2016 Research Report

Our Vision Our Values

Together, caring for the West, Compassion our patients, staff, community Consistently acting with empathy and integrity and environment Accountability Taking responsibility for our decisions and actions Respect Respect for the rights, beliefs and choice of every individual Excellence Inspiring and motivating innovation and achievement Safety Prioritising safety as an essential part of everyday practice

Our Purpose Our Strategic Aims

Leading the delivery of a Growing and improving the delivery of safe, high quality care connected and consistent patient Connecting the care provided to our community experience and providing the best care to save and improve Communicating with our patients, our partners and each the lives of those in our other with transparency and purpose community most in need Being socially responsible and using resources sustainably Valuing and empowering our people

Acknowledgement of Traditional Owners

Western Health respectfully acknowledges the traditional owners of the land on which its sites stand as the Boon Wurrung and the Wurundjeri people of the greater Kulin Nation. Contents

Foreword 2 Melbourne Neuropsychiatry Centre 58

Research 2016 3 Nephrology 62

Research Directorate 4 Neurology 66

Office for Research 8 Nursing and Midwifery 68

Western Health Research Grants 9 Oncology and Haematology 74

Research Week: Awards and Prizes 10 Paediatric Emergency Medicine 80

Allied Health and Community Services 12 Pharmacy 82

Nutrition 14 Respiratory and Sleep Disorders 84

Occupational Therapy 16 Rheumatology 86

Physiotherapy 18 Subacute and Aged Care 88

Psychology 20 Surgery 90

Social Work 22 General and Endocrine Surgery 92

Speech Pathology and Audiology 24 Orthopaedics 93

Australian Institute For Musculoskeletal Urology 94 Science (AIMSS) 26 Women’s and Children’s 98 Anaesthesia and Pain Management 28 Obstetrics and Gynaecology 100 Cancer in Primary Care 31 Maternal Fetal Medicine 102 Cardiology 34 Paediatrics 106 Drug Health Services 38 University of Melbourne 107 Endocrinology and Diabetes 40 Department of Medicine 108 Gastroenterology and Endoscopy 42 Western Clinical School 110 General Internal Medicine 45 Victoria University 112 Infectious Diseases 50 Our Partners 116 Intensive Care 52 Our Victorian Partners 118 Joseph Epstein Centre for Emergency Medicine Research 56 Western Health | Research Report 2016 Report | Research Health Western 1 Foreword

Western Health expanded its Western Health continued to research efforts in 2016 in line with build research capacities through the Research Roadmap 2015–2020 productive collaborations with and the overall strategic direction of our university partners, including our health service. participation in research projects at the MD, Masters and PhD levels. The Achievements were highlighted Clinical Research Investigators Group throughout the year to underscore holds regular events to connect the role of research in delivering younger researchers with each other best care to our patients, and more experienced professionals. culminating in Research Week in October. This featured the launch Through the Western Health Chronic of the 2015 Research Report, oral Disease Alliance we have extended A/Prof Alex Cockram presentation of the best 10 posters our engagement with general Chief Executive produced throughout the year, practices and the community. The competitive interviews for the short- Alliance focuses on better detection listed grant applicants, and the of early chronic kidney disease and introduction of three new sessions diabetes, and the shared risk factors – Women’s and Children’s, Subacute leading to these conditions, as well as and Aged Care and the Robert to cardiovascular disease and stroke. Helme Neuroscience Session. The seed grant winners – who were Our research partnerships engage awarded a total of $70,000 – and multiple other organisations, the session prize winners were including the newly opened announced at an exciting and well- Victorian Comprehensive Cancer attended closing ceremony. Centre and the Murdoch Childrens Research Institute, with whom we Recruitment of our large and will study the health of Victorian diverse patient population into newborns into their future. clinical trials, including investigator- initiated trials, has been enhanced Construction of the new Joan Kirner Prof Edward Janus to provide greater access to new Women’s and Children’s Hospital is Director of Research treatments. For example, in 2016 the underway and on track for completion IMPROVE-GAP trial commenced, in late 2018. Once complete, the aiming to recruit 800 inpatients with facility will enable more women and community-acquired pneumonia families in Melbourne’s west to give into a study of a new optimised birth and access children’s services model of care. The study is on track closer to home. to achieve this ambitious target. This report indicates the This reflects Western Health’s publications, presentations and emphasis on clinical research and its projects we are undertaking and translation into every day practice. features profiles of a number of our researchers. We trust you will enjoy reading about them. Western Health | Research Report 2016 2 Research 2016

11 Book chapters 2 Books

292 Seminars and presentations

41 Proceedings 340 Journal articles 201 New projects approved

42.7m 2016 Report | Research Health Western dollars in research grants awarded or held 510 Total projects approved and ongoing in 2016 Prof Tissa Wijeratne 3 Research Directorate

Dr Koen Simons Dr Cristian Udovicich MBBS Western Health Research Clinical Biostatistician BMedSci DipSurgAnat General Surgical Registrar, Western Health Advisory Committee Nathan Yee from March 2016 Membership Office for Research Intern (RMIT) Davina Taylor MPET GDipCritCare/ Linda Diep Dr John Gallichio InstCare B.AppSc Clinical Nurse Office for Research Volunteer Executive Director for Medical Consultant – Pain Management Services Judy Meyers Dr Forbes McGain MBBS Office for Research Volunteer Prof Edward Janus PGDipEcho FANZCA FJFICM Director of Research RANZCOG Intensive Care Physician and Anaesthetist Bill Karanatsios Kathryn Cranwell DipProjMgmt Manager, Office for Research Western Health Low (Secretary) MHSc (OT) BOT Grade 4 Risk Ethics Panel Occupational Therapist from Prof Bodil Rasmussen Membership September 2015 Chair of Nursing, Deakin University A/Prof Lata Jayaram MBChB PhD Prof Gustavo Duque Chairperson FRACP Respiratory Physician Chair of Medicine and Director of Prof Edward Janus FRACP MD PhD AIMSS Dr Martin Nguyen MBBS BMedSci FRCPA FCCP FCSANZ Head of Unit – (Hons) FANZCA Anaesthetic Dr Elizabeth Hessian General Internal Medicine Consultant Deputy Director Anaesthesia Community Member Prof Maximillian De Courten Dr Keri Chater PhD M.Nurs BSocSc Victoria University RN Quality Assurance Deborah Clark Review Members Reviewers Director of Quality Dr Anita Morris PhD MSW BSW Dr Michael Bullen Anita Panayiotou BBNSci, PGrad Manager of Social Work Registrar Dip Psych, DPsych (Clin Neuro) Clinical Neuropsychologist until Dr Anna Steer MBBS BMedSc November 2016 Critical Care Resident Prof Anne-Maree Kelly MBBS MD A/Prof Anne Marie Southcott MClinEd FACEM FCCP Professor of Office for Research Staff MBBS FRACP Director, Respiratory Emergency Medicine and Volunteers & Sleep Disorders Medicine Bill Karanatsios BSc (Hon), GradDip Prof Bodil Rasmussen RN, DipNEd, Prof Edward Janus ProjMgmt Manager, Office for MEdSt, PhD, FCNA Chair in Nursing Director of Research Research A/Prof Cate Nagle PhD MPH Bill Karanatsios A/Prof Christopher Yates B.AppSc Associate Professor, School Manager, Office for Research PhD FRACP MBBS Director of of Nursing & Midwifery, Deakin Endocrinology and Diabetes University Kerrie Russell Research Ethics Administration Assistant Dr Cuong Duong MBBS PhD FRACS Virginia Ma Upper GI Surgeon

Western Health | Research Report 2016 Research Governance Officer 4 Dr Elizabeth Hessian MBBS Noelle Gubatanga FANZCA Consultant Anaesthetist Western Health Research Intensive Care, Anaesthesia and Pain Management A/Prof Jenny Schwarz MBBS Coordinators Group FRACP GDip Ed, GDip Pall Med Samantha Bates Director, Geriatric Medicine Bill Karanatsios Intensive Care, Anaesthesia and Pain Clinical A/Prof of Geriatric Manager, Office for Research (Chair) Management

Dr Keri Chater PhD M.Nurs BSocSc Kerrie Russell Lee-Anne Lynch RN Ethics Administrator, Office for Maternal and Fetal Medicine Research (Secretary) Lei Ching Yeoh B.Pharm Heike Raunow Clinical Trials Manager Virginia Ma Medical Oncology and Haematology Research Governance Officer, Office Dr Lucinda Gabriel MBBS BA BSc for Research (Secretary) Kleopatra Hondros DipCrimL Anaesthetist Registrar Medicine and Endocrinology Nathan Yee Dr Rosalynn Pszczola MBChB, Office for Research Intern Jason Bennier BMedSci(Hons), FRACP, MBioeth Nephrology Consultant Neonatologist Coordinators Natalie Lumsden Dr Sathyajith Velandy Koottayi Elizabeth Skinner Nephrology MBBS MD FJFICM Intensivist Allied Health Essie Low Sharon Klim BN, PDACN Research Emily England Neurology Nurse JEC Emergency Medicine Cancer Trials Australia Sherisse Celestino Prof Steven Chan MBBS PhD Kelly Ann Gray Neurology FRACS FRCS Professor of Surgery, Cancer Trials Australia NorthWest Academic Centre, Sue Casanelia University of Melbourne Marsha Francke Respiratory and Sleep Disorders Cardiology Medicine Dr Tam Nguyen PhD MBA GDipSono BSc BE (Biomed) FRSPH Kerrie Russell Valarie Yee FAIM MAICD Manager, Office for Emergency Medicine/Office for Respiratory and Sleep Disorders Research, Honorary Senior Fellow, Research Medicine University of Melbourne Sharon Klim Phuong Tran Prof Tissa Wijeratne MBBS (Hons) Emergency Medicine Rheumatology FRACP FAHA FAAN Consultant Marian Croft Amanda Hickling Neurologist, Clinical Associate Gastroenterology Urology Professor, University of Melbourne

Anne Tippett 2016 Report | Research Health Western Clinical Biostatistician Intensive Care, Anaesthesia and Pain Dr Koen Simons PhD Management

Bill Karanatsios BSc (Hon), GradDip Fiona Marshall ProjMgmt Manager, Office for Intensive Care, Anaesthesia and Pain Research Management

Secretary Miriam Towns Intensive Care, Anaesthesia and Pain Virginia Ma BBiomedSc (PharmSc) Management DipMgt CertIVHlthAdmin Research Governance Officer 5 An enterprising team from Western Health has successfully bid for a highly competitive $632,000 grant from Cancer Council Victoria and the Victorian Cancer Agency.

Western Health | Research Report 2016 Dr Sumitra Ananda, Prof Michael Green and Heike Raunow. 6 Cancer Council Grant

Prof Michael Green, Heike Raunow and Dr Sumitra Ananda

The number and type of clinical “It’s important to appreciate that Cancer Council Victoria Chief trials available to Western Health’s clinical trials drive quality in patient Executive Todd Harper said it oncology patients will increase care because they set the standards was important for as many cancer thanks to a prestigious Cancer for future treatments,” he said. patients as possible to have access to Council Victoria grant. a clinical trial. Ms Raunow, Western Health’s Currently only 3.8% of Western Manager of Cancer Research, said “Trials are a valid treatment option Health’s cancer patients are admitted more than 200 Western Health and are a component of a gold into a clinical trial – well below the oncology patients currently standard health care system,” he universal benchmark of 10%. A lack participate in a clinical trial every year. said. “In fact, standard treatments of health funding generally across that extend and improve the lives Melbourne’s western suburbs, as well She said the research team would be of countless patients today are the as the language barriers inherent in taking a multi-pronged approach to result of clinical trials of the past.” a very multicultural community, are increasing these rates. Strategies will among the many reasons why the include identifying potential research Western Health is one of the biggest admission rates to clinical cancer collaborators from other institutes, providers of cancer services in trials are low. as well assessing how IT systems Victoria. The western suburbs have could be better used to identify trial the highest rate of cancer incidence of However, an enterprising team from candidates from patient records. any area in metropolitan Melbourne. Western Health is working hard to change that, having successfully bid for a highly competitive $632,000 grant from Cancer Council Victoria and the Victorian Cancer Agency.

The team – comprising Prof Michael Green, Prof Jon Emery, A/Prof Peter Gibbs, Dr Sumitra Ananda, Dr Dishan Herath, Heike Raunow, Dr William Renwick, Dr Duncan Carradice, Miss Meron Pitcher, Dr Phillip Tran and A/Prof Lara Lipton – is now working on maximising the number and types of trials available to Western Health patients. The three-year project will have a particular focus on patients from culturally and linguistically Western Health | Research Report 2016 Report | Research Health Western diverse backgrounds.

Prof Green, Western Health’s Director of Cancer Services, said the funding would provide more equitable access to clinical trials for Western Health patients with cancer, Director of Cancer Services Michael Green, breast cancer patient Kim Nguyen, as well as increasing the overall Cancer Council Victoria Chief Executive Todd Harper and Western Health’s Chief numbers of patients on clinical trials. Executive A/Prof Alex Cockram at the launch of the funding announcement. 7 Office for Research

In 2016 the Office for Research Board will motivate staff to get The establishment of the Western further embedded the Research involved in research projects, with Health Chronic Disease Alliance Roadmap 2015–2020 by ensuring that the aspiration of seeing their name (WHCDA) has been an area of priority the organisation’s research efforts included in the future. In a first for for the Office of Research. Under the were aligned with Western Health’s Research Week, session prize winners leadership of A/Prof Craig Nelson, operational strategy and broader were also given engraved glass the WHCDA aims to act as a vehicle community expectations. mementos as part of their awards. for research collaboration on behalf of Western Health and identified With each year that passes, we see As the breadth and depth of research external partners who will be critical greater research outputs in terms undertaken by our staff increases, so in initiating and conducting research of quality and impact. 2016 was an do their expectations of the Office addressing the ever-increasing exceptional year for our researchers for Research. We are determined burden of chronic disease that in this regard. The targeted research to ensure that our research and afflicts the patients we serve and the education workshops and the various education program is comprehensive broader community. It is envisaged research templates developed and equips our researchers with the that the WHCDA will be formally and implemented by the Office for requisite capabilities to undertake launched in 2017 with a website of Research ensure our researchers are their research with confidence. 2016 its own and a number of research adequately equipped to efficiently saw an additional 35 staff across initiatives under its umbrella. meet ever-increasing regulatory the organisation undertake Good demands. Clinical Practice (GCP) training for We look forward to building on the the first time. Staff receive GCP foundations and successes of the The efforts of the Office in increasing training as part of their involvement in past, increasing Western Health’s research capacity and capability are commercially sponsored clinical trials. participation in and initiation of reflected in the improved quality research to impact the health of the research submissions, the This year we expanded our outcomes of the community we serve. high calibre of the Western Health education and training program to Research Grant proposals and the respond to, and meet the needs In 2017, we will keep engaging richness of the Research Week of our researchers. A number with our internal and external program. Research Week was very of well-attended workshops on stakeholders, continue to provide well attended and presentations systematic reviews, qualitative tailored education and training, from across all sessions were of research, Stata and meta-analysis facilitate networking opportunities a very high standard, reflecting using Stata were conducted. for our researchers, and have a seat the high calibre of research being Where requested, the Office for at the table at committee meetings undertaken by our staff, in their own Research conducted bespoke of the MACH, BioMed Vic, the VCCC right or through collaborations. This training sessions across a range and our academic partners. This will year, an additional three sessions – of research methodologies for a allow us to remain active in shaping Subacute and Aged Care, Robert number of departments. In October our research environment and ensure Helme Neuroscience and Women’s we appointed Dr Koen Simons as our sphere of influence continues to and Children’s – were added onto our in-house biostatistician, filling be far reaching. Our priorities in 2017 the Research Week program, in the vacancy left by the departure will be the recruitment of an Ethics adding further breadth to an already of Dr Emily Karahalios earlier in the and Governance Submission Officer comprehensive line-up. year. The absence of an in-house to work with our clinical trials teams, biostatistician for a period of time provide support to the new A/Prof In order to commemorate our clearly demonstrated how valuable of Surgery, and to work more closely research achievements, we installed this capability is in serving the needs with the Western Health Foundation an Honours Board in the atrium of of our research endeavours. in establishing Clinical Research the WCHRE building naming all Fellowships. recipients of Research Week awards across all categories since their Bill Karanatsios inception. It is hoped the Honours Research Program Director Western Health | Research Report 2016 8 Western Health Research Grants

Western Health acknowledges the need to appropriately support early Project 1 Project 4 career researchers who are not always able to successfully compete Michael Seman: Outcomes in Briony Cutts: Maternal Thrombin for the highly competitive NHMRC Culturally and Linguistically Diverse Generation in Obesity and and ARC grants. In order to make Patients Hospitalised with Heart Pregnancy ($10,000) such researchers more competitive Failure ($20,000) in the future, the Office for Research, through the Western Health Grants initiative, funds a number of projects Project 5 during Research Week. The aim Project 2 is to provide researchers with financial support to conduct pilot Alesha Sayner: Does a or feasibility studies that are now a Lucy Troup and Kelly Fleury Pre-Operative Functional Floor prerequisite for consideration for Investigating the Effect of Electrical Exercise Program Provide Improved NHMRC and other external grants. Muscle Simulation, High and Low Post-Surgical Urinary Incontinence Dose Exercise on Strength and Outcomes When Compared with a The Office for Research again Function in an Elderly, Non-Weight Strength Training Program in Men committed $70,000 worth of Bearing Patient Population – A Pilot Undergoing Radical Prostatectomy? grant funding, awarded through a RCT ($20,000) A Pilot Study ($8000) competitive peer-reviewed process, to help early career researchers bring to life their innovative research ideas. As has been the case for every year, the calibre of research Project 3 submissions this year has been very high. The following five projects Kimberley Haines: Co-designing were awarded funding: the Future of Critical Care Recovery: Peer Support Model to Improve Patient and Family Outcomes ($12,000)

The Office for Research again committed $70,000 worth of grant funding, awarded through a competitive 2016 Report | Research Health Western peer-reviewed process, to help early career researchers bring to life their innovative research ideas. 9 Research Week: Awards and Prizes

Research Week at Western Health has become a highly anticipated Subacute and Aged Care Inaugural Robert and well attended annual event, showcasing research undertaken Research Presentation Helme Prize for Best by staff across a broad range of Neuroscience Research specialties. Each year’s Research Jennifer Zerafa Presentation Week progressively builds on Preliminary Data on the Evaluation the one before, giving everyone of a Massage Therapy Service for Essie Low the opportunity to witness the Palliative Care Patients at Western Inspection Time as a Valuable evolutionary progression of research Health Screening Tool to Measure the at Western Health. Recovery of Temporal Attention This year’s opening keynote address Post-Stroke was given by Prof Margaret Sheil AO, Provost at the University of Best Nursing and Melbourne. Prof Sheil spoke on the Midwifery Research importance of organisations fostering Presentation Inaugural Women’s and research excellence by creating supportive environments and helping Children’s Prize for Best staff advance their careers. Risk Screening Tool Team Research Presentation An Integrated Approach to The 2016 Research Week program Assessment and Care Planning Dr Sofia Walker exhibited a great breadth and depth Understanding the Failure to of research topics, with each session Identify Severe Growth Restriction featuring a high calibre of keynote speakers. Best Allied Health Research Week culminated with the Research Presentation awards for best research undertaken Best Cardiology Research and presented by Western Health Dr Kimberley Haines Presentation Prize staff. What About the Caregivers? Psychosocial Outcomes in Informal This years’ awards and prize winners Caregivers of the Critically Ill – Dr Michael Seman are listed below: Preliminary Results The Impact of limited English Proficiency on Hospital Readmission Rate in Patients Hospitalised with Acute Heart Failure Neville Yeomans Prize for Best Internal Medicine Research Best Oncology/ Presentation Haematology Research Abstract Prize Adam Steward Teaching an Old Dog New Tricks: Cindy Olguszko Conventional Film/Screen Benefits of a Specialist Prostate Principles of Exposure Selection Cancer Nurse at Western Health in the Digital Age Western Health | Research Report 2016 10 Research Week prizes Best Research Poster Best Research Poster are supported by Prize Prize oo Covidien – Major Sponsor Alan Moss Candice Poupard oo First State Super Results and Risk Factors in 1000 A Co-Located Subacute Amputee Cases from the Australian Colonic Service Reduces Length of Stay at oo TLC Aged Care EMR (ACE) study Footscray Hospital oo BioMedical Research Victoria

oo Strada

Kendall Francis Prize for 2016 Mavis Mitchell oo Sanofi

Best Surgical Research Award Winner – Best oo Theva Presentation Prize Nursing and Midwifery Research and Service oo Dorevitch Pathology Michael Bullen Improvement Prize oo Rotary Club of Footscray Use of Intra-Operative Fluoroscopy While Seated Increases Radiation oo Western Health Foundation Exposure to Radiosensitive Organs Lana Van Raay Minimising the Need for Patients oo BankVic Overnight Admission for Pre- Hydration Prior to Angiography Robert Smith Prize for Best Critical Care Research Presentation Prize

Jana Lau and Elizabeth Wyatt Surveying Junior Medical Staff in a Metropolitan Hospital: Engagement, Wellbeing and Support Western Health | Research Report 2016 Report | Research Health Western

The 2016 Research Week program exhibited a great breadth and depth of research topics, with each session featuring high calibre keynote speakers. 11 Allied Health and Community Services

Our Research Output 75 25 41 Projects Publications Presentations

Allied Health Assistant (Physiotherapy)

Western Health | Research Report 2016 Avetta Malcolm with patient Stephen. 12 Head of Department, Head of Department, Research Staff Allied Health Community Services 89 researchers and 8 students Julia Blackshaw Lebe Malkoun

Western Health Research Grant Best Allied Health Presentation, Our Grants and Awards K Haines, B MacLeod-Smith, C Western Health Research Week Holdsworth, E Skinner, S Bates, C K Haines. What About the French and L Maher. icuRESOLVE Caregivers? Psychosocial Society of Critical Care Medicine – Intensive Care Unit Recovery Outcomes of Informal Caregivers (USA) THRIVE Grants Solutions Co-Led through Survivor of the Critically Ill. Western Health K Haines, B MacLeod-Smith, C Engagement. Western Health Research Grant, $1500 (2016). Holdsworth, E Skinner, S Bates, C Research Grant, $12,000 (2016). French and L Maher. icuRESOLVE Best Poster Western Health – Intensive Care Unit Recovery Western Health Research Grant Research Week Solutions Co-Led through Survivor A Sayner, S Davies, K Haines, C Poupard. A Review of an Amputee Engagement. Society of Critical E Karahalios, I Nahon and C Rehabiliation Service to Describe Care Medicine, $71,500 (2016–2019). Ogluszko. Does a Pre-Operative Patient Outcomes and Evaluate its Functional Pelvic Floor Exercise Effectiveness in Reducing Acute Canadian Institutes of Health Program Provide Improved Post- Length of Stay at Western Hospital, Research: Project Scheme Surgical Urinary Incontinence Footscray. Western Health Research D Brooks, M Beauchamp, R Outcomes When Compared with a Grant, $1500 (2016). Goldstein, A Marques, G Dechman, Strength Training Program in Men R Moineddin, P Camp, A Lee, Undergoing Radical Prostatectomy? ANZCA Open e-Poster Prize A Holland, J Alison, E Skinner, A Pilot Study. Western Health I Boden, L Browning, E Skinner, J D Spencer et al. Randomized Research Grant, $8000 (2016). Reeve, D El-Ansary, I Robertson Controlled Trial of Balance Training and L Denehy. Lung Infection for Falls Reduction in Individuals with Austin Medical Research Post Surgery (Major Abdominal) COPD. Canadian Institutes of Health Foundation with Preoperative Physiotherapy Research, $902,111 (2016–2019). K Haines, J Moran, D Jones and (LIPSMACK:POP). ANZCA (2016). R LoPresti. End of Life Care and NHMRC Project Grant Perceptions of the Interprofessional C Hodgson, B Gabbe, S Webb, Team. Austin Medical Research J Presneill, P Young, T Iwashyna, Foundation, $10,000 (2016). M Bailey, A Higgins, C Tipping, E Skinner, H Buhr, M Saxena, M Western Health Foundation Allied Harrold and R Bellomo. Treatment Health Grant of invasively ventilated adults with E Witherow and N Byrne. Hand Early Activity and Mobilisation Therapy – Therapist Led Clinic (TEAM). National Health and Expansion. Western Health Research Medical Research Council, $1,467,137 Grant, $5000 (2016). (2016–2021). Western Health Foundation Allied HCF Research Grant Health Grant E Janus, H Karunajeewa, E J Shekleton and C Nadebaum. CAHS Skinner, M Lloyd, IMPROVE-GAP to Implement Use of the Bayley Scales

Investigators. The IMPROVE-GAP of Infant and Toddler Development to 2016 Report | Research Health Western Project HCF, $300,000 (2016). Assist with Assessment and Reduce Waitlist. Western Health Foundation, Western Health Research Grant $5000 (2016). L Troup, K Fleury, K Haines, R Kinsella and G Duque. PAIVE – Preventing Atrophy in Immobile Vulnerable Elderly. Western Health Research Grant, $20,000 (2016). 13 Allied Health and Community Services Nutrition

Malnutrition is the most clinically significant issue in hospitalised patients today and is the focus of the Nutrition Department’s research activity. The aim is to ensure best care, right care and safe care remain at the forefront of the service provided to Western Health patients. Projects include evaluation of both implementation and compliance with the Western Health fasting procedure, participation in the Victorian Cancer Services malnutrition prevalence study, and evaluation of the Volunteer Meal Assistance program as a strategy to improve access to meals and meal satisfaction.

In 2016, the dietitian to the Upper Gastrointestinal Surgery Unit commenced working in the weekly outpatient UGIG Clinic. This was in response to the development of a nutrition care pathway developed to manage the high prevalence of malnutrition detected by a previous Victorian Cancer Services study in patients with an upper gastrointestinal Patient Lukas Rosenbaum. malignancy at Western Health. The implementation of the Western Health fasting procedure in the There were two publications Future plans include collaborative high-risk units of Orthopaedics, throughout the year in peer-reviewed work with other health services Orthogeriatrics and Plastics has journals, as well as presentations looking at evaluation and reduced preoperative fasting times at national conferences, including: management of malnutrition in in these units. This work was based ‘Multimodal Support Across the hospitalised patients, together with on an initial audit of patient fasting Continuum of Care; Case Review ongoing collaboration on projects times in the Orthopaedic and on Nutritional Management of with Deakin University and the Orthogeriatric units at Footscray Intestinal Failure and Gastroparesis’ Department of Health. Hospital. (Poster), presented by Aurora Ottaway at the Australasian Society of Parenteral and Enteral Nutrition National Conference, and ‘Reducing Preoperative Fasting in Orthopaedics and Orthogeriatric Unit Patients’ (Oral) by Caroline Calkin at the Dietitian Association of Australia. Western Health | Research Report 2016 14 The implementation of the Western Health fasting procedure in the high-risk units of Orthopaedics, Orthogeriatrics and Plastics has reduced preoperative fasting times in these units.

conducted post-implementation to Evaluating Volunteer Meal Our Research determine if the average duration Assistance Program of preoperative fasting had reduced in the plastic unit. The study found Researcher: Aranka Nenov Reducing Preoperative Fasting on a median reduction in preoperative Orthopaedics and Orthogeriatric Collaborators: Kathryn Pierce, fasting from 9 to 6 hours post- Unit Patients Allison Lauder, Vanessa Carter and implementation of the Western Hollie Bevans Researcher: Caroline Calkin Health fasting procedure. The goal of this study was to Malnutrition in Victorian Cancer Collaborators: Dr Claire McKie, Dr determine whether the Volunteer Services Forbes McGain and Vanessa Carter Meal Assistance Program (VMAP) has improved the level of assistance The aim of this project was to Researchers: Kathryn Pierce and provided and energy and protein determine if there had been a Hollie Bevans intake of the midday meal. It was statistically significant reduction Collaborators: Belinda Steer found that this program, together in the median duration of fasting (Project Lead, PMCC on Project 1) with others such as the Red prior to theatre in orthopaedic and Jane Stewart (Project Lead, Dome and Lunch in the Dining and orthogeriatric unit patients, Alfred Health on Project 2) Room initiative, can help manage following the implementation malnutrition at Western Health. of the Western Health fasting This initiative comprised of two procedure. This project will also distinct projects: Nursing Care of Jejunostomy assist in determining if there has Feeding Tubes been an improvement in fasting 1. Establish Sustainable practices in high risk units, where Methodology for Repeat Cancer Researcher: Irene Defteros patients can be fasted multiple Malnutrition Point Prevalence times, since the initiation of the Survey (PPS). Collaborators: Linda Pocock, Western Health fasting procedure Regina Munieri, Rhiannon Whaites in 2014. We observed a median Over 1500 patients receiving and Vanessa Carter reduction in preoperative fasting cancer treatments at 12 Victorian This study will review current from 10 to 7 hours (p<0.001) post- hospitals, with 135 attending from nursing knowledge, attitudes and implementation of the Western Western Health, were screened for confidence relating to jejunostomy Health fasting procedure. malnutrition. feeding tube management on the Implementation of the Western 2. Improve Methods for Malnutrition surgical ward. Jejunostomy feeding Health Fasting Procedure in the Identification in Culturally and tubes are complex to manage, and Plastics Unit Linguistically Diverse (CALD) increasing numbers are being seen Patients on the ward. Issues have been raised Researcher: Sharon Er regarding the care of these tubes as This project identified that practices no training has been undertaken by Collaborators: Wai-Ting Choi, Dr relating to malnutrition screening nursing staff. The results will be used Forbes McGain and Caroline Calkin are suboptimal in CALD patients. to guide future education strategies. Dietitian respondents perceived that 2016 Report | Research Health Western This project monitored the malnutrition screening is completed implementation of the Western routinely in only one third (31%) of Health fasting procedure in the CALD patients. For those patients plastics unit, with the aim of who are screened, all respondents increasing compliance for all report using an interpreter for less patients requiring anaesthesia. A than 25% of the time. Meanwhile, baseline audit was completed prior the majority (85%) of respondents to implementation of the fasting reported using a family member procedure. A repeat audit was most (>75%) of the time. 15 Allied Health and Community Services Occupational Therapy

The Occupational Therapy Department is committed to providing an excellent occupation- focused, evidence-based service to Western Health clients. In 2016 a total of 21 research projects were commenced or completed, overseen and supported by an active leadership committee.

Projects have aimed to promote improved care for patients by evaluating service delivery models and ensuring implementation of evidence-informed practice. An increased focus on consumer engagement has seen the implementation of a strategy to ensure quality and research activities are informed by consumer feedback.

The Occupational Therapy department values the opportunity to participate in knowledge exchange with the wider profession, as demonstrated by delivery Nurse Carol Perich in a dance activity with patients. of 12 verbal and three poster presentations at professional conferences. Three articles were also accepted for publication.

In 2016 a total of 21 research projects were commenced or completed, overseen and supported by an active leadership committee. Western Health | Research Report 2016 16 Evaluating the Effectiveness An Exploratory Study into Models Our Research of a Strategy to Support of Occupational Therapy in Meaningful Participation of Orthopaedic Pre-Admission Clinic Occupational Therapy Consumers Service Delivery Use of Smart Technology Apps in Service Provision and Quality for Stroke Clients with Memory Improvement Researchers: Kate Cranwell, Belinda Impairment – A Pilot Study Woods and Bradley Wilson Researchers: Kate Cranwell, Jessica Researchers: Marlies Wanasili, Anne Toohey and Tory Head This research aims to determine Vu and Kate Cranwell the most effective model for This study aims to evaluate the occupational therapy service Collaborator: Dr Chris Barr (Flinders effectiveness of a strategy to delivery within the pre-admission University) support sustainable and meaningful clinic setting at Western Health. This study aims to determine the participation of occupational Secondary aims include the feasibility of using smart apps as therapy consumers in service comparison of phone versus face- a rehabilitation tool for memory provision and quality improvement. to-face service delivery, and the impairment post stroke. More The increased participation of exploration of occupational therapy specifically, it will determine whether consumers will contribute to clinicians’ perceptions of the barriers remediation of memory impairment delivering an improved patient and enablers to service delivery. is possible utilising these apps. experience of the occupational This research will contribute to the Additionally, it will explore whether therapy service, increased delivery of best care to patients by improvements in memory function awareness and understanding ensuring the most effective and can transfer into daily occupations. of the importance of consumer efficient model of occupational engagement among clinicians, therapy service delivery in pre- The Experiences of an and provide evidence of Western admission clinic. Occupational Therapy Leadership Health’s commitment to the Group in Public Health Practice: A Australian Commission on Safety Preliminary Study and Quality in Health Care standard on partnering with consumers. Researchers: Susan Giles and Kate Cranwell Orthogeriatric/Subacute (OGS) Occupational Therapy Service Collaborators: Danielle Hitch Review (Deakin University, Melbourne Health), Kate Bolton, Kate Lhuede Researchers: Matthew Thorpe and and Robyn Low (Melbourne Health) Renee Gill

The objective of this pilot project The aim of this project is to review is to collect the perspectives of the occupational therapy service occupational therapists in Western provision to the OGS patient Health regarding occupational population who present to ward therapy leadership. The benefit of 3A/3B at Western Health’s Footscray 2016 Report | Research Health Western this project will be to expand on the site. Benefits of this project current evidence base regarding include improved efficiency and the importance of leadership effectiveness of occupational therapy considerations for occupational service delivery to orthogeriatric therapists in public health practice. patients at Footscray, supporting the This project will inform the Western provision of best care. Health occupational therapy workforce plan in 2016–2018. 17 Allied Health and Community Services Physiotherapy

Our research program is diverse, funding. We received a $300,000 occurring across the healthcare grant from Australia’s HCF Research Our Research spectrum, from acute to community Foundation to increase adherence care. The unifying focus of our to evidence-based practice for Optimal Timeframe to Implement research is to improve patient- patients admitted with community- Pulmonary Rehabilitation for centred outcomes and restore acquired pneumonia. We were also People with Chronic Obstructive health-related quality of life. successful in securing a $50,000 Pulmonary Disease (COPD) These projects include a focus on grant from the US-based Society people with community-acquired of Critical Care Medicine’s THRIVE Researcher: Dr Clarice Tang pneumonia, chronic respiratory initiative to develop a peer support disease, stroke survivors, abdominal program for survivors of critical care. Collaborators: A/Prof Anne Marie surgery patients, survivors of Western Health is the first Asia- Southcott, Dr Lizzie Skinner, Kathryn intensive care, elderly people Pacific site to join this international Barker (Latrobe University) and A/ with lower limb fracture, children collaboration. Prof Felicity Blackstock (University of with developmental hip dysplasia, Western Sydney) prenatal women, and men following Our research has been disseminated urological surgery. in high-impact journals, including This pilot study aims to investigate Critical Care Medicine, Annals of the optimal timeframe to implement Almost all of our research projects the American Thoracic Society, pulmonary rehabilitation for people adopt an inter-professional Trials, Physical Therapy and Journal with COPD so as to ensure increased approach. We have formed strong of Physiotherapy. A highlight of the participation and completion rates collaborative relationships with year was the number of grants and in pulmonary rehabilitation. This our Medical, Nursing and Allied awards our department received study was awarded a Western Health colleagues at Western at Western Health Research Health research grant ($20000) in Health and local academic partners Week, including Best Poster 2015 with work carried out in 2016. to support high-calibre research. Presentation and Best Allied Health Identifying the optimal timeframe We also invest in national and Podium Presentation. We had a of implementing pulmonary international collaborations. Our 100% success rate in our grant rehabilitation for people with COPD department is competitive in applications, with three grants enables clinicians to encourage attracting national and international awarded to our department. patients to participate and complete pulmonary rehabilitation at the right time. This will in turn optimise the benefits of this highly effective evidence-based intervention.

Physiotherapist Erin Bicknell

Western Health | Research Report 2016 with patient Oliver. 18 We had a 100% success rate in our grant applications, with three grants awarded to our department.

PAIVE – Preventing Atrophy in Collaborators: Terry Haines Does a Preoperative Functional Immobile Vulnerable Elderly (Monash University) and Amalia Pelvic Floor Exercise Program Karahalios (University of Melbourne) Provide Improved Post- Researchers: Lucy Troup and Kelly Operative Urinary Incontinence Fleury This study aims to improve Outcomes when Compared evidence-based clinical with Standard Strength Training Collaborators: Dr Kimberley management of community- in Men Undergoing Radical Haines, Prof Gustavo Duque and acquired pneumonia within the Prostatectomy? A Pilot Study Rita Kinsella General Medicine units, combining best-practice medical, nutrition and Researchers: Alesha Sayner, Sarah This project aims to establish physiotherapy interventions. Routine Davies, Dr Kimberley Haines, Dr whether a high-dose exercise implementation of evidence-based Emily Karahalios, Dr Irmina Nahon program or use of Neuro Muscular interventions has the potential to and Cindy Ogluszko Electrical Stimulation is more accelerate time to recovery, and effective in maintaining quadriceps reduce hospital length-of-stay This randomised controlled pilot strength and function, compared and readmissions. Recruitment of study aims to compare two modes to a low-dose exercise program a target 1000 patients is currently of preoperative pelvic floor muscle (control) during the No Weight underway. training (PFMT) in men undergoing Bearing (NWB) period in the radical prostatectomy (RP). It will elderly, cognitively intact, inpatient icuRESOLVE – icu Recovery investigate whether one group population. There is no current Solutions Co-Designed with demonstrates superior continence evidence to guide recommendations Survivors outcomes post-operatively. It is also of frequency and type of exercise a feasibility study assessing whether required to achieve optimal Researchers: Dr Kimberley Haines, a larger scale and multi-site study outcomes for these patients. Belinda MacLeod-Smith, Clare can be developed in the future. Holdsworth, Kate Cranwell, Grey Optimal care of this patient cohort Searle, Prof Bodil Rasmussen, Dr Low numbers of studies exist in is vital to minimise length of stay, Elizabeth Skinner, Samantha Bates, men’s health physiotherapy. This which aligns with organisational A/Prof Craig French and A/Prof study will contribute to ongoing priorities. The results of this study Lynne Maher investigation in this field and identify will ultimately inform and guide feasible elements for development our physiotherapy practice at Collaborators: The Society of of a larger study. Identifying Western Health and beyond. The Critical Care Medicine’s THRIVE management strategies that result in Physiotherapy Department is Peer Support Collaborative improved post-operative continence collaborating with the Australian outcomes will assist in improving The aim of this project is to co- Institute of Musculoskeletal Science patient quality of life and drive design a peer support model with (AIMSS) and a high-risk ethics appropriate management pathways survivors of critical care and staff, application is being prepared for for this population. submission in March. then test the efficacy of this model in reducing negative psychological IMPROVinG Outcomes in outcomes (anxiety, depression

Community-Acquired Pneumonia and PTSD) and improving positive 2016 Report | Research Health Western (IMPROVE-GAP) psychological outcomes (social support and resilience) in patients Researchers: Prof Edward Janus, and families. This world-first A/Prof Harin Karunajeewa, Melanie research will evaluate the use of co- Lloyd, Dr Elizabeth Skinner, Prof design methods in critical care and Anne-Maree Kelly, Melina Shackell, identify whether a novel approach Dr Clarice Tang, Stephanie Lowe, Dr to improving recovery, via enhanced Parul Bali and Dr Soe Ko Ko social support, reduces Post- Intensive Care Syndrome. 19 Allied Health and Community Services Psychology

The major focus of the Psychology Streamlining the processes for Department’s research and project patients referred to the Adult Our Research activity has been on improving Neuropsychology Service is another patient outcomes across a number area of focus that will improve Mood and Anxiety Rehabilitation of areas. efficiency and timeliness of patients Following Stroke being assessed. Frequently, there The stroke project and associated are multiple sources of referrals Researchers: Dr Diana Perre and research focusses on initiating for capacity assessments, with a Jacki Carmody best practice regarding the consequent unnecessary use of assessment of cognition and mood time responding to and triaging all Collaborator: Grey Searle for all patients admitted to the referral sources. A more efficient rehabilitation ward at Sunshine streamlined referral process will This project will introduce a Hospital. Previously this has not have positive flow-on effects for mood and cognition screen on been a standard procedure. patients requiring time-consuming admission to the rehabilitation neuropsychological assessments. ward and determine if mood and For patients referred to the Chronic anxiety improve with psychology pain service, attention is being The Psychology Department’s intervention during admission. given to the value and efficacy of future research will focus on the This will improve the accurate and the variety of measures used to longer-term outcomes for stroke efficient assessment of the mental assess the patients’ pain experience. patients once mood and cognitive health needs of stroke patients. This may lead to an increase in the assessments become routine. This effectiveness of pain treatment will attempt to evaluate the impact programs. on reducing length of stay and improving quality of life, mood and The assessments and day-to-day function. recommendations of paediatric patients referred to the The other future objective is Neuropsychology Service is developing a robust and meaningful another focus for the Psychology set of processes and measures Department. This project has the to evaluate the contribution of a potential to improve the quality psychological service to patient care and value of assessment reports and outcomes for both inpatients and recommendations, with a and outpatients. likely benefit to child patients and their parents. It promotes better understanding of the needs of the child, with a subsequent improvement in the developmental trajectory for the child.

The major focus of the Psychology Department’s research and project activity has been on improving patient outcomes. Western Health | Research Report 2016 20 Reviewing the Outcome Measures Evaluating Paediatric Review of the Adult Used in the Pain Management Neuropsychology Reports Neuropsychology and SNAP Program at Western Health at Western Health: Towards Service Realignment for the Sunshine CBR Best Practice in Written Management of Decision Making Communication of Findings to Capacity Referrals in the Acute Researcher: Dr Kathleen Leach Parents Setting

Collaborator: Jazmin Cruz Researchers: Dr Caroline Researcher: Dr Tracey Henderson Nadebaum and Dr Diana Perre This study will validate the 6MWT Collaborator: Dr Diana Perre against the previously validated Collaborator: Ellen Gentle outcome measure questionnaires This evaluation was completed that measure function as well as This initiative will evaluate the to gain an understanding of what beliefs and attitudes towards pain current format and content of impact the service realignment had (eg. Brief Pain Inventory, Pain Self- paediatric neuropsychological on the referral process for DMC Efficacy Questionnaire, SOPAR and reports sent to families and assessments in the acute setting. Tampa). It will measure the perceived professionals involved in the care It was found that the realignment success of participation in a pain of children seen by the CAHS improved efficiency in the use of management program from both the Paediatric Neuropsychology the neuropsychology service and participant’s and therapist’s point Team. The overall goal is to work avoided inappropriate referrals of view (eg. Using Global Rating of towards best practice in written from multiple sources for the same Change Scale). The responsiveness communication with families client. and sensitivity of the 6MWT in the attending this service and the chronic pain population will also be professionals who work with Referral to the Neuropsychology measured (eg. Compared with other them. This will assist in delivering Service in Care Coordination functional scales such as the Human an effective service for complex (ACAS, HARP and IRS) Activity Profile, Patient Specific children prior to referral, where usual Researcher: Kelly Sinclair Functional Scale and/or COPM). assessments have been ineffective. The change in the 6MWT will be Collaborator: Tracy Henderson compared with the other validated outcome measure questionnaires. This project will update all relevant Finally, the review will explore the documents used to assist the use of previously not translated assessment of decision-making versions of PSEQ and Tampa. capacity and provide education to ensure that all neuropsychology referrals are appropriate, timely and well informed. This will increase efficiency and appropriate utilisation of the neuropsychology service. Western Health | Research Report 2016 Report | Research Health Western 21 Allied Health and Community Services Social Work

The Social Work Department In 2016, we welcomed our first social Family Meetings: Experiences of focuses on the psychosocial needs work PhD student, Vera Steiner, Patients, Families and Staff in the of patients and their families. and her important research on Hospital Setting Our research agenda reflects the end-stage cancer patients and their need to better understand the role as parents of young children. Researchers: Dr Anita Morris and vulnerabilities patients experience Vera is enrolled at the University of Margaret Bugeja which contribute to, or occur as a Melbourne and has partnered with Collaborators: Antony Periera result of, poor health and wellbeing. Western Health to gain valuable (Honours Student, Victoria Our research has spanned several access to our patient cohort. University) and Prof Marty Grace clinical areas including Women’s and (Victoria University) Children’s, Oncology, Emergency Medicine, Rehabilitation, Aged This project sought to understand Care and General Medicine. As we Our Research how family meetings at Western have sought to better understand Health are understood by staff, our patients’ needs, we have also patients and families, and how they explored experiences of our junior Understanding the Experiences of might be improved. The project workforce. Providing exposure to Staff Involved in the Development has been written up as an Honours different clinical areas not only of the Grade 1 Social Work Thesis and was presented in early prepares them for their own careers Rotational Model 2017 to the Family Meeting Working in health social work, but also Group. It will advise on next steps Researchers: Sharon Pinheiro, creates a flexible workforce that regarding upskilling staff about Helen Do, Jacqui Brown and Dr can quickly adapt to different work family meetings and the new Anita Morris environments. Western Health Family Meeting Guidelines. Family meetings are In 2016, our department has This study followed the introduction a common part of patient care at benefited from increased research of a Grade 1 Rotation model of Western Health and improving these capacity, evidenced by the induction into the Social Work for patients and families is a priority high number of low and high- Department at Western Health and as patients and carers have reported risk research projects currently sought feedback from staff and key these meetings can sometimes feel underway – an increase on 2015 – stakeholders. This project brought overwhelming and disempowering. and the increased confidence with together a group of Social Work Western Health is committed to which social workers engage in staff who were “research naive” and understanding how we can improve research design and processes. enabled them to upskill in research design, methods and analysis, these meetings. The SWIFT project, funded by a as well as learn the processes Department of Health and Human for gaining ethics approval. This Services Workforce Grant has research helped improve staff enabled Social Work to continue induction through exposure to its research on trauma-informed broader parts of the health service. care in the Emergency Department. The research aimed to improve staff Western Health is leading this multi- understanding and skill in working site project with collaborators from with patients with a broad range of Austin Health and Barwon Health. health and psychosocial issues. It This large project has attracted created variety in the workplace and interest from other health services equipped clinicians to better deal and has resulted in an evolution in with change. the credentialing requirements of clinical staff in trauma-informed care. Western Health | Research Report 2016 22 Our research agenda reflects the need to better understand the vulnerabilities patients experience which contribute to, or occur as a result of, poor health and wellbeing.

The Psychosocial Wellbeing of The SWIFT Collaboration: Patient-Centred Psychosocial Parents with Infants in the Special Implementing a Social Work Care for Parents with Incurable Care Nursery Model of Trauma-Informed Care in End-Stage Cancer: An Exploratory a Paediatric Setting Mixed Methods Study – Phase 1 Researchers: Dr Anita Morris and Karina Rosa Researchers: Dr Anita Morris and Researchers: Dr Anita Morris and Dr Nicole Lind Adrian Dabscheck Collaborators: Kathryn Elliott (Honours Student, Victoria Collaborators: Debra Leahy Collaborators: Vera Steiner (PhD University), Prof Marty Grace (Austin Health), Nicole Tokatlian Student, University of Melbourne), (Victoria University) and Leila Rahimi (Austin Health), Karen Todd Prof Lynette Joubert (University of (Victoria University) (Barwon Health), Jacinta Bourke Melbourne) and Prof Aron Shlonsky (Barwon Health) and Kristin Diemer (University of Melbourne) This project aims to provide (University of Melbourne) insights into the experiences of The overall aim of the three-phased parents whose child is in the Special This pilot social work model of study is to explore and understand Care Nursery and will inform care is being trialled in paediatric in depth the experiences of adult the supportive care provided by settings at three Victorian health patients diagnosed with any type staff, particularly social workers. services: Western Health (lead site), of incurable end-stage cancer The ultimate aim is to provide Barwon Health and Austin Health. who are parenting one or more appropriate support to staff so they Adverse childhood experiences children aged 0–18 years and can facilitate improved infant/parent can negatively impact on health receiving hospital-based treatment. bonding and attachment in this and mental health. However, due Eighty patient files were audited in environment. to the hidden nature of trauma Phase 1 and an ethics submission symptoms, health professionals for Phase 2 of the study is about Infants can spend time in the may not recognise the trauma and to be completed. This stage will Special Care Nursery following their the difficulties patients face in include interviews with patients and birth and this is a stressful time maintaining health and wellbeing. their partners. The primary focus for parents as they cope with the Understanding the trauma context is to explore what psychosocial realities of a new baby who is unwell of our patients and families will supportive care services and/or has extra care needs. To help us intervene earlier to prevent patients require to manage their better support these families, the further trauma and tailor care that psychosocial stressors and enhance research will help us to understand is sensitive to their psychosocial their hospital-based psychosocial their experiences and determine needs. supportive care experience. This what supports we can put in place to information will contribute to improve the situation for them. the development of a targeted evidence-based approach to best The research was presented at the meet the psychosocial needs of this Health Social Work Directors Group vulnerable patient population and to Research Symposium in September improve their patient experience. 2016 as part of an Honours Thesis

and was awarded ‘Best Oral 2016 Report | Research Health Western Presentation’. 23 Allied Health and Community Services Speech Pathology and Audiology

In 2016, the Western Health Victoria to expand the CALD Assist Speech Pathology and Audiology Allied Health iPad application used Our Research Departments’ main research focus by nursing staff in the inpatient was in the area of communication setting. A commercial grade, Reducing the Impact of Aphasia support and access for patients. The sustainable iPad application will in Stroke Patients and their Speech Pathology and Audiology be developed and evaluated in Caregivers a Year Post-Onset via teams are experts in the field of partnership with the CSIRO to Brief Early Intervention: A Cluster communication and view this area facilitate timely and effective Randomised Control Trial of the of clinical skill as a priority for communication between patients Action Success Knowledge (ASK) ensuring our patients and their from Non-English Speaking Program families receive the best support Backgrounds (NESB) and nursing and intervention to maximise staff, when an interpreter is not Researchers: Sally Howard and communication during their journey available. Merridy Moore within Western Health and beyond. Alongside these achievements four Collaborators: Prof Linda Worrall papers were presented at national Speech Pathology (University of Queensland) and Prof conferences. Tissa Wijeratne

The Speech Pathology Department Audiology This study aims to decrease the commenced participation in a incidence of depressive symptoms national randomised controlled trial, for People With Aphasia (PWA) and The Audiology Department has a Action Success Knowledge (ASK), their caregivers. The study aims to focus on continual improvement which is led by the University of determine whether a tailored, early and participation in formal research Queensland. This trial is exploring intervention program such as Action activities. However, due to limited the use of brief intervention to Success Knowledge (ASK) leads to capacity, this has not been possible support mood and emotional better mood and improved quality in 2016. wellbeing in people with post-stroke of life versus secondary stroke aphasia. In just nine months, 70 Future research objectives include: prevention intervention at 12 months participants have been screened at post-stroke. The incidence of Western Health and six participants oo Upskilling clinicians in research depression is high after the onset of have been recruited to the trial. methods, and aphasia following stroke. Research shows that depressive symptoms In 2016, the Speech Pathology oo Partnering with other that do not resolve after 12 months Department, together with Nursing, organisations to enable negatively impact the recovery and were successful in obtaining a involvement in research projects quality of life of these individuals. $270,000 grant from Better Care This study investigates whether early prevention and treatment of depression helps improve mood.

The Speech Pathology Department, together with Nursing, were successful in obtaining a $270,000 grant from Better Care Victoria to expand the CALD Assist Allied Health iPad application. Western Health | Research Report 2016 24 CALD Assist: Designing Technology to Support Timely Nursing Assessments of Culturally and Linguistically Diverse patients (CALD): User Needs Analysis

Researchers: Sally Brinkmann and Courtney Pocock

Collaborators: Dr Arlene Wake, A/Prof Denise Patterson, Dr David Silvera-Tawil (CSIRO) and Dr Dana Bradford (CSIRO)

This project will produce a commercial grade, sustainable iPad application to facilitate timely and effective communication between patients from Non-English Speaking Backgrounds (NESB) and nursing staff at Western Health, when an interpreter is not available. It is an expansion of the current Allied Health CALD Assist application and will help patients from NESB backgrounds participate in their healthcare in the Speech pathologist Courtney Pocock with a patient. absence of interpreters.

Western Health Assessment Right-Hemisphere Cognitive- Parent Play Resource of Dysarthria (WHAD); Does Communication Screen: Does the Updated Assessment Tool the Newly Developed Screening Researcher: Alice de Groot Improve Clinician Ability to Tool Meet the Needs of the Collaborators: Rachel Smith, Ruth Differentially Diagnose Dysarthria Western Health Speech Pathology Taylor and Lebe Malkoun and Identify Key Features to Department in the Screening Target in Therapy? of Cognitive-Communication The goal of this quality activity is to Deficits? develop a culturally and linguistically Researcher: Michelle Watling appropriate, parent-friendly play Researchers: Sarah Ward and resource that enables families Collaborator: Lauren Belleli Monique Stojkovski to play with their children at a This project will help determine This project will aim to develop developmentally appropriate level. whether the updated WHAD had an and evaluate a right hemisphere Western Health | Research Report 2016 Report | Research Health Western impact upon clinicians’ perceived communication screen. There is ability to differentially diagnose the currently no known screen to suit dysarthria subtypes, identify the our needs. This project will ensure key features of a patient’s speech we have a tool that efficiently and impacting on intelligibility, and effectively screens stroke patients guide dysarthria therapy. This will for right hemisphere communication allow us to provide a comprehensive and cognition changes and assist dysarthria assessment to our patients in the development of appropriate and plan interventions based on the intervention plans. impairments identified. 25 Australian Institute For Musculoskeletal Science (AIMSS)

Our Research Output 26 46 32 Projects Publications Presentations

1 6 Book Chapters

Western Health | Research Report 2016 Western Health Chair of Medicine and AIMSS Director Prof Gustavo Duque. 26 Institute Director Research Staff

Prof Gustavo Duque 20 researchers and 18 students

After a significant period of low standardisation of institutional Collaborator: Prof Kerrie Sanders activity, the Australian Institute for acknowledgement for AIMSS (Australian Catholic University) Musculoskeletal Science (AIMSS) has demonstrated a high level of was re-structured and re-activated productivity and collaboration This project will provide novel in 2016. With strong support from amongst our members. and internationally relevant its three stakeholders (University of insights into the causal pathways Melbourne, Victoria University and In 2017, AIMSS will focus on the underpinning the social gradient Western Health), AIMSS developed GRASP initiative. In addition, of musculoskeletal decline using a several major strategies to attract international collaborations and links life-course approach. It has utility for new membership, optimise the use of with other research institutes and targeting intervention in the clinic the facilities at WCHRE, increase our organisations will be strengthened. and/or workplace. supporting personnel and provide We also expect to attract more Inhibitors of Bone Metastasis in our members with very attractive students via our university Breast Cancer opportunities to improve the partners. Funding programs such as seed grants, travel grants and quantity and quality of their research. Researchers: A/Prof John Price and scholarships will also be increased. Joseph Polidano Twelve research programs were created, ranging from basic sciences This project evaluates the effect to population health (translational of different compounds on the research), based on the Institute’s Our Research number and invasiveness of breast founding principle of “from bench cancer metastasis in bone. The to community and back”. Program project includes in vitro and in vivo Directors, recruited from several Circulating Osteoprogenitors pharmacological studies. major academic departments and (COP) Study clinical units at Western Health, Effect of Parathyroidectomy on are now in charge of promoting Researchers: Prof Gustavo Duque, Frailty – The FRailPATHY Study and facilitating research in their Ahmed Al Saedi, Rita Kinsella and respective areas. Stephen Phu Researchers: Rita Kinsella, A/Prof Shane Hamblin, Dr Vivian Grill, Prof To increase our members’ Collaborator: Prof Robert Pignolo Gustavo Duque and Bill Fleming productivity, AIMSS has implemented (Mayo Clinic) a new strategy known as GRASP Collaborator: Dr Pushpa This project aims to identify a new (Grants, Students and Publications). Suiriyaarachchi (University of biomarker for frailty and disability in With this strategy in mind, our 45 Melbourne) older persons. The cross-sectional members have applied to multiple study has been completed and a sources of funding, received direct This study looks at the effect of longitudinal study is expected to funding from AIMSS in the form of parathyroidectomy on the clinical commence in September 2017. internal seed grants, and optimised features of frailty in patients 65 and the use of their research funds by older. The working hypothesis is Development of New Therapies to that high levels of PTH affect muscle getting easier access to our local Muscle Dystrophy infrastructure, as well as resources function and predispose patients to frailty and disability. available at our partner institutes Researchers: Dr Emma Rybalka and nationally and internationally. Prof Alan Hayes

AIMSS has also implemented an This study is a preclinical validation 2016 Report | Research Health Western active recruitment strategy. We of new potential compounds for Our Grants and Awards re-opened our positions for UROP treating muscle dystrophy. students (BioMedVic) and recruited a high number of Honours students. The Occupation, Inflammation and All research grants are held by An unprecedented number of PhD Musculoskeletal Decline Pooled our respective AIMSS Institute and Master students joined our Cohort Collaboration stakeholders and members. Institute in 2016, a number that Researchers: Dr Sharon Brennan- is expected to increase in 2017. Olsen and Dr David Scott Finally, in terms of publications, 27 Anaesthesia and Pain Management

Our Research Output 19 14 5 Projects Publications Presentations

Western Health | Research Report 2016 Anaesthetist Dr Nicole Sheridan. 28 Head of Department Research Staff

Dr Rick Horton 5 researchers

The Department of Anaesthesia established, but this has been and Pain Medicine broadened its Our Research traditionally achieved by dosing research scope in 2016 to include separately using individual syrup paediatric. Developing our research preparations. This practice is Maxigesic® PK/PD Study. A capabilities in this area aligns undesirable due to the potential for Randomised, Single-Blind, well with current Western Health dose confusion. The development Parallel Group Comparison of priorities, with the planning and of a fixed dose combination for the Pharmacokinetic Profiles, preparation for the Joan Kirner children based upon the already Dose Response, Analgesic Hospital for Women and Children developed adult fixed dose Effectiveness and Safety of well underway. Another area of focus combination would be clinically a High and Low Dose of a is the Maxigesic® PK-PD Study, useful. Paracetamol and Ibuprofen Fixed- where Western Health has been able Dose Combination in Children to make a strong contribution to SimulationN And Personality Undergoing Tonsillectomy with or the recruitment of participants for Testing in Anaesthesia Trainee without Adenoidectomy this multi-centre evaluation of a new Choice (SyNAPTIC) combination analgesic agent for Researchers: Dr David Bramley and Researchers: Dr Elizabeth Hessian, use in this clinical setting. This work Dr Simon Chong Dr Adriano Cocciante, Dr Martin will assist paediatric ENT service at Nguyen, Dr Candida Marane, Dr Sunshine Hospital, which sees many The trial aims to assess the John Ozcan, Dr Anita Panayiotou, children with either obstructed effectiveness and safety of two Dr Emily Karahalios, Dr Lahiru breathing or recurrent tonsillitis who different dose regimens of a fixed Amaratunge and Dr Navroop Johal require adenotonsillectomy. dose paracetamol and ibuprofen combination, Maxigesic® oral Collaborators: Dr John Morris, Dr Other research priorities in 2016 suspension, in children between Andrew MacComick, Dr Janette included ongoing work looking at 2–12 years undergoing tonsillectomy Wright (Royal Melbourne Hospital) the role of simulation in evaluating (with or without adenoidectomy). and Dr Damian Castenelli (Monash non-technical skills in junior Overall recruitment is projected for Unviersity) doctors, with a successful study 200 participants. Western Health day in August for the SyNAPTIC started recruitment on 1 August This study examined the feasibility Study. This research aims to look 2016 and to date have enrolled 13 of incorporating a multi-station at the feasibility of incorporating participants. We know that following selection process, including alternative selection methods tonsillectomy there is a very high assessment of simulation alongside traditional interviews rate of children re-presenting to performance, into the selection of in order to ascertain junior doctor healthcare providers, often due to junior doctors for the Anaesthesia suitability for anaesthesia training. problems with pain. This study will Training Program. It is crucial Our department also continued its improve our understanding of the that the junior doctors most substantial contributions to multi- effectiveness and safety of a new suited to anaesthesia training centre international investigator- combination analgesic preparation are selected into the program. initiated studies, answering in the setting of paediatric Although traditional selection important questions about tonsillectomy. An effective fixed techniques offer valuable insights how we manage patients in the dose combination analgesic into applicant suitability, additional 2016 Report | Research Health Western perioperative period. An example containing 500 mg paracetamol selection modalities may add useful is the RELIEF study, a clinical trial and 150 mg ibuprofen in a tablet information. This study further looking at fluid management during formulation (Maxigesic®) given extended work done in the STRICT and following major surgery. as one to two tablets at six-hourly study conducted in 2015, looking intervals, has been developed for into methods of evaluating non- use in adults. In children, the use technical skills and suitability of of paracetamol and ibuprofen candidates for anaesthesia training. in combination is already well 29 Anaesthesia and Pain Management continued

A Pilot Study to Investigate Post- REstrictive versus LIbEral Fluid Environmental and Financial OPerative Oxygen Consumption Therapy in Major Abdominal Footprint of Anaesthetic (POpOC) after Colorectal Surgery Surgery (RELIEF) Equipment Requiring Bowel Resection Researchers: Dr David Bramley and Researchers: Dr Forbes McGain, Researchers: Dr Hugh Taylor, Dr Dr Forbes McGain Prof David Story, Dr Tony Lim and Charlie Willmott, Dr David Bramley Scott McAlister and Dr Bob Smith RELIEF is a multi-centre, international study of 3000 patients The aim of this study was to The POpOC study evaluated aiming to answer the question of determine the financial and patient oxygen consumption whether a liberal or restrictive fluid environmental costs associated after major colorectal surgery. regimen is more advantageous to with using reusable or single use Although this study was designed survival and recovery from surgery. anaesthetic equipment. A number primarily as a pilot feasibility study, Recruitment was completed in of anaesthetic scenarios were it produced an interesting and September 2016. Western Health examined, considering the use quite unexpected finding – the was one of the top 10 recruiting of equipment such as reusable absence of a marked increase in sites, with 120 patients participating. and disposable anaesthetic O2 consumption post-operatively. As part of usual anaesthetic breathing circuits, face masks, This was a very different finding to care, patients undergoing major Proseal LMAs, and laryngoscope that of similar research in the 1980s, abdominal surgery receive blades. As is the case regarding which showed a 44% increase in intravenous fluids. For decades, surgical equipment, there are few oxygen (O2) consumption following debate has raged in the literature published studies comparing the colorectal surgery. The findings of as to whether “wet” or “dry” is financial and environmental impact our study may reflect improvements better for these patients. Potential of using reusable versus single in perioperative care and surgical complications of extremes of fluid use anaesthesia equipment. This techniques in the modern era. administration include acute renal study showed that using reusable Western Health has a busy impairment, acute pulmonary anaesthetic equipment resulted colorectal surgical unit, and this oedema, and tissue oedema in considerable cost savings, but study will help us better understand leading to wound and anastomotic increased the carbon footprint of the metabolic impact of major dehiscence. our six-operating theatre hospital. surgery, a factor that contributes to the capability for patients to recover Acknowledgement: Australian from surgery. and New Zealand College of Anaesthetists Clinical Trials Network (CTN), Australian and New Zealand Intensive Care Society Clinical Trials Group (ANZICS CTG), Monash University.

The Department of Anaesthesia and Pain Medicine broadened its research scope in 2016 to include paediatrics. Western Health | Research Report 2016 30 Cancer in Primary Care

Our Research Output 15 15 21 Projects Publications Presentations Western Health | Research Report 2016 Report | Research Health Western 31 Cancer in Primary Care

The Cancer in Primary Care Research This evaluation examined the impact Group covers the role of primary care Our Research of implementing the RAGE pathway across the cancer continuum. This to improve access to gastrointestinal includes studies on cancer screening, (GI) endoscopy for those with The CRISP Trial: an RCT of a Risk cancer diagnosis and survivorship suspected cancer. We were able to Assessment and Decision Support care. We are interested in the show improvements in the quality of Tool for Stratified Colorectal application of risk stratification and GP referrals and selection of patients Cancer Screening in Primary Care risk assessment tools to support more referred for endoscopy, as well as tailored and specific care across the Researchers: Jon Emery, Jenny shorter waiting times for patients cancer continuum. For example, our Walker, Sibel Saya, Jasmeen Oberoi, referred via the RAGE pathway. This work in colorectal cancer screening, Kristi Miller and Marie Pirotta. project received the Premier’s Public as well as the implementation of fast- Healthcare Award for Excellence in track pathways for suspected cancer Collaborators: Mark Jenkins, Finlay Cancer Care. It has also informed using risk assessment tools in general Macrae, Ingrid Winship, Lyndal a new project relating to the practice. Our work also examines Trevena, Fiona Walter and Alex implementation of the cancer Optimal potential causes of poorer cancer Boussioutas Care Pathways, the I-PACED project. outcomes in specific populations, including rural and Culturally and As part of our NHMRC Centre for Implementing Pathways for Linguistically Diverse (CALD) Research Excellence on optimising Cancer Early Diagnosis (The communities. colorectal cancer screening, we have I-PACED Project) received funding for a trial of a novel In 2016, we published the results electronic colorectal cancer risk Researcher: Jon Emery of the ProCare trial, testing a assessment tool in general practice. Collaborators: Anna Boltong, model of shared care for men with This four-year trial will test the effect Amber Kelaart, Natalie Appleby, prostate cancer, and are developing of a nurse-led consultation using the Cancer Council Victoria, North similar models for other common tool on risk-appropriate colorectal Western Melbourne Primary Health cancers, such as the SCORE Trial for cancer screening. Network and Western Victoria colorectal cancer shared care, led by Primary Health Network A/Prof Michael Jefford. As part of this program we are conducting studies on Building on the findings from the We are a highly collaborative communicating risk and the harms RAGE implementation project, we group and have formed strong and benefits of various preventive have been funded to support the collaborations with several local, strategies for colorectal and breast implementation of the Optimal Care national and international research cancer (the CRISP-Q and BRISK-Q Pathways for lung and colorectal groups who share our interests studies). We are also testing tools cancer. This uses a similar academic in primary care oncology. This is to collect information about risk detailing model, offering educational supported through the Primary Care factors for melanoma using iPads in visits delivered by Cancer Council Collaborative Cancer Clinical Trials general practice waiting rooms (the Victoria nurse educators, to over Group, also known as PC4, of which Melatools-Q study). 500 general practices in the North Prof Jon Emery is the Director. Prof Western Melbourne Primary Health Emery was part of the international Implementation and Evaluation of Network. We aim to support the use team which received the inaugural the Rapid Access GI Endoscopy of symptom risk assessment tools Cancer Research UK Catalyst (RAGE) Pathway and implement preferred referral Award in 2016. This £5 million five- pathways for patients with suspected year grant supports international Researcher: Jon Emery cancer. In addition, the project collaborative research on early Collaborators: A/Prof Alan Moss, will support practices in delivering cancer diagnosis in primary care. Cancer Council Victoria, South West cancer prevention and screening This grant is part of a long-standing Melbourne and Macedon Ranges and promote stronger links with the program of collaborative research and North Western Melbourne Cancer Council Victoria information with the University of Cambridge Medicare Locals, and North Western and support services. primary care cancer research group, Western Health | Research Report 2016 Melbourne Primary Health Network led by Dr Fiona Walter. 32 Head of Department Research Staff

Prof Jane Gunn 12 researchers and 8 students

Audits of Cancer Diagnostic 2. Population surveys of cancer Pathways awareness and the barriers to Our Grants and Awards help-seeking in people with Researcher: Jon Emery symptoms of cancer, and NHMRC Project Grant Collaborators: Dr Sally Greenfield, 3. Development of Vietnamese J Emery, F Macrae, L Trevena et Dr Karen Winter, Ilana Hornung and culturally specific cancer al. The CRISP Trial: an RCT of Risk Ian Faragher awareness campaign materials to Assessment and Decision Support promote earlier presentation to to Implement Risk-Stratified Two clinical audits were completed healthcare Colorectal Cancer Screening in in 2016: Primary Care. National Health Linking VCCC and General and Medical Research Council, 1. An audit of all patients attending Practice Data to Explore the $936,640.80 (2016). Western Health Emergency Management of Cancer in Primary Departments who are diagnosed Care Researcher: Jon Emery Cancer Research UK Catalyst Grant with a new cancer within the F Walter, W Hamilton, R Neal, Y subsequent two months, and Collaborators: Meredith Leyton, Lyratzopoulos, J Emery, H Singh and Dougie Boyle, Jim Bishop and M Thompson. CanTest – Detecting 2. An audit of diagnostic pathways Maureen Turner Cancer in Primary Care: A Paradigm of all patients with colorectal Shift for Cancer Diagnosis. Cancer cancer treated at Western Health During 2016 we continued to make Research UK, £5,000,000 (2016). between 2013–2014 progress linking general practice data with data from the VCCC Victorian Cancer Agency This work is informing the hospitals. As an initial proof-of- J Emery, M Jenkins, F Macrae et al. development of cancer diagnostic principle, we are linking data from The CRISP Trial: A Phase 2 RCT of a pathways at Western Health. the Victorian Cancer Registry, Colorectal Cancer Risk Assessment Cancer Diagnosis in Vietnamese Western Health, Melbourne Health Tool in Primary Care. Victorian Communities and general practice NPS Medicine Cancer Agency, $300,000 (2016). Insight data. This will allow us to Researchers: Jon Emery, Sharon examine patterns and causes of Department of Health and Human Licqurish, Mary Huynh diagnostic delay in cancer and the Services Victoria involvement of primary care during J Emery and A Boltong. Collaborator: Cancer Council Victoria and after cancer treatment. This work Implementation of the Optimal Care forms part of a larger initiative to Pathways. Department of Human We continue our work exploring develop a VCCC Cancer Health Data Services, $155,000 (2016). cancer symptom awareness and Platform to support health services Premier’s Public Healthcare Award patient experiences preceding a research across the partnership. cancer diagnosis in Vietnamese for Excellence in Cancer Care communities. Specifically, our work Western Health and University of includes: Melbourne. Department of Premier and Cabinet (2016). 1. A mixed-methods study Western Health | Research Report 2016 Report | Research Health Western of diagnostic pathways in Vietnamese patients at Western Health diagnosed with breast, lung or bowel cancer 33 The Cardiology Unit continues to develop its research program in association with key areas of clinical service. This year saw an unprecedented number of abstract presentations at the Cardiac Society of Australia and New Zealand, as well as the inauguration of two prizes for advanced trainee research, including the Robert Newman Prize for best abstract. In terms of investigator-led studies, observational clinical service research in heart failure remains a priority, and two pilot randomised controlled trials commenced. In addition to the link with the Cardiology University of Melbourne Department of Medicine – Western Precinct, collaborative ties with Victoria University, Monash University and the Baker Institute were strengthened. The Unit looks forward to increased growth and research output in the year to come.

Our Research Output 13 7 Projects Presentations

Western Health | Research Report 2016 Cardiology Registrar Dr Michael Seman. 34 Head of Department Research Staff

A/Prof Nicholas Cox 4 researchers and 4 students

Effects of Dietary Inorganic Nitrate Our Research Supplementation on Exercise Our Grants and Awards Performance in Heart Failure

A Cardiogeriatric Model of Care: Researcher: A/Prof Christopher Neil Western Health Research Week Prospective Assessment of a Grant New Method of Care for Elderly Collaborator: Prof Jason Allen M Seman. Culturally and Linguistically Patients Admitted with Heart (Victoria University) Diverse Patients Hospitalised with Failure Heart Failure. Outcomes and Cost This study will evaluate the effects Analysis. Western Health Research Researchers: A/Prof Nicholas Cox of nitrate-rich beetroot juice in Grant, $20,000 (2016). and A/Prof Christopher Neil patients with heart failure, exploring reported beneficial effects on Vanguard Heart Foundation Grant Collaborators: Prof Edward Janus, exercise capacity and vascular D Stub. The Role of Coronary Dr Claire Long and Dr Sara Vogrin function. This study may lead to a Angiography in Cardiac Arrest. simple dietary means of extending Vanguard Heart Foundation, This study evaluates the impact of functional capacity in patients with $75,000 (2016). a novel model of care, targeting heart failure. elderly patients with heart failure, Vanguard Heart Foundation Grant examining outcomes at follow-up. Determinants of Death Associated M Wong. The PaceKiD Study: This will help us identify problems with Out of Hospital Cardiac Pacemaker Implantation in in our treatment in contrast to other Arrest in a Single Tertiary Hospital Kidney Disease. Vanguard Heart patients within our predominantly Foundation, $75,000 (2016). adult service system. Researchers: A/Prof Nicholas Cox, Dr Dion Stub and Dr Justin Cole Vanguard Heart Foundation Grant Optimising Clinical and Functional C Neil. BEET HF Dietary Inorganic Outcomes in Older Adults with CHF This study examines real world Nitrate in CHF. Vanguard Heart Using the Peripheral Remodelling predictors of outcome in a large Foundation, $75,000 (2016). Through Intermittent Muscular cohort of patients surviving initial Exercise (PRIME) Approach cardiac arrest. This work will help us Vanguard Heart Foundation Grant better understand our patients and C Neil and R Maddison. Improving Researchers: A/Prof Christopher practice. Self-Management of Heart Failure. Neil and Catherine Giuliano Vanguard Heart Foundation, $75,000 Screening for Asymptomatic (2016). Collaborator: Prof Jason Allen Coronary Heart Disease in Siblings (Victoria University) of Young Myocardial Infarction Alfred Trust Patients W Chan (PI). Doxycycline Use to This study will evaluate the feasibility Protect the Heart and Reduce the of a more tolerable method of low Researchers: Dr Nadim Shah, A/Prof Net Injury in STEMI Patients. Alfred intensity resistance training for Kean Soon and A/Prof Chiew Wong Trust, $95,000 (2016). elderly heart failure patients. This study aims to address a gap in the Collaborator: Prof Anne-Maree Kelly provision of supervised exercise 2016 Report | Research Health Western training to frailer patients and may This cross-sectional study looked at inform future studies. siblings of patients with premature coronary events, treated at Western Health, demonstrating the presence of asymptomatic coronary plaque. This study adds to the literature and may inform future studies in the field CT coronary arteriography. 35 Dr Seman is hoping the combined research will ultimately help drive policy change and improve the quality of healthcare provision for minority groups in the community. Western Health | Research Report 2016 36 Dr Michael Seman

Cardiology Registrar

The western suburbs are home to He said he first noticed a difference some of the highest rates of heart in readmission rates among CALD failure in Melbourne – and new patients in the Cardio-Geriatric research has pinpointed the most model of care research project, at-risk group. carried out by the cardiology department in 2015. Patients with limited English have a 22% chance of representing to “The complexity of healthcare hospital with acute heart failure is increasing, particularly in the within 180 days of their first episode, management of chronic diseases as opposed to 15% who are proficient such as heart failure – and in the language, a Western Health this is further complicated by study has found. communication barriers, cultural differences and poorer health The findings emerged from research literacy,” he said. at Footscray and Sunshine Hospitals in 2016 by Cardiology Registrar Dr “With this group in particular, Michael Seman, who said the causes the problem has a lot to do with needed exploration for the gap to be communication between the health closed. care providers and the patient, and the patient’s ability to understand Dr Seman said mapping by the Heart and then self-manage when they Foundation identified the Western return home.” Metropolitan Melbourne region as having one of the highest risks He said further research was needed for heart failure across the greater and he is now preparing to embark Melbourne area. There were more on a state-wide study with more than 1200 admissions at Western than 30,000 patients, examining Health in 2016, a dramatic increase the impact of cultural and linguistic from 800 in 2013. diversity on health outcomes of those hospitalised with heart failure. Dr Seman studied the most vulnerable cohort of Culturally and Dr Seman is hoping the combined Linguistically Diverse (CALD) patients research will ultimately help drive for the study last year, tracking policy change and improve the the rate of rehospitalisation and quality of healthcare provision for emergency department visitation minority groups in the community. after discharge, compared to fluent- 2016 Report | Research Health Western speaking patients. 37 Drug Health Services

Our Research Output 3 1 3 Projects Publication Presentations

Western Health | Research Report 2016 Ruben Ruolle, Acting Director Drug Health Services, Western Health. 38 Head of Department Head of Unit, Research Staff Addiction Medicine Robyn Jackson 1 researcher and 2 students A/Prof Mike McDonough

Drug Health Services incorporates most such patients were taking Addiction Medicine and Toxicology Our Research high opioid doses, had prolonged Services, which provide medical disability and high levels of mental specialist services to dedicated distress. Compared to other Continuing, Cutting Down or inpatient beds within Footscray published work that describes Ceasing Opioids in Chronic Hospital and also outreach to the populations of chronic non-cancer Non-Cancer Pain Patients Western Community Detoxification pain patients, this population Unit co-located at the same Researchers: A/Prof Mike was significantly different. Likely campus. The unit also operates McDonough and Ross Newman iatrogenic opioid dependence was a outpatient clinics and provides common finding in this population. addiction medicine services to This low risk research project The audit’s findings were prepared the Rural Addiction Medicine investigated why some patients as a monograph and provided to Pharmacotherapy Service, which decide to cut down or even stop the TAC and WorkCover, which gave covers over half the population of taking opioid analgesics while others consent for a paper to be drafted Victoria. The Service also provides continue for long periods, despite and submitted for publication. undergraduate and postgraduate mounting evidence of potentially medical education, with serious opioid-related side effects. Clinical Audit of Cases of Cannabis accreditation for registrar advanced The project commenced in 2015, Hyperemesis/CHS seen at training with RACP, RANZCP and collecting a patient cohort of Western Health ACEM. We also undertake both over 50. In the 2016, as part of Researcher: A/Prof Mike research and quality assurance continuation of the study, the same McDonough activities. cohort was re-interviewed between 6 and 12 months to follow up. Many In this study, a total of twelve cases patients reported prescriber advice were identified – four female and as significant in their decision eight males – aged between 20–50 making, suggesting doctor-patient years, all cannabis dependent. The relationships may be important results found 10 smoked “bongs”, determinants of long-term opioid the average duration of smoking prescribing. In 2017, a further cannabis was approximately extension to this project is planned eight years, and all had significant to look more specifically at doctor- psychosocial problems, most of patient relationship with regard which were related to cannabis to opioid prescribing. A paper is withdrawal. Successful treatment drafted for publication. followed IV fluids, electrolyte replacement and parenteral Clinical Audit of IME Reports on an Chlorpromazine, Olanzepine or Insurance Cohort Involving Opioids Droperidol. In conclusion, only four and Chronic Non-Cancer Pain of 12 cases were identified having Researchers: A/Prof Mike CHS onset following peak use levels, McDonough and Lewis Murray which were mostly related to the phase of cannabis withdrawal. 2016 Report | Research Health Western This quality assurance project audited a sample of 100 chronologically selected Independent Medical Examiner reports on accident compensation to the Victorian TAC and WorkCover Accident Insurers, where chronic pain patients were prescribed long term opioid analgesics. The audit found that 39 Endocrinology and Diabetes

Our Research Output 4 11 Projects Publications

7 1 Presentations Proceeding

Western Health | Research Report 2016 Head of Department A/Prof Shane Hamblin. 40 Head of Department Research Staff

A/Prof Shane Hamblin 5 researchers

The western region of Melbourne The Effect of Betamethasone has one of the highest rates of Our Research on Blood Glucose in Pregnant diabetes mellitus in the country. One Women With and Without third of all inpatients of Western Gestational Diabetes Psychosocial Factors in Patients Health have diabetes, predominantly Presenting with Diabetic Type 2. Gestational diabetes is also Researchers: Dr Christopher Yates, Ketoacidosis very common, affecting nearly 20% Dr Amy Harding, Dr Anna Watts, Dr Ellissa McNamara and Cheryl Steele of all pregnant women treated here. Researchers: A/Prof Shane Western Health also cares for many Hamblin, Dr Sylvia Xu, Dr Azni Betamethasone is commonly given people with Type 1 diabetes and Abdul-Wahab and Cheryl Steele to pregnant women towards the unfortunately every year nearly 100 end of pregnancy to help fetal lung episodes of life-threatening diabetic Collaborator: Grey Searle maturation before delivery. However, ketoacidosis are managed in these this drug also elevates maternal patients. Our research activities This project examines the blood glucose, which may have therefore focus predominantly on prevalence of depression and deleterious effects on the fetus. diabetes. diabetes distress, and the social factors such as unemployment This study uses continuous glucose Our future research projects (in prevalence, in patients monitoring technology to examine partnership with North Western admitted with life-threatening the extent of beta-methasone Primary Health Network) include: diabetic ketoacidosis (DKA). By induced maternal hyperglycaemia understanding the drivers behind and the effect of insulin dosing oo A safe discharge project back to our high rates of DKA we hope to be strategies used in clinical practice. GPs for patients of the Western able to reduce overall presentations The study aims to develop better Health Diabetes Clinic of this life-threatening condition. insulin dosing strategies to optimise blood glucose control in pregnant oo Assessment of the metabolic and women, thereby minimising adverse bone health effects of Androgen effects on the baby. Deprivation therapy in males with prostate cancer, and oo Investigating the glycaemic impact of glucocorticoid treatment in medical inpatients Western Health | Research Report 2016 Report | Research Health Western Western Health also cares for many people with Type 1 diabetes and unfortunately every year nearly 100 episodes of life-threatening diabetic ketoacidosis are managed in these patients. 41 Gastroenterology and Endoscopy

Our Research Output 21 13 Projects Publications

14 10 Presentations Proceedings

Western Health | Research Report 2016 Head of Department A/Prof Alan Moss. 42 Head of Department Research Staff

A/Prof Alan Moss 4 researchers and 1 student

Seven endoscopy research projects Six research projects were were undertaken during 2016, all of undertaken in hepatology and Our Research which will have a significant impact Inflammatory Bowel Disease (IBD). on our clinical practice. Active multi- Studies were conducted to evaluate Australian Colonic EMR (ACE) centre research projects include: the impact of Direct-Acting Antiviral Study the multi-centre Australian Colonic Agents (DAA) on hepatitis, the Endoscopic Mucosal Resection comparability of non-invasive liver Researchers: A/Prof Alan Moss and (ACE) study, the evaluation of bowel elastography techniques, changes Dr Simon Zanati preparation in order to optimise in Fibroscan results following views obtained during capsule treatment with DAA, and scoring All patients referred for Endoscopic endoscopy, and the safety and systems that predict outcomes Mucosal Resection (EMR) of large efficacy of hot avulsion compared of treatment with Trans-Arterial or complex colonic polyps were to argon plasma coagulation in Chemoembolization (TACE) for audited for outcomes (with no the management of non-lifting hepatocellular carcinoma. exclusions), and de-identified polyps and the safety and efficacy data submitted to the Australian of endoscopic polypectomy in the The Department of Colonic EMR study group database setting of anti-platelet agents such Gastroenterology actively for evaluation of long term as Clopidogrel (The EPOC Study). participated in multiple international outcomes. This project has been A/Prof Alan Moss was co-chair of the pharmaceutical industry-sponsored ongoing since 2008. Traditionally, European Society of Gastrointestinal clinical trials in the fields of IBD and large or complex colonic polyps Endoscopy (ESGE) polypectomy viral hepatitis. These studies have were managed surgically rather and EMR guideline committee and enabled our patients to access than endoscopically. Endoscopic was instrumental in the authorship modern therapeutic agents that management is associated with and publication of the ESGE colonic otherwise would not yet be available reduced morbidity, reduced polypectomy and EMR guidelines. In in Australia. mortality, reduced cost and shorter the realm of Endoscopic Retrograde admissions. However, outcomes Cholangio Pancreatography (ERCP), need to be rigorously evaluated. a retrospective study of our ERCP This serves as a quality assurance practice over four years confirmed project, but also allows for study of that our modern approach to ERCP long term outcomes. – including optimising therapeutic indications for ERCP by appropriate non-invasive diagnostic imaging, wire-guided cannulation, rectal indomethacin, peri-procedural intravenous fluids and pancreatic stenting in high-risk cases – resulted in very high success rates and Seven endoscopy research very low rates of adverse events compared to benchmarks. projects were undertaken Western Health | Research Report 2016 Report | Research Health Western during 2016, all of which will have a significant impact on our clinical practice. 43 Gastroenterology and Endoscopy continued

A Modern Approach to ERCP: A baseline detection rates will inform This project evaluated the reported Practice Audit the planned introduction of targeted immunisation rates of Inflammatory educational programs to enhance Bowel Disease (IBD) patients Researchers: Dr Kumanan Nalankilli, detection. attending the Footscray Hospital Dr Suthershan Kannuthurai and A/ IBD clinic. Patients were interviewed Prof Alan Moss Treatment of Non-Cirrhotic about their immunisation status Hepatitis C Patients in Primary and their medical records were This study conducted an Care Has Only a Modest Impact retrospectively examined. Endoscopic Retrograde on Current Hepatitis Clinic Usage Consensus guidelines from the Cholangiopancreatography European Crohn’s and Colitis (ERCP) practice audit. Results Researchers: Dr Kumanan Nalankilli, Organization (ECCO) and the were compared with an Australian Than Huynh, Emma McLaughlin, Australian Inflammatory Bowel national survey in order to assess Marian Croft, Rachel Liddle, E Disease Association have quality of outcomes and review Kathpal, Ian Kronborg, A/Prof Alan recommended routine screening the evidence base underlying Moss and Dr Niranjan Arachchi and immunisation of these infections modern ERCP practice. Endoscopic in patients with IBD. This study retrograde ERCP is technically This project aimed to characterise found that the reported vaccination challenging and complications the current patient cohort that rates for our cohort of IBD patients such as Post-ERCP Pancreatitis attends the viral hepatitis clinic at is low. There is a need to educate (PEP) remain a concern. This study Footscray Hospital. New Direct- our patients and engage our assessed the safety and efficacy of Acting Antiviral Agents (DAA) primary care providers to improve ERCP practice at Western Health. agents for hepatitis C patients are immunisation rates among this As a result of this study, we found predominantly still accessed via vulnerable group of patients. that modern ERCP techniques result tertiary centres. We found that in This study has paved the way for in a high rate of successful biliary the present era of DAA, 37% of all a prospective study evaluating cannulation (97%) and a very low hepatitis C patients in our public specific strategies to improve rate of adverse events such as post- hepatitis clinic could be managed vaccination rates in IBD patients in ERCP pancreatitis (0.8%). in a primary care setting. This corresponds to only 15% of the the community. A Multi-Site Study Reviewing overall number of patients who Sessile Serrated Adenoma (SSA) are seen at the clinic, due to large and Conventional Adenoma numbers of Hepatitis B patients. Detection Rates The data is useful for identifying Our Awards the proportion of patients who can Researchers: Dr LiWei Suen, Dr R be treated and discharged back Prentice, Dr Kumanan Nalankilli and to the community, thus improving Western Health Research Week: A/Prof Alan Moss the patient load of the hepatitis Best Published Paper Award clinic over the medium term. It also A Moss. Long-Term Adenoma This study aimed to assess the SSA allows for appropriate planning and Recurrence Following Wide-Field Detection Rate (SSADR) at Western allocation of resources. Endoscopic Mucosal Resection (WF- Health across all colonoscopists EMR) for Advanced Colonic Mucosal and all sites and to identify risk Reported Immunisation Rates of Neoplasia is Infrequent: Results and factors for high and low detection Patients with Inflammatory Bowel Risk Factors in 1000 cases from the rates. Sessile Serrated Adenoma Disease Australian Colonic EMR (ACE) study. are a newly described entity of flat Western Health (2016). colorectal polyps that are difficult Researchers: Dr Yin Hiew Kia, to detect. They are now recognised Rebekah Van Leest, Dr Dalijean Victorian Public Health Care Award to contribute to up to one-third of Sandhu, Dr Shamilah Lachal and Dr for Excellence in Cancer Care colorectal cancers. An evaluation of Thai Quach A Moss. Rapid Access to Gastrointestinal Endoscopy (RAGE). Government of Victoria (2016). Western Health | Research Report 2016 44 General Internal Medicine

Our Research Output 3 9 Projects Publications

8 2 2016 Report | Research Health Western Presentations Chapters

Prof Edward Janus, Head of General Internal Medicine and A/Prof Harin Karunjeewa 45 General Internal Medicine

We admit over 6000 mostly elderly Another major project (RAPT) completed in mid-2015, with a large multi-morbid patients annually. We focused on identifying and contribution from Western Health. need to ensure patients reach wards following up patients with high The intervention trial results were promptly after ED arrival, optimise readmission risk. We also monitored published in 2016, showing 10% of treatments, minimise unnecessary a multipronged approach for pregnancies at Western Health are hospital stays, transition patients markedly shortening the transition complicated by gestational diabetes. to the community efficiently and time from arrival in ED to the wards. As well as optimal treatment during prevent unnecessary readmissions. pregnancy, follow up is critical to We are also aiming to improve prevent later development of Type the way our system prioritises 2 diabetes and its complications in outcomes related to symptom relief, these mothers. This process, and independent function and quality Our Research effective interventions to prevent of life for this group. We believe later diabetes, have been lacking that applying research methods to Preventing Diabetes in Pregnancy and this very large project addressed evaluating our service performance from Progressing to Type 2 these issues. is vital to addressing this aim. Diabetes: Macro-Level System Change in South Australia and EPI-FIND – Epigenetic Factors in Where clear evidence for particular Victoria (MAGDA) Diabetes treatments exists, we implement them. However, trials are done on Researcher: Prof Edward Janus Researcher: Prof Edward Janus highly selected patient populations Collaborators: L Ackland (Deakin that are not representative of those Collaborators: JA Dunbar, JD Best, University), J Dunbar (Deakin we actually treat. Real patients and R Carter, J Oats, M Ackland and P University) and JD Best (previously staff don’t behave like those in Ebeling University of Melbourne) trials. Therapeutic benefits shown The first part of the project is an in randomised controlled trials are ongoing study using GHRANITE- A MAGDA spin-off project identified commonly reduced in real patients. encrypted linkage technology epigenetic (environmental) effects on Our research addresses gaps in both to analyse multiple Gestational gene expression in the development treatment and treatment delivery. Diabetes Mellitus (GDM) of diabetes during pregnancy. This is real-world translation, related data sets from hospitals, Subjects are drawn from Western implementation, health service government and pathology Health gestational diabetes and non- delivery and health-economic laboratories. This allows a large gestational diabetes clinics. The pilot research. amount of information to be study, published in 2016, showed differences between a number of We have completed research on gathered for an individual while groups. It appears that environmental length of stay and clinical costs in protecting their identity. The factors interact with genes to produce diabetes and lower limb cellulitis, individual’s condition can then adverse effects on both mothers with high-level publications be tracked over time to test if and their babies. For example, (including first author publications the appropriate interventions malnutrition during pregnancy has by our registrars in JAMA and the are happening. Research on a long-term health implications for Journal of Antimicrobial Therapy) gestational diabetes register aims to the babies who may develop heart and RACP registrar prizes. We also ensure long term follow up and an disease and diabetes in adult life. secured a $300,000 HCF Research intervention (MAGDA) to decrease Understanding how this happens Foundation grant to evaluate a progression of GDM mothers to will inform strategies to prevent new model of care for managing Type 2 diabetes. intergenerational transmission of community-acquired pneumonia – The second component of the these common diseases. the IMPROVE-GAP trial. project involved the recruitment of 578 subjects for a study comparing lifestyle intervention with usual care. The intervention was Western Health | Research Report 2016 46 Head of Department Research Staff

Prof Edward Janus 2 researchers and 9 students

False Economies in Home- Collaborator: T Haines (Monash We set out to compare diagnosis Based Antibiotic Treatment: A University) of Acute Kidney Injury (AKI) and/or Health-Economic Case Study Chronic Kidney Disease (CKD) using of Management of Lower-Limb This is a controlled evaluation, International Statistical Classification Cellulitis at a Large Metropolitan utilising a novel “stepped-wedge” of Diseases and Related Health Health Service clinical research design, to evaluate Problems (ICD 10), coding with a new model of care for managing Kidney Disease: Improving Global Researchers: K Kameshwar, community-acquired pneumonia (the Outcomes (KDIGO) criteria, to A Karahalios, E Janus and H IMPROVE-GAP trial). IMPROVE-GAP identify the proportion of patients Karunajeewa aims to address the gap between with AKI and/or CKD as per KDIGO evidence (including routine use criteria, and to evaluate their impact This is our seminal health systems / of steroids and early mobilisation on clinical outcomes. health-economic research project. antibiotic stopping rules) and Through this work we have proved practice. The study began in October When the gold-standard KDIGO we can interrogate the administrative 2016 and aims to recruit 800–1000 criteria are used, close to 70% of data sources at Western Health to patients. As of December 2016, 300 admissions to General Internal produce high quality published patients have been recruited. Medicine have kidney injury research that has direct relevance which may be acute, chronic or to service delivery planning. We Community-acquired pneumonia both. A review of records shows a hope it will be a platform that will is the most common and costly substantial number of admissions help us leverage dedicated funding condition we treat at Western are missed and not coded, with and position Western Health as a Health. Improvements in efficiency significant clinical implications for leader in health services and health- will pay a large dividend for patient the patient and financial implications economic research. outcomes and resource utilisation. for the health service. We hope this study will build Cellulitis is an extremely common a platform for further research and costly condition to manage of acute respiratory infections, at Western Health (330 inpatient facilitate expanded internal and admissions per year, costing $1.7 external collaboration, enhance Our Grants million). Improving efficiency of funding applications and see management will ensure resources Western Health positioned as a Bill and Melinda Gates Grant are freed up for more effective use. scientific leader in this field. H Karunajeewa (PI), I Mueller and JK The study results were published in Baird. Finding the Best Treatment 2015 and we responded to relevant Other sub-studies have commenced, for Vivax Malaria in the Solomon letters to the editor in 2016. including patient-reported outcome Islands. Bill and Melinda Gates measures (PROMS). IMPROVE-GAP: IMPROVing Foundation, $1,300,000 (2016–2018). Evidence-Based Treatment International Statistical HCF Project Grant Gaps and Outcomes in Classification of Diseases and E Janus, H Karunajeewa, E Skinner, Community-Acquired Pneumonia: Related Health Problems: Coding ML Ong, A Karahalios, R Harrison Standardising Evidence-Based Underestimates the Incidence and and T Haines. Hospitalisation Interventions to Shorten Length Prevalence of Acute Kidney Injury 2016 Report | Research Health Western for Pneumonia in the Elderly: of Stay, Reduce Readmissions, and Chronic Kidney Disease in Standardising Evidence-Based Reduce Hospital Costs and Improve General Medical Patients Interventions to Shorten Length of Patient-Reported Outcomes Researchers: Dr Soe Ko, A/Prof Vicki Stay, Reduce Readmissions, Reduce Researchers: E Janus, H Levidiotis, A/Prof Craig Nelson, Prof Hospital Costs and Improve Patient- Karunajeewa, E Skinner, ML Ong, M Edward Janus and Dr Kushma Nand Reported Outcomes. HCF, $300,000 Shackell, M Boyd, A Karahalios, AM (2016–2017). Kelly and R Harrison Collaborator: Sudharsan Venkatesan 47 Melanie Lloyd

Physiotherapist

They make up the biggest group of The year-long trial, which has recruited patients in the busiest wards at most 800 patients from the General hospitals, but never before have Internal Medical units at Footscray pneumonia patients been the subject and Sunshine hospitals, is one of the of such in-depth scientific scrutiny. biggest ever conducted at Western Health. The results could have far- The co-morbidities faced by many reaching implications not only for patients with Community-Acquired Western Health, but hospitalised Pneumonia (CAP) – particularly the pneumonia patients everywhere. elderly – mean that they typically, as a cohort, receive less attention from It is hoped that the multi-disciplinary researchers. approach will ultimately help generalist clinicians – who are often However that is changing at Western bombarded with a plethora of Health, where a team of specialist guidelines for multiple illnesses – clinicians are conducting a large- work as a team to provide consistent scale trial designed to improve the evidence-based treatment to an management and outcomes of CAP important cohort. patients. “They are the biggest group of The ‘IMPROVing Evidence-based patients, with a very common Treatment Gaps and Outcomes in diagnosis, but the complexity of Community-Acquired Pneumonia’ their medical conditions means they (IMPROVE-GAP) study aims to are often excluded from research,” optimise the care of CAP patients, says Ms Lloyd, who worked as a combining the best evidence-based physiotherapist in Queensland and in interventions from the medical, the UK before joining Western Health. physiotherapy and nutrition specialties. Each year, CAP causes an estimated 61,000 hospital admissions in Physiotherapist Melanie Lloyd is Australia, costing more than $300 one of eight principal investigators million. At Western Health alone, in the study, which is being led by there are more than 1000 CAP A/Prof Harin Karunajeewa and Prof admissions annually. Edward Janus, Western Health’s Director of Research and head of the General Internal Medicine Unit. The other principal investigators are Dr Elizabeth Skinner, Dr Emily Karahalios, Prof Terry Haines, Melina Shackell and Prof Anne-Maree Kelly. Western Health | Research Report 2016 48 Western Health | Research Report 2016 Report | Research Health Western

The year-long trial, which has recruited 800 patients from the General Internal Medical units at Footscray and Sunshine hospitals, is one of the biggest ever conducted at Western Health. 49 Infectious Diseases

Our Research Output 5 3 Projects Publications

3 1 Presentations Proceeding Western Health | Research Report 2016 50 Head of Department

A/Prof Garry Lane

The Infectious Diseases Unit qSOFA Performance in an provides clinical services across Our Research Australian Health Service all Western Health campuses at all (qSOFAinOz) times, including contributions to CAMERA2 – Combination the Infection Prevention Program Researchers: Dr Christian McGrath Antibiotic Therapy for Methicillin and Antimicrobial Stewardship and Dr Adrian Tramontana Resistant Staphylococcus Aureus Program. Until 2015/16, research was infection – An Investigator- This study aims to compare the predominantly focused on quality Initiated, Multi-Centre, usefulness of qSOFA scores for assurance (QA) and entirely related Parallel Group, Open Labelled timely identification of sepsis with to auditing these clinical services. In Randomized Controlled Trial that of traditional SIRS criteria. 2015/16, the Infectious Disease Unit Sepsis is a common presentation has for the first time commenced Researchers: Dr Stephen Guy and at Western Health and has collaborative research as part of Dr Adrian Tramontana significant morbidity and mortality. a multinational trial (CAMERA2 Good outcomes depend on Study), as well as participation in the Collaborators: S Tong and J Davis timely identification of sepsis and Diabetic Foot Study Interest Group (Menzies School of Health Research) administration of antibiotics. (DEFIANZ). These are the first of This study evaluates whether several collaborative projects under The Utility of GeneXpert MTB/RIF addition of a B-lactam antibiotic the umbrella of the Australasian Assay in the Western Region of improves outcomes in the treatment Society for Infectious Diseases Melbourne: The First Three Years (ASID) Clinical Research Group. of MRSA bacteremia. MRSA This complements the ongoing QA bacteremia has poorer outcomes Researchers: Dr Shio Yen Tio, projects currently held in the Unit compared with “sensitive” Dr Jenny (Siaw Jin) Wong and Dr and local research undertaken by Staphylococcal bacteremia. Stephen Guy registrars. The topics chosen for collaborative research, local QA Delays in Presentation and This study evaluates the sensitivity projects and registrar projects are Diagnosis of Pulmonary and specificity of GeneXpert MTB/ all selected for their direct relevance Tuberculosis: A Retrospective RIF assay versus smear microscopy to patients seeking care through the Study of a Tertiary Health Service with MTB culture, using positive health service, with improved patient in Western Melbourne, 2011–2014 histology as our reference. There care outcomes the primary objective. has always been a high burden of Researchers: Dr E Williams, A/Prof tuberculosis among populations G Lane and Dr S Guy who seek treatment at Western Collaborator: A Cheng (Alfred Health. This study aims to assess Health, Monash University) the utility of this test in guiding early commencement of TB treatment This project seeks to evaluate and appropriate second line TB reasons why delays between treatment in patients with positive symptom onset and therapy GeneXpert and rpoB mutation commencing exist for patients respectively.

with pulmonary Tuberculosis. 2016 Report | Research Health Western Early diagnosis and prompt commencement of treatment are important for effective tuberculosis control. Delayed diagnosis may worsen the severity of disease and increase the risk of death. 51 Intensive Care

Our Research Output 17 16 13 Projects Publications Presentations

Western Health | Research Report 2016 Dr Forbes McGain 52 Head of Department Research Staff

A/Prof Craig French 5 researchers and 1 student

The Department of Intensive Care Two large studies will commence conducts clinical research at both in 2017 at Western Health. The Sunshine and Footscray Hospitals. first is PLUS, an evaluation of a Our research addresses questions balanced electrolyte solution of importance to both clinicians compared with 0.9% Saline. These and patients, and focuses on are two of the most commonly studies evaluating patient-centred prescribed intravenous solutions outcomes: how a patient feels, looks used worldwide and this will be the and survives. We are a member of the largest study ever to address the Australian and New Zealand Intensive relatively simple but unanswered Care Society Clinical Trials Group question: is one better than (ANZICS CTG), one of Australia’s the other? The second project leading clinical trial networks. to launch will be SUDDICU, a A/Prof Craig French, the Director of uniquely designed study using Intensive Care, is the current chair. a cluster randomised crossover. Many of our current projects are This represents a new clinical trial NHMRC funded and ANZICS CTG methodology that may redefine how endorsed. Our research consistently large pragmatic clinical trials are informs our practice by providing conducted. high-level evidence that reduces inter-clinician and inter-hospital In 2016, A/Prof French received variation. High profile examples the Peter Schiff Award from the include: the NICE sugar study, which Australian and New Zealand Society definitively demonstrated that tight for Blood Transfusion. This award glycaemic control, a labour intensive recognised A/Prof French’s research and expensive intervention, leads to into the nature and roles of blood patient harm; the CHEST study which products and his promotion of their demonstrated that an expensive appropriate clinical use leading to artificial colloid solution increased better healthcare in Australia. the number of patients requiring renal replacement therapy; and, the ARISE study which concluded that some invasive and expensive treatments for severe infection did not improve patient outcomes. Western Health | Research Report 2016 Report | Research Health Western 53 Intensive Care continued

STandaRd Issue TrANsfusion the ICU. In Australia, almost 800,000 Our Research versuS Fresher Red Blood Cell Use units of blood are required each in intenSive carE (TRANSFUSE) – A year to provide Australians with Randomised Controlled Trial the blood they need. This study A Randomised Blinded Placebo will provide critically important Controlled Trial of Hydrocortisone Researchers: A/Prof Craig French, information that will help blood in Critically Ill Patients with Septic Dr John Mulder, Dr Sathyajith banks implement the findings. The Shock (the ADRENAL Study) Velandy Koottayi, Dr Forbes McGain results of our study will impact and Dr Zia Ansari Researchers: A/Prof Craig French, transfusion policy worldwide and could ultimately save many Dr John Mulder, Dr Sathyajith Collaborators: The ANZIC research thousands of lives each year. Velandy Koottayi, Dr Forbes McGain centre, ANZICS Clinical Trials Group and Dr Zia Ansari and Australian Red Cross Blood A Randomized, Double-Blind, Service Collaborators: The George Institute Placebo-Controlled, Phase 3 Study to Assess the Safety and Efficacy for Global Health, ANZICS Clinical Once blood is donated it can be of ART-123 in Subjects with Severe Trials Group stored for up to 42 days, however Sepsis and Coagulopathy we do know that changes occur in Septic shock is a leading cause of the blood when it is stored. This mortality in the critically ill. The Researchers: A/Prof Craig French, is called a storage lesion. It is not use of steroids in the treatment of Dr John Mulder, Dr Sathyajith known whether these changes are sepsis has been much debated for Velandy Koottayi and Dr Forbes harmful to patients. It is standard over 40 years. Previous research McGain practice to always first issue the has suggested that the use of low oldest blood stored in blood The purpose of this study is dose steroids may have short term bank to minimise the amount that to evaluate the safety and benefits in improving the circulation. is wasted by reaching its use-by efficacy of a human recombinant However, there is no agreement date. This study will determine the thrombomodulin (ART-123) amongst doctors around the world effect of transfusing the freshest compared with placebo in about whether treatment with or blood in the inventory compared participants with Severe Sepsis and without low dose steroids improves to transfusing the oldest blood in Coagulopathy. Approximately 800 the overall mortality. The purpose inventory (current standard of care). participants will be enrolled into the of this study is to find out whether We will determine if these two study from 240 sites globally. adult patients admitted to the inventory management approaches Intensive Care Unit with septic shock affect mortality in critically ill Sepsis is a life-threatening condition who are given hydrocortisone, patients. Footscray Hospital have that affects millions of patients compared to placebo, will have recruited 124 patients and Sunshine worldwide and continues to have an improved rate of survival at 90 Hospital have 16 patients recruited high mortality rates. Sepsis can lead days. This study aims to enrol 3800 so far. Blood transfusion is a very to severe organ failure and result in patients from over 50 international common and potentially life-saving coagulopathy. Information and data sites. Footscray Hospital have treatment. Hundreds of thousands gathered in this study may benefit recruited 77 patients, and Sunshine of Australians and an estimated 16 the community, scientists and Hospital have 12 patients. This study million persons worldwide receive doctors to learn more about ART-123 only has <200 patients to finish a blood transfusion each year and as a treatment for Severe Sepsis and recruitment globally. about one sixth of these occur in Coagulopathy. Western Health | Research Report 2016 54 Our research addresses questions of importance to both clinicians and patients, and focuses on studies evaluating patient-centred outcomes: how a patient feels, looks and survives.

Standard Versus Accelerated The Augmented Versus Routine Initiation of Renal Replacement Approach to Giving Energy Trial: Our Grants and Awards Therapy in Acute Kidney Injury A Randomised Control Trial (STARRT-AKI): A Multi-Centre, (TARGET) Peter Schiff Award Randomised, Controlled Trial Researchers: A/Prof Craig French, C French (joint winner). The award Researchers: A/Prof Craig French, Dr John Mulder, Dr Forbes McGain, recognises significant contributions Dr John Mulder, Dr Sathyajith Dr Gerard Fennessy, Miriam Towns, to transfusion medicine through Velandy Koottayi, Dr Forbes McGain Samantha Bates, Caroline Calkin and efforts leading to better healthcare and Dr Gerrard Fennessy Heather Jordan in Australia or New Zealand. Australian and New Zealand Society Collaborators: Canadian Critical Collaborators: ANZIC research of Blood Transfusion, $5000 (2016). Care Trials Group, Applied Health centre, ANZICS Clinical Trials Group, Research Centre, St Michael’s Medical Research Institute of New ACTA Trial of the Year Awards 2016 Hospital (Canada), George Institute Zealand and the Centre of Research C French (Finalist). The EPO-TBI Trial for Global Health (Australia), Excellence Translating Nutritional – A randomised Placebo Controlled ANZICS Clinical Trials Group and Science into Good Global Health Trial of Erythropoietin in ICU Patients Australasian Kidney Trials Network with Traumatic Brain Injury. Australian Each year around 130,000 Clinical Trial Alliance (2016). This study aims to determine Australians are admitted to ICU at whether immediate initiation of a daily cost of approximately $4000 renal replacement therapy (RRT), per patient. Their care consumes compared to delayed approach to close to $3 billion per year. These RRT initiation, improves survival and critically ill patients are the sickest renal recovery (RRT independence) in the hospital. Nutrition therapy is at 90 days in critically ill patients an essential standard of care for all with severe AKI. Recruitment started ICU patients who are mechanically at Western Health in March 2016 ventilated and remain in ICU for and is ongoing. Acute kidney injury more than a few days. Enteral (AKI) occurs in up to 20% of patients nutrition (via a nasogastric tube) treated in ICU. When severe, it is usually initiated within 24 hours requires RRT and is associated with of ICU admission). Previous trials high healthcare costs and a high support the concept that optimising mortality. Beyond the acute high nutrition in the critically ill will mortality, survivors of AKI carry improve outcome, however, the long-term greater risks of mortality, evidence is limited, inconclusive and requirement for institutional care generally of low quality. The primary and the development of chronic and aim of the study is to determine if end stage kidney disease. There are augmentation of calorie delivery, currently no proven treatments to using energy dense enteral nutrition reduce the burden of morbidity or in mechanically ventilated patients, mortality with AKI. improves 90-day survival when 2016 Report | Research Health Western compared to routine care. This is a 4000 patient, multi-centre, double- blinded, randomised, controlled, parallel-group, phase 3 clinical trial. Recruitment commenced at Footscray Hospital ICU on 16 June 2016. 55 The Joseph Epstein Centre for Emergency Medicine Research (JECEMR) conducts clinical research to address issues faced by patients in our emergency departments. We are always striving to understand the impact of their illness or injury and ways we can provide better care. Emergency care does not occur in isolation – we work with clinicians from across disciplines – and the issues in Melbourne’s West are often common to those faced elsewhere in the world. Thus, JECEMR has an active program of collaboration, this year engaging with clinicians from Joseph Epstein the Department of Cardiology and countries including New Zealand, Centre for Emergency Australia, Singapore, Hong Kong, Malaysia, France and the United Medicine Research Kingdom. This year’s key project has been the (JECEMR) Asia, Australia and New Zealand Dyspnoea in Emergency Medicine (AANZDEM) study. This project, currently in its analysis phase, collected data from 3044 patients across more than 40 sites in five countries to better understand the causes, assessment, treatment and outcome for patients presenting Our Research Output to emergency departments with shortness of breath.

JECEMR continues to foster early career researchers. This year two research students, Imogen Ackerly 5 15 5 and Brittany Scott-Rimington, Projects Publications Presentations completed projects on more efficient diagnosis of pulmonary embolism in older adults and contamination of stethoscopes. New projects this year concentrate on agreement between plasma and blood gas electrolytes and the rate and risk factors for catheter- associated urinary tract infections.

Western Health | Research Report 2016 Prof Anne-Maree Kelly 56 Head of Department Research Staff

Prof Anne-Maree Kelly 3 researchers and 2 students

The AANZDEM Study is to determine what proportion of Our Research analysis using the blood gas analyser Researchers: Prof Anne-Maree Kelly falls outside defined clinically and Sharon Klim acceptable limits of agreement. Age-Specific D-Dimer Cut Off Scores in the Assessment of Collaborators: The AANZDEM study Incidence of Catheter-Associated Pulmonary Thromboembolism – group (50 members from Australia, Urinary Tract Infection in ED A Comparative Investigation of New Zealand, Singapore, Hong Patients Catheterised for Acute Accuracy and Impact – The ADAPT Kong, Malaysia and France) and Prof Urinary Retention (AUR) study Charles Lawoko (Victoria University) Researchers: Prof Anne-Maree Kelly, Researchers: Prof Anne-Maree Kelly, This international study explores the Sharon Klim and Dr Benjamin Butcher Sharon Klim, Imogen Ackerly and Dr causes of shortness of breath among James McFarlane adults presenting to emergency The study looked at adult male departments. This will help us patients presenting to the ED with This study investigated whether any of evaluate the best quality of care. acute urinary retention and the three described age-specific D-dimer incidence of catheter associated cut-offs could be used to safely rule Agreement Between Blood Gas urinary tract infection (CA-UTI) during out PE in low-risk patients aged over Electrolytes, Haemoglobin and the period of catheterisation. The 50 years presenting to an Australian Lactate Values and Serum Values project also considered the time of Emergency Department. It also asked in ED Patients insertion (in days) to trial of void (TOV) which of the described cut-offs had impact on the rate of CA-UTI. This Researchers: Prof Anne-Maree Kelly, the best clinical performance. Our project could potentially be used to Sharon Klim, Dr Michael Gibbons and findings show an age-specific D-dimer establish an incidence of CA-UTI in Arthur Mantzaris cut-off would improve specificity an ED population of patients with and NPV, reducing the number of There is usually >1-hour delay to acute urinary retention treated as unnecessary CTPAs. laboratory results for electrolytes outpatients, reduce complications for patients catheterised for AUR, and How Clean is Your Stethoscope? and haemoglobin, so for critically ill ED patients, point-of-care blood inform development of an evidence- Researchers: Prof Anne-Maree Kelly, gas analyses are often used to based guideline on time to TOV. Sharon Klim and Brittany Scott- guide initial care. In order for this Rimington to be clinically justified, clinicians need to understand agreement The aim of this observational, point (and non-agreement) between prevalence study was to measure the point of care and laboratory compliance with stethoscope analysis methods. It is recognised cleaning procedures in the that the different analytical methods Emergency Department (ED). The may generate a difference in project sought to determine what results however it is important to proportion of stethoscopes used in determine the magnitude and ED are contaminated and with what spread of this difference. This Western Health | Research Report 2016 Report | Research Health Western microbial agents, and measure the project reviewed established impact of an educational program for bias and 95% limits of agreement doctors and nurses on stethoscope between electrolyte values (sodium, cleaning compliance rates (using potassium and bicarbonate), a before and after comparison of lactate and haemoglobin in whole observational study). Results showed blood specimens analysed by the implementation of a multimodal ED resuscitation room blood gas educational package resulted in a analyser and specimens analysed modest change of staff behaviour using standard techniques in the towards the cleaning of stethoscopes. central hospital laboratory. The aim 57 Melbourne Neuropsychiatry Centre

Our Research Output 8 20 37 Projects Publications Presentations

1 4 Chapter Proceedings

The Western Centre for Health Research

Western Health | Research Report 2016 and Education at Sunshine Hospital. 58 Head of Department Research Staff

Prof Christos Pantelis 18 researchers and 9 students

The Melbourne Neuropsychiatry The CRC Psychosis Study – Part Centre (MNC) is a multi-site Our Research of CRC for Mental Health; clinical research centre, based in Study Examining Patients with the Alan Gilbert Building at the Treatment-Resistant Schizophrenia Identifying Neuroimaging University of Melbourne, Parkville, Biomarkers of Psychosis Onset the Neuropsychiatry Unit at the Researchers: C Pantelis, I Everall, C and Relapse Royal Melbourne Hospital and Bousman, A Zalesky, S Sundram, C Rahm, S Lieblich and C Phassouliotis the Western Centre for Health Researchers: C Pantelis, V Cropley, (Coordinator) Research & Education (WCHRE) A Zalesky, B Baune, J Olver, P at Sunshine Hospital. The Centre Amminger, A Scott, C Phassouliotis, Collaborators: C Martinez, S focuses on understanding the R Banati, G O’Keefe, A Fornito, C Cornejo, S Mancuso, S Atherton, S neurobiology of mental disorders Shannon Weickert, I Everall, S Kumar, Dimitrakopoulos and A Pereira from childhood to adulthood, using N Thomas, D Velakoulis, M Jimenez- novel research techniques and the Alvarez, B Nelson, U Ackermann, J PhD Students: C Wannan, E latest technologies. The Centre Sachinidis, G Chan, T Rolfe, L Allen, Ganella, S Mostaid, S Saini, C Liu, D consists of over 60 people, and C Bousman, M Hopwood, A Polari, I Kang, Y Tian and L Laskaris receives funding support from major Hickie and P McGorry grants through the NHMRC and Research Assistants: A Burnside ARC, as well as other national and PhD students: M Di Biase and L and S Gale international funding agencies. Laskaris Patients with the most severe Two of the ongoing research streams This study uses sophisticated forms of schizophrenia are often within the MNC have significant brain imaging to investigate brain referred to as having treatment- and longstanding links with inflammation. We are using positron resistance. Many will be treated Western Health. The Psychosis and emission tomography (PET) to with clozapine, our most effective Developmental Neuropsychiatry label the brain’s inflammatory medication for this disorder and the stream seeks to understand the cells, the microglia. We seek to drug of choice for TRS. However, neurobiology of disorders emerging understand if the progressive brain this medication has a number of in childhood and adolescence, changes we first identified over a side-effects and only about 50% including autism and psychotic decade ago (with a seminal paper of TRS patients will respond to this disorders. A major component of this published in 2003 – Pantelis et al, drug. We are assessing a number work has continued to be undertaken Lancet) are explained in part by of brain imaging, cognitive and at the WCHRE throughout neuroinflammation. To date, we blood biomarkers with the goal of 2016, including recruitment of have scanned over 70 participants, identifying those who will respond participants with psychotic illnesses, including patients at all stages of to treatment. Early identification psychopharmacological studies psychosis and schizophrenia as of those patients who will respond in schizophrenia, and studies well as healthy controls If brain would be of great help to clinicians in children with developmental inflammation is involved in some making treatment decisions and disorders. The Depression and of our patients with schizophrenia could help our patients at earlier Anxiety Neuroscience stream aims to and other psychoses, we will be stages of the illness before they are

develop integrated models based on able to identify new ways to treat deemed treatment-refractory. 2016 Report | Research Health Western affective neuroscience for treatment- this disorder. The aim is to examine oriented research and discovery in if our medications might reduce mood and anxiety disorders. The such inflammation and prevent or group established a base at the ameliorate the brain changes we WCHRE and Sunshine headspace have seen. in 2012. Its ongoing projects involve recruitment and treatment of young people with affective disorders and the use of Sunshine Hospital’s MRI scanning services. 59 Melbourne Neuropsychiatry Centre continued

Neural Predictors of Treatment Neural Correlates of Childhood Investigation of Cardiac Response in Youth Depression Schizotypal Disorder Relative to Abnormalities in Schizophrenia Autism Spectrum Disorder and Patients Treated with Clozapine Researchers: B Harrison, C Davey, ‘Typically Developing’ Children C Pantelis, P McGorry, R Kerestes, Researchers: C Pantelis, N Thomas, C Bousman, K Stephanou and S Researchers: C Pantelis, I Harding, M Jayaram, C Neil and C Bousman Whittle R Testa, B Tonge, A Zalesky and S Skafidas This is a project to identify the onset Research Assistant: L Incerti of myocarditis in patients who are Collaborators: A Abu-Akel, B treated with clozapine for treatment- In order to reduce the substantial Harrison, H Jones, I Everall, M Seal, resistant schizophrenia, with a focus burden of depression on individuals N Ross, S Whittle, S Wood and N on how to carefully re-challenge and society there is a need to Stefanis with clozapine, as the options for optimise the early provision of treating this condition beyond existing treatments. This issue is Students: H Jones (PhD) and F van clozapine are limited. Following on especially relevant to the treatment Beurden from discussions with the cardiology of young people with depression, team and close liaison with the MDT, Schizotypal disorder in children where there is a lack of consensus on two patients received successful is characterised by bizarre and what constitutes the most effective re challenge with clozapine, fantastical ideation with children first-line treatment: particularly using a very carefully controlled spending much of their waking whether psychotherapy should be and monitored titrating regime. hours immersed in imaginary worlds. offered alone or in combination These patients showed significant This contrasts with autistic children with medication. This study uses functional improvements and the who become preoccupied with functional magnetic resonance results are in the process of being items in the external world. In a imaging (fMRI) to characterise submitted for publication. novel brain-based biomarkers of world-first study, we are examining treatment response in young people differences in brain networks in Further work explores the causes with depression participating in children with schizotypal disorder of myocarditis with clozapine a 12-week randomised clinical and autism spectrum disorders treatment, including identification trial (RCT) of psychotherapy plus in comparison with typically of genetic markers. Clozapine medication versus psychotherapy developing children. Understanding remains the last and most effective plus placebo. This project the neurobiological basis of these line of treatment for those patients represents the largest cross- disorders will inform intervention who have not responded well to sectional study of brain function approaches to ameliorate disorder other treatments. Unfortunately, in young people with depression. and improve functional outcomes. clozapine is associated with serious It is the largest longitudinal study side effects for a proportion of of treatment effects on the brain patients. Such patients may show a in this patient group and the first good symptom response, however, neuroimaging study in depression to may suffer from cardiac or other assess predictors of psychotherapy side effects. This project has shown and medication in the context of a that by developing a carefully placebo-controlled RCT. A total of calibrated protocol, it is possible to 152 young people with depression successfully reintroduce clozapine, and 105 healthy controls have resulting in significant improvement been scanned at the MRI centre in their condition. at Sunshine Hospital for this study since 2013. Western Health | Research Report 2016 60 The Centre focuses on understanding the neurobiology of mental disorders from childhood to adulthood, using novel research techniques and the latest technologies.

NHMRC Project Grant NHMRC Project Grant Our Grants and Awards B Harrison, C Davey, M Yucel, S A Chanen, P McGorry, B Nelson, S Whittle, A Fornito, J Pujol, C Pantelis Cotton, H Jackson, K Thompson, and P McGorry. Neural Predictors C Bartholomeusz, M Jovev, A NHMRC-EU Grant of Treatment Response in Youth Ratheesh, C Davey and C Pantelis. C Pantelis, S Skafidas, D Velakoulis Depression. National Health and Randomised Controlled Trial of and I Everall. PRONIA – Personalised Medical Research Council, $498,820 Aripiprazole for Treatment of Prognostic Tools for Early Psychosis (2014–2017). Auditory Verbal Hallucinations in Management. National Health and Borderline Personality Disorder. Medical Research Council, $386,686 NHMRC Project Grant National Health and Medical (2014–2017). A Fornito, C Bousman, A Zalesky, Research Council, $2,748,148 B Harrison, V Cropley and D NHMRC-EU Grant (2016–2019). Velakoulis. Dopamine, Fronto- P McGorry and C Pantelis. PSYSCAN Subcortical Circuits and Risk for NHMRC Senior Principal Research – Translating Neuroimaging Schizophrenia. National Health and Fellowship Findings from Research into Clinical Medical Research Council, $828,633 C Pantelis. Neurobiological ‘Risk’ Practice. National Health and (2013–2017). and ‘Resilience’ Biomarkers of Medical Research Council, $366,081 Severe Mental Illness. National (2014–2017). NHMRC Project Grant Health and Medical Research A Fornito, V Cropley, P Thomas, B CRC for Mental Health Council, $926,980 (2016–2020). Harrison, C Pantelis and S Francey. C Pantelis, I Everall, B Dean, C A Combined PET-fMRI Study of NHMRC Career Development Bousman and S Sundram. Frontostriatal Dysfunction in First- Fellowship Identification of Biomarkers of Episode Psychosis. National Health B Harrison. Depression and Anxiety Treatment-Resistant Schizophrenia and Medical Research Council, Neuroscience. National Health and and Other Psychotic Disorders: Can $606,562 (2014–2018). Medical Research Council, $470,144 We Predict Clozapine Response? (2017–2020). CRC for Mental Health, $750,523 NHMRC Project Grant (2011–2018). C Davey, P McGorry, A Chanen, NHMRC Career Development S Hetrick and K Yuen. Youth Fellowship NHMRC Project Grant Depression Alleviation: A C Bousman. Pharmacogenetics V Cropley, C Pantelis, B Baune, J Randomised Controlled Trial of of Antidepressant Response and Olver and P Amminger. Investigating Cognitive Behavioural Therapy with Remission: Toward Genotype- Neuroinflammation and its Fluoxetine or Placebo. National Guided Prescribing in Major Relationship with Progressive Brain Health and Medical Research Depressive Disorder. National Structural Loss in Schizophrenia. Council, $1,200,000 (2012–2017). Health and Medical Research National Health and Medical Council, $470,144 (2017–2020). Research Council, $447,525 (2014– NHMRC Project Grant 2017). A Zalesky, C Pantelis, D Velakoulis, NARSAD Young Investigator Grant C Bousman and I Everall. Resilient V Cropley, A Fornito and C Pantelis. NHMRC Project Grant Brain Networks in Patients with Investigating the Dopaminergic P Amminger, C Pantelis, T Whitford, Schizophrenia and their Unaffected Basis of Dysregulated Frontostriatal 2016 Report | Research Health Western S Whittle, A Fornito and D Hermens. Siblings. National Health and Circuitry in Psychosis: A PET Erythrocyte Membrane Fatty Acid Medical Research Council, $474,226 [18F]FDOPA and Resting-State Concentrations and Myelin Integrity (2016–2019). Functional Imaging Study. Brain in Young People at Ultra-High Risk & Behavior Research Foundation, of Psychosis. National Health and $60,000 (2014–2017). Medical Research Council, $390,879 (2014–2017). 61 In 2016, the Department of Nephrology at Western Health continued to participate in multi- centre international trials exploring new therapies for diabetic nephropathy. It acquired six new trials investigating therapies for anaemia complicating kidney disease, ANCA vasculitis and Focal Segmental Glomerulosclerosis (FSGS), and a novel anti- inflammatory against fatty liver disease.

Researchers in the department have continued to participate in Nephrology national trials co-ordinated by the Australasian Kidney Trials Network.

The Primary Care project, eMAP CKD:VIC, is a collaborative effort between Western Health, Kidney Health Australia, Networking Health Victoria, Macedon Ranges and North Western Melbourne Medicare Local and the Department of Health and Human Services. It is funded Our Research Output through the Department’s Victoria Renal Health and Aboriginal Health Clinical Networks and was finalised and results have been published.

The Chronic Disease IMPACT project, funded by a legacy grant 15 11 2 from Macedon Ranges and North Projects Publications Presentations Western Melbourne Medicare Local was commenced and is now well underway.

A/Prof Craig Nelson, Head of

Western Health | Research Report 2016 Western Health’s Nephrology Unit. 62 Head of Department Research Staff

A/Prof Craig Nelson 3 researchers and 2 students

disease is the number one cause of PDOPPS: The Australian Our Research death in patients with kidney disease Peritoneal Dialysis Outcomes and and this may be contributed to by Practice Patterns Study vascular calcification. Chronic Disease IMPACT Researcher: A/Prof Craig Nelson CKD FIX Trial: A randomised Researcher: A/Prof Craig Nelson Controlled Trial of Slowing of Collaborator: Australasian Kidney Trials Network Collaborators: Prof David Story Kidney Disease Progression from the Inhibition of Xanthine Oxidase (University of Melbourne), Dr Jo- This project aims to provide a Anne Manski- Nankervis (University Researcher: A/Prof Craig Nelson better understanding of the impact of Melbourne), Prof Maximilian De of modifiable practices in the Courten (Victoria University), A/ Collaborator: Australasian Kidney management of PD patients on the Prof Shane Hamblin, A/Prof Nick Trials Network risk of all-cause peritoneal dialysis Cox, A/Prof Chris Neil, Prof Tissa technique failure. Currently, in Wijernatne, Prof Edward Janus, Bill The primary aim of the study is to Australia, nearly 25% of people on Karanatsios, Debbie Broomfield, Dr test the hypothesis that uric acid dialysis are using peritoneal dialysis. Jo Silva and Bianca Bell lowering therapy, with the xanthine oxidase (XO) inhibitor, allopurinol, Chronic vascular diseases can be will significantly slow kidney failure under-reported or only detected progression in patients with in later stages. This project is a moderate chronic kidney disease Our Grants and Awards collaboration between primary (CKD). CKD affects 1 in 10 people care and disease specialists, which in Australia and is a major cause of Legacy Grant aims to reduce the burden of cardiovascular death. C Nelson (PI). Chronic Disease chronic vascular diseases (T2DM, IMPACT. North Western Melbourne CVD, CKD) and risk factors, such as SCOUP-HOME DIALYSIS-VIC: Medicare Local, $250,000 (2016– familial hypercholesterolaemia. The Standardising Care, Outcomes, 2018). project will design and implement a Uptake and Persistence in Home disease management e-technology Dialysis in Victoria NHMRC Centre for Research module to be installed into primary Excellence Researchers: A/Prof Craig Nelson, care practices. Eight primary care C Nelson (AI). Chronic Kidney Dr Sandra Crikis and Shaun practices have been recruited, Disease Centre for Research Finlayson software has been designed, and user Excellence. National Health acceptance testing has commenced. Collaborator: Victorian Renal and Medical Research Council, The platform aims to facilitate earlier Clinical Network $2,500,000 (2014–2020). disease diagnosis and identify those patients at risk of developing a The study will review the major Victorian Renal Clinical Network chronic vascular disease. differences in practices among C Nelson, S Crikis and S Finlayson. treating home therapy units with SCOUP-HOME DIALYSIS-VIC: Improve Trial a view to identify strengths and Standardising Care, Outcomes,

Uptake and Persistence in Home 2016 Report | Research Health Western Researcher: A/Prof Craig Nelson weaknesses across home dialysis units throughout Victoria. Despite Dialysis in Victoria. Victorian Renal Collaborator: Australasian Kidney the recognised advantages of home Clinical Network, $143,038 (2016– Trials Network based dialysis therapies, most centres 2017). in Victoria are not reaching state KPI This project aims to test if phosphate targets. A state-wide effort is needed binders not containing calcium have to ensure standardisation of home an impact on vascular calcification based therapies in different centres. before the commencement of dialysis therapy. Cardiovascular 63 Improving the rate of diagnosis of kidney disease was the motivation for A/Prof Nelson setting up the eMAP CKD project two years ago. Western Health | Research Report 2016 64 A/Prof Craig Nelson

Head of Western Health’s Nephrology Unit

The facts behind what A/Prof Craig The second is the establishment of Nelson considers the “forgotten the Western Chronic Disease Alliance, cousin of the chronic diseases” are a collaboration that aims to improve sobering. the early detection and management of chronic vascular diseases such as One in 10 Australians will develop chronic kidney disease, diabetes and kidney disease. And when they do, cardiovascular disease. 95% of them won’t be aware of it. The alliance, chaired by A/Prof “What a lot of people don’t know Nelson, is an evolving partnership is that kidney disease is twice as between Western Health, the common, and twice as deadly, University of Melbourne’s Health as diabetes alone,” says A/Prof Economics Unit, Kidney Health Nelson, Head of Western Health’s Australia, Diabetes Victoria, Heart Nephrology Unit. Foundation, Primary Healthcare Network and Victoria University’s “I think that’s because people don’t Department of Population Health. understand kidney disease. It’s under-recognised in primary care, A/Prof Nelson says the alliance and only 0.55% of the population aims to assess two major groups: know they’ve got it. We see about high-risk patients being re-admitted one in four people who arrived at to hospital who are already using (the need for) dialysis not knowing the health service; and rising-risk about their kidney disease.” patients in both the primary care and hospital settings. Improving the rate of diagnosis of kidney disease was the motivation A/Prof Nelson says it is important for A/Prof Nelson setting up the that researchers and clinicians eMAP CKD project two years ago. across major areas of chronic The trial, which involved 170,000 disease, including kidney disease, patients across 22 Victorian cardiovascular disease, obesity and primary care practices, dramatically diabetes, join forces. increased the detection of chronic kidney disease. “We should all be singing with one voice, rather than individual silos, The success of the project, achieved because by ignoring one of the with modified software dubbed specialties you’re not doing justice “artificial intelligence on primary to the patient,” he says. care desktop”, has led to two very significant developments. “It’s becoming clearer that people don’t have just one chronic disease. The first is the launch of another It’s more common now to have large-scale primary care trial, the multiple chronic diseases than a 2016 Report | Research Health Western CD IMPACT (Chronic Disease single disease alone.” early detection and Improved Management in PrimAry Care A/Prof Nelson hopes the alliance ProjecT), which aims to increase model will, ultimately, be applicable the diagnosis of a broad range of to a much broader range of chronic diseases. These include chronic disease, such as respiratory heart disease, heart failure, familial medicine, osteoporosis, mental hypercholesterolemia, stroke and health, and drug and alcohol issues. Type 2 diabetes mellitus as well as Kidney Disease. 65 Neurology

Our Research Output 26 14 Projects Presentations

Western Health | Research Report 2016 Head of Department Prof Tissa Wijeratne. 66 Head of Department Research Staff

Prof Tissa Wijeratne 3 researchers and 15 students

Stroke is the leading cause of adult This trial is aimed at determining This study will contribute to the disability. One in three of us are at the safety and effectiveness of a field of rehabilitation post-stroke by risk of stroke or dementia according combination of low-dose aspirin identifying and optimizing better to the Framingham study. Western and clopidogrel (compared to rehabilitation regimes. This will Health is one of the largest providers aspirin only), in reducing the risk subsequently contribute to increased in stroke care for fellow Victorians. of stroke, heart attacks, and other quality of life for communities that Our research work in acute stroke complications in TIA or minor suffer from impaired vascular integrity. medicine has made significant in- ischemic stroke patients. This study roads to providing better care for will help us to optimise acute therapy DIDO: Door-In-Door-Out Times acute stroke patients. in minor strokes and TIAs. in Stroke Patients Transferred for Emergency Clot Retrieval In 2016, the Neurology Department EXTEND-IA TNK: Extending had four PhD students continuing the Time for Thrombolysis in Researchers: Prof Tissa Wijeratne, their work in brain health related Emergency Neurological Deficits Prof Helen Dewey, Dr Philip Choi, Dr issues. We had another research – Intra Arterial Using Intravenous Douglas Crompton, Dr Felix Ng, Dr student completing her Masters Tenecteplase Essie Low, Emily Andrew and Karen degree. Our group published 20 Smith papers in high quality journals during Researchers: Prof Tissa Wijeratne, Dr Collaborators: Eastern Health the year, with the START-EXTEND IA Hans Tu, Elizabeth Mackey, Jennifer Neurology Department, Northern clinical trial being published in NEJM Goff, Dr Ben Stevenson et al Health Neurology Department and in early 2015 and cited by more than Collaborators: Neuroscience Trials Ambulance Victoria 1400 authors since then. Australia, the Florey Institute of This is a retrospective study aimed In 2017, we are keen to map the Neuroscience and Mental Health and at analysing endovascular clot trajectories of stroke and other Royal Melbourne Hospital retrieval (ECR) transfer workflow, neurological disorders to promote This trial investigates whether with an emphasis on door-in-door- better brain health through ischemic stroke patients selected out (DIDO) times. DIDO time is translational research on the back of for endovascular therapy will show proposed as a new important five PhD students completing their improved reperfusion at initial clinical performance measure in projects at Western Health. angiogram, following treatment with modern stroke care, and may be IV Tenecteplase versus IV Alteplase. used to evaluate the timeliness and This study will help us to find a quality of initial care at the initial better clot buster therapy for acute Primary Stroke Centre. DIDO time Our Research ischemic stroke. is a key metric that may emerge as a quality benchmark to ascertain Cognitive Processing Following performance and improvement. POINT: Platelet-Oriented Cerebrovascular Events This audit ultimately aims to identify Inhibition in New TIA and Minor and quantify delays in the transfer Ischemic Stroke Trial Researchers: Prof Tissa Wijeratne, workflow which may be amendable Prof Sheila Crewther, Dr Diana Perre, to system optimisation and quality Researchers: Prof Tissa Wijeratne, Deena Ebaid, Vinh Nguyen, Dr Ben improvement efforts. 2016 Report | Research Health Western Elizabeth Mackey, Jennifer Goff, Dr Ong and Dr Essie Low Ben Stevenson et al Collaborator: La Trobe University Collaborators: Neuroscience Trials Australia at the Florey Institute of This study aims to investigate the Neuroscience and Mental Health and effects of a first TIA or stroke event University of California, San Francisco on information processing, attention, and visual processing functions. 67 Nursing and Midwifery

Our Research Output 12 9 22 Deakin University Victoria University Projects Publications Publications

9 1 12 Deakin University Victoria University Presentations Proceedings Proceeding

Western Health | Research Report 2016 Clinical Nurse Specialist Lana van Raay. 68 Executive Director, Research Staff Nursing and Midwifery 7 researchers and 13 students A/Prof Denise Patterson

Western Health Chair of Nursing – Deakin University

Prof Bodil Rasmussen

In 2016, the Centre for Nursing and Important studies led by researchers Midwifery Research, a partnership at Victoria University continue to between Western Health and focus on women’s experience during Deakin University, had a high birth and the postnatal period. level of clinical research focusing Evidence gained was used to ensure on safety and risk management, best and safe care of women at patient and carer engagement Western Health. Use of technology and experiences, and healthcare in provision of care is an increasingly workforce and service delivery. important priority in nursing and These major pillars underscore the midwifery research. Nursing and Midwifery 2016–2020 Research Blueprint. The Centre Projects testing web-based aims to build research capacity in educational interventions aimed nursing and midwifery, engaging at improving knowledge of healthy in research-focused workshops diet and lifestyle were undertaken. as well as supervision of research Researchers from Victoria University students. The Centre has been very focused in women with Gestational successful in attracting research Diabetes Mellitus, while researchers students, with more than 12 from Deakin University focused currently under supervision. Major on young people with Type 1 research undertakings were initiated diabetes. Both have resulted in the to gain a better understanding of planning of bigger studies with the psychosocial and cultural factors international collaborators, including influencing breastfeeding in women Copenhagen University, Denmark. with diabetes, involving three major Other international collaborations health services in Melbourne. have been established and led These studies were supported by a by Prof Bodil Rasmussen, who major grant from the Nurses Board commenced her appointment of Victoria and the Australasian in May 2016. Prof Rasmussen Diabetes in Pregnancy Society. works closely with Scandinavian Clinical research undertaken by Lana researchers around chronic van Raay, exploring prehydration in conditions and e-health. She angiography patients and possible is an executive member of the improvements for clinical practice, Scandinavian Translational Research was supported by the Mavis Mitchell in Chronic Conditions, which focuses Scholarship. on interventional research across chronic conditions with the aim of 2016 Report | Research Health Western translating evidence into clinical practice to assist people to live well with chronic conditions. 69 Nursing and Midwifery continued

Developing an Educational Exploring Prehydration in Our Research Intervention for High-Risk Women Angiography Patients: A Pilot with Gestational Diabetes Mellitus Study (GDM) Physical, Social, Psychological Researchers: Prof Bodil Rasmussen, and Cultural Factors Influencing Researcher: Cheryl Steele Dr Julian Nguyen, Dr Marcus Breastfeeding Intention, Initiation Mykytowycz, Lana van Raay and and Duration Among Women with Collaborator: Prof Mary Carolan- Jasmin Navarro Type 1 (T1DM) and Type 2 (T2DM) Olah (Victoria University) Diabetes Living in Victoria This study aims to improve hospital This project has developed a benchmarks by increasing availability Researchers: Prof Bodil Rasmussen, website to support women self- of overnight beds to those who need A/Prof Catherine Nagle and Cheryl managing their GDM. It addresses them and shortening waiting lists Steele issues of literacy and is available in for this procedure type. This study English and Vietnamese. Feedback will help us to improve the patient Collaborators: A/Prof Alison indicates that women find the experience without compromising Nankervis (Royal Women’s Hospital), website useful in terms of reinforcing patient safety. Cath McNamara (Mercy Hospital) health messages and promoting and Prof Helen Skouteris (Deakin greater understanding and self- A Haemodialysis Exercise University) management of GDM. Program: A Pilot Study Exploring a New Workforce Model This study’s main aim is to identify Women’s Perception of Safety facilitators and barriers to the During Labour and Birth Researchers: Krystyna Bender, intention to breastfeed, and the Dr Paul Bennett, Dr Wai Wang, A/ initiation and continuation of any Researcher: Margaret McCormick Prof Craig Nelson, Dr Lizzy Skinner, breastfeeding from birth for six Jason Bennier, Melina Shackell and Collaborators: A/Prof Marie Gerdtz, months in Victorian women with Prof Bodil Rasmussen T1DM and women with T2DM. The Dr Wendy Pollock and Dr Kiran Kilian second aim is to identify physical, (University of Melbourne) This study aims to investigate psychosocial and cultural risks whether this model improves the This study aims to develop and and protective factors associated physical function of people on evaluate information materials for with women with T1DM and T2DM dialysis and is acceptable to dialysis pregnant women in relation to their ceasing to breastfeed during the patients and nurse clinicians. This safety during labour and birth. This first six months following birth using project will assist us to provide study will assist organisations in Victorian population samples. This appropriate, safe and high-quality developing material that will improve project will assist us to provide care that improves physical function women’s perception of safety during appropriate, safe and high-quality of people on dialysis. labour and birth. care for women transitioning into motherhood, as well as encouraging breastfeeding as long as possible, hopefully meeting the World Health Organisation’s recommendation of six months after birth. Western Health | Research Report 2016 70 QPS Bridging Grant Our Grants and Awards B Rasmussen, J Currey, B Haig, V Zoffmann and T Dunning. An Innovative Online Self-Management Deakin University Intervention for Victorian Young Adults with Type 1 Diabetes: Guided Ella Lowe – Major Grant Self-Determination Program. The B Rasmussen. Physical, Social, Centre for Quality and Patient Safety Psychological and Cultural Factors Research, $12,500 (2016). Influencing Breastfeeding Intention, Initiation and Duration Among QPS Bridging Grant Women with Type 1 and Type 2 B Rasmussen, H Skouteris, S Brumby, Diabetes Living in Victoria. The H Rawson and R Brown. Investigate Nurses Board of Victoria Legacy the Prevalence, Health Literacy and Limited, $60,000 (2016) Well-Being of Patients in Australia with Diabetes and/or Cardiovascular ADIPS-NOVO NORDISK Grant Disease and the Comorbidity of B Rasmussen. Physical, Social, Anxiety and/or Depression. The Psychological and Cultural Centre for Quality and Patient Safety Factors Influencing Breastfeeding Research, $18,000 (2016). Intention, Initiation and Duration Among Women with Type 1 and Type 2 Diabetes Living in Victoria. Victoria University Australasian Diabetes in Pregnancy (ADIPS), $6,600 (2016) Lord Mayor’s Charitable Foundation Grant Diabetes Australia Research M Carolan-Olah, C Nagle, N Stepto, Program – 2016 Grant Round C Steele and V Vasilevski. Growing a G Wadley, B Rasmussen, S Mason Healthy Baby: Getting the Balance and S Hamblin. Improving Glycaemic Right in Pregnancy. Lord Mayor’s Control in Type 2 Diabetes with Charitable Foundation Exploration, Ascorbic Acid. Diabetes Australia $49,849 (2016). Research Trust, $59,921 (2016)

In 2016, the Centre for Nursing and Midwifery Research 2016 Report | Research Health Western had a high level of clinical research focusing on safety and risk management, patient and carer engagement and experiences, and healthcare workforce and service delivery. 71 Lana van Raay

Clinical Nurse Specialist

Ringing up patients to cancel She launched a similar six-month overnight hospital stays due to trial in July, funded by the $5000 a bed squeeze is not a task that sponsorship grant established in Clinical Nurse Specialist Lana van memory of the Western Hospital’s Raay relishes. first Matron, Mavis J Mitchell.

But rather than accept it as an “I was always the one having to unfortunate consequence of the make the call to patients to rebook, demands on the public health system, which is what made me start she went searching for answers. thinking about doing something different,” said Ms van Raay, an The Footscray Hospital nurse won Infection Control Link Nurse in the Western Health’s Mavis Mitchell Radiology Department. Memorial Scholarship in 2016 for a proposal to eliminate overnight “Patients would get frustrated and admissions for patients who need really angry. Many of the vascular intravenous hydration prior to having patients are elderly, and one woman angiography (radiography of blood had to organise respite for her or lymph vessels). husband so she could stay. But this trial involves running the hydration Vascular patients with poor kidney before, during and post-procedure, function require 10 hours of so they don’t need to come in the hydration to protect them from day before.” the dye used in the scans, which can cause a condition injuring the One patient a week is being recruited kidneys called Contrast Induced over a six-month period into the Nephropathy (CIN). trial, a collaboration between the Radiology and Vascular departments. At present, the high-risk group is admitted a day earlier and hooked up She said the cohort of patients are the to the intravenous drip from midnight. same as those involved in the Dutch study – including co-morbidities like But Ms van Raay discovered that heart problems and diabetes, and 10% of cases between March and aged from 45–90 – and is hoping it will July last year were cancelled due to be equally as successful. a lack of overnight hospital beds, with one patient rebooked three “I hope we can see a change in times. procedures and improved quality of care for patients, who are not She discovered Dutch research getting messed around and can go citing the success of administering back to their families and their own the drip on the same day as the beds that night,” Ms van Raay said. procedure, benefitting both the hospital and patients. “The flow-on affect will be freeing up beds and resources.” Western Health | Research Report 2016 72 The Footscray Hospital nurse won Western Health’s Mavis Mitchell Memorial Scholarship in 2016 for a proposal to eliminate overnight admissions for patients who need intravenous hydration prior to having angiography. Western Health | Research Report 2016 Report | Research Health Western 73 Oncology and Haematology

Our Research Output 51 26 2 Projects Publications Presentations

Western Health | Research Report 2016 Oncologist A/Prof Jeanne Tie. 74 Head of Department Research Staff

Prof Michael Green 32 researchers

2016 has been a year of chemotherapy in Stage 2 colorectal consolidation and growth for Cancer cancers in the future. Of the 13 sites Services at Sunshine Hospital. participating in this trial, Western The service has embedded its Health provided the largest group of collaboration with the Sunshine/ patients (111 of 252 participants). Peter Mac combined Radiotherapy Centre, coordinating three open- Overall, 2016 saw the accrual of 102 to-accrual trials and accruing 16 trial participants across the major participants onto these trials. tumour streams of Breast, Lung, Urology, Upper GI, Colorectal and Our partnerships with the Australian Gynaecological cancers, as well as Gastrointestinal Trials Group, Haematology and Radiotherapy. On Australia and New Zealand Breast average, the unit had 38 open-to- Cancer Trials Group, International accrual trials at any one time – 15 Breast Cancer Study Group, of these opened during 2016. The Australia and New Zealand Germ trials covered the spectrum of Cell Trials Group, Gynaecologic phase 1b to phase 3 trials, working Cancer Intergroup, Australian with commercial as well trial study and New Zealand Urogenital and groups, with research institutes as Prostate Cancer Trials Group and trial sponsors. the Australasian Leukaemia & Lymphoma Study Group, as well The research team grew in 2016, as the Victorian Comprehensive employing staff in two new roles Cancer Centre, Walter and Eliza Hall – a Haematology Data Manager, Institute and Cancer Trial Australia who will focus on Haematology have continued successfully. Of data collection and establishing note is Dr Tie’s presentation of the a new research biobank in ctDNA Trial Stage 2 at the American collaboration with VCCC, and a Society of Clinical Oncology 2016 Research Link Nurse, who will focus Annual Meeting. The results of this on streamlining clinical trial care trial have the potential to change delivery between the research unit how we assess the need for adjuvant and the ambulatory care unit.

On average, the unit had 2016 Report | Research Health Western 38 open-to-accrual trials at any one time – 15 of these opened during 2016. 75 Oncology and Haematology continued

treatment. Access to this drug may This study will examine if the Our Research lengthen survival and improve quality addition of radiotherapy treatment of life for our patients. to chemotherapy and surgery can increase survival for patients with Circulating Tumour DNA Analysis A Phase 3 Study Comparing operable gastric cancer. Many Informing Adjuvant Chemotherapy Daratumumab, Lenalidomide, patients with gastric cancer who in Stage 2 Colon Cancer and Dexamethasone (DRd) vs receive chemotherapy and surgery (DYNAMIC) Lenalidomide and Dexamethasone do not survive five years. This trial (Rd) in Subjects with Previously Researcher: A/Prof Peter Gibbs might help patients to lengthen the Untreated Multiple Myeloma chances of longer term survival. Collaborators: Dr Jeanne Tie who are Ineligible for High Dose (Walter and Eliza Hall Institute), Dr Therapy MMY3008 (MAIA) A study of Palbociclib in Ben Tran, VCCC and Jeremy Shapiro Combination with Letrozole as Researcher: B Renwick (Monash Health) Treatment of Post-Menopausal Women with Hormone Receptor- Collaborators: D Carradice, A Lim This project examines if the use of Positive, HER2-Negative and E Hatzis circulating tumour cells (CtDNA) Advanced Breast Cancer for can determine the need for This study investigates if the Whom Letrozole Therapy is chemotherapy post-surgery for addition of Daratumumab (a new Deemed Appropriate_A5481037 colon cancers. It provides access to monoclonal antibody) to the Researcher: C Oakman the possibility of a reduced need standard treatment for patients for chemotherapy post-surgery for with newly diagnosed myeloma Collaborators: S Greenberg, L, S colon cancer. will be beneficial for this treatment Loi and Dr M White group. The trial gives our myeloma A Phase 3, Open-Label, Multi- participants access to a novel This trial enables access to the Centre, Randomised Study monoclonal antibody (target new drug Palbociclib for post- Evaluating the Efficacy and immunotherapy) in additional to menopausal Her2+ breast cancer Safety of MPDL3280A (Anti- the standard of care for patients patients ahead of the drug PD-L1 Antibody) in Combination that cannot tolerate high dose becoming commercially available. with Carboplating+Paclitaxel or chemotherapy or are not suitable for Palbociclib lengthens the time to MPDL32oA in Combination with bone marrow transplant. This study cancer recurrence in women with Carboplatin+NAB-Paclitaxel versus has the potential to extend time to post-menopausal breast cancer Carboplatin+NAB-Paclitaxel in progression of their disease. by approximately 10 months, on Chemotherapy-Naïve Patients with average. This trial allows women Stage 4 Squamous Non-Small Cell A Randomised Phase 2/3 Trial of access to this drug before it Lung Cancer (GO29437) Preoperative Chemoradiotherapy becomes available on the PBS. Versus Preoperative Researcher: S Kosmider Chemotherapy for Resectable Collaborators: D Hearth, C Oakman, Gastric Cancer TOPGEAR C Do, M Moore (Alfred Health) and G Researcher: Dr Philip Tran Richardson (Cabrini Institute) Collaborators: A/Prof Lara Lipton, This study investigates if the addition Dr Sumitra Ananda, Dr Liang Low, of Atezolizumab (immune targeting Dr Rodney Jacobs, Dr Daisy Mak, therapy) to standard chemotherapy Australasian Gastro Intestinal Group, in the treatment of squamous non- NHMR Clinical Trials Centre, Shine small cell lung cancer will improve Radiotherapy Centre, TROG Cancer patient outcomes. Lung cancer is Research and Peter MacCallum difficult to treat and over 50% of Cancer Centre patients do not survive year one of Western Health | Research Report 2016 76 Servier Project Grant Victorian Cancer Survivorship Our Grants and Awards P Gibbs. Analysis of the Routine Program Phase 2 Grants Scheme Treatment of Metastatic Colorectal I Hornung. Implementing and Cancer in Australia. Servier Australia, Evaluating a Shared Care Model Cancer Australia Project Grant $80,000 (2016). of Survivorship for Prostate P Gibbs. Development of a Clinico- Cancer Patients in the West – A Molecular Colon Cancer Nomogram Sysmex Project Grant Western Health and North Western for Personalisation of Adjuvant P Gibbs. Validation of a Marker of Melbourne Primary Health Network Chemotherapy in the Australian Recurrence in Stage 2 and 3 Colon Collaboration. Department of Population. Cancer Australia, Cancer. Sysmex Japan, $100,000 Health and Human Services, $594,254 (2016). (2016). $300,000 (2016–2018). NHMRC Project Grant Roche Australia Project Grant WCMICS 2013/14 Funding Program P Gibbs Circulating tumour P Gibbs. Neoadjuvant Therapy for L Lipton. Prospective analysis of DNA (ctDNA) to guide adjuvant HER2+ Early Breast Cancer. An 30-day Mortality Following Palliative chemotherapy in patients with rectal Australian Registry. Roche Australia, Chemotherapy for Cancer at cancer. National Health and Medical $100,000 (2016). Western Health. Western & Central Research Council, $1,320,000 (2016). Melbourne Integrated Cancer WCMICS 2015/16 Funding Services, $96,941 (2014). NHMRC Project Grant Program P Gibbs. Extension of the ASPREE M Pitcher. Integrating Primary Care WCMICS 2014/15 Funding Program Study. National Health and Medical Practitioners in Multidisciplinary S Greenberg. Improving the Pathway Research Council, $1,700,000, (2016). Cancer Care. Western & Central to Cancer Diagnosis and Specialist Melbourne Integrated Cancer Avner Foundation Project Grant Review by Analysing Patient Service, $113,483 (2016–2017). P Gibbs. Organoid Cultures for Presentation to the Emergency Department. Western & Central Pancreatic Cancer. Avner Pancreatic WCMICS 2015/16 Funding Melbourne Integrated Cancer Cancer Foundation, $900,000 (2016). Program Services, $89,380 (2015). A Dabscheck. Determining the Marcus Foundation Project Grant Feasibility of a Multi-Disciplinary P Gibbs. Adjuvant Studies in WCMICS 2014/15 Funding Program Psycho-Oncology Team at Western Colorectal, Pancreatic and Ovarian C Oakman. Oral Chemotherapy Health Using a Partnership Model. Cancer. The Marcus Foundation, Clinic – Improving Education and Western & Central Melbourne $5,550,000 (2016). Care for Cancer Patients. Western Integrated Cancer Service, $70,682 & Central Melbourne Integrated Sirtex Australia Project Grant (2016). Cancer Services, $119,648 (2015). P Gibbs. The RESIN Registry. Use WCMICS 2015/16 Funding and Outcomes of SIRT in Routine WCMICS 2014/15 Funding Program Program Clinical Care in Australia. Sirtex M Pitcher. Partnering with Local S Kosmider. Management of Male Australia, $250,000 (2016). Community Health Organisation Sexual Dysfunction Following to Provide Rehabilitation to Cancer Amgen Australia Project Grant Treatment for Colorectal and Patients. Western & Central

P Gibbs. Analysis of the Impact of Prostate Cancer Survivors at Melbourne Integrated Cancer 2016 Report | Research Health Western Primary Tumour Site on Colorectal Western Health. Western & Central Services, $120,869, (2015). Cancer Outcome. Amgen Australia, Melbourne Integrated Cancer $60,000 (2016). Service, $93,044 (2016). Grants in Aid of VCCC Scientific Meetings Merck Australia Project Grant General Practice Placement in J Emery. Primary Care Across P Gibbs. Analysis of the Impact of Cancer Survivorship Program the Cancer Continuum. Victorian Primary Tumour Site on Colorectal M Pitcher. Peter MacCallum Cancer Comprehensive Cancer Centre, Cancer Outcome. Merck Australia, Centre, $2,500 (2016). $5000 (2015). $50,000 (2016). 77 A/Prof Tie, who has earned global attention for her work on the so-called “liquid biopsy”, says almost 1000 patients have contributed to her research by donating blood during their treatment. Western Health | Research Report 2016 78 A/Prof Jeanne Tie

Oncologist

Helping revolutionise the treatment of University in the US. Additionally, bowel cancer for future generations is over 20 Australian hospitals have top priority for A/Prof Jeanne Tie. contributed patients to the liquid biopsy research. But the leading oncologist remains acutely aware of the people who help The success of this test – published making breakthroughs possible – the in the American Society of Clinical current generation of cancer patients. Oncology’s prestigious Clinical Cancer Advances 2017 report, A/Prof Tie, who has earned global which highlights the biggest attention for her work on the so- breakthroughs and trends of the called “liquid biopsy”, says almost year in global cancer research – has 1000 patients have contributed to many benefits. her research by donating blood during their treatment. By predicting the risk of relapse of cancer patients in real-time – well “I would like to say a big thank you before current methods of detection – to those patients, for without their the “liquid biopsy” will spare patients altruism, none of these researches needless chemotherapy and better would be possible,” says A/Prof Tie. target those at risk of recurrence.

“Thank you for your time and your A/Prof Tie says while most patients blood samples. We’re hoping this diagnosed with Stage 3 bowel work will change how we manage cancer are given chemotherapy, bowel cancer, ultimately you could only about 10–15% will benefit. The be helping many people around the remainder are either resistant to the world.” chemotherapy or they did not need it in the first place. A/Prof Tie and fellow Western Health oncologist A/Prof Peter “Patients undergo treatment blindly Gibbs have won international and we cross our fingers hoping that accolades for their work on they would benefit, because until circulating tumour DNA analysis, now, there’s been no way of knowing which is the detection of miniscule which patients needed chemo or fragments of tumour DNA in the not,” she says. blood of patients. While initial trials focused on whether liquid biopsy Depending on the results of the can be used to predict cancer current studies, it is hoped the test recurrence, current and future trials will be used in clinical practice within are looking at whether this blood the next five to 10 years in early test is a more effective way than the stage bowel cancer, and maybe Western Health | Research Report 2016 Report | Research Health Western routine practice in deciding the best sooner in advanced stage bowel post-surgery chemotherapy strategy cancer. for patients with Stage 2 and other stages of bowel cancer. A/Prof Tie and A/Prof Gibbs were also presented with the American A/Prof Tie and A/Prof Gibbs, also Association for the Advancement of from the Melbourne’s Walter and Cancer Research’s annual award for Eliza Hall Institute of Medical team science in 2017. They were part Research, developed the test in of an international team led by Dr collaboration with the John Hopkins Luis Diaz from Johns Hopkins. 79 Paediatric Emergency Medicine

Our Research Output 3 7 4 Projects Publications Presentations Western Health | Research Report 2016 80 Head of Department Research Staff

Dr David Krieser 2 researchers and 4 students

Sunshine Hospital Paediatric High Flow Humidified Nasal Emergency Department (SH PED) Our Research Cannulae Oxygen: An audit managed over 25,000 children in 2016. This was the highest number Researchers: Dr Priya Shenton, Dr Bell’s Palsy In Children (BellPIC) of paediatric presentations in Bindu Bali, Suzana Lazarovska and Dr David Krieser the history of the Department, Researchers: Dr Lisa Barrow and Dr and presented challenges, given David Krieser Collaborators: Dr Priya Shenton infrastructure and personnel (Monash Children’s Hospital) and constraints. Despite this, research Collaborator: A/Prof Franz Babl Suzana Lazarovska (University of continued to be undertaken in the SH (Murdoch Childrens Research Notre Dame Australia) PED during this clinically busy year. Institute, Royal Children’s Hospital) SH PED remains affiliated with the Infants admitted with bronchiolitis Bell’s palsy management has been Paediatric Research in Emergency require supportive care, involving extrapolated from adult studies and Departments International the delivery of supplemental the role of steroids has not been Collaborative (PREDICT). Our oxygen and/or fluids. High-flow, subjected to a placebo controlled, research has included: humidified nasal cannulae oxygen randomised study. The BellPIC (HFHNCO2) allows delivery of flow 1. Bell’s Palsy In Children (BellPIC) study aims to compare outcomes rates sufficient to increase Positive study. Recruitment has started for children with Bell’s palsy who are End Expiratory Pressure (PEEP) across Australia and New given prednisolone against those to improve respiratory function. Zealand into a PREDICT network provided with a placebo. Systemic Identification of complications and randomised control trial steroids are powerful medications transport needs of these infants comparing oral steroid to placebo with a broad range of side effects. will inform service delivery. There in children with Bell’s Palsy Bell’s palsy has a good prognosis is a need for ICU to assist in the in most children, even in those not management of the sicker infants, 2. Presentations at the International given steroid therapy. It is essential but HFHNCO2 may mean that all but Conference for Emergency to know if our treatment is required. Medicine (ICEM) those requiring ICU can remain at their local hospital. –– Parental Understanding of Fever in Children (PUFIC)

–– PREDICT Research Priorities Delphi Study

Future research in the SH PED include: oo An audit of cervical spine imaging in children and young adults comparing Plain X-Ray to CT Sunshine Hospital Paediatric oo An audit of the availability of Emergency Department (SH PED) external medical imaging for managed over 25,000 children in 2016 Report | Research Health Western patients presenting to ED, and oo Contribution to PREDICT studies 2016. This was the highest number including: Status epilepticus of paediatric presentations in the management, Sedation registry and Seizure registry history of the Department. 81 Pharmacy

Our Research Output 2 3 Projects Presentations Western Health | Research Report 2016 82 Head of Department Research Staff

Kent MacMillan 8 researchers and 3 students

The Pharmacy Department is A Patient’s Perspective of Adverse committed to providing excellent Our Research Drug Reactions Management in a patient care and promoting quality Hospital Setting use of medicines at Western Health. Towards Improving Medicine Researcher: Matthew Scott In 2016, the Pharmacy Department Safety: Development and assisted in the roll out of the Validation of Screening Tools Collaborators: A/Prof Michael Medicine Management Plan (MMP) for Patients at Risk of Medicine- McDonough, Grace Wong and and the new version of the National Related Problems at Presentation Richard Summers (La Trobe University) Inpatient Medication Chart across and After Discharge from the This study assesses the the Western Health Network. Emergency Department effectiveness of the ADR reporting We have also conducted several Researcher: A Weeks system and management process quality assurance research projects at Western Health. This will help us Collaborators: J Edwards and S in 2016. Our Renal Pharmacy identify problems in our current ADR Taylor (Austin Health) team are investigating whether reporting system and management process. the introduction of MMP and The study aims to develop a screening reconciliation in the outpatient tool (phase 1) and validate this tool Hospital Discharge Opioid dialysis setting can improve patient (phase 2) to identify patients at high Guidelines and Policies – A care. We collaborated with other risk of experiencing a medication- Victorian Survey health networks in the development related problem, such that they may and validation of screening tools be prioritised by the emergency Researcher: Shane Downie for patients at risk of medicine- medicine pharmacist. This will related problems at presentation reduce the likelihood of medication- Collaborators: A/Prof Michael to, and after discharge from, the related problems occurring. McDonough, Grace Wong and Joy Emergency Department. The Spark (La Trobe University) MedGap Project was a quality Improving Care: Introduction assurance project which assessed of Medication Management This study aimed to discover the roll out of an interim residential Planning and Reconciliation in the what strategies, if any, Victorian care medication administration Outpatient Dialysis Setting hospitals are using to decrease risk chart. It was presented as a poster in associated with opioids prescribed 2016 at both the NPS Medicine Wise Researchers: Amela Korajkic, Deanna on discharge. It also aimed to Conference and Western Health’s Lee, Justine Neagle, Bessie Wong, explore the perceived barriers to Research Week. James Wong and Wei Hurn Soh implementing these strategies. This will help guide us in future plans to The Medicines Information and This study evaluates the impact develop and implement a hospital- Adverse Drug Reaction Pharmacist of introducing pharmacist-led wide policy on opioids on discharge co-supervised two Latrobe medication reconciliation using and perhaps also for state-wide use. University research projects at an official form on timeliness Western Health. They are ‘A Patient’s of medication reconciliation, Perspective of Adverse Drug medication interventions, as well as Reaction Management in a Hospital patient and staff satisfaction. This 2016 Report | Research Health Western Setting’ and ‘Hospital Discharge will help us identify methods of Opioid Guidelines and Policies – a improving medication management Victorian Survey.’ of high-risk hospital outpatients.

Three abstracts were submitted by Pharmacy staff at the 2016 SHPA Conference. The quality assurance project titled ‘Monitoring of Sterile Cleanroom – What’s Involved?’ was selected as a poster presentation. 83 The Department of Respiratory and Sleep Disorders Medicine is a busy clinical service dealing with the diagnosis and management of patients with a broad range of respiratory conditions and sleep disorders. We also provide the State service for review of immigrants issued with Tuberculosis Health Undertakings by the Commonwealth Government.

Our research areas examine the services that we provide and seek to evaluate their effectiveness and efficiency, with the aim of improving Respiratory and patient care and diagnostic methods. We also undertake clinical trials sponsored by pharmaceutical companies, with the aim of helping Sleep Disorders to develop new therapies for the treatment of respiratory diseases.

Our current projects include patients with asthma, COPD and pleural space infection, and areas related to diagnostic tests of Our Research Output pulmonary function and sleepiness. 10 1 Projects Publications

6 6 Presentations Proceedings Western Health | Research Report 2016 84 Head of Department Research Staff

A/Prof Anne Marie Southcott 3 researchers

healthcare utilisation, and quality of We are collecting anonymous Our Research life. A new model of care may offer data around inhaled drug use in better outcomes for Western Health a convenience sample of patients patients. referred for lung function tests at When is the Optimal Timing Footscray and Sunshine Hospitals. to Implement Pulmonary Reliability of DLCO Measurements The purpose is to identify the Rehabilitation for People with at 2, 4 and 6-Minute Time prevalence of inhaled drug use COPD Intervals in Restrictive and within our population. By better Obstructive Respiratory Researcher: Dr Clarice Tang understanding the nature of drug Conditions use in our patient population we can Collaborators: AM Southcott, E provide better care. Researcher: Lynnette Reid-Price Skinner, FC Blackstock and K Barker Western Health COPD Collaborators: Georgette Mchaileh, The aim of this study is to evaluate Readmission Project: Identifying Ceilito Samson, Dr Emily Karahalios, the start time of pulmonary Factors Associated with All-Cause Dr Lata Jayaram and Dr Anne Marie rehabilitation following admission Readmissions after a COPD- Southcott for COPD exacerbation to see if this Related Hospitalisation improves uptake and completion of This project follows on from our pilot Researchers: Norman Weber, Dr pulmonary rehabilitation. Pulmonary work in healthy normal subjects, Mark Lavercombe and Dr Melissa rehabilitation is standard for where we found no significant Yang inpatients with COPD and improves difference in DLCO measurements many outcomes, including mortality. at different time intervals. Currently This study is an analysis of all Currently the rates of uptake and the requirement to wait four minutes patients with COPD admission and completion are low. Earlier start between each measurement when subsequent readmission to identify dates may improve this. assessing gas transfer in the lung factors associated with readmission. function laboratory lengthens the A Multidisciplinary, Nurse-Led If we can identify specific risk duration of the test. The aim is to Model of Asthma Care at Western factors for readmission after COPD see whether testing intervals impact Health to Meet Our Patients’ Needs admission in our patient cohort, the test result in participants with intervention might allow for a Researcher: Dr Lata Jayaram diagnosed restrictive or obstructive reduction in the readmission rate. respiratory conditions. Recruitment Collaborators: Dr Andrew Gillman, is ongoing. If shorter testing intervals Does reversibility in FEF 25-75 Sue Casanelia, Valerie Yee, Victor are equivalent this may shorten the correlate with reversibility in Reginato, Anita Morris, Lynnette Reid- duration of testing for patients with FEV1? Price and Dr Anne Marie Southcott improved comfort and increased efficiency of the diagnostic service. Researchers: Dr Irena Laska, Asthma management is often poorly The completion of this project may Seymone Doyle and A/Prof Lata adhered to after discharge, resulting provide evidence for revision of Jayaram in exacerbation, readmission, and existing testing guidelines published This project evaluates the clinical occasionally death. This project by the ATS/ERS. usefulness of reversibility in FEF 25– is a prospective randomised 2016 Report | Research Health Western controlled trial of standard care Prevalence of Illicit Inhalant Use 75% on spirometry to detect small for patients admitted with asthma, Among Patients Undergoing to medium airways dysfunction in versus an intensive intervention Respiratory Function Testing at patients with asthma. Findings from arm which offers additional follow Western Health this study may help identify more up, education, and support post- patients with airways disease who discharge. The trial will evaluate Researchers: Dr Mark Lavercombe, are not currently being identified on whether additional hospital support Dr Mark Dimitri and Georgette standard lung function reporting. post-discharge can improve McHaileh measures of asthma control, 85 Rheumatology

Our Research Output 14 5 Projects Presentations

2 1 Proceedings Chapter Western Health | Research Report 2016 86 Head of Department Research Staff

A/Prof Keith Lim 8 researchers and 1 student

The Department’s main research oo The role of DECT in detection of GM CSF and RA activities centre around the twin gout and CPPD areas of mechanical osteoarthritis Researchers: Dr Cecil Hor and A/ (OA) and inflammatory arthritis. oo Digital Tomeosynthesis (DTS) in Prof Keith Lim ankylosing spondylitis, and On mechanical osteoarthritis, Collaborators: Prof John Hamilton the Rheumatology team continue oo The effect of biologics on joint and Dr Andrew Cook (University of to spearhead the collaborative erosions in rheumatoid arthritis Melbourne) long-term OA cohort study (HREC (RA) This project explores the role played 120/07). Recruitment has passed the by GM CSF in the sera and synovial original target of 800. Data analysis In collaboration with Prof John fluids of RA patients. This may open continues and the team is in the Hamilton’s group at University of up new therapeutic pathways for the process of updating the database. Melbourne, Dr Cecil Hor is pursuing treatment of RA. The main projects to spin off from an MD thesis on the role of GM-CSF in RA. this cohort study are: Unloader Knee Bracing in Medial Knee OA oo Quantifying the role of knee The Western Rheumatology Group has a large database of rheumatic effusions Researchers: A/Prof Keith Lim and conditions, being run by our Dr Albert Leung oo The role of XRay changes and Post Graduate Fellow, Matthew response to therapy Jiang. This database has about Collaborator: Carolyn Page (St 4000 patients and current lines of Vincent’s Hospital) oo The use of the unloader brace in enquiry include outcomes following medial compartment OA biologics and its effect on infections This project aims to show the value like TB, Hep B and Hep C. of bracing in various deformities. oo Optimising the time for total knee This in turn may help delay the need replacement (TKR) in advanced for TKR and improve quality of life disease, and for patients afflicted with medical oo Weight loss through dietary Our Research knee osteoarthritis. advice, effect on outcome The role of DTS in Ankylosing The Rheumatology team has OA Hip and Knee Spondylitis demonstrated leadership in Researchers: A/Prof Keith Lim, Researchers: Dr Kim Le Marshall the region by taking over the Dr Albert Leung and Dr Chamila and A/Prof Keith Lim funding and hosting of the Dabare Asian Osteoarthritis Network Collaborator: Dr Louise Bentley website (osteoarthritisnetwork. Collaborators: Carolyn Page (St com). Through this website and Vincent’s Hospital) and Prof Peter By using DTS as a means of collaboration with regional centres, Choong (St Vincent’s Hospital) diagnosing sacroiliitis earlier, this we hope to encourage research and study investigates whether it is educational activities. This is a longitudinal prospective possible to obviate the need for cohort, looking at the optimum MRI scans. On inflammatory arthritis, the management of OA and the natural Western Health | Research Report 2016 Report | Research Health Western main projects involve radiological history of OA under conservative Bone Scintigraphy in techniques, in collaboration with Dr care. If we can understand how to Undifferentiated Arthritis Louise Bentley of Radiology. These better treat OA, a very common Researchers: Dr Matthew Jiang, Dr include: disease, we will also to be able to Kim Le Marshall and A/Prof Keith Lim delay surgery in most cases. This will have significant impact on the health This study will aim to quantify the budget and quality of life. value of scintigraphy in diagnosis and management of undifferentiated arthritis. By rationalising it usage, costs can be saved. 87 In 2016, the Division of Aged Care and Subacute Services continued multiple collaborative research activities across diverse stakeholders with a focus on developing and improving best care for patients and carers.

A strength of the Division in 2016 has been improvements in the care of patients admitted to Western Health with Behavioural and Psychological Symptoms of Dementia (BPSD). Working in partnership with the Subacute and National Ageing Research Institute (NARI) and the Dementia Behaviour Management Advisory Service (DBMAS), we are increasing the Aged Care capacity of hospital staff to improve the care of patients with BPSD and/ or delirium, as well as the safety of staff and other patients.

The Wellcare Program, a day program for individuals with life limiting conditions, has been successfully piloted and we evaluated a massage therapy Our Research Output program for palliative care inpatients and outpatients. This ensures that patients receive holistic care that is aligned with national centres of excellence and has led 11 1 11 to a reduction in symptom severity Projects Publication Presentations for patients accessing the service. Continuation of the service has been made possible via a grant from North and West Metropolitan Region Palliative Care Consortium (NWMRPCC), ensuring more holistic care for future palliative care patients at Western Health. Western Health | Research Report 2016 88 Clinical Services Divisional Services Research Staff Director Director 1 student Dr Kris Ghosh Natasha Toohey

Clinical Effectiveness of Aspirin Does the Development of the Our Research as an Adjunct to Compression Re-Admission Prevention Team at Therapy in Healing Chronic Western Health Reduce 30-Day Venous Leg Ulcers: A Randomised Hospital Re-Admission Rates? Evaluation of a Massage Therapy Double-Blinded Placebo- Service for Palliative Care patients Controlled Trial (ASPRIVLU study) Researcher: Dr Ruth The at Western Health Researcher: Dr Elizabeth Dapiran Collaborators: Prof Edward Janus, Researchers: Jennifer Zerafa, Dr Dr Inge Von Olshausen and Cherie Maria Coperchini, Anita Panayiotou Collaborators: Dr Carolina Weller Hunter and Debra Kerr (Monash University), Dr Anna Barker (Monash University), A/Prof Terrence The Readmissions Prevention Team The Wellcare Program is an Haines(Monash University), Prof (RAPT) was developed at Western ambulatory, interdisciplinary service John McNeil (Monash University), Health to identify and intervene providing holistic care for people Dr Stephanie Ward (Monash among patients at high risk of early with palliative conditions and is University), Prof Martin Underwood readmission, using the developed part of the integrated subacute (University of Warwick) and A/Prof revised LACE Index scoring tool. unit at Sunshine Hospital. It aims to Ian Darby (Royal Melbourne Institute The study aimed to identify support clients and carers through of Technology) readmission rates for high vs low-risk their illness, managing symptoms patients, compare readmissions and promoting wellbeing. Wellcare Venous leg ulcers are a common and rates for general medicine Program nursing staff identified the costly problem to our community. discharges before and after use of complementary therapies This study will look into treatment implementing RAPT, evaluate the as an area that they would like to for venous ulcers with the aim to revised LACE as a useful screening expand on. A six-month trial and improve rates of healing and reduce tool, and to identify effective formal evaluation of a massage rates of recurrence. The study is part measures in reducing readmission therapy service was undertaken by of a multi-centre placebo controlled risk. This study demonstrated the specialist-trained oncology massage trial looking at aspirin in the healing complexity of applying readmission therapists at Sunshine Hospital. The and recurrence of venous leg risk screening tools in clinical evaluation explored the impact on ulcers. There is also a concurrent practice, and highlighted the palliative care patients’ wellbeing, observational cohort study looking potential contribution of frailty investigating attendance rates and at venous leg ulcers. status. It also showed patient uptake uptake of the service and patient of current preventive strategies satisfaction with the service. was low, with the ongoing need Preliminary survey data showed to address barriers to follow up. 100% uptake of the service, with Moreover, there was low impact 100% of patients who accessed the of current interventions with the service requested further sessions. need for careful evaluation of future A 61% decrease in overall symptom strategies. severity was reported. The results of this project demonstrated that a massage therapy service is feasible 2016 Report | Research Health Western and effective in the palliative care patient cohort at Western Health, Our Grants and Awards ensuring that this group of patients receive holistic care that is aligned National Stroke Foundation Grant with national centres of excellence. J Carmody. Stroke Connect Program, $100,000 (2016). 89 Surgery

Our Research Output 26 14 7 Projects Publications Presentations Western Health | Research Report 2016 90 Head of Department Research Staff

Prof Helen O’Connell 19 researchers and 8 students

Western Health provides a Urology is about to embark on a prodigious surgical service with shared care project, rolling out a 32,091 procedures performed in model proven in previous primary 2016. 23,000 of these were elective, care research in collaboration with 8500 emergency. Surgical units have Prof Jonathan Emery, the Herman had a strong focus on oncological Prof of Primary Care Cancer Research and functional outcomes. at the University of Melbourne.

Excellent formal presentations at Research Week, highlighted in this report from the Breast and Endocrine Unit, demonstrate that with little Our Grants and Awards formal research infrastructure, surgical research is robust. Head Victorian Cancer Survivorship of Colorectal Surgery, Ian Faragher Program Project Grant presented data from the DHHS database, with Dr Foster comparing C Ogluszko. Implementing and hospital datasets. This data shows Evaluating a Shared-Care Model that colorectal outcomes achieved by of Survivorship for Prostate the team at Western Health are of a Cancer Patients in the West – A high standard relative to comparable Western Health and North Western large health networks. Melbourne Primary Health Network Collaboration. Department of Research to improve cancer Health and Human Services, outcomes and survivorship is $300,000 (2016–2019). increasingly at the forefront of the field as our treatments save more Research Week Best Abstract lives. In Urology, supported by the Poster Award for Oncology/ Continence Service, Urologists, Haematology Radiation Oncologists and Oncologists, the Prostate Cancer C Ogluszko. Evaluating the Patient Nurse Specialist is driving several Experience of the Prostate Cancer initiatives that dovetail with primary Specialist Nurse Role. Western care improvements to reduce Health Research Week, $1,500 (2016). the burden associated with prior treatment.

The Orthopaedic Unit deserves recognition for the quality and number of surgical research projects brought to fruition. We look forward to welcoming A/Prof Justin Yeung, 2016 Report | Research Health Western who has been appointed as a full- time academic surgeon. Our existing collaborations, the energy and skill of the Western Health surgeons, and the formal research leadership will drive our research and data-fuelled productivity. 91 Surgery General and Endocrine Surgery

Head of Department Size matters: Systematic Our Research Differences Between Ultrasound Bill Fleming and Pathological Evaluation of Thyroid Nodules – A Method Diagnostic Accuracy of FNA in Comparison Study The Western Health General and Thyroid Nodules Endocrine Unit is committed Researchers: Dr Carolyn Chew and Researchers: Joanne Chionh to contributing to the pool of Dr Laura Chin-Lenn knowledge in endocrine surgery and This is an ongoing MD research other aspects of general surgery. We Collaborators: Dr Tracey Lam and project examining the concordance are primarily interested in research Prof Steven Chan of fine needle aspiration results that improves our patients’ clinical of thyroid nodules compared with care. In 2016, we have commenced This project examines the correlation final pathology results following a new MD research project. Two of between ultrasound and pathology thyroidectomy at our institution. We our projects have been published in size of thyroid nodules. This has been will be able to ensure that the quality peer-reviewed journals and one of accepted for publication in the ANZ of our cytology preoperatively is our other projects is ongoing. Journal of Surgery. adequate and compare it with the international standards. How Does Thyroidectomy for Benign Thyroid Disease Post-Operative Hypocalcaemia in Impact Upon Quality of Life? A Total Thyroidectomy Patients with Prospective Study Incidental Parathyroidectomy Researchers: Dr Synn Lynn Chin and Researchers: Dr Carolyn Chew and Dr Laura Chin-Lenn Bill Fleming Collaborators: Dr Tracey Lam, Dr Collaborators: Dr Ran Li and Dr Carolyn Chew and Prof Steven Chan Michael Ng This is an ongoing prospective This project examined the study examining the quality of life correlation of hypocalcemia of patients following thyroidectomy when parathyroid glands were for benign disease. A manuscript is inadvertently removed during being prepared for submission. surgery. It was published in the ANZ Journal of Surgery in March 2017.

The Western Health General and Endocrine Unit is committed to contributing to the pool of knowledge in endocrine surgery and other aspects of general surgery. Western Health | Research Report 2016 92 Surgery Orthopaedics

Head of Department Comparison of Two Total Knee Our Research Replacement Designs – A Phong Tran Randomised Control Trial Averaging Rotational Landmarks Researchers: Dharsh Musiienko and The Orthopaedic Department During Total Knee Arthroplasty Phong Tran performs over 1500 elective and Reduces Component Malrotation 1500 emergency operations Caused by Femoral Asymmetry There are numerous total knee per year. We commenced our replacement designs but few direct PROMs project a number of years Researchers: Tat Woon Chao, Liam comparison outcome studies. This ago, which allows us to monitor Geraghty, Pandelis Dimitriou and study will help us decide which total our elective patients’ outcomes Simon Talbot knee design philosophy brings the preoperatively, whilst on the waiting best results. Femoral component malrotation list, and postoperatively. There is is a common cause of patient increasing interest in healthcare Outcome of Foot and Ankle dissatisfaction after total knee governance on the value and Surgery arthroplasty. The sulcus line (SL) efficacy of operative interventions, is more accurate than Whiteside’s Researchers: Karen Bournes, David and the ongoing PROMs database line as it corrects for variation in the Shepherd, Sasha Roshan Zamir and will allow us to deliver much needed coronal orientation of the groove. Phong Tran information. The Department is The hypothesis is that averaging the conducting a number of randomised SL and posterior condylar axis (PCA) Foot and ankle surgery techniques control trials and continues to be a will reduce femoral malrotation. and outcomes are continually major contributor at the Australian evolving. This study will help us Orthopaedic Association’s Annual assess the outcomes of various Scientific Meeting. techniques.

Comparison of Wound Closure Techniques in Neck of Femur Fractures

Researchers: Inas Badres and Phong Tran

Wound ooze is a significant problem post-surgery for neck of femur fractures. This study will assess the difference between three different type of wound closure methods.

Comparison of Surgical Approach for Total Hip Replacement –

Randomised Control Trial 2016 Report | Research Health Western

Researchers: Adrian Talia and Phong Tran

There are three common surgical approaches to total hip joint replacement surgery. This study will allow us to assess which approach is more beneficial to patients. 93 Surgery Urology

Head of Department Navigate: Randomised Control Our Research Trial of an Online Treatment Aide Prof Helen O’Connell for Men with Localised Prostate Cancer and their Partners Patient Satisfaction Survey – The Urology Unit at Western Health Prostate Cancer Specialist Researcher: Kevin Chu is about to embark on a shared care Nurse Role project, rolling out a model proven Collaborators: Cindy Ogluszko and in previous primary care research. Researcher: Cindy Ogluszko Prof Helen E O’Connell This is a collaboration with Prof Collaborator: Ailsa Cowie Jonathan Emery, the Herman Prof The primary aim of this study is to evaluate the impact of an online of Primary Care Cancer Research at This project aims to identify decision aid for men with low risk the University of Melbourne. It is an areas that satisfy patient needs prostate cancer and their partners. exciting initiative. Prostate Cancer and identify areas for service This will help men and their families Nurse Specialist Cindy Ogluszko has improvement from the patient understand their diagnosis for superbly developed a clinical role to perspective. Regular surveys of low-risk localised prostate cancer support cancer patients with carefully patients who use the PCSN service and confidence in selecting active documented outcomes. Over the at Western Health will provide surveillance as their treatment last 12 months our collaborative information about the accessibility, modality. research will enable us to complete quality and value of the service, help an anatomical study and further to identify gaps between patient Management of Sexual our smooth muscle neosphincter expectation and experience, and Dysfunction Following Treatment studies. These are long term works in inform actions to maintain and for Colorectal and Prostate Cancer progress. We have been developing improve the service. some major data-driven projects in Researcher: Dr Suzy Kosmider the integration of continence services and improving access to outpatients. Collaborators: Cindy Ogluszko, Finally, Dr Foster’s data shows our Darren Katz and Ian Faragher oncological and morbidity outcomes in major cancer surgery are some of This project will review current the best in Victoria. assessment and management of treatment-related sexual dysfunction in male colorectal and prostate cancer survivors at Western Health and develop and implement pathways to better serve their needs. Western Health | Research Report 2016 94 Macroscopic Anatomy of Anterior Re-Innervation of Transplanted An 8-year Audit of Radical Vaginal Wall and Urethra Dartos Smooth Muscle Cystectomy Outcomes in a Single Neosphincters in Rams Victorian Centre Researcher: Prof Helen E. O’Connell Researcher: Prof Helen E. O’Connell Researchers: J Crozier, P Tan, H Collaborators: Prof Janet Keast O’Connell, J Huang and C Bishop (University of Melbourne), Dr Collaborators: A/Prof James Nathan Hoag (Austin Hospital), Prof Brock (University of Melbourne), This study found patient selection, Noel Woodford (Victorian Institute Prof Glenn Edwards (Charles Sturt operative parameters, perioperative of Forensic Medicine) and Dr Patrick University) and Dr Christine Hirst and oncological outcomes at Preece (Neo-sphincter Technologies) Western Health are consistent with existing Australian series. Key A series of 13 fixed and fresh Free grafts of ram dartos have markers of surgical quality, such donated cadavers were been successfully transplanted to a as percentage of patients having systematically dissected to location below the bladder neck. Re- lymphadenectomy, lymph node determine the anatomy of the innervation has been only sparsely counts, operative times, complication anterior vaginal wall. In particular, and inconsistently demonstrated in rates and mortality, demonstrate we sought to determine whether the smooth muscle neo-sphincters. Western Health is a leading centre a visible structure consistent Relative to human and rabbit for cystectomy in Australia. with the G spot concept could smooth muscle, the ram dartos is a be identified. Controversy exists relatively thin smooth muscle source around female urethral and vaginal interspersed with fibrous tissue. A anatomy. Knowledge of structures biological neo-sphincter derived underpinning sexual health have from the patient’s own tissue, direct relevance to surgery in this transplanted to the urethra and area enabling us to best preserve stimulated may prove to be an ideal important structures during our treatment in a group of patients operations. Macroscopic anatomical with severe sphincter dysfunction evidence for a discrete G spot are resulting in poor quality of life due lacking. A further histological study to incontinence. is being established to determine the histology of this functional zone. Western Health | Research Report 2016 Report | Research Health Western Dr Foster’s data shows our oncological and morbidity outcomes in major cancer surgery are some of the best in Victoria. 95 Since becoming Australia’s first female urologist, Prof Helen O’Connell’s many achievements have included revolutionising the way medical students study female pelvic anatomy, as well as conducting more than 30 clinical trials. Western Health | Research Report 2016 96 Prof Helen O’Connell

Director of Surgery and Head of the Urology Unit

Pioneering research has been the Swinburne University. “One of the hallmark of Prof Helen O’Connell’s things with a cancer diagnosis is internationally renowned career. there is potentially so much anxiety for patients around what they don’t Since becoming Australia’s first female know,” Prof O’Connell says. “For urologist, her many achievements them to be able to get good quality have included revolutionising the information is likely to translate into way medical students study female better quality of life while they’re pelvic anatomy, as well as conducting living with a diagnosis, which may more than 30 clinical trials. That spirit never materialise into a problem. of innovation is now driving Prof That’s a really important thing.” O’Connell’s work at Western Health, where she was appointed Director The Urology Unit is also establishing of Surgery and Head of the Urology a partnership with the Victorian Unit in 2016. Prostate Cancer Registry which carefully tracks the outcome of A major collaborative study involving prostate cancer treatments. the Urology Unit Urologists, the Prostate Cancer Nurse Specialist, Prof O’Connell is excited to be North Western Melbourne Primary forging a collaboration with Monash Health Network and Cancer Services University’s School of Public Health at Western Health is a trial of a model and Preventive Medicine, which will of shared care for patients with low- allow Western Health Urologists stage prostate cancer. The five-year access to data from the Aspirin Shared Care project is supported Reducing Events in the Elderly (or by Department of Health funding ASPREE) study. The study, led by for our dedicated Prostate Cancer Prof John McNeil, has tracked 19,000 Nurse, who facilitates personalised healthy adults over five years, with care shared by regional General the primary goal of determining Practitioners and Western Health whether daily low-dose aspirin clinicians. Prof O’Connell says this prevents or delays the onset of age- model not only improves care for related illness. Prof O’Connell says patients, but will deliver “high-quality the data is a “magnificent” resource data” for future research. “There is across a broad range of specialties also potential for more advanced – thanks to the detailed health and forms of prostate cancer to come clinical measurements collected from under this banner,” she says. participants. Western Health | Research Report 2016 Report | Research Health Western Another new initiative for prostate “We are in the throes of setting up cancer patients includes the some studies using this very powerful Navigate Decision Aid – an Melbourne-based database,” Prof interactive, online resource designed O’Connell says. “We’re delighted to help guide men and their families that the group has given us access through the stress of diagnosis and to this valuable information.” There potential treatment options. The is a series of urological questions online tool is a collaborative study embedded within the data which will between Western Health, Peter serve as excellent control data for MacCallum Cancer Centre and other studies. 97 Women’s and Children’s

Our Research Output 33 15 Projects Presentations

3 5 Proceedings Publications Western Health | Research Report 2016 98 Head of Department Research Staff

A/Prof Glyn Teale 9 researchers and 5 students

As we welcome the commencement of construction of the Joan Our Grants and Awards Kirner Women’s and Children’s Hospital, we continue to expand NHMRC Project Grant (CIA) our capacity to manage the Understanding the Role of diversity and complexity of our Endogenous and Pharmacologic patient population. The continued Glycosaminoglycans in Preventing development of our Maternal-Fetal Pre-Eclampsia. National Health Medicine, Gynaecological Oncology, and Medical Research Council, Urogynaecology and Critical Care $500,146.63 (2013–2015, extended Services has increased our capacity into 2016). to conduct research to better understand and develop evidence- NHMRC Project Grant (CIB) based practice that will improve Chondroitin Sulphate A and the patient care. Research is very Immune System during Placental much a collaborative activity, with Malaria. National Health and our obstetricians, gynaecologists Medical Research Council, $507,860 and midwives continuing to (2014–2017). build relationships with other disciplines, such as anaesthetics, Lesley Eric Paddle Scholarship in general medicine, academics and Paediatric Orthpopaedics institutions from partners at Deakin M Bullen. The Applicability of pQCT University, University of Melbourne in the Assessment of Fracture and Murdoch Childrens Research Healing in Children. University of Institute. The growth of these Melbourne, $7500 (2016). collaborations is reflected in the broad range of research projects the Best Women’s and Children’s Division participates in and supports. Research Presentation S Walker. Understanding the In 2016, our research focused on Failure to Identify Severe Growth identifying women and babies at Restriction. Western Health higher risk of adverse outcomes. Research Week (2016). A number of health service improvement projects were also undertaken to deliver standard of care for both obstetric and gynaecology patients.

The results of previous research projects addressing topics such as post-partum haemorrhage, Western Health | Research Report 2016 Report | Research Health Western maternity observations and response to deterioration, care of the obese pregnant woman, and postnatal bladder care have now been incorporated into guidelines and procedures, increasing service capability and improving patient outcomes. 99 Women’s and Children’s Obstetrics and Gynaecology

Head of Department, oo The prolonged time patients Our Research with incontinence and/or POP Obstetrics wait for assessment and primary management when referred by Implementation of a Women’s Dr Robin Burr GPs Health Advanced Practice Physiotherapy Clinic at Western Head of Department, oo The low rates of women Health receiving standard-of-care first Gynaecology line treatments for pelvic floor Researchers: Karina Coffey, Oliver issues and potential for these Daly and Narelle Watson Dr Rupert Sherwood treatments to reduce need for The aims were to determine if a medical intervention women’s health physiotherapist- oo Inefficient use of the service due led clinic would result in improved to patients failing to attend, and access for patients referred to the Urogynaecology Clinic, enhanced oo The need for validated service efficiency and coordination, patient reported outcomes and improved patient and staff and satisfaction to assess the satisfaction, without compromise to quality of care, as well as staff quality of care and patient outcomes. satisfaction

This project addressed a number of After six months, 69% of patients issues: seen in the clinic were discharged without requiring medical review. oo The need for coordination of There was increased availability care between disciplines treating of new appointments in the continence and pelvic floor issues Urogynaecology Clinic as well as an at Western Health, including increased number of discharges. Physiotherapy, the Continence 90% of patients were very satisfied Clinic and Gynaecology, and all staff felt the service was Urogynaecolgy and Urology, appropriately structured to deliver as well as the need to develop safe, co-ordinated, person-centred a common pathway for GPs to care. Cost-effectiveness was access these services demonstrated and the Clinic has now received ongoing funding.

90% of patients were very satisfied and all staff felt the service was appropriately structured to deliver safe, co-ordinated, person-centred care. Western Health | Research Report 2016 100 Understanding the Failure to Identify Severe Growth Restriction

Researchers: Dr Sofia Walker, Dr Lauren De Luca and A/Prof Glyn Teale

The percentage of severely growth- restricted infants delivered at 40 weeks or beyond is an important indicator used to assess perinatal service performance. Such growth- restricted infants are at higher risk of adverse outcomes and as such should be delivered before the due date. The aim of this study is to determine the change in incidence of severely growth- restricted infants delivered at or after 40 weeks gestation over two years, and measure the current provision of antenatal care against Women’s Perception of Safety This integrative review highlights Western Health standards as they During Labour and Birth: An a lack of shared understanding pertain to assessment, surveillance Integrative Review when defining safety during labour or management of fetal growth and birth. This has significant restriction. Researcher: Margaret McCormick implications for both women and organisations. Broadening the The study concluded there were Collaborators: A/Prof Marie Gerdtz organisation perspective of safety lower rates of severe growth and Dr Wendy Pollack (University of to include the women’s view is restriction delivered after 40 Melbourne) essential. It will provide not only weeks, falling from 46% in 2012 to valuable insights, but possible 22% in 2016. It appears that the Safety during childbirth is a solutions, to understanding and delay in delivery is attributable complex, multidimential, yet improving the safety of women to the difficulties of detecting ill-defined concept. Research during childbirth. growth restriction, rather than the suggests “not feeling safe” can management when it is identified. contribute to the development This improvement may be of a range of poor outcomes for attributable to greater awareness women and their babies, and and new referral pathways, with increasingly expose healthcare further improvement possible providers to complaints and with greater adherence to current litigation. For this reason, providing 2016 Report | Research Health Western practice standards. a contemporary understanding of what “feeling safe” actually means Dr Sofia Walker presented this for women, during labour and at Research Week and was the birth, is fundamental to improving recipient of the best Women’s and organisational strategies aimed to Children’s research presentation. achieving positive health outcomes for women and their babies. 101 Women’s and Children’s Maternal Fetal Medicine

Head of Department The FOX study (Fetal Oxygenation Study) was also completed in 2016. Our Research A/Prof Joanne Said We have generated a vast amount of genomic data, which is currently Magnesium Sulphate at 30 to undergoing bioinformatics analysis, The Maternal Fetal Medicine (MFM) 34 weeks Gestational Age: with some exciting results presented research group has been working to Neuroprotection Trial (MAGENTA at the Society for Reproductive complete a number of laboratory- Study) Investigation in March 2017. based research projects, as well as Researchers: A/Prof Joanne Said transitioning towards more clinically- We continue to recruit for an and Dr Rossalyn Pszczola focused research projects. A ongoing multi-centred randomised notable achievement in 2016 was the trial, the MAGENTA study, which Collaborators: Prof Caroline graduation of our PhD student, Tilini investigates the role of magnesium Crowther, Philippa Middleton, A/ Gunatillake, who then continued as sulphate in the prevention of Prof Dominic Wilkinson and A/Prof a Postdoctoral Researcher with the cerebral palsy in infants born Ross Haslam (University of Adelaide) group for the remainder of 2016. between 30–34 weeks gestation. The aim of this study is to assess We have had an ongoing In addition, we have generated whether giving magnesium sulphate, collaboration with Prof Mary Wlodek some interesting pilot data compared to placebo, to women from the Department of Physiology regarding the role of antenatal immediately prior to pre-term birth at the University of Melbourne, corticosteroids in women with between 30–34 weeks reduces the investigating the role of various diabetes prior to elective caesarean risk of death or cerebral palsy in heparins in a mouse model, and our section after 36 weeks. These data their children at age two corrected Masters student, Will Bevens, was have formed the basis of an exciting years. This will help us to identify awarded First Class Honours for his international collaboration to ways of reducing the risk of thesis in this area. undertake a formal randomised trial developing cerebral palsy in infants in this challenging area of perinatal We have also completed recruitment who are at high risk. This trial has medicine. and data collection for another now achieved over 75% of its total recruitment target and recruitment multi-centred randomised trial. Finally, 2016 has seen us join at Sunshine Hospital continues This project will investigate the two new large multi-centred to be steady. The two-year-old role of daily enoxaparin injections collaborative trials – the My Baby’s children have been returning for their for preventing the subsequent Movements trial and the LEAP1 trial. neurodevelopmental and paediatric development of pre-eclampsia and Our involvement in these trials is assessments and so far we have been fetal growth restriction in women further recognition of the important able to achieve 100% follow up. who have previously experienced patient population we have at these complications. The findings Sunshine as well as our increasing from this important study were capacity to contribute meaningfully presented at the Society for to this type of research. Maternal Fetal Medicine Meeting in January 2017. Western Health | Research Report 2016 102 A notable achievement in 2016 was the graduation of our PhD student, Tilini Gunatillake, who then continued as a Postdoctoral Researcher with the group for the remainder of 2016.

The Effect of Folic Acid readout in maternal blood. This Novel Approaches to Supplementation in Pregnancy on study has the potential to improve Understanding the Molecular Preeclampsia (The FACT Study) the way we monitor babies who Mechanisms of Placental are not growing well in the womb. Thrombosis in Human Fetal Growth Researchers: A/Prof Joanne Said This simple blood test may help Restrictions and Preeclampsia and A/Prof Glyn Teale to improve our ability to detect small babies which are not getting Researcher: A/Prof Joanne Said Collaborators: Prof Mark Walker sufficient oxygen and nutrition, so and Prof Shi Wu Wen (Ottawa Collaborators: Prof Paul Monagle, Dr that we can deliver them before they Hospital Research Institute) Vera Ignjatovic (Murdoch Childrens die in the womb. We have generated Research Institute, Royal Children’s vast arrays of genomic data which is The overall aim of this study is Hospital) and Prof John Whitelockv undergoing bioinformatics analysis. to evaluate a new pre-eclampsia (University of New South Wales) prevention strategy using a daily The findings will be presented in 4.0mg folic acid supplement in 2017 at the Society for Reproductive Proteoglycans and their high-risk women. If this simple Investigation meeting in Orlando. glycosaminoglycan side chains intervention is proven effective, are abundantly expressed in Enoxaparin for the Prevention of it will help to reduce the risks and the human placenta and play Pre-Eclampsia and Intrauterine consequences of pre-eclampsia, important roles in anticoagulation Growth Restriction (The EPPI Study) making pregnancy safer for mothers pathways, angiogenesis and and babies. In 2016, we completed Researcher: A/Prof Joanne Said inflammation. Our preliminary recruitment and data collection data has demonstrated significant for this trial and will complete the Collaborators: Dr Katie Groom, differences in the expression analysis of results in 2017. In the Prof Lesley McCowan and Dr Claire of placental proteoglycans in meantime, we are getting ready to McLintock (University of Auckland) pre-eclampsia and fetal growth launch the FACT4Child study – the restriction, suggesting that long-term follow-up study of the The aim of this study is to disordered proteoglycan function children born to mothers enrolled in determine the difference in effect may play a role in these major the FACT study. of prophylactic daily Low Molecular placental mediated complications Weight Heparin (LMWH) injections of pregnancy. This research aims Maternal Blood Test to Determine with standard high risk antenatal to comprehensively investigate the Acidaemic Status of Growth care, compared to standard high risk functions of proteoglycans in human Restricted Foetuses in Utero (The antenatal care only, for the prevention placenta and understand how these FOX Study) of pre-eclampsia and Intrauterine functions are altered in pregnancy Growth Restriction (IUGR) and to disorders. A related collaborative Researcher: A/Prof Joanne Said assess the size of the effect in this project investigates the roles of population. This study will help us Collaborators: Dr Owen Stock, Prof pharmacologic glycosaminoglycans to determine whether enoxaparin Stephen Tong and Prof Susan Walker in an animal model representing injections (low molecular weight (Mercy Hospital for Women) altered proteoglycan expression. heparin) are useful in preventing the Together, the studies will improve We have data suggesting hypoxia development of pre-eclampsia or our understanding and guide induced mRNA in maternal blood fetal growth restriction. In 2016, we development of therapeutics to 2016 Report | Research Health Western quantitatively correlates with the completed recruitment and data prevent and treat serious placental degree of fetal acidaemia in utero. collection and the final manuscript mediated disorders of pregnancy. Therefore, the aim of this study is was prepared. The findings were to develop and validate a reference presented at the international Society that can estimate the degree of for Maternal Fetal Medicine (SMFM) fetal acidaemia for a given mRNA in January 2017. 103 Tilini Gunatillake

PhD Student

Improving the lives of pregnant The study, which ran from 2011–2016, women and children is at the heart began at the Royal Women’s of Tilini Gunatillake’s passion for Hospital but later moved to Sunshine research. Hospital, with Ms Gunatillake promoted in the final year to So when the 21-year-old was asked Postdoctoral Research Fellow. to help solve the mystery behind a potentially lethal pregnancy The research has been published complication for her PhD, she in five journals and although it was jumped at the chance. found that having less of the proteins in the placenta was not a precursor Researchers remain baffled about to developing pre-eclampsia, the what causes pre-eclampsia, which is study was able to demonstrate a the most serious medical disorder of novel insight into one of the current human pregnancy. It affects 5–10% treatments for pre-eclampsia. of pregnant women and contributes to over 60,000 maternal deaths “We didn’t find any differences in worldwide each year. Currently, cell function and still don’t know there is no effective treatment or what causes it, however, the results prevention for this disorder, which from my study were able to help results in a continuous battle us better understand and redirect between survival of the fetus and the current body of research the mother. It is usually a question into developing better targeted of whether to deliver the baby therapeutic interventions to prevent prematurely to improve maternal pre-eclampsia,” she said. health or to allow the fetus to reach its full growth potential and Ms Gunatillake’s interest in the compromise the mother’s health. field was piqued during lectures on maternal and fetal health at the Dr Gunatillake joined a team, led University of Melbourne, where she by the head of Sunshine Hospital’s completed a Bachelor of Science. Maternal Fetal Medicine Unit, A/Prof Joanne Said, in analysing a group “It really fascinated me, how so of proteins that were decreased in much of our long-term health the placenta among women with the outcomes are influenced by what condition. happens in-utero,” she said.

She said her goals were to investigate Her attraction to research has now the proteins’ function in the sent her in a different direction placenta, determine how reductions – as an Ethics and Governance in the proteins could potentially Submission Officer with Western lead to pregnancy disorders, and Health – but one that she finds establish therapeutic interventions equally as satisfying. to reduce the likelihood of developing pre-eclampsia. Western Health | Research Report 2016 104 Western Health | Research Report 2016 Report | Research Health Western

“It really fascinated me, how so many of our long-term health outcomes are influenced by what happens in-utero.” 105 Women’s and Children’s Paediatrics

Head of Department Admissions and Readmissions Our Research for Diabetic Ketoacidosis (DKA) Dr Martin Wright in 15–25 Year Olds at Western Health in 2012 Assessment of Fracture Healing The Western Health Paediatric Using pQCT Researchers: Dr Annie Hung, A/Prof Department is one of the busiest Christine Rodda and A/Prof Shane Researchers: Dr Michael Bullen and secondary paediatric departments Hamblin in the State and with paediatric A/Prof Christine Rodda presentations anticipated to This project audited the admission Collaborators: A/Prof Peter Pivonka increase in the near future, demand and readmission rates for young (St Vincent’s Hospital), Dr Romane with only grow further. With the people with Type 1 DM aged 15–25 Blanchard (St Vincent’s Hospital) and development of the new Women’s years old in 2012. By comparing Phong Tran and Children’s hospital at the the data from year 2012 to the Sunshine Hospital campus, we will This study assessed the influence of admission and readmission be well placed to meet the growing casting materials on the interpretation rates of the patients in the same medical and allied health needs of of pQCT, assessed the effect of population in the years following the the expanding paediatric population casting materials on moulding, and introduction of the Young Adults of the community in the West. validated the use of pQCT in the Diabetes Service to Western Health, assessment of fracture healing in we hypothesise that by providing Through collaborations, both children and teenagers using pQCT. a developmentally appropriate, internally through the Orthopaedic Currently, fracture healing in children multidisciplinary clinic for young Department, Emergency Medicine, and teenagers is assessed by clinical people with T1DM, they will have Endocrinology and Diabetes, examination and plain radiography, improved glycaemic control and less and the Australian Institute for both of which are quite imprecise. It is admissions to hospital with DKA. Musculoskeletal Science, and hypothesised that pQCT potentially externally through the Royal HAPPI Kids Study provides a more precise assessment Children’s Hospital, Parkville, of fracture healing. the Western Health Paediatric Researchers: Dr Martin Wright and Department has been involved in a A/Prof Christine Rodda number of research projects across a Collaborator: Prof Paul Monagle range of paediatric diseases. With the (Royal Children’s Hospital) future plans for the new Joan Kirner Women’s and Children’s Hospital at This is a Royal Children’s Hospital Sunshine campus, it is anticipated that / Murdoch Institute-led project, our involvement in research will only with Prof Paul Monagle as Principal increase as we continue to pursue Investigator. The aim of this project the delivery of evidence-based best is to establish age-appropriate practice in paediatrics. reference ranges for commonly ordered pathology tests. The outcome of this study is expected to provide up to date age-appropriate reference intervals for a large number of commonly ordered blood analytes for infants and children, using modern technologies. Western Health | Research Report 2016 106 University of Melbourne

Our Research Output 16 46 Projects Publications

16 1 2016 Report | Research Health Western Presentations Book 107 University of Melbourne Department of Medicine

Chair of Medicine With the aim of increasing the Finally, following the University of quality and quantity of our research Melbourne initiative to identify major Prof Gustavo Duque activities, several novel programs research strengths and develop have been implemented at the those specific areas, Western Health Department of Medicine – Western has identified the following key areas Research Staff Health. Our Master of Medicine of research for 2017: cardiometabolic, Program has been a major success neurology, musculoskeletal, 16 researchers and 18 students and has attracted four Physicians respiratory medicine and from Western Health, whom population health. Clinical trials The Department of Medicine – otherwise would not have the time and commercialisation initiatives Western Health partnership was re- or the support to perform their in these areas will be encouraged. launched in May 2016, when we then research activities. Our ongoing Applications to major funding confirmed our members (68 in total) Project 20/10, targeted to recruit 20 agencies are being encouraged, and and their specific research interests. new PhD students and train 10 new our limited resources will be spent on Our Department has established graduate supervisors between June those very promising research areas. a solid supporting structure for 2016–2017, has been a success, with In 2016, the Department of Medicine our researchers, which includes 14 new graduate students and seven – Western Health hosted 16 out a biostatistician on site (0.2FTE), new graduate supervisors already of 22 Scholarly selective students simplified access to the research commenced. (MD-RP) undertaking their research facilities at WCHRE (clinical trials and In terms of international presence, project at Western Health. lab spaces), easy linking with the we implemented a Visiting Fellows University’s resources (Post-Graduate and Visiting Scholars Program, which Office, IT, Minerva, etc.), and received 15 applications in 2016, with assistance with recruitment of new five international research fellows students and Postdoctoral Fellows. visiting Western Health in 2016. In terms of supporting personnel, For 2017, the Department of our Department has made a Medicine – Western Health will number of appointments. continue an intensive recruitment Dr Sharon Brennan-Olsen, a globally program which involves new recognised expert in population academics, honorary appointees, health research, has been appointed graduate students and supporting as Senior Research Fellow. Steven personnel. Funding will also be a Phu has come on board as Exercise priority, with major facilitation and Physiologist and Research Assistant. support for funding applications Senior Scientist Dr Lakshman Singh offered to our members. With is in charge of developing our basic more than 30 applications to our sciences infrastructure. Dr Ebrahim international visiting fellows program Bani-Hassam has been appointed in 2017, we expect that this program as Research Fellow in charge of will continue as a major success providing imaging services to all of our Department and a way of researchers at the Department. solidifying the international image Ahmed Al Saedi will act as research of Western Health as an important assistant for basic sciences projects research hub. and as Executive Assistant in charge of providing clerical support to our members. Western Health | Research Report 2016 108 Rheumatoid Arthritis, Social Our Grants and Awards Our Research Adversity and Low Health Literacy: An Intervention Study to Reduce Disease Severity and AIMSS Seed Grant A Translational Network-Led Treatment Non-Adherence D Myers. Development of a 3D Multi-Centre RCT to Examine the stem cell system to mimic the Efficacy of Oral N-Acetylcysteine Researcher: Dr Sharon Brennan- bone marrow microenvironment. in Bronchiectasis Olsen Australian Institute for Musculoskeletal Science, $15,000 Researcher: A/Prof Lata Jayaram Collaborators: Prof Gustavo Duque, (2016–2017). Prof Kerrie Sanders (Australian Following A/Prof Jayaram’s previous Catholic University) and Dr David research initiative, this project AIMSS Seed Grant Scott R Kinsella. Effect of vitamin D on aims to establish a translational balance in older falls. Australian network in preparation to several This project will analyse multiple Institute for Musculoskeletal RCTs, testing the efficacy of oral databases obtained from several Science, $10,000 (2016–2017). n-acetylcysteine in bronchiectasis. major cohorts around the world, focusing on the relationship Development of a New Treatment AIMSS Seed Grant between social adversity and non- for Osteoporosis E Rybalka. Pre-Clinical Safety adherence to treatment in patients Evaluation of Purine Nucleotide Researchers: Prof Gustavo Duque, suffering from rheumatoid arthritis. Therapy for the Treatment of Dr Lakshman Singh, A/Prof Damian Duchenne Muscular Dystrophy. Dose Range-Finding Study Myers and Ahmed Al Saedi Australian Institute for to Assess Multiple Doses and Musculoskeletal Science, $10,000 Collaborators: Prof Gilles Guillemin Evaluate Safety and Tolerability (2016–2017). (Macquarie University) and Dr Chris of Bimagrumab in Patients with Vidal (University of Sydney) Sarcopenia

This project focuses on preclinical Researchers: Rita Kinsella, Dr David validation of picolinic acid as a new Scott, Steven Phu and Dr Stephanie treatment for osteoporosis. It will Ward complete all the FDA-required steps The is phase 2 RCT testing of for preclinical validation of new the effect of Bimagrumab on treatments for osteoporosis and sarcopenia. If effective, this will be a aims to generate enough evidence major advance for the treatment of to move into human studies. sarcopenia in humans.

Phenotype of Sarcopenic Obesity

Researcher: Dr David Scott

Our Master of Medicine Program has Collaborator: Prof Peter Ebeling 2016 Report | Research Health Western been a major success and has attracted This project looks at the specific four Physicians from Western Health, characteristics of patients suffering from sarcopenic obesity. whom otherwise would not have the Assessment includes imaging and biochemistry with the aim of time or the support to perform their identifying a phenotype to be used research activities. in future clinical trials. 109 University of Melbourne Western Clinical School

Head of Department projects in the latter half of 2016 saw Looking ahead, we hope to offer more an increase in supervisor numbers, projects in 2017 by increasing our A/Prof Stephen Lew with AIMSS representing the lion’s pool of supervisors and partnering share of projects (11 of the 22). Of with other parts of the University to the 22 projects, 16 were taken up by develop projects. With the growth 2016 has seen a flurry of activity, Western Clinical School students, of research at Western Health with 11 projects completed in the compared with six of the 11 in 2016. we can be optimistic that we will early half of the year and a further increase both the number and quality 22 taken up by incoming students In 2016 the name of the projects of projects on offer in the future. in the latter. As in previous years, changed to MD Research Project there were strong contributions from (MDRP), to lessen confusion with the the Orthopaedics Unit, Emergency, Vocational Selective, another part of Drug and Alcohol and Surgery in the the MD4 year. completed projects. The increase in

Western Clinical School Selected Scholarly Projects

Student name Project title Supervisor

Annika Berglund Cervical Spine Imaging in Children and Young Adults Following Dr David Krieser Trauma. An Audit of Computed Tomography and Plain X-Rays

Karen Bourns Patient Reported Outcomes in Orthopaedic Surgery Mr Phong Tran

Bing Jian Chang Building Bone from Blood: How Does Vitamin D Supplementation Prof Gustavo Duque Affect the Number of Circulating Osteoprogeniter Cells?

Amanda Chong- The Effect of Vitamin D on Osteoblasts in the Presence of Palmitate Prof Gustavo Duque Halliday

Lucy Desmond PCR-Based Microbial Diagnostics for Community-Acquired Pneumonia Dr Harin Karunaweewa in Modern Hospital Populations

Konrad Gunter Uptake of Pertussis and Influenza Vaccination During Pregnancy A/Prof Jo Said

David Heelan Community Opioids Following Acute Surgical Care: A Multicentre Study Dr Noam Winter

Charis Kho Outcome Measures in OA of the Knee A/Prof Keith Lim

Ade Kurniawan Intrathecal Morphine (ITM) for Hepatobiliary Surgery. A Systematic Dr Georgina Imberger Review with Meta-Analysis and Trial Sequential Analysis

Ronnie Lau The Environmental Footprint of Septic Shock in the ICU Dr Forbes McGain

Michael Marazita What Effects do Age, Hormone Levels and Nutrition Have on COP Prof Gustavo Duque Cells in Osteosarcopenic Obesity?

Timothy Mason Emergency Department (ED) Presentations from Residential Aged Dr Inese Tucker Care Facilities (RACFs)

Samuel Maxwell Patient Reported Outcomes in Orthopaedic Surgery Mr Phong Tran Western Health | Research Report 2016 110 Student name Project title Supervisor

Nusry Nazeem Efficacy and Feasibility of a Pedometer Guided Physical Activity Dr Elizabeth Hessian Intervention in Overweight Pregnant Women – A Pilot Study

Jing Qiao Radiological Progression in RA and AS A/Prof Keith Lim

Callan Rauchfuss Diagnostic accuracy of Fine Needle Aspiration (FNA) in thyroid Nodules Dr Joanne Chionh

Matthew Changes in Circulating Osteoprogenitors (COP) Cells in Prof Gustavo Duque Redmond Osteosarcopenic Obese Older Individuals

David Sahhar Patient Reported Outcomes in Orthopaedic Surgery Mr Phong Tran

Ian Teh Radiological Progression in RA and AS A/Prof Keith Lim

Andrew Wang Efficacy and Feasibility of a Pedometer Guided Physical Activity Dr Elizabeth Hessian Intervention in Overweight Pregnant Women – A Pilot Study

Norman Weber In Admissions at Western Health, Where the Principle Diagnosis is Dr Mark Lavercombe COPD, What Factors are Associated with Unplanned Readmission?

Zheyi (Zoe) Zhou Outcome Meassures in OA of the Knee A/Prof Keith Lim

Imogen Ackerley Age-Specific D-Dimer Cut-Off Scores in the Assessment of PTE – The Prof Anne-Maree Kelly ADAPT study

Andy Ho Does Patellar Resurfacing During Total Knee Arthroplasty Improve Patient Mr Phong Tran Satisfaction in Patients with Abnormal Preoperative Coronal Alignment?

Sue Lynn Lim Does EphB1 have a Functional Role in Colon Cancer Spread? Prof Steven Chan

Lewis Murray Independent Medical Examinations Regarding Chronic Non-Cancer A/Prof Mike Pain with Prolonged Opioid-use: A Quality Assurance Audit McDonough

Ross Newman Identification of Factors Affecting Individual Patients’ Opioid Dosage A/Prof Mike Over Time and their Decisions to Change Dosage, in the Context of McDonough Chronic Non-Cancer Pain

Nicholas Patient-Reported Outcomes of Arthroscopic Debridement of Isolated Mr Phong Tran Pergaminelis Ligamentum Teres Tears

Christa Purdie A Descriptive Analysis of Patient Reported Outcome Measures (PROMs) Mr Phong Tran as Completed by Patients with a Foot or Ankle Pathology that has been Managed by the Orthopaedic Department at Western Health

Jesse Renouf Outcome of the Arthroscopic Treatment of an Isolated Labral Tear Mr Phong Tran 2016 Report | Research Health Western Using the i-HOT33

Brittany Scott- Are Stethoscopes Vectors of Contamination in the Emergency Prof Anne-Maree Kelly Rimington Department?

Sean Seow Investigating the Effect of EphB2 in Colon Cancer Tumour Growth and Prof Steven Chan Stromal Interactions Using In Vivo Models

Stephen Tsimos Children Presenting to Sunshine Hospital’s Emergency Department Dr Martin Wright are More Likely to be Obese 111 Victoria University

Our Research Output 12 21 11 Projects Publications Presentations

1 4 Chapter Proceedings Western Health | Research Report 2016 112 Head of Department Research Staff

Prof Alan Hayes 23 researchers and 9 students

Victoria University research at Enteric Nervous System Western Health includes Nursing Our Research as a Target to Alleviate (see separate entry) and AIMSS (see Gastrointestinal Side-Effects of separate entry). Further research Chemotherapy The Design of Novel Therapeutics conducted at the WCHRE includes for Metastatic Cancers staff and students from the College Researcher: Dr Kulmira Nurgali of Health & Biomedicine and Researcher: A/Prof JT Price Collaborators: Prof R Abalo College of Sport & Exercise Science, (Universidad Rey Juan Carlos), who are affiliated with the Centre for Collaborators: Prof G McArthur Prof JC Bornstein (University of Chronic Disease (CCD) and Institute (Peter MacCallum Cancer Centre), Melbourne), Prof S Brookes (Flinders for Sport, Exercise and Active A/Prof J Wilce (Monash University) University), Prof John Orbell (Victoria Living (ISEAL). Research extends and Dr J Quinn (Garvan Institute of University), Prof V Apostolopoulos from basic sciences, investigating Medical Research) (Victoria University) and Dr E Rybalka mechanisms for chemotherapy- (Victoria University) induced gastrointestinal and skeletal We have identified a number of important molecular targets that muscle dysfunction, to pre-clinical This project aims to understand the are fundamental to the process testing of potential therapies for mechanisms underlying delayed of cancer metastasis. This project muscular dystrophy. All projects and persistent gastrointestinal seeks to design first-in-class have a disease focus and our (GI) side-effects of chemotherapy inhibitors of these targets that can aim is to translate these findings and to test treatments that might be used as stand-alone agents or to improved clinical outcomes. alleviate these debilitating and life- in combination with conventional Staff are also actively engaged in threatening side-effects. The use therapeutics for the treatment of collaborative projects in stroke of a novel neuroprotective strategy metastatic cancers. Metastasis rehabilitation (in collaboration provides new avenues for the is the major cause of morbidity with Physiotherapy) and treatment development of therapies to achieve and death in cancer patients and of heart failure patients (in this aim. Colorectal cancer is the currently no curative treatments are collaboration with Cardiology). second most commonly diagnosed available for metastatic cancers. cancer and cause of cancer death The development of treatments that in Australia. Chemotherapy is given specifically target metastatic cancer before or after surgery to most will lead to improved survival, clinical patients. Diarrhoea, constipation, outcomes and enhanced quality of oral mucositis, nausea and vomiting life for patients who have metastatic are common GI side-effects of anti- disease in the most common and cancer chemotherapy experienced aggressive cancers such as breast, by 80-90% of patients. As a result of prostate, melanoma, colorectal, these side-effects, patients develop renal and pancreatic. malnutrition and dehydration leading to rapid weight loss (cachexia). Early death rates of up to 4.8% associated with chemotherapy are due to GI toxicity. The incidence 2016 Report | Research Health Western of chronic post-treatment diarrhoea amongst cancer survivors can persist for up to 10 years. Due to these side effects the dose of chemotherapy is often limited, reducing efficacy of the anti-cancer treatment. This project will develop novel therapies to improve the efficacy of anti- cancer treatment. 113 Victoria University continued

Mesenchymal Stem Cells for the The Effects of Dietary Inorganic Optimising Clinical and Functional Treatment of Enteric Neuropathy Nitrate on Exercise Performance Outcomes in Older Adults with Associated with Inflammatory in Heart Failure Heart Failure using the Peripheral Bowel Disease Remodelling Through Intermittent Researchers: Prof Jason Allen and Muscular Exercise (PRIME) Researcher: Dr Kulmira Nurgali A/Prof Itamar Levinger Approach: A Pilot Study

Collaborators: Prof JC Bornstein Collaborator: A/Prof Christopher Researcher: A/Prof Christopher Neil (University of Melbourne), Prof Neil Vasso Apostolopoulos (Victoria Collaborators: Dr Emily Karahalios University), Dr Raj Eri (University This study aims to determine the (University of Melbourne), Prof of Tasmania), Prof Claude Bernard effects of one week of inorganic Jason Allen (Victoria University), (Monash University), Prof Richard nitrate supplementation on exercise A/Prof Itamar Levinger (Victoria Boyd (Monash University), Dr Paul performance in patients with heart University) and Dr Elizabeth Skinner Bertrand (RMIT), Prof Enzo Palombo failure. Results from this study will (Swinburne University) and Dr Samy provide preliminary data about This study aims to determine Sakkal (Victoria University) the feasibility and applicability of the effects of PRIME exercise inorganic nitrate supplementation training, in comparison to ESSA The proposed project is the first to as a novel treatment for patients recommended exercise training on investigate therapeutic potential with heart failure. We ultimately aerobic capacity, muscle strength of mesenchymal stem cell (MSC)- hope that this line of research can and quality of like in older patients based treatments on human enteric provide new therapeutic targets and with chronic heart failure (CHF). neurons and in the animal model innovative treatments for patients Older patients with CHF are often of spontaneous chronic colitis. with congestive heart failure. physically fragile and current Understanding the mechanisms of enrolment into Western Health’s neuroprotective effects of MSCs cardiac rehabilitation programs is will lead to target identification for poor. Data from this study will inform therapeutic intervention and provide whether PRIME is tolerable in the avenues for the development of elderly patient with CHF. Ultimately, MSC-based therapies that can be if successful we may change current safely used for the treatment of practice and improve the delivery Inflammatory Bowel Disease (IBD). of exercise rehabilitation to the full spectrum of CHF patients, including IBD comprises two main the frail elderly, and optimise clinical pathologies, Ulcerative Colitis (UC) and functional outcomes in this and Crohn’s Disease (CD), affecting patient group and others. more than 80,000 Australians. This number is expected to increase to over 100,000 by 2022. IBD costs our economy $3.1B per year. Every year approximately 5,200 Australians are diagnosed with CD or UC. Current therapeutics for IBD are very toxic, have severe adverse effects and become ineffective over time. Thus, the search for novel therapies for the treatment of IBD is crucial. Western Health | Research Report 2016 114 Victoria University Central AIMSS Seeding Grant Our Grants and Awards Research Grant E Rybalka, A Hayes and C Timpani. S Sakkal, K Kulmira Nurgali and V Pre-Clinical Safety Evaluation of Apostolopoulos. Mesenchymal Purine Nucleotide Therapy for the NHMRC Project Grant Stem Cells for the Treatment of Treatment of Duchenne Muscular. J Quinn, MT Gillespie and JT Price. Enteric Neuropathy Associated AIMSS Seed Funding Grant, $10,000 Does Causing Stress in a Bone Cause with Inflammatory Bowel Disease. (2016–2017). it to Become Weaker? The Role of Cell Victoria University Central Research Stress Responses in Inflammation- Grant Scheme, $29,328 (2016). National Heart Foundation Project Associated Bone Loss. National Grant Health and Medical Research Council, Western Health Research Grant J Allen, I Levinger, C Neil and M $653,558 (2014–2016). C Neil, J Allen, I Levinger, E Skinner, Woessner (PhD Candidate). BEET E Karahalios, J Saliba and C Giuliano CHF – Effects of Dietary Inorganic Victoria University Clinical (Masters Candidate). Optimising Nitrate Supplementation on Exercise Science Program Grant Clinical and Functional Outcomes Exercise Performance in Chronic E Rybalka, A Petersen, A Hayes, G in Older Adults with Heart Failure Heart Failure. National Heart McConell, K Nurgali, C Goodman, R Using the Peripheral Remodelling Foundation of Australia, $74,666 Blazev, M Sullivan-Gunn, C Timpani Through Intermittent Muscular (2017). and E Hanson. Protective Potential Exercise (PRIME) Approach: A Pilot of BGP-15, Idebenone and Nitrate Study. Western Health Research Bega Cheese Industry Grant Against Chemotherapy-Induced Grant, $30,000 (2016). A Hayes, E Rybalka and C Skeletal Muscle Atrophy and Goodman. Whey Peptide WP-1 for Dysfunction. Victoria University, National Strength and the Treatment and Prevention of $19,900 (2015–2016). Conditioning Association Sarcopenic Muscle Wasting. Bega Foundation International Cheese, $58,669 (2017). The Irene Lucas Foundation Collaboration Grant Equipment Grant S Dorgo, A Hayes and D Scott. V Apostolopoulos and K Nurgali. Combating Dynapenia in Diverse Research Equipment Purchase Grant Ethnic Groups of Older Adults. for Eppendorf Xplorer Electronic NSCA Foundation, $55,537 (2016). Multichannel Multistepper Pipettes. The Irene Lucas Foundation, $4966 (2016). Western Health | Research Report 2016 Report | Research Health Western All projects have a disease focus and our aim is to translate these findings to improved clinical outcomes. 115 Our Partners

5 16 9 1 2 3 4 6 10 11 12 13 14 15 8 36 7 33 34 35 24 17 27 48 49 54

20 37 38 39 18 19 21 22 23 50 40 41 25 26 28 29 52 30 31 32 42 43 44 47 51 53 45 46

Australia 19. The University of Sydney 40. Modbury Hospital 20. Wollongong Hospital 41. Queen Elizabeth 1. Queensland Institute of Medical 21. Youth Health, Brain and Mind 42. Australian National University Research (QIMR) Research Institute 43. Australian Research Council 2. Queensland University of 22. Blacktown / Mt Druitt (ARC) Technology (QUT) 23. Canterbury 44. Australian Sports Medicine 3. Royal Brisbane Hospital (RBH) Association 24. Dubbo Base Hospital 4. The University of Queensland 45. Cooperative Research Centres 25. Liverpool Hospital 5. Cairns Hospital (CRC) 26. Nepean Hospital 6. Greenslopes Hospital 46. National Health and Medical 27. Port Macquarie 7. Gold Coast Research Council (NHMRC) 28. RPA Hospital 8. Ipswich Hospital 29. Royal North Shore New Zealand 9. Mt Isa Hospital 30. St George 10. Nambour Hospital 47. Kidsfirst Kindergartens, 31. St Vincent’s Sydney New Zealand 11. Prince Charles 32. Sutherland 48. Starship Children’s Health, 12. Princess Alexandra New Zealand 33. Princess Margaret Hospital 13. Queen Elizabeth II Jubilee for Children 49. Auckland University of 14. Redcliffe Hospital Technology (AUT) 34. Armadale Hospital 15. Redlands Hospital 50. Hawkes Bay 35. Sir Charles Gairdner 16. Townsville Hospital 51. Hutt Valley 36. Peel Health 17. University of Newcastle 52. Palmerston North Hospital 37. Flinders University 18. The George Institute for 53. Wellington Regional Hospital 38. SA Health Global Health 54. Auckland Bioengineering 39. University of South Australia Western Health | Research Report 2016 Institute 116 70 71

73 57 56 65 66 67 74

55 68 69 75 58 84 85 86 59 60 61 63 64 72 62 87 88 89

76

77 78

79 80

81 82 83

Global 65. Nottingham University 78. University of Colombo, Hospitals NHS Trust (UK) Sri Lanka 55. Population Health Research 66. Oxford University (UK) 79. USM-Universiti Sains Malaysia Institute (PHRI) McMaster 67. The University of Sheffield (UK) 80. UKM-Universiti Kebangsaan University, Ontario (Canada) Malaysia 68. Universities of Exeter and 56. University of Manitoba, Plymouth (UK) 81. Changi General Hospital Winnipeg (Canada) 69. Bristol University 82. Khoo Teck Puat Hospital 57. University of Saskatchewan 70. World Health Organisation 83. NUH National University 58. Mayo Clinic, MN (US) (Switzerland) Hospital 59. University of California, 71. ETH Zurich 84. Queen Mary Hospital, San Francisco (US) Hong Kong 72. Instituto de Salud Carlos 60. University of Missouri III. Ministry of Science 85. The University of Hong Kong (Kansas City)

and Innovation Fondo de 86. Pamela Youde Nethersole 2016 Report | Research Health Western 61. Harvard University, MA Investigación Sanitaria, Spain Eastern Hospital, Hong Kong 62. National Institute of Mental 73. Lund University, Sweden 87. Prince of Wales Hong Kong Health (NIMH), Washington DC 74. Aarborg University, Denmark 88. The Chinese University 63. The Brain and Behavior 75. Vienna University of Technology of Hong Kong Research Foundation, New York USA 76. Asia Pacific Stroke Association, 89. Tuen Mun Hospital, Hong Kong India 64. Yale University, CT (US) 77. National Stroke Association of Sri Lanka 117 Our Victorian Partners

Collaborators

oo Alfred Health oo Australasian Leukemia and Lymphoma Group oo Ambulance Victoria oo Australian Medical Association, oo ANZ Breast Cancer Trials Group Victorian Branch oo ANZ Intensive Care Society oo Australian Sports Medicine Clinical Trials Group Association oo ANZ Intensive Care Research oo Australasian Kidney Trials Centre (ANZICRC) Network oo Asia Pacific Association of Young oo Australian Lung Trials Group Neurologists and Trainees oo Baker IDI oo Austin Health oo Bendigo Health Care Group oo Australasian College for Emergency Medicine (ACEM) oo Beyond Blue Clinical Trials Group oo BioGrid

Wodonga

Bendigo Horsham

Ballarat Melbourne

Bairnsdale

Warrnambool Geelong Western Health | Research Report 2016 118 oo Biomedical Research Victoria oo Melbourne Brain Centre oo St Vincent Hospital (SVH) oo Cancer Trials Australia (CTA) oo MonashHeart, Southern Health oo Stroke Society of Australasia oo Cochrane Renal Group oo Monash Medical Centre (MMC) oo The Cancer Council of Victoria (CCV) oo College of Intensive Care oo Monash University oo The Heart Foundation Medicine of Australia and New oo Murdoch Children Research Zealand Institute oo The Royal Women’s Hospital (RWH) oo CRC for Mental Health oo National Stroke Research Institute oo The Royal Children’s Hospital oo Dorevitch Pathology oo Networking Health Victoria (RCH) oo Deakin University oo Neuroscience Trials Australia oo The University of Melbourne oo Department of Health, Victoria (NTA) oo The Victorian Forensic Paediatric oo Diabetes Australia (Victoria) oo North-East Health Wangaratta Medical Service (VFPMS) oo Diabetes Australia Research oo North West Melbourne PHN oo University Hospital Geelong Foundation oo Nurses Board of Victoria oo Victorian and Interstate Health oo Eastern Health oo ORYGEN Services oo Florey Neurosciences Institutes oo Osteoporosis Australia oo Victoria University oo General Practice Victoria oo Peter MacCallum Cancer Centre oo Victorian Cancer Agency (VCA) oo Kidney Health Australia oo Royal Australasian College of oo Victorian Comprehensive Cancer oo LaTrobe University General Practitioners (RACGP) Centre (VCCC) oo Ludwig Institute of Cancer oo Royal Australasian College of oo Victorian Stroke Clinical Network Research Physicians (RACP) oo Walter and Eliza Hall Institute oo MACH Partners oo Royal Melbourne Hospital (RMH) (WEHI) oo Melbourne Medicare Local oo Royal Melbourne Institute of oo Western Region Health Centre Technology (RMIT) oo Melbourne Neuroscience Institute

Sponsors oo Abraxis BioScience oo Gilead oo Sanofi-Aventis oo AstraZeneca oo GlaxoSmithKline oo Servier Australia oo Amgen Australia Pty Ltd oo ImClone oo Shire Pharmaceuticals oo Bank Vic oo Intensive Care Foundation oo SIRTeX Medical Ltd oo Boehringer-Ingelheim oo Jannsen-Cilag oo Victorian Cancer Agency (VCA) oo Bayer Australia Ltd oo Jansen and Millinium oo Windermere Foundation

oo Covance oo Novartis Oncology Australia oo Western and Central Melbourne 2016 Report | Research Health Western Integrated Cancer Service oo Covidien oo Merck, Sharp and Dohme (MSD) (WCMICS) oo Dorevitch Pathology oo Pfizer Oncology oo Western Region Health Centre oo Eli Lilly Australia oo Pharmaxis oo Wyeth Australia Pty Ltd oo Ethicon oo PPD Australia oo First State Super oo Roche Pharmaceuticals oo G&C Mutual Bank oo Rotary (Footscray Club Inc) 119 Design by

Footscray Hospital Sunbury Day Hospital Gordon Street 7 Macedon Road Footscray VIC 3011 Sunbury VIC 3429 Locked Bag 2 9732 8600 Footscray VIC 3011 8345 6666 Williamstown Hospital Sunshine Hospital Railway Crescent Williamstown VIC 3016 Furlong Road 9393 0100 St Albans VIC 3021 PO Box 294 Drug Health Services St Albans VIC 3021 8345 1333 3-7 Eleanor Street Footscray VIC 3011 Sunshine Hospital 8345 6682 Radiation Therapy Centre Hazeldean Transition Care 176 Furlong Road St Albans VIC 3021 211-215 Osborne Street 8395 9999 Williamstown VIC 3016 9397 3167 Western Centre for Health Research and Education Sunshine Hospital Furlong Road St Albans VIC 3021 8345 1333

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