1), 115-116. doi: 10.1111/j.1742-6723.2011.01528.x
• Ardagh M., Richardson SK., Robinson V., Than M., Gee P., Henderson S., Khoderverdi L., McKie J., Robertson G., Shroeder P., Deely JM. (February, 2011) The initial health system response to the earthquake in Christchurch, New Zealand. Lancet 379:2109-15
• Than, M., Cullen, L., Reid, CM., Lim, SH., Aldous, S., Ardagh, MW., Peacock, WF., Parsonage, WA., Ho, HF., Ko, HF., Kasliwal, RR., Bansal, M., Soerianata, S., Ding, DHR., Hua, Q., Seok-Min, K., Sritara, P., Sae-Lee, R., Chiu, TF., Tsai, KC., Chu, FY., Chen, WK., Chang, WH., Flaws, DF., George, PM., Richards, AM., (26 March 2011) A 2-h diagnostic protocol to assess patients with chest pain symptoms in the Asia-Pacific region (ASPECT): a prospective observational validation study. The Lancet 377(9771) 1077-1084 DOI: 10.1016/S0140-6736(11)60310-3
• Peddie S., Richardson S., Salt L., Ardagh M. (25 March 2011) Frequent attenders at emergency departments: research regarding the utility of management plans fails to take into account the natural attrition of attendance. New Zealand Medical Journal 124(1331); ISSN 1175 8716. URL: http://www.nzma.org.nz/journal/124-1331/4581/
• Dolan, B., Esson, A., Grainger, P., Richardson, S., & Ardagh, M. (2011). Earthquake disaster response in Christchurch, New Zealand. Journal of Emergency Nursing 37(5), 506-509. doi: 10.1016/j.jen.2011.06.009
• Ardagh MW., Pitchford AM., Esson A., Manson H., Dolan B. (14 October 2011). Project RED – a successful methodology for improving emergency department performance. New Zealand Medical Journal 124(1344); ISSN 1175 8716 http://journal.nzma.org.nz/journal/124-1344/4905/
• Ardagh M. Tonkin G. Possenniskie C. (14 October 2011). Improving acute patient flow and resolving emergency department overcrowding in New Zealand hospitals—the major challenges and the promising initiatives. New Zealand Medical Journal 124(1344); ISSN 1175 8716 http://journal.nzma.org.nz/journal/124-1344/4904/
• Ardagh, M. (2011). Improving Emergency Department performance at Christchurch hospital: An update [Letter]. New Zealand Medical Journal 124(1345). Retrieved from http://journal.nzma.org.nz/journal/124-1345/4953/content.pdf
• Ardagh, M. (2011) Utility rather than futility in emergency medicine (Editorial). Emergency Medicine Australasia 25, 530–531
• Ardagh, M. (11 June 2010) How to achieve New Zealand's shorter stays in emergency departments health targets. New Zealand Medical Journal 123(1316) :ISSN 1175 8716  URL: http://www.nzma.org.nz/journal/123-1316/4152/
• Than, MP., Helm, J., Calder, K., Ardagh, M.W., Smith, M., Flaws, DF., Beckert, L. (2009) Comparison of high specificity with standard versions of a quantitative latex D-dimer test in the assessment of community pulmonary embolism. Thrombosis Research 124 230-235.
• Simpson, JC., Turnbull, BL., Ardagh, M., Richardson, S. (September 2009) Child home injury prevention: understanding the context of unintentional injuries to preschool children. International Journal of Injury Control and Safety Promotion 16(3) 159-167.
• Ardagh, M. (September 2009) What do we do about increasing demand for Emergency Department care (Editorial). New Zealand Medical Journal
• Heitger, M.H., Jones, R.D., Dalrymple-Alford, J.C., Frampton,C.M., Ardagh, M.W., Anderson T.J. (2007). Mild head injury – a close relationship between motor function at one week post-injury and overall recovery at three and six months. Journal of the Neurological Sciences 253(1) 34-47 
• Heitger, M.H., Jones, R.D., Frampton, C.M., Ardagh, M.W., Anderson T.J. (2007), Recovery in the first year after mild head injury – divergence of symptom status and self-perceived quality of life. Journal of Rehabilitation Medicine 39 (8) 612-621
• Price, CSG., Bell, SF., Janes, SEJ., Ardagh, M. (2006) Cardio-pulmonary resuscitation training, knowledge & attitudes of newly-qualified doctors in New Zealand in 2003. Resuscitation 68, 295-299
• Ardagh, M. (15 December 2006) The case for a New Zealand Acute Care Strategy. New Zealand Medical Journal 119(1247)
• Beckert, L., Taylor, C., Ardagh, M., Than, M. Latex IL (2006) D-Dimer outperforms pre-test probability scoring systems in assessment of possible community pulmonary embolism (Abstract). Respirology 11(Supplement):A22 
• Ardagh, M. (13 October 2006) Criteria for prioritizing access to resources during times of overwhelming demand, such as during and influenza pandemic. New Zealand Medical Journal 119(1243). 
• Heitger, MH., Jones, RD., Dalrymple-Alford, JC., Frampton, CM., Ardagh, MW., Anderson, TJ. (July 2006) Motor deficits and recovery during the first year following mild closed head injury. Brain Injury 20(8):807-824
• Richardson, S., Ardagh, M., Hider, P. (21 April 2006) Health professionals do not agree about what defines appropriate attendance at an emergency department. New Zealand Medical Journal 119(232) 
• Ardagh, M. (17 February 2006) The skills of our New Zealand junior doctors – what are these skills and how do they get them? (Editorial). New Zealand Medical Journal 119 (229) 
• Raniga, S., Hider, P., Spriggs, D., Ardagh, M. (Dec 16 2005) The attitudes of hospital medical practitioners to the mandatory reporting of professional misconduct. New Zealand Medical Journal 118 (1227)
• Richardson, SK., Ardagh, M., Gee, P. (Jan 2005) Emergency Department Overcrowding: the Emergency Department Cardiac Analogy Model (EDCAM). Accid Emerg Nurs.13 (1) 18-23
• Cooper, JG., Johnstone, AJ., Hider, P., Ardagh, MW. (2005) Local anaesthetic infiltration increases the accuracy of assessment of ulnar collateral ligament injuries. Emergency Medicine Australasia 17, 132-6.
• Beckert, L., Ardagh, M., Lawson, R., Taylor, C., Than, M. IL (2005) D-Dimer outperforms pretest scoring systems in assessment of possible pulmonary embolism (Abstract). Respirology 10(Supplement):A52 
• Williams, T., Richardson, S., O'Donovan, P., & Ardagh, M. (2005) The forensic nurse practitioner role (emergency nursing) - a potential response to changing health needs in New Zealand. Medicine and Law 24:111-123.
• Ardagh, M. (10 Sep 2004) Meningitis: Tragedy, culture and blame. (letter). New Zealand Medical Journal. 117 (1201): U1057
• Ardagh, M. (07 May 2004) A Brief History of Resuscitation. New Zealand Medical Journal. 117 (1193): U868
• Ardagh, M., Richardson, S. (20 Feb 2004) Emergency Department Overcrowding. Can we fix it? New Zealand Medical Journal. 117(1189):U774
• Heitger, MH., Anderson, TJ, Jones, RD., Dalrymple-Alford, JC., Frampton, CM., Ardagh, MW. (2004) Eye movement and visuomotor arm movement deficits following mild closed head injury. Brain 127, 575-590. 
• Ardagh, M. (2004) A change of ethics (Abstract). Emergency Medicine Australasia 16(2):A22 
• Cooper, J., Johnstone, A., Ardagh, M. (2004) Local anaesthetic infiltration increases the accuracy of assessment of ulnar collateral ligament injuries in the emergency department. Emergency Medicine Australasia 16 (Supplement)A64 
• Ardagh, M. (2004) Indigenous and cultural challenges (Abstract). Emergency Medicine Australasia 16(Supplement)A69 
• Kennedy, D., Ardagh, M. (2004) Frequent attenders at Christchurch Hospital's Emergency Department: a 4 year study of attendance patterns. New Zealand Medical Journal. 117(1193):U871
• Graber, D., Ardagh, M., O'Donovan, P., St George, I. (11 Jul 2003). A telephone advice line does not   decrease the number of presentations to Christchurch Emergency Department, but does decrease the number of phone callers seeking advice. New Zealand Medical Journal 116:(1177):U495 
• Ardagh, M. (24 Jan 2003) Beyond Ashburton: junior hospital doctor employment in New Zealand (letter). New Zealand Medical Journal 116 (1168): U314 
• Heitger, M., Anderson, T., Jones, R. & Ardagh, M. (2002). Recovery of oculomotor, visuomotor and neuropsychological deficits following mild closed head injury. (Abstract). New Zealand Medical Journal 115. 
• Ardagh, M. (2002) What's happening in New Zealand Emergency Departments? New Zealand Medical Journal 115:83-5
• Ardagh, M., Hart, S., Lyons, R., Cooper, K. (02 Jul 2002) Effect of a rapid assessment clinic on the waiting time to be seen by a doctor and the time spent in the department, for patients presenting to an urban emergency department: a controlled prospective trial. New Zealand Medical Journal 115:(1157):U28

Peer-Reviewed Journal Articles

• Aldous, SJ., Richards, MA., Cullen, L., Troughton, R., Than, M. (2012) A New Improved Accelerated Diagnostic Protocol Safely Identifies Low‐risk Patients With Chest Pain in the Emergency Department. Academic Emergency Medicine 19(5) 510-516
• Parsonage, W., Cullen, L., Younger, J., Than, M. (2012) The role of Cardiac Computed Tomography in assessment of acute chest pain Heart, Lung and Circulation http://dx.doi.org/10.1016/j.hlc.2012.04.011
• Than, M., Cullen, L., Aldous, S. et al. (May 9, 2012) A 2-hour Accelerated Diagnostic Protocol to Assess patients with chest Pain symptoms using contemporary Troponins as the only biomarker (ADAPT): a prospective observational validation study. J Am Coll Card  doi:10.1016/j.jacc.2012.02.035
• Aldous, S., Florkowski, C., Crozier, I., Than, M. (2012) The performance of high sensitivity troponin for the diagnosis of acute myocardial infarction is underestimated; Clinical Chemistry and Laboratory Medicine 50(4):727-729
• Kline, JA., Rpy, PM., Than, MP.,  Hernandez, J., Courtney, DM., Jones, AE., Penazola, A., Pollack, CV. (April 2012) Derivation and validation of a multivariate model to predict mortality from pulmonary embolism with cancer: the POMPE-C tool. Thromb Res doi: 10.1016/j.thromres.2012.03.015
• Ardagh, MW., Richardson, SK., Robinson, V., Than, MP., Gee, P., Henderson, S., Khodaverdi, L., McKie, Robertson, JG., Schroeder, PP., Deely, JM. (20 April 2012) The initial health system response to the 22 February 2011 Christchurch earthquake. The Lancet doi:10.1016/S0140-6736(12)60313-4
• Aldous, S., Richards, AM., Troughton, R., Cullen, L., Pemberton, C., Than, MP. (Feb 2012) ST2 has diagnostic and prognostic utility for All-Cause mortality and Heart Failure in patients presenting to the Emergency Department with chest pain. Journal of Cardiac Failure. 18(4) 304-310
• Cowan, I., Cresswell, C., Liu, H., Siew, T., Ardagh, M., Than, M. (Feb 2012) Selective versus mandatory whole-body computed tomography scanning in the multiply injured patient.Emerg Med Australas 24
• Aldous, SJ., Richards, M., Cullen, L., Troughton, R., Than, M 30 Jan 2012) Diagnostic and prognostic utility of early measurement with high-sensitivity troponin T assay in patients presenting with chest pain. CMAJ.  
• Than, MP., Smith, RA., Cassidy, S., Kelly, R., Marsh, C., Maderal A, Kirsner RS. (21 Jan 2012) Use of a keratin-based hydrogel in the management of recessive dystrophic epidermolysis bullosa. J Dermatolog Treat.
• Vivas, AC., Maderal, AD., Than, MP., Kirsner, RS. (14 Dec 2011) Designing clinical trials to bring wound products to market. Int Wound J. doi: 10.1111/j.1742-481X.2011.00907.x
• Aldous, S., Richards, AM., Cullen, L., Than, M.  (Nov 2011) High-sensitivity cardiac troponin assays – is change important? Clin. Chem.58, 313-314
• Aldous, S., Richards, AM., Troughton, R., Cullen, L., Pemberton, C., Than, MP. (Nov 2011) High sensitivity Troponin T for early rule out of myocardial infarction in recent onset chest pain Emerg Med J doi:10.1136/emermed-2011-200222
• Aldous, SJ., Richards, AM., Cullen, L., and Than, MP. (Nov 2011) High-sensitivity cardiac troponin assays – is change important? Clin. Chem. doi:10.1373/clinchem.2011.176305 
• Aldous, SJ., Richards, AM., Cullen, L., and Than, MP. (Aug 2011) Early Dynamic Change in High-Sensitivity Cardiac Troponin T in the Investigation of Acute Myocardial Infarction Clin. Chem. 57: 1154 - 1160.  
• Than, M., Cullen, L., Reid, CM., Lim, SH., Aldous, S., Ardagh, MW., Richards, AM. (30 July 2011) Rapid diagnostic protocol for patients with chest pain Lancet ; 378: 398-399.
• Harris, JC., Caesar, DH., Davison, C.^, Phibbs, R.,Than, MP. ⁽June 2011) Are laboratory investigations useful for the Emergency Department evaluation of possible Osteomyelitis? A literature review.  Emergency Medicine Australasia 23(3) 317–330,
• Aldous, S., Richards, AM. (June 2011) Than, M. Can high sensitivity troponin accelerate current diagnostic protocols for the diagnosis of acute myocardial infarction. Heart, Lung and Circulation, 20(6) 376
• Aldous, SJ., Florkowski, CM., Crozier, IG., Elliott, J., George, P., Lainchbury, JG., Mackay, RJ., Than, M. (May 2011) Comparison of high sensitivity and contemporary troponin assays for the early detection of acute myocardial infarction in the Emergency Department. Ann Clin Biochem 48(Pt 3):241-8. Epub 2011 Mar 25.
• Aldous, SJ., Florkowski, CM., Crozier, IG., George, P., Macka, R., Than, M. (May 2011) High sensitivity troponin outperforms contemporary assays in predicting major adverse cardiac events up to two years in patients with chest pain. Ann Clin Biochem 48 (Pt3):249-55. Epub 2011 Mar 25.
• Than, M., Cullen, L., Reid, CM., Lim, SH., Aldous, S., Ardagh, MW., et al. (2011) A 2-h diagnostic protocol to assess patients with chest pain symptoms in the Asia-Pacific region (ASPECT): a prospective observational validation study. Lancet 377: 1077-84.
• Kaji, AH., Lewis, RJ., Beavers-May, T., Than, M. et al. Summary of NIH (November 2010) Medical-Surgical Emergency Research Roundtable Held on April 30 to May 1, 2009 Annals of Emergency Medicine, 56, 522-537
• Hammond, CE., Than, M. & Walker, JW. (Nov 2010) From the laboratory to the leg: Patients' and nurses' perceptions of product application using three different dressing formats Wound practice and research 18(4)
• Brown, A., Cullen, L., Than, M (2010) Future developments in chest pain diagnosis and management. Medical Clinics of North America 94(2) 375-400
• Aroney, CN., Hickman, PE., Schneider, HG., Tate, JR. and Than, MP (2010) Troponin measurement and the new assays: how low can we go? MJA ; 192(5): 245-246
• Cullen, L., Than, M., & Brown, A.F. et al. (2010). Comprehensive standardized data definitions for acute coronary syndrome research in emergency departments in Australasia. Emergency Medicine Australasia, 22, 35-55.
• Kline, J., Courtney, D., Than, M., Hogg, K., Miller, C., Johnson, C., Smithline, H. (2010) Accuracy of Very Low Pre-test Probability Estimates for Pulmonary Embolism Using the Method of Attribute Matching Compared with the Wells' Score. Acad Emerg Med 17:133–141
• Than, MP. and Flaws, DF. (2009) Communicating diagnostic uncertainties to patients: The problems of explaining unclear diagnosis and risk.  Evid Based Med 14: 66-67. doi:10.1136/ebm.14.3.66 
• Than, MP., Helm, J., Calder, K., Ardagh, MW., Smith, M., Flaws, DF. et al. (Jun 2009) Comparison of high specificity with standard versions of a quantitative latex D-dimer test in the assessment of community pulmonary embolism: HaemosIL D-dimer HS and pulmonary embolism. Thromb Res 124(2):230-5
• Kline, JA., Mark, CD., Kabrhel C., Moore, CL., Nordenholz, K., Smithline, HA., Plewa, MC., Richman, PB., O'Neil, BJ., McCubbin, TR., Beam, DM., Than, MP., Nordenholz, KE., A. Mitchell, M., Johnson, L., Camargo, A. Jr,  (May 2008) Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. J Thromb Haemost 6(5):772-8
• Martin, J., Cartabelotta, A., Than, M., & Glasziou, P. (2006) EBM notebook. 3^rd International conference of evidence-based healthcare teachers & developers. Evidence Based Medicine, 11
• Ardagh, M., Than, M. (2006) Diagnostics in emergency medicine - an overview of strategies and a few conditions which conspire to fool us. New Zealand Family Physician 33(2) 126
• Than, M., Bidwell, S., Davison, C., Phibbs, R., Walker, M. (Aug 2005) Evidence-based emergency medicine at the 'coal face'.  Emergency Medicine Australasia. 17(4):330-40
• Stevenson, A., Hider, P., Than, M. (11 Mar 2005) The utility of blood cultures in the management of non-facial cellulitis appears to be low. New Zealand Medical Journal. 118(1211):U1351 
• Corwin, P., Toop, L., McGeoch, G., Than, M., et al. Randomised controlled trial of intravenous antibiotic treatment for cellulitis at home compared with hospital. BMJ  2005;330:129
• Iles, S., Beckert, L., Than M., & Town I. (2003) Making a diagnosis of pulmonary embolism -new methods and clinical issues. New Zealand Medical Journal 116(1177):U499
• Goodacre S., Than, M., Goyder, EC. & Joseph, A. (1999) Can the distance fallen predict injury severity after a fall from a height? Journal of Trauma 46(6) 1055-8
• Greenslade, JH., Cullen, L., Parsonage, W., Reid, CM., Richard Body, Richards, M., Hawkins, T., Lim, SH., Than, MP. (in press) Discomfort and suspected Acute Coronary Syndrome across countries in the Asia-Pacific region: A prospective observational study Ann Emerg Med

Refereed Conference Procedings

• 2011 Australasian College of Emergency Medicine, Winter Symposium ASPECT and evidence based review of investigation of pulmonary embolism
• 2011 Asian Conference of Emergency Medicine, Bangkok – ASPECT study
• 2011 Annual Biomarker scientific symposium, San Diego – ASPECT study