NoPac Trial
Start date:May 2017 Co-ordinated by:
Royal Devon & Exeter NHS trust
Patients commonly present to the Emergency Department with epistaxsis (nose bleed). Standard first aid measures such as applying pressure can often stem bleeding however in more severe cases of epistaxsis further treatment is required. These treatments range from the use of vasoconstrictors to cauterisation and eventually to nasal packing.
It is well documented that patients who require nasal packing find this procedure uncomfortable and painful despite its ultimate effectiveness. The NoPac trial is investigating the novel use of tranexamic acid* (TXA) to reduce the need for nasal packing. Recruited participants will receive application of TXA or a placebo before nasal packing is considered. Identifying an effective alternative to this procedure would provide clear patient benefits.
EMERGE hope to commence recruitment to NoPac in spring 2017.
*TXA is a drug that has a good evidence base for the treatment of haemorrhage in trauma. EMERGE is currently involved in two other clinical trials of TXA,
www.emergeresearch.org/trial/halt-it/ www.emergeresearch.org/trial/tich-2/
Local PI
Dr Matt Reed
Director of EMERGE, Consultant, NRS Career Research Fellow & Honorary Reader in Emergency Medicine
Research Team
Allan MacRaild
Stroke Lead Research Nurse
Polly Black
Senior Research Nurse
More EMERGE Trials
ATTEST2 Trial
Alteplase-Tenecteplase Trial Evaluation for Stroke Thrombolysis (ATTEST 2)
People who develop an Acute Kidney Injury (AKI) often have a poor prognosis and many go on to develop chronic kidney disease (CKD). The recognition that AKI and CKD are linked is recent and the molecular pathways that control the transition from acute injury to chronic disease are not well defined. Currently there are no specific treatments that reduce the risk of progressing to CKD after AKI.
Preliminary investigations (not yet published) suggest that AKI causes sustained activation of the endothelin (ET) system to the long-term detriment of renal and systemic haemodynamic function. These pilot data form the basis of our project that seeks to determine whether the ET system is active in patients with AKI and, thus, represents a potential target for therapeutic intervention.
KRAKIL aims to recruit altogether 100 patients from across the emergency department, acute medical unit and inpatient wards at the Royal Infirmary. 50 of which with AKI’s and 50 matched controls with normal kidney function. We will monitor their bloods and urine for 90 days and compare the data from between the two groups.
KRAKIL Study
Trauma remains a major cause of mortality and morbidity. 10% of blunt force trauma patients admitted to a major trauma centre will have sustained one or more fractured ribs, which may cause significant pain and problems with breathing.
To establish the outcome of rib fractures and their treatments it is important to know what to measure, and how to measure this accurately. A patient reported outcome measure (PROM) is a questionnaire used to measure patient reported outcomes, to show how the patient is doing from their perspective.
Whilst there is ongoing interest in surgery to fix broken ribs, there is no PROM specifically designed for patients with broken ribs following chest trauma. Therefore, it is not clear whether the symptoms that are most important to these patients are being represented by the current outcome measures. This study aims to create a PROM specific to rib fracture patients to give us a better understanding of whether a new treatment actually makes a difference to the patient’s recovery.
The 1st part of the study involves asking patients with rib fractures to help design a new PROM. This will be conducted through focus groups at a site in Nottingham. The 2nd part of the study entails field testing, whereby patients with rib fractures will be asked to test this new PROM. This will be conducted across multiple secondary care settings in the UK, including the Royal Infirmary of Edinburgh. The study is expected to run for approximately 2 years, with recruitment targets of 50 patients for the PROM Creation phase and 250 for the Field Testing phase.