Dr Leonie Calver

Dr Leonie Calver

Lecturer

School of Nursing and Midwifery

Career Summary

Biography

Leonie Calver PhD

Having been a clinical nurse for over 35 years working in predominantly critical care areas including intensive care units, coronary care, operating theatres and emergency departments, I enjoyed a 12 year stint in nurse management positions. During this time I  became involved in quality improvement projects, innovation and education in the clinical setting.

Approximately 10 years ago the opportunity arose to manage a randomised controlled trial (RCT) in the emergency department of the Calvary Mater Newcastle and have been researching ever since that appointment. The studies that I have managed include prospective, observational, multi-site RCTs, individual patient assessments ,pilot and historical studies. My research opportunities continue as there is never an end to discover and change outdated practise.

Recently I returned to the hospitals as a clinical nurse for a period of over 12 months to re-gain my nursing skills and to re-connect with my career which commenced in the 1990s. I was both enlightened and dismayed at the changes in care delivery within the public hospital setting.Together with a interest in teaching and having a conviction that the most effective way to have an influence on developments and changes made from within the institutions is to be in a position to have input. Therefore I have commenced my new career as Lecturer of Nursing at UoN.


Qualifications

  • Doctor of Philosophy, University of Newcastle
  • Master of Nursing, University of Western Sydney
  • Graduate Certificate of Nursing (Critical Care), University of Western Sydney

Keywords

  • Acute behaviour disturbance
  • Droperidol
  • Sedation

Professional Experience

UON Appointment

Title Organisation / Department
Lecturer University of Newcastle
School of Nursing and Midwifery
Australia

Professional appointment

Dates Title Organisation / Department
1/04/2008 - 1/09/2014 Clinical Nurse Specialist -Research

After mastering the role of Nurse Unit Manager in the critical care setting and the surgical setting I felt the need for a new challenge. I moved onto research involving the design and management of the Australia wide multi site Redback Spider Bite Project of Antivenom vs Placebo. My thesis topic for my PhD by publication was Sedation of Acute Behavioural Disturbance. The outcome from this thesis has led to changes in the policy and guidelines of Hunter New England Health Lower Health District (HNELHD) in the emergency departments and the NSW Ambulance Department and HNELHD Mental Health.

Calvary Mater Newcastle
Toxicology
Australia
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Publications

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


Journal article (22 outputs)

Year Citation Altmetrics Link
2017 Isbister GK, Brown AL, Gill A, Scott AJ, Calver L, Dunlop AJ, 'QT interval prolongation in opioid agonist treatment: analysis of continuous 12-lead electrocardiogram recordings.', Br J Clin Pharmacol, 83 2274-2282 (2017)
DOI 10.1111/bcp.13326
Co-authors Geoffrey Isbister, A Dunlop
2016 Isbister GK, Calver L, Downes MA, Page CB, 'On the Temporal Relation of Droperidol Administration and the QT Interval Reply', ANNALS OF EMERGENCY MEDICINE, 67 146-147 (2016)
DOI 10.1016/j.annemergmed.2015.09.029
Co-authors Geoffrey Isbister
2016 Isbister GK, Calver LA, Downes MA, Page CB, 'Ketamine as Rescue Treatment for Difficult-to-Sedate Severe Acute Behavioral Disturbance in the Emergency Department', Annals of Emergency Medicine, 67 581-587e1 (2016) [C1]

© 2016 American College of Emergency Physicians. Study objective We investigate the effectiveness and safety of ketamine to sedate patients with severe acute behavioral disturban... [more]

© 2016 American College of Emergency Physicians. Study objective We investigate the effectiveness and safety of ketamine to sedate patients with severe acute behavioral disturbance who have failed previous attempts at sedation. Methods This was a prospective study of patients given ketamine for sedation who had failed previous sedation attempts. Patients with severe acute behavioral disturbance requiring parenteral sedation were treated with a standardized sedation protocol including droperidol. Demographics, drug dose, observations, and adverse effects were recorded. The primary outcome was the number of patients who failed to sedate within 120 minutes of ketamine administration or requiring further sedation within 1 hour. Results Forty-nine patients from 2 hospitals were administered rescue ketamine during 27 months; median age was 37 years (range 20-82 years); 28 were men. Police were involved with 20 patients. Previous sedation included droperidol (10 mg; 1), droperidol (10+10 mg; 33), droperidol (10+10+5 mg; 1), droperidol (10+10+10 mg; 11), and combinations of droperidol and benzodiazepines (2) and midazolam alone (1). The median dose of ketamine was 300 mg (range 50 to 500 mg). Five patients (10%; 95% confidence interval 4% to 23%) were not sedated within 120 minutes or required additional sedation within 1 hour. Four of 5 patients received 200 mg or less. Median time to sedation postketamine was 20 minutes (interquartile range 10 to 30 minutes; 2 to 500 minutes). Three patients (6%) had adverse effects, 2 had vomiting, and a third had a transient oxygen desaturation to 90% after ketamine that responded to oxygen. Conclusion Ketamine appeared effective and did not cause obvious harm in this small sample and is a potential option for patients who have failed previous attempts at sedation. A dose of 4 to 5 mg/kg is suggested, and doses less than 200 mg are associated with treatment failure.

DOI 10.1016/j.annemergmed.2015.11.028
Citations Scopus - 6Web of Science - 5
Co-authors Geoffrey Isbister
2016 Foo LK, Duffull SB, Calver L, Schneider J, Isbister GK, 'Population pharmacokinetics of intramuscular droperidol in acutely agitated patients', British Journal of Clinical Pharmacology, 82 1550-1556 (2016) [C1]

© 2016 The British Pharmacological Society Background: Intramuscular droperidol is used increasingly for sedation of aggressive and violent patients. This study aimed to characte... [more]

© 2016 The British Pharmacological Society Background: Intramuscular droperidol is used increasingly for sedation of aggressive and violent patients. This study aimed to characterise the pharmacokinetics of intramuscular droperidol in these patients to determine how rapidly it is absorbed and the expected duration of measurable drug concentrations. Methods: We undertook a population pharmacokinetic analysis of a subgroup of patients from a clinical trial comparing droperidol and midazolam: 17 receiving 5¿mg and 24 receiving 10¿mg droperidol. Droperidol was measured using high-performance liquid chromatography. Pharmacokinetic modelling was performed under a nonlinear mixed effects modelling framework (NONMEM v7.2). The model was used to simulate concentration time profiles of three typical doses, 5¿mg, 10¿mg and 10¿mg¿+¿10¿mg repeated at 15¿min. Results: A two-compartment first-order input with first-order output model fitted the data best. The absorption rate constant was poorly characterised by the data and an estimate of the first order rate constant of absorption when fixed to 10¿h ¿1 provided a stable model and lowest objective function. This represents extremely rapid absorption with a half-life of 5¿min. The final model had a clearance of 41.9¿l¿h ¿1 and volume of distribution of the central compartment of, 73.6¿l. Median and interquartile range of initial (alpha) half-life was 0.32¿h (0.26¿0.37¿h) and second (beta) half-life was 3.0¿h (2.5¿3.6¿h). Simulations indicate that 10¿mg alone provides an 80% probability of being above the lower limit of quantification (5¿µg¿l ¿1 ) for 7¿h, 2¿h longer than for 5¿mg. Giving two 10¿mg doses increased this duration to 10¿h. Conclusions: Intramuscular droperidol is rapidly absorbed with high therapeutic concentrations after 5 and 10¿mg doses, and supports clinical data in which droperidol sedates rapidly for up to 6¿h.

DOI 10.1111/bcp.13093
Citations Scopus - 1
Co-authors Jennifer Schneider, Geoffrey Isbister
2015 Calver L, Drinkwater V, Gupta R, Page CB, Isbister GK, 'Droperidol V. haloperidol for sedation of aggressive behaviour in acute mental health: randomised controlled trial', BRITISH JOURNAL OF PSYCHIATRY, 206 223-228 (2015) [C1]
DOI 10.1192/bjp.bp.114.150227
Citations Scopus - 5Web of Science - 6
Co-authors Geoffrey Isbister
2015 Calver L, Page CB, Downes MA, Chan B, Kinnear F, Wheatley L, et al., 'The Safety and Effectiveness of Droperidol for Sedation of Acute Behavioral Disturbance in the Emergency Department', Annals of Emergency Medicine, (2015) [C1]

Study objective: We investigate the safety and effectiveness of droperidol for sedation of acute behavioral disturbance in the emergency department (ED). Methods: This was a prosp... [more]

Study objective: We investigate the safety and effectiveness of droperidol for sedation of acute behavioral disturbance in the emergency department (ED). Methods: This was a prospective observational study in 6 EDs (August 2009 to April 2013). Adult patients requiring parenteral sedation for acute behavioral disturbance received droperidol 10 mg. If this did not sedate the patient within 15 minutes, further sedation was allowed but droperidol 10 mg was recommended as part of a sedation protocol. The primary outcome was the proportion of patients with an abnormal QT interval, defined by the at-risk line on the QT nomogram. Secondary outcomes were effectiveness determined by the time to sedation measured on the Sedation Assessment Tool, use of additional sedation, adverse events, and injury to staff or patients. Results: There were 1,009 patients with an ECG performed within 2 hours of droperidol administration, with a median dose of 10 mg (interquartile range [IQR]10 to 17.5 mg). Thirteen of the 1,009 patients had an abnormal QT (1.3%; 95% confidence interval 0.7% to 2.3%), but 7 of these had another cause attributed for prolonged QT (methadone, escitalopram, amiodarone, or preexisting). In 1,403 patients sedated with a median total dose of droperidol of 10 mg (IQR 10 to 20 mg), the median time to sedation was 20 minutes (IQR 10 to 30 minutes) and 97% were sedated within 120 minutes. Additional sedation was required for 435 patients (31.0%; 95% confidence interval 28.6% to 33.5%). Adverse events occurred in 70 patients (5%) and oversedation without complications in 109 (8%), the latter more common for patients receiving benzodiazepines as additional sedation (16/109 [15%]). There were no cases of torsades de pointes. Injuries occurred in 34 staff members and 4 patients. Conclusion: The study supports the use of high-dose droperidol as a safe sedating agent for patients with acute behavioral disturbance in the ED. There is no evidence of increased risk for QT prolongation with the doses used in this study.

DOI 10.1016/j.annemergmed.2015.03.016
Citations Scopus - 18Web of Science - 16
Co-authors Geoffrey Isbister
2014 Isbister GK, Page CB, Buckley NA, Fatovich DM, Pascu O, MacDonald SPJ, et al., 'Randomized controlled trial of intravenous antivenom versus placebo for latrodectism: The second redback antivenom evaluation (RAVE-II) study', Annals of Emergency Medicine, 64 620-628 (2014) [C1]

© 2014 American College of Emergency Physicians. Study objective Latrodectism is the most important spider envenomation syndrome worldwide. There remains considerable controversy... [more]

© 2014 American College of Emergency Physicians. Study objective Latrodectism is the most important spider envenomation syndrome worldwide. There remains considerable controversy over antivenom treatment. We aimed to investigate whether antivenom resulted in resolution of pain and systemic effects in patients with latrodectism who received standardized analgesia. Methods In a multicenter randomized placebo-controlled trial of redback spider antivenom for latrodectism, 224 patients ( > 7 years) with a redback spider bite and severe pain, with or without systemic effects, were randomized to receive normal saline solution (placebo) or antivenom after receiving standardized analgesia. The primary outcome was a clinically significant reduction in pain 2 hours after trial medication compared with baseline. A second primary outcome for the subgroup with systemic features of envenomation was resolution of systemic features at 2 hours. Secondary outcomes were improved pain at 4 and 24 hours, resolution of systemic features at 4 hours, administration of opioid analgesics or unblinded antivenom after 2 hours, and adverse reactions. Results Two hours after treatment, 26 of 112 patients (23%) from the placebo arm had a clinically significant improvement in pain versus 38 of 112 (34%) from the antivenom arm (difference in favor of antiven om 10.7%; 95% confidence interval -1.1% to 22.6%; P=.10). Systemic effects resolved after 2 hours in 9 of 41 patients (22%) in the placebo arm and 9 of 35 (26%) in the antivenom arm (difference 3.8%; 95% confidence interval -15% to 23%; P=.79). There was no significant difference in any secondary outcome between antivenom and placebo. Acute systemic hypersensitivity reactions occurred in 4 of 112 patients (3.6%) receiving antivenom. Conclusion The addition of antivenom to standardized analgesia in patients with latrodectism did not significantly improve pain or systemic effects.

DOI 10.1016/j.annemergmed.2014.06.006
Citations Scopus - 10Web of Science - 9
Co-authors Geoffrey Isbister
2014 Calver L, Isbister GK, 'High dose droperidol and QT prolongation: analysis of continuous 12-lead recordings.', Br J Clin Pharmacol, 77 880-886 (2014) [C1]
DOI 10.1111/bcp.12272
Citations Scopus - 9Web of Science - 7
Co-authors Geoffrey Isbister
2014 Downes MA, Calver LA, Isbister GK, 'Intralipid therapy does not improve level of consciousness in overdoses with sedating drugs: a case series.', Emerg Med Australas, 26 286-290 (2014) [C1]
DOI 10.1111/1742-6723.12237
Citations Scopus - 8Web of Science - 6
Co-authors Geoffrey Isbister
2013 Calver L, Isbister GK, 'Parenteral sedation of elderly patients with acute behavioral disturbance in the ED', AMERICAN JOURNAL OF EMERGENCY MEDICINE, 31 970-973 (2013) [C1]
DOI 10.1016/j.ajem.2013.03.026
Citations Scopus - 4Web of Science - 3
Co-authors Geoffrey Isbister
2013 Calver L, Drinkwater V, Isbister GK, 'A prospective study of high dose sedation for rapid tranquilisation of acute behavioural disturbance in an acute mental health unit', BMC PSYCHIATRY, 13 (2013) [C1]
DOI 10.1186/1471-244X-13-225
Citations Scopus - 4Web of Science - 3
Co-authors Geoffrey Isbister
2012 Calver L, Isbister GK, 'Dexmedetomidine in the emergency department: Assessing safety and effectiveness in difficult-to-sedate acute behavioural disturbance', Emergency Medicine Journal, 29 915-918 (2012) [C1]
Citations Scopus - 2Web of Science - 2
Co-authors Geoffrey Isbister
2012 Calver L, Dunlop AJ, Isbister GK, 'Individual patient assessment of methadone-induced QT prolongation with digital holter recording', Journal of Addiction Medicine, 6 92-93 (2012) [C3]
Citations Scopus - 4Web of Science - 3
Co-authors A Dunlop, Geoffrey Isbister
2011 Berling I, Isbister GK, Calver L, Clunas S, 'Digital Holter measurement of QT prolongation in ziprasidone overdose', Clinical Toxicology, 49 694-696 (2011) [C3]
DOI 10.3109/15563650.2011.597035
Citations Scopus - 7Web of Science - 6
Co-authors Geoffrey Isbister
2011 Calver L, Stokes BJ, Isbister GK, 'Sedation assessment tool to score acute behavioural disturbance in the emergency department', Emergency Medicine Australasia, 23 732-740 (2011) [C1]
Citations Scopus - 9Web of Science - 9
Co-authors Geoffrey Isbister, Barrie Stokes
2011 Isbister GK, Calver L, 'Managing aggressive and violent patients', Australian Prescriber, 34 National Prescribing Service (2011) [C3]
Co-authors Geoffrey Isbister
2011 Isbister GK, Calver L, 'Hyperferritinaemia without positive HFE gene mutation', Australian Prescriber, 34 166-167 (2011) [C3]
Co-authors Geoffrey Isbister
2010 Isbister GK, Calver L, Page CB, Stokes BJ, Bryant J, Downes MA, 'Randomized controlled trial of intramuscular droperidol versus midazolam for violence and acute behavioral disturbance: The DORM Study', Annals of Emergency Medicine, 56 392-401 (2010) [C1]
DOI 10.1016/j.annemergmed.2010.05.037
Citations Web of Science - 40
Co-authors Barrie Stokes, Geoffrey Isbister
2010 Page CB, Calver L, Isbister GK, 'Risperidone overdose causes extrapyramidal effects but not cardiac toxicity', Journal of Clinical Psychopharmacology, 30 387-395 (2010) [C1]
DOI 10.1097/JCP.0b013e3181e5f7a5
Citations Scopus - 18Web of Science - 26
Co-authors Geoffrey Isbister
2010 Calver L, Downes MA, Page CB, Bryant J, Isbister GK, 'The impact of a standardised intramuscular sedation protocol for acute behavioural disturbance in the emergency department', BMC Emergency Medicine, 10 1-7 (2010) [C1]
DOI 10.1186/1471-227X-10-14
Citations Scopus - 13
Co-authors Geoffrey Isbister
2009 Isbister GK, Calver L, Van Gorp F, Stokes BJ, Page CB, 'Inter-rater reliability of manual QT measurement and prediction of abnormal QT,HR pairs', Clinical Toxicology, 47 884-888 (2009) [C1]
DOI 10.3109/15563650903333820
Citations Scopus - 19Web of Science - 17
Co-authors Geoffrey Isbister, Barrie Stokes
2009 Calver LA, Stokes BJ, Isbister GK, 'The dark side of the moon', Medical Journal of Australia, 191 692-694 (2009) [C1]
Citations Scopus - 8Web of Science - 6
Co-authors Geoffrey Isbister, Barrie Stokes
Show 19 more journal articles

Conference (10 outputs)

Year Citation Altmetrics Link
2014 Drinkwater V, Calver L, Bjorksten C, Isbister G, Gupta R, 'HOW AN INTERFACE BETWEEN ACUTE PSYCHIATRIC SERVICES AND AN EMERGENCY DEPARTMENT HAS IMPROVED THE MANAGEMENT OF ACUTE BEHAVIOURAL DISTURBANCE', AUSTRALIAN AND NEW ZEALAND JOURNAL OF PSYCHIATRY (2014) [E3]
Co-authors Geoffrey Isbister
2014 Scott A, Brown A, Dunlop A, Gill T, Holland R, Fisk C, et al., 'QT PROLONGATION IN OPIOID SUBSTITUTION THERAPY: ANALYSIS OF CONTINUOUS 12-LEAD ELECTROCARDIOGRAM RECORDINGS', DRUG AND ALCOHOL REVIEW (2014) [E3]
Co-authors A Dunlop, Geoffrey Isbister
2012 Calver L, Page BC, Downes M, Chan B, Isbister GK, 'Safety of droperidol for sedation and acute behavioural disturbance', Academic Emergency Medicine (2012) [E3]
Co-authors Geoffrey Isbister
2012 Calver L, Page BC, Downes M, Chan B, Isbister GK, 'Droperidol for sedation of acute behavioural disturbance', Academic Emergency Medicine (2012) [E3]
Co-authors Geoffrey Isbister
2011 Calver L, Downes MA, Isbister GK, 'Assessment of QT prolongation in high-dose droperidol administration using continuous 12-lead holter recording', Clinical Toxicology (2011) [E3]
Co-authors Geoffrey Isbister
2011 Downes MA, Calver L, Isbister GK, 'Intralipid treatment of sedative hypnotic drug overdose: A case series', Clinical Toxicology (2011) [E3]
Citations Web of Science - 1
Co-authors Geoffrey Isbister
2010 Isbister GK, Calver LA, Page CB, Stoke B, Bryant JL, Downes MA, 'Randomised Comparison Study of Intramuscular Droperidol Versus Midazolam for Violence and Acute Behavioural Disturbance in the Emergency Department - the DORM Study', CLINICAL TOXICOLOGY (2010) [E3]
Co-authors Geoffrey Isbister
2010 Isbister GK, Calver L, Page CB, Stokes BJ, Bryant J, Downes MA, 'Randomised comparison study of intramuscular droperidol versus midazolam for violence and acute behavioural disturbance in the emergency department - the DORM Study', Clinical Toxicology (2010) [E3]
Co-authors Barrie Stokes, Geoffrey Isbister
2010 Calver L, Downes MA, Page CB, Bryant J, Isbister GK, 'Randomised controlled trial of intramuscular droperidol versus midazolam for acute behavioural disturbance - The DORM study', International Journal of Mental Health Nursing (2010) [E3]
DOI 10.1016/j.annemergmed.2010.05.037
Citations Scopus - 44
Co-authors Geoffrey Isbister, Barrie Stokes
2009 Page CB, Calver LA, Isbister GK, 'Risperidone overdose: Much to do about nothing', Clinical Toxicology (2009) [E3]
Co-authors Geoffrey Isbister
Show 7 more conferences
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Dr Leonie Calver

Position

Lecturer
School of Nursing and Midwifery
Faculty of Health and Medicine

Contact Details

Email leonie.calver@newcastle.edu.au
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