Dr Nicole Ryan

Dr Nicole Ryan

Postdoctoral Research Fellow

School of Medicine and Public Health (Public Health)

Career Summary

Biography

The combination of an industrial science/engineering background and research higher degree studies within health science (medicine) has provided me with a good understanding into the practical applications and importance of investigation and objective testing for evidence based medicine. My current position is as an NHMRC Early Career Research Fellow in the Clinical Toxicology Research Group within the School of Medicine and Public Health. I co-ordinate and conduct randomised controlled trials into snake and spider envenoming as well as observational studies into the epidemiology and characterisation of medication toxicity. I am particularly interested in neuropathic disorders and neuropathic medication profiling.

My previous research role was based in Respiratory Medicine investigating the causes and mechanisms involved in refractory chronic cough. I  developed objective cough testing at the HMRI research facility and in the department of respiratory medicine at John Hunter Hospital. I like to approach my research from a clinical perspective when feasible by being actively involved in the testing and collection of data from research participants. Analysing the subsequent data is always interesting and the translation of findings into practical application.

Research Expertise
I have recently (early 2014) had a change in my research focus by commencing a post-doctoral research fellow position with the Clinical Toxicology Research Group located at the Calvary Mater Newcastle hospital site. Here I continue to develop my interest in the assessment of the efficacy and safety of drug therapy. During my PhD I completed a randomised controlled trial looking at the effectiveness and adverse effects of gabapentin medication in the treatment of chronic cough. The snake and spider studies that I now investigate have provided me with the opportunity to conduct three more RCTs testing the effects of medications. My prior research focus was in the identification and treatment of patients with refractory and idiopathic chronic cough. Ten years of research in this area led to the significant finding that laryngeal hypersensitivity is common in refractory chronic cough patients and that this can be successfully treated with neuropathic medications such as gabapentin or by behavioural techniques such as speech pathology and cough suppression techniques.

Teaching Expertise
Current co-supervisor of two PhD students. One of which is investigating myotoxicity and the early use of antivenom in Australia and Sri Lanka while my second student's PhD focuses on antidotes. Brief teaching role at Newcastle TAFE to 3rd and 4th year Applied Science (Chemistry) students before my move into medical research.

Qualifications

  • PhD (Medicine), University of Newcastle
  • Bachelor of Science, University of Newcastle

Keywords

  • Evidence based medicine
  • Medication Effectiveness
  • Science based
  • Snake Envenoming
  • Spider Envenoming
  • Toxicity
  • Toxicology

Fields of Research

Code Description Percentage
111502 Clinical Pharmacology and Therapeutics 40
111506 Toxicology (incl. Clinical Toxicology) 60

Professional Experience

UON Appointment

Title Organisation / Department
Postdoctoral Research Fellow University of Newcastle
School of Medicine and Public Health
Australia

Academic appointment

Dates Title Organisation / Department
1/05/2014 -  NHMRC Early Career Research Fellow

NHMRC - Early Career Fellowships (Formerly Postdoctoral Training Fellowships)

University of Newcastle
Clinical Toxicology Research Group
Australia
1/10/2010 - 1/06/2013 Research Officer University of Newcastle
School of Medicine and Public Health
Australia
1/12/2005 - 1/10/2010 Research PhD Candidate University of Newcastle
School of Medicine and Public Health
Australia

Membership

Dates Title Organisation / Department
1/01/2014 - 30/06/2016 Membership - ASMR

Australian Society for Medical Research Committee Member, 2015 Satellite Scientific Meeting Convenor.

Australian Society for Medical Research (ASMR)
Australia

Awards

Research Award

Year Award
2012 HMRI Early Career Travel Award
Unknown
2012 Faculty of Health Research Higher Degree Excellence Award
Unknown
2011 HMRI Pulse Education Prize
Unknown
2008 Finalist 10 of the Best Research Showcase
Unknown

Invitations

Speaker

Year Title / Rationale
2012 Gabapentin for refractory chronic cough: A randomised controlled trial
Organisation: Thoracic Society of Australia and New Zealand Description: CICADA Cough Symposium Invited Speaker
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Publications

For publications that are currently unpublished or in-press, details are shown in italics.

Highlighted Publications

Year Citation Altmetrics Link
2012 Ryan NM, Birring SS, Gibson PG, 'Gabapentin for refractory chronic cough: a randomised, double-blind, placebo-controlled trial', The Lancet, 380 1583-1589 (2012) [C1]
Citations Scopus - 80Web of Science - 54
Co-authors Peter Gibson

Journal article (18 outputs)

Year Citation Altmetrics Link
2016 Vertigan AE, Kapela SL, Ryan NM, Birring SS, McElduff P, Gibson PG, 'Pregabalin and Speech Pathology Combination Therapy for Refractory Chronic Cough: A Randomized Controlled Trial.', Chest, 149 639-648 (2016)
DOI 10.1378/chest.15-1271
Citations Scopus - 1
Co-authors Peter Gibson
2016 de Silva HA, Ryan NM, de Silva HJ, 'Adverse reactions to snake antivenom, and their prevention and treatment.', British journal of clinical pharmacology, 81 446-452 (2016) [C1]
2015 Ryan NM, Kearney RT, Brown SGA, Isbister GK, 'Incidence of serum sickness after the administration of Australian snake antivenom (ASP-22)', Clinical Toxicology, 54 27-33 (2015) [C1]

© 2015 Taylor & Francis.Context: Serum sickness is a delayed immune reaction resulting from the injection of foreign protein or serum. Antivenom is known to cause serum sickness ... [more]

© 2015 Taylor & Francis.Context: Serum sickness is a delayed immune reaction resulting from the injection of foreign protein or serum. Antivenom is known to cause serum sickness but the incidence and characteristics are poorly defined. Objective: To investigate the incidence and clinical features of serum sickness following the administration of Australian snake antivenoms. Materials and methods: This was a prospective cohort study of patients recruited to the Australian Snakebite Project who received snake antivenom from November 2012 to March 2014. Demographics, clinical information, laboratory tests and antivenom treatment were recorded prospectively. Patients administered antivenom were followed up at 7-10 days and 6 weeks post-antivenom. The primary outcome was the proportion with serum sickness, pre-defined as three or more of: fever, erythematous rash/urticaria, myalgia/arthralgia, headache, malaise, nausea/vomiting 5-20 days post-antivenom. Results: During the 16-month period, 138 patients received antivenom. 23 were not followed up (unable to contact, tourist, child, bee sting) and 6 died in hospital. Of 109 patients followed up, the commonest reason for antivenom was venom induced consumption coagulopathy in 77 patients. An acute systemic hypersensitivity reaction occurred post-antivenom in 25 (23%) and 8 (7%) were severe with hypotension. Serum sickness occurred in 32/109 (29%) patients, including 15/37 (41%) given tiger snake, 6/15 (40%) given polyvalent and 4/23 (17%) given brown snake antivenom. There was no association between the volume of antivenom and serum sickness, p = 0.18. The commonest effects were lethargy, headache, muscle/joint aches and fever. Discussion: The incidence of serum sickness after snake antivenom in Australia was higher than earlier investigations which failed to define symptoms or follow-up patients, but similar to more recent studies of antivenoms in the United States. Conclusion: Serum sickness is common with Australian snake antivenom but does not appear to be predictable based on the volume of antivenom administered.

DOI 10.3109/15563650.2015.1101771
Co-authors Geoff Isbister
2015 Ryan NM, Isbister GK, 'Tramadol overdose causes seizures and respiratory depression but serotonin toxicity appears unlikely', Clinical Toxicology, 53 545-550 (2015) [C1]

© 2015 Informa Healthcare USA, Inc.Context. Tramadol is a commonly used centrally acting analgesic associated with seizures and suspected to cause serotonin toxicity in overdose.... [more]

© 2015 Informa Healthcare USA, Inc.Context. Tramadol is a commonly used centrally acting analgesic associated with seizures and suspected to cause serotonin toxicity in overdose. Objective. This study sought to investigate the effects of tramadol overdose, and included evaluation for serotonin toxicity based on the Hunter Serotonin Toxicity Criteria where the seven clinical features of spontaneous clonus, inducible clonus, ocular clonus, agitation, diaphoresis, tremor and hyperreflexia are examined for in all patients taking serotonergic medications; seizures and central nervous system depression. Materials and methods. This was an observational cases series based on a retrospective review of tramadol overdoses (> 400 mg) admitted to a tertiary toxicology unit from November 2000 to June 2013. Demographic details, information on ingestion (dose and co-ingestants), clinical effects, complications (seizures, serotonin toxicity and cardiovascular effects) and intensive care unit (ICU) admission were extracted from a clinical database. Results. There were 71 cases of tramadol overdose (median age: 41 years, range: 17-69 years; and median ingested dose: 1000 mg, interquartile range [IQR]: 800-2000 mg). Seizures were dose related and occurred in 8 patients, one of them co-ingested a benzodiazepine compared with 16 patients without seizures. There were no cases of serotonin toxicity meeting the Hunter Serotonin Toxicity Criteria. Tachycardia occurred in 27 and mild hypertension occurred in 32. The Glasgow Coma Score was < 15 in 29 and < 9 in 5 patients; three co-ingested tricyclic antidepressants and two tramadol alone (3000 mg and 900 mg). Respiratory depression occurred in 13, median dose: 2500 (IQR: 1600-3000) mg which was significantly different (p = 0.003) to patients without respiratory depression, median dose: 1000 (IQR: 750-1475) mg. Eight patients were admitted to ICU, five due to co-ingestant toxicity and three for respiratory depression. Discussion. Tramadol overdose was associated with a significant risk of seizures and respiratory depression in more severe cases, both which appear to be related to the ingested dose. There were no cases of serotonin toxicity, while opioid-like effects and adrenergic effects were prominent. Conclusion. Tramadol overdose is associated with seizures and respiratory depression, but is unlikely to cause serotonin toxicity.

DOI 10.3109/15563650.2015.1036279
Citations Scopus - 5
Co-authors Geoff Isbister
2015 Ryan NM, Downes MA, Isbister GK, 'Clinical features of serum sickness after Australian snake antivenom', Toxicon, 108 181-183 (2015) [C3]

© 2015 Elsevier Ltd. All rights reserved.Serum sickness is a delayed immune reaction in which the immune system responds to a protein in antiserum as a potentially harmful substa... [more]

© 2015 Elsevier Ltd. All rights reserved.Serum sickness is a delayed immune reaction in which the immune system responds to a protein in antiserum as a potentially harmful substance and mounts an IgG-mediated antibody response. A 32 year-old female patient had systemic envenoming following a bite by a red-bellied black snake (Pseudechis porphyriacus). She was treated with Tiger snake antivenom and recovered over 24 h and did not develop myotoxicity. She then presented with local pain, itching and swelling, which was partially treated with antihistamines. Eleven days after the bite she presented again with symptoms of worsening serum sickness including rash on the upper legs, joint and muscle pain in arms, ankles and knees, and nausea. The patient was prescribed five days of prednisone 50 mg/day, antihistamine 10 mg/day and analgesia 1000 mg/day and improved over 2 days. She had no further problems on follow up at 4 months. This case highlights that serum sickness can cause significant effects after the treatment of snake envenoming. It develops 5-14 days after antivenom administration and has characteristic clinical and laboratory features. Severe cases of serum sickness can result in morbidity but it appears to respond well to corticosteroid treatment.

DOI 10.1016/j.toxicon.2015.10.012
Co-authors Geoff Isbister
2014 Simpson JL, Baines KJ, Ryan N, Gibson PG, 'Neutrophilic asthma is characterised by increased rhinosinusitis with sleep disturbance and GERD', Asian Pacific Journal of Allergy and Immunology, 32 66-74 (2014) [C1]

Background: Asthma is a heterogeneous inflammatory disease and eosinophilic, noneosinophilic and neutrophilic forms are recognised. While clinically similar to eosinophilic asthma... [more]

Background: Asthma is a heterogeneous inflammatory disease and eosinophilic, noneosinophilic and neutrophilic forms are recognised. While clinically similar to eosinophilic asthma, patients with non-eosinophilic asthma have different responses to treatment and little is known about the triggers of symptoms and inflammation. Objective: This study sought to characterise asthma control, exacerbation frequency and potential triggers of non-eosinophilic and specifically neutrophilic asthma such as infection, gastroesophageal reflux disease, and rhinosinusitis. Methods: Adults with asthma (n=65; doctor's diagnosis plus demonstrated response to bronchodilator and/or airways hyperresponsiveness to hypertonic saline) were recruited from the Respiratory and Sleep Medicine Ambulatory Care Service at John Hunter Hospital, NSW, Australia. Questionnaires were administered to assess gastroesophageal reflux disease, rhinosinusitis and asthma control. A sputum induction was performed and sputum was processed for assessment of inflammatory cells, infection, and lipid laden macrophages (Oil Red O). Results: Participants with neutrophilic asthma (n=11, 23%) had a higher frequency of primary care doctor visits for asthma exacerbations and a high prevalence (>70%) of chest infections in the previous 12 months. There was also an increased prevalence of rhinosinusitis (64%) and increased symptoms of gastroesophageal reflux disease compared to those with eosinophilic asthma. Conclusions: The clinical pattern of neutrophilic asthma is different from paucigranulocytic and eosinophilic asthma with evidence of abnormal upper airways responses. Specific and targeted treatment of these airway problems may assist in the control and management of neutrophilic asthma.

DOI 10.12932/AP0322.32.1.2014
Citations Scopus - 4Web of Science - 1
Co-authors Katherine Baines, Jodie Simpson, Peter Gibson
2014 Gibson PG, Simpson JL, Ryan NM, Vertigan AE, 'Mechanisms of cough', CURRENT OPINION IN ALLERGY AND CLINICAL IMMUNOLOGY, 14 55-61 (2014) [C1]
DOI 10.1097/ACI.0000000000000027
Citations Scopus - 8Web of Science - 5
Co-authors Jodie Simpson, Peter Gibson
2014 Ryan NM, 'A review on the efficacy and safety of gabapentin in the treatment of chronic cough.', Expert Opinion on Pharmacotherapy, 16 1-11 (2014) [C1]
DOI 10.1517/14656566.2015.981524
Citations Scopus - 6Web of Science - 3
2014 Ryan NM, Gibson PG, 'Recent additions in the treatment of cough', JOURNAL OF THORACIC DISEASE, 6 S739-S747 (2014) [C1]
DOI 10.3978/j.issn.2072-1439.2014.03.13
Citations Web of Science - 1
Co-authors Peter Gibson
2014 Ryan NM, Birring SS, Gibson PG, 'Arnold¿s nerve cough reflex: evidence for chronic cough as a sensory vagal neuropathy', Journal of Thoracic Disease, 6 S748-S752 (2014) [C3]
DOI 10.3978/j.issn.2072-1439.2014.04.22
Co-authors Peter Gibson
2013 Ryan NM, Birring SS, Gibson PG, 'Gabapentin for refractory chronic cough Reply', LANCET, 381 624-625 (2013) [C3]
Citations Scopus - 2Web of Science - 2
Co-authors Peter Gibson
2012 Ryan NM, Birring SS, Gibson PG, 'Gabapentin for refractory chronic cough: a randomised, double-blind, placebo-controlled trial', The Lancet, 380 1583-1589 (2012) [C1]
Citations Scopus - 80Web of Science - 54
Co-authors Peter Gibson
2012 Ryan NM, Vertigan AE, Ferguson JK, Wark PA, Gibson PG, 'Clinical and physiological features of postinfectious chronic cough associated with H1N1 infection', Respiratory Medicine, 106 138-144 (2012) [C1]
DOI 10.1016/j.rmed.2011.10.007
Citations Scopus - 7Web of Science - 5
Co-authors Peter Wark, Peter Gibson, John Ferguson
2011 Gibson PG, Ryan NM, 'Cough pharmacotherapy: Current and future status', Expert Opinion on Pharmacotherapy, 12 1745-1755 (2011) [C1]
Citations Scopus - 14Web of Science - 11
Co-authors Peter Gibson
2010 Ryan NM, Vertigan AE, Bone S, Gibson PG, 'Cough reflex sensitivity improves with speech language pathology management of refractory chronic cough', Cough, 6 1-8 (2010) [C1]
Citations Scopus - 26
Co-authors Peter Gibson
2009 Ryan NM, Vertigan AE, Gibson PG, 'Chronic cough and laryngeal dysfunction improve with specific treatment of cough and paradoxical vocal fold movement', Cough, 5 1-8 (2009) [C1]
DOI 10.1186/1745-9974-5-4
Citations Scopus - 17
Co-authors Peter Gibson
2009 Ryan NM, Gibson PG, 'Characterization of laryngeal dysfunction in chronic persistent cough', Laryngoscope, 119 640-645 (2009) [C1]
DOI 10.1002/lary.20114
Citations Scopus - 15Web of Science - 12
Co-authors Peter Gibson
2008 Ryan NM, Gibson PG, 'Extrathoracic airway hyperresponsiveness as a mechanism of post infectious cough: Case report', Cough, 4 1-4 (2008) [C3]
DOI 10.1186/1745-9974-4-7
Citations Scopus - 8
Co-authors Peter Gibson
Show 15 more journal articles

Conference (14 outputs)

Year Citation Altmetrics Link
2016 Ryan NM, Page CP, Isbister GK, 'The incidence of pregabalin overdose has increased but clinical effects are primarily associated with the coingestants' (2016)
Co-authors Geoff Isbister
2016 Page CB, Ryan NM, Isbister GK, 'The use and safety of high-dose insulin euglycaemia therapy in toxin-induced cardiac toxicity' (2016)
Co-authors Geoff Isbister
2016 Isbister GK, Heppell SP, Page CB, Ryan NM, 'Adult clonidine overdose: prolonged bradycardia and central nervous system depression, but not severe toxicity' (2016)
Co-authors Geoff Isbister
2016 Johnston C, Silva A, Siribaddana S, Ryan NM, Maduwage K, Isbister GK, 'Sri Lankan Russell's viper envenoming causes mild myotoxicity.' (2016)
Co-authors Geoff Isbister
2015 Ryan N, Isbister GK, 'Tramadol overdose is associated with an increased risk of seizure but not serotonin toxicity', CLINICAL TOXICOLOGY (2015) [E3]
Co-authors Geoff Isbister
2015 Ryan NM, Brown SGA, Isbister GK, 'Serum sickness after the administration of Australian snake antivenoms' (2015)
Co-authors Geoff Isbister
2014 Ryan NM, Isbister GK, 'Tramadol overdose is associated with an increased risk of seizure and unassociated with serotonin toxicity', TAPNA Conference Program (2014) [E3]
Co-authors Geoff Isbister
2014 Ryan NM, Brown SSGA, Isbister GK, 'Serum sickness after the administration of Australian snake antivenoms', CLINICAL TOXICOLOGY (2014) [E3]
Co-authors Geoff Isbister
2013 Ryan NM, 'Recent additions in the treatment of cough', J Thorac Dis (2013) [E3]
2013 Ryan NM, Vertigan AE, Bone SL, Gibson PG, 'Pregabalin and Speech Pathology for Chronic Cough', Journal of Thorac Disease (2013) [E3]
2013 Simpson JL, Baines KJ, Ryan NM, Gibson PG, 'NEUTROPHILIC ASTHMA IS CHARACTERIZED BY INCREASED GERD AND RHINOSINUSITIS WITH SLEEP DISTURBANCE', RESPIROLOGY (2013) [E3]
Co-authors Jodie Simpson, Peter Gibson, Katherine Baines
2012 Ryan NM, Gibson PG, 'Gabapentin for idiopathic chronic cough: A randomised controlled trial', Lung (2012) [E3]
Co-authors Peter Gibson
2011 Ryan NM, Vertigan AE, Ferguson JK, Wark PA, Gibson PG, 'Investigation and characterization of persistent cough associated with H1N1 2009 influenza', Respirology (2011) [E3]
Co-authors Peter Gibson, Peter Wark, John Ferguson
2010 Ryan NM, Vertigan AE, Bone S, Gibson PG, 'Cough reflex sensitivity improves with speech language pathology management of refractory chronic cough', Respirology (2010) [E3]
DOI 10.1186/1745-9974-6-5
Co-authors Peter Gibson
Show 11 more conferences
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Grants and Funding

Summary

Number of grants 8
Total funding $248,594

Click on a grant title below to expand the full details for that specific grant.


20161 grants / $19,966

Combination Analgesia for Redback spider Envenoming (CARE) Study- A randomised controlled trial$19,966

Funding body: University of Sydney

Funding body University of Sydney
Project Team Doctor Nicole Ryan, Professor Geoff Isbister, Professor Nicholas Buckley, Professor Andis Graudins, Professor Daniel Fatovich
Scheme Translational Australian Clinical Toxicology (TACT) Pilot Grant
Role Lead
Funding Start 2016
Funding Finish 2016
GNo G1501400
Type Of Funding Grant - Aust Non Government
Category 3AFG
UON Y

20151 grants / $3,000

Faculty of Health and Medicine Pilot Grant $3,000

2015 Faculty Pilot Grant for Project: Early snake antivenom administration (ESAA) Study.

Funding body: The University of Newcastle

Funding body The University of Newcastle
Scheme Faculty of Health and Medicine Pilot Grant
Role Lead
Funding Start 2015
Funding Finish 2015
GNo
Type Of Funding Internal
Category INTE
UON N

20141 grants / $152,300

Combined Treatment for Chronic Cough$152,300

Funding body: NHMRC (National Health & Medical Research Council)

Funding body NHMRC (National Health & Medical Research Council)
Project Team Doctor Nicole Ryan
Scheme Early Career Fellowships
Role Lead
Funding Start 2014
Funding Finish 2017
GNo G1300679
Type Of Funding Aust Competitive - Commonwealth
Category 1CS
UON Y

20132 grants / $29,810

Pregabalin and Speech Pathology Treatment for Refractory Chronic Cough with Laryngeal Hypersensitivity $23,810

Funding body: John Hunter Hospital Charitable Trust

Funding body John Hunter Hospital Charitable Trust
Project Team Doctor Nicole Ryan, Doctor Anne Vertigan, Doctor Michael Hayes, Ms Sarah Bone
Scheme Research Grant
Role Lead
Funding Start 2013
Funding Finish 2013
GNo G1300784
Type Of Funding Other Public Sector - State
Category 2OPS
UON Y

HMRI Early Career Travel Award 2012$6,000

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Doctor Nicole Ryan
Scheme Research Grant
Role Lead
Funding Start 2013
Funding Finish 2013
GNo G1300514
Type Of Funding Grant - Aust Non Government
Category 3AFG
UON Y

20121 grants / $4,000

PULSE Education Prize$4,000

Funding body: Hunter Medical Research Institute

Funding body Hunter Medical Research Institute
Project Team Doctor Nicole Ryan
Scheme PULSE Education Prize
Role Lead
Funding Start 2012
Funding Finish 2012
GNo G1200455
Type Of Funding Scheme excluded from IGS
Category EXCL
UON Y

20091 grants / $20,000

HMRI RHD Support Grant$20,000

RHD Support Grant from the Hunter Medical Research Institute [the Greaves family] for PhD candidacy.

Funding body: Hunter Medical Research Institute (HMRI)

Funding body Hunter Medical Research Institute (HMRI)
Project Team

Nicole M Ryan, Peter G Gibson

Scheme Research Grant
Role Lead
Funding Start 2009
Funding Finish 2009
GNo
Type Of Funding Grant - Aust Non Government
Category 3AFG
UON N

20071 grants / $19,518

Mrs Nicole M Ryan$19,518

Funding body: CCRE in Respiratory and Sleep Medicine

Funding body CCRE in Respiratory and Sleep Medicine
Project Team

Prof Peter G Gibson

Scheme Postgraduate Research Scholarship
Role Investigator
Funding Start 2007
Funding Finish 2007
GNo
Type Of Funding Internal
Category INTE
UON N
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Research Supervision

Number of supervisions

Completed0
Current2

Total current UON EFTSL

PhD0.35

Current Supervision

Commenced Level of Study Research Title / Program / Supervisor Type
2015 PhD Snake Envenoming in Australia and Beyond: Investigating Myotoxicity and the Early use of Antivenom
PhD (Clinical Pharm), Faculty of Health and Medicine, The University of Newcastle
Co-Supervisor
2015 PhD Antidotes and Treatments in Overdose
PhD (Clinical Pharm), Faculty of Health and Medicine, The University of Newcastle
Co-Supervisor
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Research Projects

ATOM Studies: Pregabalin, Gabapentin Toxicity Project 2015 -

The aim of this project is to investigate the toxic effects and pharmacokinetics of pregabalin and gabapentin in overdose.


Investigating the QT Interval in a Normal Population 2015 -

  The objectives of this study are to:

  1. Investigate the QT interval in a normal population including individual QT variability;
  2. Investigate the relationship between QT and heart rate (RR interval) for individuals in a normal population;
  3. Investigate other factors that many influence the length of the QT interval – age, sex, diurnal variation
  4. Investigate QT hysteresis in a normal population.  Our hypothesis is that about 1 to 3% of the normal population will have an abnormal QT based on the QT nomogram. Little information is known about QT hysteresis in the normal population but previous studies suggest it is on average about 2 minutes.


A randomised controlled trial of early antivenom for red-bellied black snake envenoming 2014 -

The purpose of this project is to investigate the effectiveness and safety of early antivenom administration for the treatment of red-bellied black snake bites/envenoming. Red-bellied black snakebites are the most common in Eastern Australia and are not routinely treated with antivenom because they appear to cause minor effects and there is concern about the risk of allergic reactions to antivenom. However, recent work by the ASP investigators suggests that the early use of antivenom will reduce the chance of people developing muscle damage. This study is a randomised controlled trial of one vial of tiger snake antivenom compared to standard care (placebo) and this will provide good evidence for or against the early administration of antivenom for muscle damage. The study will also investigate whether antivenom neutralises other effects of RBBS envenoming and determine the frequency of allergic reactions, including anaphylaxis, after antivenom use.


Randomised controlled trial of early antivenom administration in Australian snakebite 2015 -

Current standard practice for any snake bite requires laboratory testing to determine if a patient has been envenomed, and coagulation studies are the most important tests. The administration of antivenom is then based on the presence of clinical effects of envenoming and abnormal laboratory investigations. Many of these envenoming effects are irreversible, so once they develop they are unlikely to be reversed by antivenom. This means that, antivenom needs to be given prior to the development of irreversible envenoming syndromes. The aim of this project will be to administer antivenom early – as soon as the patient presents to hospital ‐ without first waiting for laboratory tests or the development of clinical signs of envenoming (except non‐specific symptoms), and/or retrieval to a major hospital for laboratory testing. The objective is to determine if the administration of early antivenom will prevent envenoming effects and therefore significant morbidity or death.


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Dr Nicole Ryan

Position

Postdoctoral Research Fellow
Clinical Toxicology & Pharmacology
School of Medicine and Public Health
Faculty of Health and Medicine

Focus area

Public Health

Contact Details

Email nicole.ryan@newcastle.edu.au
Phone (02) 4921 1312
Fax (02) 4921 1870
Link Twitter

Office

Room 5.46A, Level 5 New Med Building
Building Calvary Mater Newcastle
Location Calvary Mater Newcastle Hospital

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