2012 RESEARCH REPORT OUR VISION Together, caring for the West - our patients, staff, community and environment.

OUR PURPOSE Working collaboratively to provide quality health and well-being services for the people of the West.

OUR VALUES Compassion - consistently acting with empathy and integrity Accountability - empowering our staff to serve our community Respect - for the rights, beliefs and choice of every individual Excellence - inspiring and motivating, innovation and achievement Safety - working in an open, honest and safe environment. OUR PRIORITIES Safe and effective patient care People and culture Community and partnerships Research and learning Self-sufficiency and sustainability

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.

Cover: The Sunshine Radiation Therapy Centre is a partnership between Western Health and Peter MacCallum

WESTERN HEALTH RESEARCH REPORT 2012 001 Contents

Foreword 2 Research Highlights 2012 3 Research Support 2012 3 Research Directorate 4 Research Week Awards 5 Allied Health 6 Anaesthesia and Pain Management 22 24 Drug Health Services 26 – incl. Addiction Medicine & Toxicology 27 Gastroenterology & Endoscopic Services 28 General Internal Medicine 30 Geriatric Medicine 32 Infectious Diseases 33 Intensive Care Unit 34 Joseph Epstein Centre for Emergency Medicine Research 36 Nephrology 38 Neurology 42 North West Academic Centre 45 Nursing 49 Oncology Haematology Unit 52 Orthopaedic Unit 58 Paediatric Emergency Medicine 60 Pharmacy 64 Respiratory and Sleep Disorders Medicine 66 Rheumatology 68 Australian Institute for Muscuoloskeletal Science (AIMSS) 71 Neuropsychiatry Centre 75 University at Western Centre for Health Research and Education 80 Our Partners 82 Our Partners - Victoria 84

WESTERN HEALTH RESEARCH REPORT 2012 002 Foreword

Research Week at Western Health is a major annual event in which we celebrate Western Health experienced the achievements of our Western Health an exciting and successful research community. While this event is designed to showcase the depth and breadth year of research during 2012. of research done here at Western Health, This edition of our annual it is also an important forum for bringing Research Report highlights people together to talk about research ideas, projects, collaborations and opportunities the outstanding research across a range of academic and clinical efforts of the staff at Western disciplines. Research Week in 2012 had a number of distinguished key note speakers, Health during 2012. The major and we were extremely fortunate to have highlights were 273 published the Governor of Victoria, His Excellency, the Honourable Alex Chernov AC QC, formally journal articles, 180 research open the proceedings. projects approved, and over Six major prizes were awarded in different $24M in research grant categories to recognise quality in research at Associate Professor Alex Cockram funding. All of these numbers Western Health. We would like to take this Chief Executive opportunity to thank the sponsors of these represent an increase on prizes. Without their generosity and support the previous year, reflecting we would not be able to present these awards. We congratulate all the researchers the ongoing growth of the at Western Health whose achievements research effort at Western and contributions were celebrated during Research Week. We would also like to Health. thank the hard work and dedication of the members of the Western Health Low Risk Ethics Panel, whose tireless efforts continue to support and sustain the research effort at Western Health.

We look forward to ongoing development and expansion of clinically-focused, patient- centred research at Western Health. The Western Centre for Health Research and Education was established in 2011 and is now delivering real benefits in research collaboration. The Centre houses the Australian Institute for Musculoskeletal Science (AIMSS) which focuses on health Dr David Newman issues of significant importance to the Director, Office for Research Western Health community. With the hard work, commitment and enthusiasm of our staff, Western Health’s research efforts will continue to grow. While we look towards a bright research future, we celebrate in this Report the achievements of 2012.

WESTERN HEALTH RESEARCH REPORT 2012 003 Research Highlights 2012

183 273 Seminar and Conference Presentations Published Journal Articles $2.08M 180 Income from Commercially Sponsored Clinical Trials Research Projects Approved $24.56M 8 Awarded or held for Research Grants during 2012* Published Book Chapters * Total awarded for the duration of the grants to our researchers and their collaborators

PUBLICATIONS GRANTS ($M) CLINICAL TRIALS ($M)

300 273 30 4 $3.45 $24.56 217 3 200 20

$14.51 $2.08 2 126 111 $11.12 $1.30 100 10 $1.09 1 $5.76

0 0 0 2009 2010 2011 2012 2009 2010 2011 2012 2009 2010 2011 2012 Research Support 2012

13,620 paper medical records supplied to 900 unique email queries received and researchers by Health Information Services replied to by the Office for Research

186 literature searches performed by Library 148 research consultation meetings Services to support research development were held by the Office for Research

48 protocols reviewed and 1650 dispensations 19 research seminars were organised by Pharmacy for clinical trials by the Office for Research

research projects approved by the Low 180 Risk Ethics Panel and Office for Research

WESTERN HEALTH RESEARCH REPORT 2012 004 Research Directorate

Western Health Research Office for Research Staff Review Members Advisory Committee Angela Marsiglio MBBS BMedSci Membership Dr David Newman DRANZCOG Anaesthetic Registrar Director, Office for Research Dr Mark Garwood Angela Mellerick RN Nurse Unit Manager Dr Tam Nguyen Executive Director Medical Services Day Oncology Manager, Office for Research Dr David Newman Anne Marie Southcott MBBS FRACP Mrs Kerrie Russell Director, Office for Research (Chair) Director, Respiratory & Sleep Disorders Ethics Administration Assistant Medicine Dr Tam Nguyen Ms Virginia Ma Manager, Office for Research (Secretary) Elizabeth Hessian MBBS FANZCA Research Governance Officer Consultant Anaesthetist Ms Wendy Calder (appointed December 2012) Executive Director, Nursing & Midwifery Elizabeth Skinner PhD BPhty Ms Fiona Lobo Physiotherapist Intensive Care Unit Professor Steven Chan Office for Research Intern Professor of Surgery (Victoria University student) Emily Incledon BBSc (Hon), DPsych (Clinical), Assoc MAPS Clinical Health Professor Peter Ebeling Ms Phoebe Blank Psychologist Professor of Medicine; Assistant Dean Office for Research Intern Chair NorthWest Academic Centre (Deakin University student) Harin Karunajeewa MBBS FRACP PhD () Director, Clinical Research – Division of Ms Christine Mizrahi Medicine Professor Michael Green Office for Research Volunteer Director of Cancer Services Jenny Schwarz MBBS FRACP GDipEd GDip Ms Lauren Scofield Pall Med Clinical Associate Professor in Professor Edward Janus Office for Research Volunteer Geriatric Medicine Director, General Medicine Julian Choi MD FRACS Consultant Surgeon Mr Ian Higgins Western Health Low Risk Ethics Director, Western Health Foundation Panel Membership Keri Chater PhD M.Nurs BSocSc RN Clinical (until October 2012) Coordinator, Westgate Aged Care Facility

Dr Harin Karunajeewa Chairperson Lei Ching Yeoh B.Pharm Clinical Trials Director, Clinical Research Division Tissa Wijeratne, MBBS (Hons) FRACP FAHA Manager of Medicine Consultant Neurologist Lynette Reid-Price MClinEpi MAppMgt Dr Debra Kerr (Hlth) BBiomedSc Manager Medical Specialty Senior Lecturer, School of Nursing Deputy Chairperson Diagnostics Victoria University Debra Kerr, RN MBL PhD Senior Lecturer, Sathyajith Velandy Koottayi MBBS MD Faculty of Nursing, Victoria University A/Professor Ruth McNair FJFICM Intensivist Director, General Practice and Primary Terence McCann PhD MA RMN RGN DipNurs Health Care Academic Centre Node Lawyer (Lon.)RNT, RCNT Professor of Nursing, University of Melbourne Paula Shelton BA LLB Practice Group Faculty of Nursing (VU) Leader-Medical Law Group Slater & Gordon Dr Craig Nelson Lawyers Director, Department of Nephrology Manager Tam Nguyen PhD BSc/BE (Biomed) FRSPH Mr Silvio Pontonio Manager, Office for Research Executive Director, Community Integration and Partnership

Dr John Violet Director, Radiation Therapy Centre

WESTERN HEALTH RESEARCH REPORT 2012 005 Research Week Awards

Western Health’s annual Research Week health and nursing staff presented their • Kendall Francis Prize for Best Surgical was held from 12 to 16 November 2012, research projects throughout the week. Registrar Research presentation giving an exciting overview of the extent and sponsored by Covidien: A Public Lecture on Wednesday 14 variety of research undertaken by Western Dr Manny Cao, Surgical Registrar for November presented by Professor Rob Health researchers, along with its two research into: Carbon dioxide insufflation Moodie highlighted some of the major main partners, The University of Melbourne colonoscopy decreases time-to-caecum causes of illness globally and the social, and Victoria University. The program was and post-procedural discomfort: cultural and economic drivers behind these developed by the Office for Research with a randomised control trial support and guidance from the Research patterns of illness. Professor Moodie • Best Allied Health Research presentation Advisory Committee. Many of the sessions compared these to the local experience sponsored by Alcidion: were well attended, and there were good of migrants and refugees in the Western audience numbers for the major key note suburbs of Melbourne and discussed some Sarah Pitt from Nutrition for research addresses. Over 450 abstract booklets of the key challenges to finding global and into: Malnutrition in Western Health were handed out and over 600 attendees local solutions to these changing patterns haemodialysis patients registered for sessions during Research of illness. He discussed a new systems • Best Nursing Research presentation Week. theory related to prevention, where each sponsored by Health Super: part of the overall health care system might Marieta Pring for research into: On Monday 16 November, the Governor be more effective in keeping patients at the Implementation of Strategies to Increase of Victoria, The Honourable Alex Chernov appropriate level of care, and how clinicians the Exclusively Breastfeeding Rates of AC QC officially launched Western Health play an absolutely crucial role in this, at all babies born to women with Gestational Research Week. Professor Jim McCluskey, levels. Diabetes Deputy Vice-Chancellor (Research) from the University of Melbourne in his opening Research Week continues to grow, which • Best Published Research paper is a new keynote address discussed the University’s reinforces not only the importance of award this year and is sponsored by the strategic framework for the next 10-15 research but also the strong involvement Western Health Foundation: years: the Grand Challenges strategy. that Western Health staff have in conducting Dr Claudia Gagnon from Endocrinology The Grand Challenges philosophy aims to be quality research across a range of for the research into: Serum embedded across the University, particularly disciplines. This year a record 120 abstracts 25-Hydroxyvitamin D, Calcium Intake, and through its precincts and research were submitted - a remarkable increase on the risk of Type 2 Diabetes after 5 years last year’s 80 and the previous year’s 20, partnerships strategies, including Western • Best Research Poster Prize, sponsored highlighting the vast amount of high quality Health. by Police Credit Union: research occurring at Western Health. The Week featured a number of Research Week was supported by six major Dr David Krieser from Paediatric distinguished keynote addresses, including prizes and two runner-up prizes, of $1500 Emergency for research into: international speaker, Professor Michael and $500 each respectively, provided by A Randomised Trial Comparing Kimlin, Director, NHMRC Centre for sponsors, in order to encourage research Nasogastric with Intravenous Hydration Research Excellence in Sun & Health and activities in several disciplines at Western in Infants with Bronchiolitis Director, AusSun Research Lab, School of Health. Congratulations to the following • The runner up for Best Research poster, Public Health & Social Work, Queensland prize winners: sponsored by Dorevitch: University of Technology, and Professor • Neville Yeomans Prize for the Best Dr Hui-Li Wong from Oncology for Leonard Berlin, Professor of Radiology, research into: Impact of Diabetes on Rush Medical College (US). Medical Research Presentation (Registrars & Advanced Trainees), Clinicopathologic and Genetic Features of Colorectal Cancer Formation The research capacity building panel sponsored by Pfizer: discussion featured Professor Danny Liew Dr Hui Liew from Nephrology for research • Best Research Poster (Research Higher Degree Student) Sponsored by GE: from the Centre for Clinical Epidemiology, into: “EMAN“Anaemia: An Open Labelled Biostatistics and Health Services Research Randomised Controlled Trial Of The Belal Khan for research into: Associations (Melbourne Health & The University of Electronic Management Of Anaemia Of Long-Term Dietary Calcium Intake Melbourne) and A/Professor Terry Haines In Chronic Kidney With Fractures, Cardiovascular Events from Allied Health Research Unit (Southern And Aortic Calcification In A Prospective Health & Monash University) provided an Cohort Study excellent discussion on motivators, enablers and obstacles to building research capacity. Our medical and surgical registrars, allied

WESTERN HEALTH RESEARCH REPORT 2012 006 Allied Health Care Coordination

Research undertaken in Care Coordination their staff and contributes to development HARP service providers; and provides a in 2012 relates to the following areas: of standards, tools and protocols to support platform from which to implement strategies the care coordination service. to support improved workforce integration. • Understanding client experiences and how This knowledge will contribute to broader we integrate client feedback into service/ Care Coordination Experienced discussions in supporting workforce workforce redesign Based Co-Design Project integration and innovation in complex • Use of routinely collected service data Kate Cranwell, Jacinta Roberton, aged care. to evaluate the effectiveness of care Abby Bean, Mark Murray, Rebecca coordination services Power, Assunta Morrone, Trish Downes, Helen Gray, Michelle Pitcaithly • Workforce innovation and reform Our Researchers Care Coordination Services are focused Collaborators: A/Prof Liza Heslop Rebecca Power: Group Manager, on meeting the needs and improving the (Victoria University), Dr John Bamburg Care Coordination experiences of our clients with chronic and (Western Region Health Centre) complex needs. Through our involvement in Helen Gray: Acting Manager, workforce innovation we hope to contribute The study aims to seek feedback about Hospital Admission at Risk Program to the national workforce reform evidence the patient and carer experience of Care Kate Cranwell: Care Co-ordination base. We anticipate that these areas of Coordination service provision and utilise Workforce Innovation and Integration research will continue to be relevant in 2013. information to develop and improve how care coordination services are delivered, Project Lead inform and educate staff. Abby Bean: Information Management Lead Our Research There is increasing evidence from Health Independence Programs effectiveness studies that consumer and Evaluating Interprofessional Care Jacinta Roberton: Aged Care Assessment community participation can improve health in Sub-acute Teams Service Senior Clinician Kate Cranwell outcomes, lead to more responsive care, facilitate people’s involvement in treatment Mark Murray: Immediate Response Service Care Coordination Services Reduce decisions and improve quality and safety. Team Leader Hospital Demand at Western Health In addition to better health outcomes Abby Bean, Peter Roe consumer and community participation Prue Deckert: Care Coordination Workforce can help reduce risk, hold professionals Integration and Innovation Project Manager An Exploratory Study of Care Coordination accountable, encourage clinical Work Practice and Activity accountability, identify workforce issues Peter Roe: Data Officer, Care Coordination Kate Cranwell, Prue Deckert, Abby Bean and foster more responsive and equitable services. Trish Downes: Pharmacist, Collaborators: Associate Professor Liza Care Coordination Heslop (Victoria University) 10 Years On.... Exploring Virtual Teamwork in HARP Michelle Pitcaithly: Care Coordination - This study aims to map and analyse Drug and Alcohol Specialist workflow processes and functions of Kate Cranwell, Kerryn Hornby, care coordination staff using an activity Jenelle McHugh log data collection tool. A series of focus This study aims to evaluate the model Project Grant groups with staff will ascertain viewpoints, of sharing staff across agencies within understandings and values of the care Rebecca Power “Care Coordination the HARP virtual team. It determines key coordination role, and opportunities for Workforce Integration and Innovation Project enablers and barriers which influence the workforce reform. This study will provide the - Building Regional Capacity in the West” effectiveness of the model and contribute necessary data to inform/support improving Awarding Body: Health Workforce : to job satisfaction for workforce within the balance of specialist and generalist $450,000 (July 2012- Jan 2014) the HARP virtual team. The project will roles within this workforce. It will enable implement and evaluate change which establishment of roles with expanded Mark Murray “Improving Discharge supports improved integration in workforce scope of practice that may lead to a more Communication to Aged Care Facilities” for those working within complex aged care. efficient ‘fit for purpose’ workforce. The Mavis Mitchell Award, Western Health: Improved understanding of the barriers and study gathers information on the gaps and $5,000 enablers of working within the HARP virtual barriers which may limit optimal integration team will help to support current working of service delivery with related services and relationships between WH and community

WESTERN HEALTH RESEARCH REPORT 2012 Western Health’s Physiotherapy Department has a large number of staff actively involved in research.

WESTERN HEALTH RESEARCH REPORT 2012 Care Coordination: solving the round peg, square hole quandary

In 2012, Western Health’s “Until recently there were a whole lot of “This research is around building our round pegs and we’d made nothing but evidence base,” said Kate Cranwell, Care Coordination Service was square holes,” Rebecca adds. Care Coordination Workforce Innovation successful in its application and Integration Project Lead. “You need Care Coordinators to re-scope for funding from Health the holes and find the services these “We’re evaluating throughout, talking Workforce Australia. clients need.” to staff, monitoring referral numbers, Emergency Department presentations, Led by Group Manager of Care Coordination, When the opportunity arose, Rebecca productivity and efficiency, and whether Rebecca Power, “The Care Coordination submitted an application to Health there has been a shift in the types of tasks Workforce Integration and Innovation Project Workforce Australia for funding with a view that staff are doing. It’s about building - Building Regional Capacity in the West” to getting some robustness behind the Care sustainability for our Care Coordination received an impressive $450,000 for the Coordination service, and really putting it workforce.” period July 2012 to January 2014. at the forefront of Western Health’s delivery of patient care. Western Health is extremely “Care Coordination is a fairly new profession, grateful to Health Workforce perhaps only ten or so years old,” Rebecca Several streams of work are taking place Australia for its support and said. under the over-arching project, with a view the allocation of funding to meeting a number of objectives, including: which has made this “It’s a group of services that looks at research possible. • developing and implementing a providing care to complex clients and competency framework targeting care focuses more along the lines of generalist coordination roles; care. • reviewing the current role and trialling “Recruiting used to be difficult because and evaluating non traditional workforce people didn’t understand what a Care models; Coordinator was or did. We needed a group • actively integrating workforce practices of people who were comfortable with to facilitate coordination of care; complexity, able to do really good generalist • providing experience and classroom work and were committed to following the based learning opportunities to support patient through their journey. workforce skills; “Our clients have multiple chronic diseases, • implementing an experience based co- such as diabetes, pulmonary, cardiac, plus design framework; and usually, psycho-social factors. Sometimes • contributing to the current evidence base mental health or drug and alcohol issues for workforce redesign and complex care too. So a whole lot of things which make roles. it difficult for them to fit neatly into other services.

Care Coordinator Maureen Kinston visits a client at home.

WESTERN HEALTH RESEARCH REPORT 2012 WESTERN HEALTH RESEARCH REPORT 2012 010 Allied Health (cont.) Nutrition

The Nutrition Department has continued Our Research - Nutrition Investigating Practices Relating a major research focus within the area to Malnutrition in Victorian Cancer of malnutrition. This strongly links with Audit on the Use of “Nil By Mouth” and Hollie Bevans, Heather Jordan, Kathryn clinical service provision, where improved “Clear Fluid” Diet Codes on Two Surgical Pierce Collaborator: Kathryn Marshall identification and management of Wards at Western Hospital (Department of Health) malnutrition across the organisation has Kim Dennis and Vanessa Carter continued to be a high priority. In this project, patients receiving cancer Investigation of the Impact of Ward treatment across 15 Victorian were During 2012, the Department commenced Mealtime Environment in Achieving screened for malnutrition using the MST and or continued an increased number of studies Adequate Oral Intake PGSGA tools. 1693 patients were screened with a malnutrition focus. There have been at Rachael Evans, Allison Lauder, Hollie for malnutrition, with 118 attending Western least six ongoing research projects in 2012, Bevans (Senior Dieticians), Raquel Health for cancer treatment. The overall with one major study receiving external Baptista, Alex Hoare, Jemima Hill, prevalence of malnutrition in Victorian funding from the Department of Health. This Vanessa Korfiatis (Deakin University cancer patients was 31% with the higher project, ‘Investigating Practices Relating to Masters students) incidence of 35% amongst Western Health Malnutrition in Victorian Cancer Services’ patients. Results indicate that malnutrition collaborated with 15 other health services. Collaborators: Deakin University has a significant relationship with outcomes, including 30-day mortality, complications, Audit on the Outcomes of Patients Another major ongoing study “Malnutrition unplanned admissions and length of Commenced on Enteral Feeds in the in Western Health Dialysis Patients” hospitalisation.Malnutrition is associated Stroke Unit at Western Hospital over identified 61% of all Haemodialysis patients with reduced treatment tolerance, reduced a 12 Month Period had mild-moderate malnutrition initially, and quality of life, increased complications and Allison Lauder, Rachael Evans fell to 30% and then 15% after interventions higher mortality rates. Malnutrition can from the renal dieticians and other staff from Audit of Patients Commenced on Total increase the length of hospital stay and 2010-2012. This project lead by Sarah Pitt Parenteral Nutrition Across All Wards at result in higher health-care costs. and Alison Qvist, Senior Renal Dieticians Western Hospital Over a 6 Month Period was awarded `Best Allied Health Research Malnutrition in Western Health Dialysis Kim Dennis Presentation Prize 2012` in Western Health Patients Research Week 2012. Gestational Diabetes Modules Sarah Pitt, Alison Qvist, Giang Nguyen, Mridula Bandyopaday and Mary Carolan Kathryn Pierce A number of our ongoing and future (Victoria University), Vicky Saunders research projects will be in collaboration All Western Health Dialysis patients were (Dietetics), Jacqui Young (Dietetics), with Deakin University, Victoria University assessed three times, twelve months apart, Cheryl Steele (Diabetes Educator) and the Department of Health. The findings using a validated nutrition screening tool from these projects are incorporated into Collaborators: Victoria University (Subjective Global Assessment- SGA), and innovation and improvement in Nutrition biochemistry, cause of renal failure; cultural service provision, within Western Health. background and dialysis duration were also noted. 39% of patients had mild-moderate malnutrition initially, and fell to 35% and then 15% after interventions from the renal dieticians and other staff over three years. Malnutrition is evident in 23-73% of Haemodialysis patients. Malnutrition increases morbidity and mortality, but also reduces quality of life and increases hospital stay.

WESTERN HEALTH RESEARCH REPORT 2012 011

Volunteer Meal Assistance Program “Dining with Friends” Comparison of the Rachael Evans: Senior Dietician Hollie Bevans, Rachael Evans, Protein and Energy Intake of Hospital Kathryn Pierce, Jeff Garner, Kate Mangion, Elderly Between the Dining Room Vanessa Carter: Senior Dietician Wendy Watson, Michael Burns and at their Bedside Vicky Saunders: Senior Dietician Aranka Nenov, Karon Markovski During 2011/12 over 300 patients were and Aurora Ottaway Heather Jordan: Oncology/Surgical Dietician assisted at lunch meal times by trained volunteers. This assistance ranged from set- This study found that 34 out of 52 patients Giang Nguyen: Renal Dietician up, prompting and opening food packages (61%) favoured eating their meal in the to full feeding. dining room and consumption of a higher Karon Markovski: Dietician proportion of protein (29g in dining room The provision of individual meal assistance compared with 24g at the bedside) and Aurora Ottaway: Dietician by specially-trained volunteers to Western energy (2321Kj in the dining room compared Health patients resulted in an improved oral with 2050Kj at the bedside) was observed. Jacqui Young: Dietician intake and increased satisfaction by these patients at lunch time. The study also found of the 21 patients with Our Research Students a BMI less than 22, 15 (71%) ate better in Raquel Baptista: Masters of Nutrition Patients eating less during their stay the dining room, of the 31 patients identified and Dietetics, Deakin University in hospital can increase their risk of with significant cognitive impairment 24 developing malnutrition which can increase (71%) ate better in the dining room and of Alex Hoare: Masters of Nutrition complication, , functional decline, the 29 patients who were identified as being and Dietetics, Deakin University and overall length of stay in hospital. at moderate and high risk of malnutrition 20 (68%) ate better in the dining room. A Jemima Hill: Masters of Nutrition Audit on the Use of “Nil By Mouth” dining room environment in hospital can and Dietetics, Deakin University and “Clear Fluid” Diet Codes on Two increase opportunities to enjoy the social Surgical Wards at Western Hospital Vanessa Korfiatis: Masters of Nutrition aspect of meal times, increases food intake Kim Dennis and Vanessa Carter and Dietetics, Deakin University which potentially lead to weight gain and An observational audit of 43 patients improvement in nutritional status and rehabilitation. was performed to determine the reason, O ur AwARDS prevalence and duration of Nil by Mouth (NBM) or Clear Fluids (CF) diet code usage Best Allied Health Research Presentation Our Researchers on two gastrointestinal surgical wards at Prize Western Health 2012 Western Hospital (WH) over a 5-day period. Recipient(s): Sarah Pitt, Alison Kathryn Pierce: Manager, Nutrition Patients at WH are experiencing prolonged Qvist, Giang Nguyen, Kathryn Pierce fasting for anaesthesia. The current practice Sarah Pitt: Senior Renal Dietician Malnutrition in Western Health Dialysis of fasting all patients from midnight appears Patients Awarding Body: Western Health to be a significant contributing factor. Alison Qvist: Senior Renal Dietician Total Funding Amount: $1,500

Despite the lack of evidence for the use of Kim Dennis: Senior Dietician Allied Health Research Presentation Prize CF diets after surgery, WH surgical patients - Highly Recommended Western Health are still being allocated these diet codes. Hollie Bevans: Senior Radiotherapy/ 2012 Prolonged fasting and the use of low-energy Oncology Dietician Recipient(s): Hollie Bevans, clear fluid (CF) diets can exacerbate existing Heather Jordan, Kathryn Pierce Aranka Nenov: Senior Dietician malnutrition or place patients at risk of Malnutrition in Victorian Cancer Services developing malnutrition. Allison Lauder: Senior Dietician

WESTERN HEALTH RESEARCH REPORT 2012 012 Allied Health (cont.) Occupational Therapy

The OT Department completed a large Management of Oncology Symptoms number of quality and research projects Affecting Occupational Performance: The Occupational Therapy in 2012, in addition to reviewing and An Evidence Based Practice Project (OT Department) is committed evaluating previously established Therapist Sarah Shipp, Judi Bolton, Gemma O’Brien led clinics in plastics and hand therapy. To (OT) to providing an excellent share this knowledge with the wider OT occupation focused, evidence profession and promote the strong quality The aim of this project is to investigate if current Occupational Therapy practice at based service to clients of and research focus of the OT Department at Western Health, a total of nine conference Western Health addresses the issues that Western Health. Contributing presentations were delivered in 2012, at both oncology symptoms such as pain, fatigue a state and national level. and sleep deprivation negatively impact on to this is an active quality occupational performance. Occupational committee which provides 2012 also saw a focus on an interdisciplinary Therapy services for oncology patients at approach to quality and research within Western Health will address symptoms leadership and support to Allied Health. As part of this process, that impact negatively on occupational staff undertaking quality the Grade 4 Occupational Therapist and performance in line with best practice and research activities. Physiotherapist, in conjunction with senior within an acute setting. staff from other Allied Health disciplines, led a project to promote consistency of To Determine the Proportion of Primary- practice and processes for Allied Health staff Aged School Children Referred to a completing quality activities. This included Learning Difficulties Clinic who meet the development of an Allied Health wide the DSM IV Diagnostic Criteria for quality learning package and review of Developmental Coordination Disorder quality tools used within Allied Health to (DCD) ensure consistency between disciplines. Leanne Chapman, Renee Debrincat, Dr Renee Testa (Clinical Neuropsychologist) OT/CAHS ORur esearch – Occupational Therapy The aim of this project is to determine the proportion of primary-aged children A Narrative Study on OTs Preparedness referred to a learning difficulties clinic who to Move Up a Grade Level - “Climbing meet the DSM-IV diagnostic criteria for the Career Ladder - What I Wish I’d Developmental Coordination Disorder (DCD). Known First” This project will assist us with improving Helen Nelson, Susan Giles, therapist knowledge and confidence to Heather McInnes OT identify children with DCD within a learning This project investigates whether there are difficulties population of primary age common themes/ issues for Occupational children. This will also assist us to identify Therapists (OTs) in preparing to move more effective therapy approaches used between grade levels. This project assists us for children with DCD and provide a better to identify strategies to prepare staff for the understanding and support for the child’s transition between grade levels, leading to difficulties within the home and school a smoother transition and seamless service environment. provision.

WESTERN HEALTH RESEARCH REPORT 2012 Occupational therapists play a key role in preparing patients to return home.

“Transprofessional Practice Evaluation of the Assessment and Our Researchers and Occupational Therapy” Diagnosis Process of Autism Spectrum Heather McInness OT Disorder at Western Health Susan Giles: Manager: Occupational Sally Butzkueven (SP), Renee Debrincat Therapy The aim of this project is to investigate (OT) SP/OT/ CAHS the current knowledge level, opinions Helen Nelson: Grade 4 Occupational and attitudes within Occupational The aim of this project is to make Therapist Therapy in regards to the evolution of recommendations to improve the service transprofessional roles, and to identify provided to families whose children have Heather McInnes: Grade 3 Occupational the risks and opportunities (if any) to the been referred to the Autism Assessment Therapist Occupational Therapy profession in regards Clinic at Western Health. Karen Kessner: Grade 3 Occupational to transprofessional roles. Data collection has been completed and Therapist The results of this project will be used data is currently being analysed to identify Sarah Shipp: Grade 2 Occupational Therapist to assist occupational therapists who priorities for service development and are developing or working within improvement. Western Health (Sunshine Judi Bolton: Grade 2 Occupational Therapist transprofessional roles. The results are Hospital) is a key provider for autism intended to contribute to the creation of a assessments in the West. Autism Renee Debrincat: Grade 2 Occupational profession wide knowledge base in regards assessments comprise a significant Therapist to transprofessional roles and occupational component of the work conducted by the therapy. Children’s Allied Health Service (CAHS) Leanne Chapman: Grade 2 Occupational team. Outcomes from this project will Therapist ensure that the quality of the assessments Gemma O’Brien: Grade 1 Occupational provided by Western Health are of the Therapist. highest possible standard with respect to the accuracy of diagnosis; patient satisfaction; ensuring safe and effective patient care and clear and concise communication. O ur AwARDS Amanda McAliece “Study Scholarship” Victorian Stroke Care Network Scholarship $2,000

WESTERN HEALTH RESEARCH REPORT 2012 014 Allied Health (cont.) Physiotherapy

Research in the Physiotherapy Department A Very Early Rehab Project (AVERT) The Associations between Characteristics has progressed significantly in 2012 with Kirsty Kat, Libby Talbot, Brooke Lee, of Sarcopenia, Vitamin D and Falls in the development of formal collaborations Natalie Teasdale Community-Dwelling Older Adults with Victoria University and The University of Dr David Scott, Dr Pazit Levinger, Melbourne through the Australian Institute Collaborators: National Stroke Research Dr Lizzie Skinner of Musculoskeletal Science in the form Institute of successful seeding grant applications Collaborators: AIMSS Defining the Benefits of Exercise in which aim to form the foundation for future Interstitial Lung Disease: A Multi-Centre Improving Outcomes for the Upper NHMRC Project Grants. Our established Randomised Controlled Trial Limb in Severe Stroke: The Efficacy research projects in the areas of distal radius Kathryn Barker, Claire Boote of Rehabilitation Interventions Based fracture management, aquatic physiotherapy on the Bobath Concept – A Pilot Study programs, stroke management and Collaborators: Austin Hospital/Victoria Jane Tillyard, Dr Kim Brock education have been joined by developing University (Leona Dowman), The Alfred initiatives in falls, sarcopenia, mobilisation Hospital (A/Prof Anne Holland) Collaborators: St. Vincent’s Hospital in critical care and simulation. This research breadth of 24 projects encapsulates the Does Immersive Simulation Training A Novel Web-Support Intervention for clinical service provision depth of the Improve Student Supervision Skills Patients Following Anterior Cruciate physiotherapy services with the majority of Physiotherapy Clinical Educators? Ligament Reconstruction of our projects being led and conducted by Clare Holdsworth, A/Prof Clare Delany, Dr Pazit Levinger, Darren Fraser, clinical leaders in their respective areas. Dr Lizzie Skinner Becky Pile, Simon Talbot

The Physiotherapy Department aspires to Collaborators: The University of Melbourne Collaborators: AIMSS (Victoria University) become a national leader in the conduct of clinical research aligned with the strategic A Specialised Rehabilitation to Optimise Level of Health Professional’s Adherence priorities for Western Health and our Recovery Following Knee Replacement to GOLD Strategy Management Plan for broader community and focusing on the Surgery Patients Admitted to Hospital with an translation of evidence into clinical practice. Dr Pazit Levinger, Simon Talbot, Cam Fary, Acute Exacerbation of COPD We were involved in several competitive Kane Rodda, Darren Fraser, Jackson Boyd, Clarice Tang seeding grants from bodies such as the Prof Rezaul Begg, Prof Mark Taylor, Physiotherapy Research Foundation, Dr Dominic Thewlis, Prof Nick Taylor, Collaborators: LaTrobe University AIMSS and the Pat Cosh Trust. We have Dr Lizzie Skinner. Application of a Novel Research Design several postgraduate students involved in to Aid Disinvestment from Existing Health performing our research and hope to build Collaborators: Victoria University, The Technologies with Uncertain Effectiveness, our profile in research within Melbourne over University of Melbourne, LaTrobe University, Cost-Effectiveness and/or Safety the next five years. In addition, we aim to University of SA, Flinders University (SA) Dr Lizzie Skinner, Tim Chiu develop research programs in other strategic Minimum Standards of Practice for areas such as the management of chronic Physiotherapists Working in Intensive Collaborators: Monash University, disease and the use of new technologies Care: A Delphi Study Southern Health to align with National Research Priorities. Dr Lizzie Skinner, Dr Peter Thomas, Functional Exercise Capacity Measurement A/Prof Shane Patman, Dr Julie Reeve Another priority for the Physiotherapy in Non-Small Cell Lung Cancer and Department is improving the dissemination Collaborators: The University of Colorectal Cancer: Validation of Potential of research findings. In 2012, Physiotherapy Queensland, Auckland University of Field Walking Tests staff were successful in having four peer- Technology, University of Notre Dame Kirsty May, Catherine Granger, reviewed publications with four national (Western Australia) Dr Lizzie Skinner conference presentations and seven local presentations at Western Health Research Collaborators: , Week. We hope to build on these numbers in The University of Melbourne the coming years and expand our research collaborations both locally and nationally as a first step.

Our Research - Physiotherapy

WESTERN HEALTH RESEARCH REPORT 2012 015

Botulinum Toxin Outcomes Treatment of Patellofemoral Pain than age and gender matched normative for Stroke Patients Syndrome in Adolescents: A Review of samples on long-term follow-up. Early Sarah Kenny, Anna Matthews, the Literature and Recommendations rehabilitation has been shown to reduce Marina Demetrious for Physiotherapy Treatment length of stay; delirium and morbidity Sam Wills following ICU stay in the USA. These findings Collaborators: Royal Melbourne Hospital need local confirmation, particularly as the STRIPE - Simulated Training standard of rehabilitation care is high in Selection for Inpatient Rehabilitation after and Interprofessional Education the Australian ICU population (with routine Severe Stroke: What Factors Influence Clare Holdsworth, Janet Beer, David Mai. blanket referral rather than physician Rehabilitation Assessor Decision-Making? directed in the USA). Libby Talbot, Kirsty Kat, Shae Cooke Collaborators: Diane Neri, Cathy Dow, STRIPE Project Team A New Approach to Balance Retraining at Collaborators: LaTrobe University, Barwon Community Based Rehabilitation: The Ai Health, Florey Institute The aim of the STRIPE program was to Chi Aquatic Therapy Group “Aqua Balance” improve communication, teamwork and Melissa Hewitt, Tammy Dinh, Inter- and Intra-Observer Reliability of response to deteriorating patients within the Claire Thwaites PT/SACS Anatomic Parameters of X-rays that are interprofessional team. Learning objectives used in Classifying Distal Radius Fractures (communication, teamwork and response The aim of this project was to implement an in Adults to deteriorating patients) were met and Aquatic Ai Chi Therapy group and evaluate Narelle Watson, Professor Jenny Keating, thematic analyses demonstrated the benefits the effect of the group on balance outcome Dr David Alexander, Dr Saeed Asadollahi, of awareness of roles in interprofessional measures and self-reported falls. 30 patients Dr Frank Parrish, Ms Jacqui Ridgway, teams. Interprofessional practice and completed the AquaBalance program with a Mr Phong Tran multidisciplinary team work are becoming reduction in the number of self-reported falls increasingly important in the complex and Collaborators: Monash University, Peninsula and high patient satisfaction with no adverse exciting health environment and community Health and Private Radiology Clinic events. that we work within at Western Health. A Randomised Controlled Trial Strategies to optimise communication Balance tests were significantly improved Investigating the Effect of Duration of and collaboration must be implemented following the program in participants Immobilisation on Function Following to optimise health care outcomes. attending AquaBalance (Timed Up and Go Open Inter- and Intra-Observer Reliability Test, 10 metre Walk Test, 4 Square Step A Trial of Early Activity and Mobility of Wrist and Forearm Active Range of Test). Falls and the elderly population are a in ICU (TEAM) Motion Measurements Using a Goniometer significant focus for our community-based Dr Lizzie Skinner, Clare Holdsworth, in Adults Following Distal Radius Fracture rehabilitation services at Sunshine Hospital. Sam Bates, A/Prof Craig French, Narelle Watson, Professor Jenny This pilot project demonstrates sufficient Carol Hodgson PT Keating, Emily Cross, Darren Fraser, evidence to allow us to plan for a pilot randomised controlled trial in 2013-14. Collin McIlveen, Anna Nethercote, Collaborators: ANZ Intensive Care Society, Rebecca Pile, Kane Rodda. , Monash University The Effect of Moderate-Intensity Cardiovascular Fitness Training Compared Collaborators: Monash University The aim of this project is to document to Standard Care in People with a current levels of mobility and activity in Comparison of the Management of Diagnosis of Stroke: A Pilot Randomised patients intubated in the ICU for longer than Patients Presenting to the Emergency Controlled Trial 24 hours. This international multi-centre Departments of Western and Sunshine Hanna Reynolds, Jane Tillyard, Sarah study supported by the Clinical Trials Group Hospitals with Acute Knee Injuries Kenny, A/Prof Andy Stewart, Dr Lizzie of ANZICS is recruiting 200 patients and Narelle Watson, Clarice Tang Skinner, Western Health has currently contributed 8 patients. Collaborators: AIMSS & Victoria University

The goal of the audit data is to allow development of an early goal directed mobility (EGDM) program for pilot implementation which will form the basis for future NHMRC Project Grants. Patients admitted to the ICU have health-related quality of life and physical function lower

WESTERN HEALTH RESEARCH REPORT 2012 016 Allied Health (cont.)

Previous work in this area has developed Reduction and Internal Fixation for Distal Our Researchers and introduced a guideline for cardiovascular Radius Fractures in Adults training in people with a diagnosis of stroke. Narelle Watson, Professor Jenny Keating, Tim Chiu: Manager of Physiotherapy The aim of this project is to build on former Emily Cross, Darren Fraser, Collin work and conduct a pilot randomised McIlveen, Anna Nethercote, Rebecca Pile, Dr Elizabeth Skinner: Physiotherapy controlled trial of cardiovascular training in Kane Rodda, Paul Silk, Clarice Tang, Research Co-ordinator; Senior ICU this population. The research proposal has Physiotherapist been developed and the HREC application Collaborators: Monash University Narelle Watson: Co-ordinator Advanced is being developed for submission early The primary aim of this investigation is Practice Allied Health; Senior Orthopaedic in 2013.The National Stroke Foundation’s to compare the immobilisation periods of Physiotherapist Clinical Guidelines for Stroke Management one, three and six weeks for acute distal 2010 state that stroke rehabilitation should radius fractures following locked volar Clare Holdsworth: Senior ICU include interventions aimed at improving plate fixation for the outcome measures Physiotherapist CV fitness for secondary prevention and of function (PRWE, DASH), range of to optimise rehabilitation outcomes. Christine Polmear: Senior movement, grip strength and pain (Visual Cardiovascular training may have benefits Cardiorespiratory/ICU Physiotherapist Analogue Scale, VAS) when measured on quality of life and functional performance over a six month period from the date in patients with stroke. This pilot work will Kirsty May: Senior Cardiorespiratory/ICU of surgery. Collaboration between the form the foundation of future project grant Physiotherapist WH Physiotherapy and WH Orthopaedic applications and is the first example of our Departments has been one of the key Claire Boote: Senior Cardiorespiratory collaborative research with AIMSS. factors facilitating the implementation of Physiotherapist Does a Structured Simulation-Based this investigation. Data collection for this Kathryn Barker: Senior Cardiorespiratory Training Program Improve Junior investigation commenced in June 2012 and Rehabilitation Physiotherapist Physiotherapists’ Confidence in will continue throughout 2013/14. Although distal radius fractures commonly occur, Cardiorespiratory Skills for Weekend Hanna Reynolds: Senior Neurological factors that affect treatment outcomes Work? Physiotherapist Christine Polmear, Clare Holdsworth PT have not been well defined. There is a gap in our current knowledge regarding how Jane Tillyard: Senior Neurological The aim of this project was to evaluate long a wrist should be immobilised in a cast Physiotherapist the effect of simulation sessions targeting following surgical repair. Information from cardiorespiratory core competencies on this investigation will be used to determine Sarah Kenny: Senior Neurological junior physiotherapists’ confidence. whether one immobilisation period is better Physiotherapist than another in regards to function and pain. Self-rated confidence of participants in the This information will enable us to improve Kirsty Kat: Senior Neurological use of CPAP, airways improved significantly the management of wrist fractures following Physiotherapist following training. Future work will focus surgical repair in the future. on evaluating change in practice in addition Catherine Grant: Senior Neurological to self-report. Physiotherapist

Training staff to deliver optimal care using Darren Fraser: Senior Musculoskeletal evidence-based practice is critical to deliver Physiotherapist best health outcomes. Training can be resource intensive and research is required Kane Rodda: Senior Musculoskeletal into the best ways of training graduate Physiotherapist clinicians. The results of this training will be Rebecca Pile: Senior Musculoskeletal relevant to all disciplines across Western Physiotherapist Health. Jackson Boyd: Senior Musculoskeletal Physiotherapist

Collin McIlveen: Senior Musculoskeletal Physiotherapist

WESTERN HEALTH RESEARCH REPORT 2012 017

Clarice Tang: Senior ED Physiotherapist O ur AwARDS Seeding Grant

Sam Wills: Senior Paediatric Physiotherapist Excellence Award Dr David Scott, Dr Pazit Levinger, (Safe and Effective Patient Care) Dr Elizabeth Skinner, A/Prof Terry Haines, Melissa Hewitt: Grade 2 Physiotherapist Recipient(s): Melissa Hewitt, Tammy Dinh Prof Peter Ebeling, A/Prof Kerrie Saunders “A New Approach to Balance Retraining “Associations Between Sarcopenia, Vitamin D Tammy Dinh: Grade 2 Physiotherapist at Community Based Rehabilitation: The Ai and Falls” AIMSS: $19,909 Anna Nethercote: Grade 2 Physiotherapist Chi Aquatic Therapy Group “Aqua Balance” Western Health: $500 Libby Talbot: Grade 2 Physiotherapist Seeding Grant Allied Health Innovation Award Sarah Davies: Grade 2 Physiotherapist Recipient(s): Clare Holdsworth, Janet Dr Pazit Levinger, Darren Fraser, Beer, David Mai, Diane Neri, Cathy Becky Pile, Simon Talbot “A Novel Web- Grade 2 Physiotherapist Shae Cooke: Dow “STRIPE - Simulated Training and Support Intervention for Patients Following Interprofessional Education” Western Health: Anterior Cruciate Ligament Reconstruction” Emily Cross: Grade 2 Physiotherapist $250 AIMSS: $10,000 Anna Matthews: Grade 2 Physiotherapist Allied Health Innovation Award Claire Thwaites: Grade 2 Physiotherapist Recipient(s): Hanna Reynolds, Jane T aGGED Grant Tillyardm “Cardiovascular Fitness Training Paul Silk: Member Research Committee in People with a Diagnosis of Stroke: Dr Elizabeth Skinner, A/Prof Shane Development of a Clinical Guideline” Patman, Dr Julie Reeve, Dr Peter Melanie Lloyd: Member Research Western Health: $250 Thomas “Minimum Standards of Practice Committee for ICU Physiotherapists” Awarding Body: Physiotherapy Research Foundation Fiona McManus: Member Research Project Grant (WA Board): $25,000 Committee Clare Holdsworth, A/Prof Clare Delany, Bernadette Sexton: Member Research Dr Elizabeth Skinner “Using Immersive Committee Professional and Simulation Training to Enhance Student Community Engagement Liesel Jansen: Member Research Supervision Skills of Physiotherapy Clinical Committee Educators: A Randomised Controlled Trial” Skinner EH: Cardiorespiratory Australia Pat Cosh Trust (Australian Physiotherapy (Australian Physiotherapy Association) Aruska D’Souza: Member Research Association) $24,570.40 National Conference Scientific Committee Committee Skinner EH: Scientific manuscript reviewer Our Research Students for , Value in Health, Physical Therapy, Respiratory Care, Health Narelle Watson: PhD and Quality of Life Outcomes, Heart Lung and Circulation, Journal of Ageing and Clarice Tang: Clinical Doctorate Physical Activity.

WESTERN HEALTH RESEARCH REPORT 2012 018 Allied Health (cont.) Psychology

A Cluster Analysis Exploration of the Lateralisation of the Perception of Characteristics of High-Functioning Affective Facial Expressions in Unilateral The Psychology Department Subgroups within the Autism Spectrum Stroke Patients comprises Adult in Children Aged 8-12 Years Diana Perre, Tissa Wijeratne, Jacenta Dr Renee Testa Abbott, Annukka Lindell, Geoff Cumming, Neuropsychology, Paediatric Andrew Hughes, Lisa Sherry Neuropsychology and Adult Collaborators: Associate Researchers: Felicity Klopper; Prof. Chris Pantelis; This research project investigates whether Clinical Psychology across Prof. Bruce Tonge; Prof. Stan Skafidus, the right and left sides of the brain differ three campuses. Monash University, Melbourne University in how they process positive and negative emotions, and whether the strategies used Validation of the Turkish Version of to process negative and positive emotions the DASS21 in a Turkish Immigrant are holistic (i.e. process the whole face) There has been an exciting development Outpatient Population – Recruited and/or featural (i.e.process particular facial in collaboration for a research project for Participants through General Outpatients parts). This project is in the final stages of cancer patients with Newcastle University at Western Health data collection with data analysis scheduled NSW, and a second study in the early stages Dr Litza Kiropoulos for early 2013. of collaboration with Victoria University undertaking qualitative research with people Collaborators: The University of Melbourne Investigating how the right and left sides of diagnosed with prostate cancer. the brain process emotions will help shed Examination of Psychosocial Risk light on how the mind processes emotion in Factors in Greek-Born and Italian-Born Collaboration is also underway with faces. We rely on our ability to understand Immigrants and Anglo-Australians with La Trobe University and research in how others are feeling in everyday life in Coronary Heart Disease: The Healthy the adult neuropsychology field. Two order to respond appropriately. Therefore Mind, Healthy Heart Study - Recruited further areas have focussed on paediatric the benefits from increasing understanding Participants Through the Coronary Care neuropsychology and culturally specific of the how the brain processes negative Unit at WHF patient cohorts in Clinical Psychology. and positive facial emotions could guide the Dr Litza Kiropoulos neuro-psychological assessment as well as An Investigation into the Cognitive Skills the development of intervention programs Underpinning Single Word Decoding in Collaborators: The University of Melbourne, to better assist the rehabilitation of patients Children with Reading Disorders Monash University, MonashHeart, Southern with acquired brain injury. Collaborator: Dr Renee Testa, Associate Researchers: Health La Trobe University. Mrs Amy Lee; Ms Nola Ross An Examination of Distress Tolerance and Collaborators: Professor Jennie Ponsford, Anxiety Sensitivity as Predictors of Anxiety Department of Psychology and , Symptoms in an Australian Cardiac Our Researchers Monash University Sample Grey Searle: Manager, Psychology An Investigation of Pervasive, Social and The Role of Individual Patient, Social Dr Renee Testa: Psychology Interpersonal Difficulties in Childhood: and Treatment Centre Variables in the Psychosocial Outcomes of Cancer Patients Cognitive, Motor, Language and Dr Litza Kiropoulos: Psychology Neurological Functioning Prof. Rob Sanson-Fisher and Team, Dr Renee Testa Prof. Michael Green, Grey Searle Dr Dianna Perre: Psychology

Collaborators: Associate Researchers: Collaborators: The University of Newcastle, Dr Hunter Mulcare: Psychology Mr Harvey Jones; Ms Nola Ross; Dr Marc NSW. Treatment Hospitals in Tasmania, New South Wales and Victoria Seal; Prof. Bruce Tonge; Prof. Christos Our Research Students Pantelis, Monash University, Melbourne Jacenta Abbott (Psych), Doctor of University and Murdoch Children’s Research Psychology (Clinical Neuropsychology) Institute

WESTERN HEALTH RESEARCH REPORT 2012 019 Allied Health (cont.) Social Work

Melbourne University and The initial findings of the program will through Translation: Cancer Research Western Health Department be presented at the 7th International Informing Practice”. The primary focus for of Social Work Research Conference on Social Work in Health and the conference was psycho-oncology and Partnership Mental Health in 2013. The paper will be COSA’s disease theme was skin cancer. presented by Associate Lecturer, Sevi The Department of Social Work (DSW) staff Vassos on behalf of the clinical educators, At the conference, a poster was presented are actively involved in the Community from each health service. on behalf of the Radiotherapy Allied Health of Practice / Clinical Rotation Research Team on the Development of the Allied program, auspiced by The Melbourne Ande Szendoe Health Team at the Sunshine Radiotherapy University School of Social Work. Dr Maree Centre. The poster was well received and Connelly (Chair and Head, School of Social was an excellent opportunity to showcase Work) and Sevi Vassos (Associate Lecturer) DEVELOPING AN ALLIED HEALTH the inter-disciplinary work that has been are researching a new model for health SERVICE IN A NEW RADIOTHERAPY achieved in developing and delivering allied social work fieldwork programs. Western CENTRE IN THE WEST OF health services to patients undergoing Health DSW is a primary participant along MELBOURNE radiotherapy treatment at the Centre and with Melbourne Health, Austin Health, St their families. Vincent’s Health and The Children’s Hospital. Senior social worker Laurelle Stalker and Laurelle Stalker In 2012, phase 2 was completed (phase 1 Dr. Hunter Mulcare a psychologist, at the completed in 2011) with six social work Sunshine Radiotherapy Centre attended students participating in the Western Health the 39th Annual Scientific meeting of the program. Phase 3 will be undertaken in COSA / IPOS combined conference held in Our Researchers 2013, with results expected by mid 2014. The Brisbane on 13th to 15th November 2012. Ande Szendoe: Manager, Social Work program focuses on workforce development The conference was held in partnership with key Australian partners; Cancer Council in the area of clinical education and applied Laurelle Stalker: Senior Social Worker practice, as well as new and innovative Queensland, POCOG (Psycho-Oncology student learning through practice based Co-operative Research Group) and OZPOS research. COSA’s psycho-oncology group. The theme for the joint conference was “Impact

A Western Health Social Worker listens to the patient experience.

WESTERN HEALTH RESEARCH REPORT 2012 020 Allied Health (cont.) Speech Pathology

In 2012, the Speech Pathology Department Evaluation of the Implementation of has worked in conjunction with the a Tracheostomy Review Service (TRS) The Speech Pathology multidisciplinary team to assess the at Western Health Department is currently service delivered to children by the Autism Anita McKinstry & Louise Malcolm (SP), Assessment Team; and to identify the type Clare Holdsworth (PT), Dr. Anne Marie conducting research within a and prevalence of communication barriers Southcott (Head of Respiratory Medicine), variety of areas relating to the that exist within the geriatric population on Anna Green (Nursing), Multidisciplinary assessment and management our sub-acute wards. It is anticipated that Tracheostomy Review Service (TRS) the outcomes of these projects will drive of communication and service change to improve the healthcare Identifying Communication Barriers on journey of these patients. Geriatric Evaluation and Management swallowing impairments, (GEM) Wards at Western Health across both the continuum The implementation of the Dysphagia (A Prevalence Study) Clinic is anticipated to reduce waiting Hemant Jeena, Merridy Moore, of care and lifespan. Of times for outpatients referred with Sally Howard, Courtney Pocock, particular focus in 2012, swallowing impairments and to improve Kathryn Langshaw SP has been the evaluation of their access to specialist instrumental dysphagia assessments. It is hoped the This project aims to identify the existing outcomes associated with a Multidisciplinary Tracheostomy Review barriers to effective communication between number of service delivery Service will result in reductions in length patients and staff on the GEM wards at of stay, ICU re-admission rates, adverse Western Health. initiatives aimed at improving events, and cannulation times. Data collection has been completed the healthcare journey of both The Speech Pathology Department was within the GEM wards at both Sunshine patients and their carers. responsible for delivering 10 conference/ and Western Hospitals, and is nearing seminar presentations in 2012. completion at Williamstown Hospital. Effective communication between It is anticipated that 2013 will be another patients and healthcare providers within busy year for the Speech Pathology the ward environment is essential to Department, with completion of data the provision of high quality clinical collection and analysis for a number of care, with current evidence suggesting a ongoing projects. The department will link between good communication and additionally be investigating the impact of positive healthcare outcomes. Conversely, smart technology on patient participation reduced patient and healthcare provider in therapy within the sub-acute setting. accessibility to information has been shown to result in adverse medical events such as misdiagnosis, inappropriate Our Research treatment, medication errors, and even death; highlighting the importance of Improving Access to Communication identifying and addressing barriers to Intervention for Acute Stroke Patients effective communication within the ward at Western Hospital environment. Jane Smith, Sarah Ward, Ruth Best

Establishment of a Dysphagia Clinic: An Investigation of Patient and Service Delivery Outcomes Ruth Best, Lauren Belleli SP

WESTERN HEALTH RESEARCH REPORT 2012 021

Speech Pathology Pulmonary Our Researchers Nikol Faris: Speech Pathologist Rehabilitation Education Package Kathryn Langshaw, Ruth Best, Meredith Swaby: Manager, Speech Tom Gauci: Speech Pathologist Laura Bezzina, Tom Gauci SP Pathology & Audiology Hemant Jeena: Speech Pathologist This project aims to assess the impact of Ruth Best: Senior Speech Pathologist Kathryn Langshaw: Speech Pathologist a revised Speech Pathology Pulmonary Sally Butzkueven: Senior Speech Rehabilitation education package on patient Richa Mishra: Speech Pathologist knowledge in a number of areas including Pathologist self-management of dysphagia. To assess Courtney Pocock: Speech Pathologist Sally Howard: Senior Speech Pathologist the impact of the revised education Jane Smith: Speech Pathologist package on the consistency of information Louise Malcolm: Senior Speech Pathologist provided by Speech Pathology staff during Rachel Smith: Speech Pathologist education sessions. Data collection has Anita McKinstry: Senior Speech Pathologist been completed and data is currently being analysed.Aspiration of food and liquid is Merridy Moore: Senior Speech Pathologist common in patients with Chronic Obstructive O ur AwARDS Sarah Ward: Senior Speech Pathologist Pulmonary Disease, such as those attending Western Health Excellence Award the Pulmonary Rehabilitation program at Lisa Worthington: Senior Speech Recipient(s): Rachel Smith “The Global Western Health. It is therefore essential that Pathologist Mealtime Guide” Awarding Body: Western these patients have access to high quality Health Total Funding Amount: $2,000 Year(s) education regarding the identification and Nadine Alexander: Speech Pathologist Awarded: 2012 self-management of dysphagia. Speech Pathologist Lauren Belleli: Innovations in Client Centred Care Evaluation of the Implementation of (Allied Health Innovation Award) a Tracheostomy Review Service (TRS) Sally Butzkueven: Senior Speech Recipient(s): Rachel Smith & Richa Mishra at Western Health Pathologist (SP), Vicky Saunders (DT) “Fun with Food Anita McKinstry & Louise Malcolm (SP), Group” Awarding Body: Western Health Total Clare Holdsworth (PT), Dr. Anne Marie Sally Howard: Senior Speech Pathologist Funding Amount: N/A Year(s) Awarded: 2012 Southcott (Head of Respiratory Medicine) Louise Malcolm: Senior Speech Pathologist Most Innovative Concept This project evaluates the effect of Anita McKinstry: Senior Speech Pathologist (Allied Health Innovation Award) implementing a specialised multidisciplinary Recipient(s): Sally Howard “iPads: A New tracheostomy team/review service on the Merridy Moore: Senior Speech Pathologist Technology in the Health Care Setting” outcomes of Western Health patients with Awarding Body: Western Health Total tracheostomy tubes in situ. The TRS was Sarah Ward: Senior Speech Pathologist Funding Amount: N/A Year(s) Awarded: established at Western Hospital in 2012 and 2012. is currently in its trial phase during which Lisa Worthington: Senior Speech Pathologist data is being collected. It is anticipated PT = Physiotherapy that implementation of the TRS will have Nadine Alexander: Speech Pathologist SP = Speech Pathology positive outcomes for patients, including a OT = Occupational Therapy reduction in length of stay, reduction in ICU Lauren Belleli: Speech Pathologist SACS = Subacute Ambulatory Care Services, re-admission rates, reduction in adverse CAHS = Children’s Allied Health Services events, and reduction in cannulation times. Laura Bezzina: Speech Pathologist SW = Social Work, DT = Dietician

Allied Health Research Output

Publications: 6 Presentations: 42

WESTERN HEALTH RESEARCH REPORT 2012 022 Anaesthesia and Pain Management

In collaboration with the Respiratory Central and Muscular Fatigue during Department, Dr David Bramley has been Severe Exercise Research in the Department coordinating an observational study looking Institute of Sport, Exercise and Active of Anaesthesia and Pain at respiratory outcomes in patients at risk Living at Victoria University of Technology, of obstructive sleep apnoea. With increasing Prof Michael McKenna, Trevor Farr, Management has focused numbers of Western Health surgical patients Dr Bob Smith in 2012 on perioperative presenting with risk factors associated Using Non-Invasive Measurement pain management, exercise with OSA, this is an important study to help guide risk stratification and allocation of of Cardiac Output Devices during physiology, and modification health resources like post-operative high Cardiopulmonary Exercise Testing dependency care. Assoc. Prof Bernard Riedel, of cardiovascular and Dr Hilmy Ismail, Dr Bob Smith respiratory disease risk A long-standing area of research interest within the department has been exercise POISE-II factors. physiology and perioperative optimisation Dr Andrew Jeffreys, Dr Elizabeth Hessian, of cardiorespiratory function, led by Dr Bob Ms Ellen Kinkel Smith. Dr Smith commonly lectures on these Collaborators: Study led by Prof P. J. Research projects have ranged in size areas in the UK. He has developed strong Devereaux, Population Health Research from departmental audits and locally run collaborative links with Aintree Hospital Institute (PHRI) McMaster University, studies through to multicentre, international in UK, Peter MacCallum Cancer Centre in Hamilton Ontario Canada. Local coordinator randomised controlled trials (RCT). Melbourne, and Victoria University. He is ANZCA Trials Group An important benefit of our expanding currently planning further studies looking at research involvement has been the valuable optimisation of cardiorespiratory function This is a factorial study looking at collaborations established internationally, to improve outcomes following upper whether aspirin and clonidine can reduce locally, and within our organisation. gastrointestinal surgery and colorectal cardiovascular morbidity and mortality in surgery. Throughout 2012, the department has patients at risk of these complications. The recruitment has just reached 7,000 patients increased its involvement in large-scale Future goals for our department are to of a planned 10,000 participant sample. international studies. POISE-II aims to continue to grow our research capability Many of our Western Health patients have recruit 10,000 patients to answer the and involvement. There are many exciting risk factors for cardiovascular disease. question of whether aspirin and clonidine new research opportunities on the horizon, The results from this study will help guide could play a role in preventing perioperative including some locally developed, large- administration of aspirin and clonidine cardiovascular morbidity and mortality. The scale projects that would be particularly to potentially reduce these risks in the department is also recruiting to Enigma-II, suited to our Western Health patient perioperative period. another large RCT looking at the effects population. of nitrous oxide gas on patients at risk of SUSTAIN for PAIN perioperative cardiovascular complications. Our Research Dr Elizabeth Hessian, Dr Kate Algie, At a more local level, we have been leading Ms Jill Woods, Ms Ellen Kinkel. our own research projects. SUSTAIN for Enigma-II Collaborators: Barwon Health, Royal PAIN is a multicentre RCT looking at a Dr Andrew Jeffreys, Dr Adriano Cocciante, Melbourne Hospital, North-East Health technique of pain relief following abdominal Dr David Bramley, Ms Ellen Kinkel Wangaratta, Wollongong Hospital. surgery. Western Health is the coordinating Study led by Prof. Paul Myles, Director site for this project, which is funded by This RCT is studying whether the use of Department of Anaesthesia and $30,000 in grants from the Australian and transversus abdominis plane ropivacaine Perioperative Medicine, Alfred Hospital, New Zealand College of Anaesthetists, and infusions can reduce postoperative pain Chair, Local coordinator ANZCA Trials the Australian Society of Anaesthetists. following abdominal surgery. The study Group has reached the mid-point of planned Effects of Salbutamol on Potassium and recruitment. Performance during Severe Exercise Effective analgesic techniques can help Institute of Sport, Exercise and Active improve postoperative quality and time Living at Victoria University of Technology, to recovery, and reduce postoperative Prof Michael McKenna and Tania complications. Atanasovsk, Dr Bob Smith

WESTERN HEALTH RESEARCH REPORT 2012 023

Sublingual Ketamine for OSA Study Our Professional and Painful Ward Procedures Dr Anne-Marie Southcott, Dr Laina Sheers Community Engagement Ms Jill Woods, Dr Nick Litzow, (Respiratory Department) Dr Bronwen Evans, Dr Elizabeth Hessian, David Bramley Ms Ellen Kinkel, Ms Col Killmier This is an observational study looking at postoperative respiratory outcomes in Scientific Convenor Australian and New This audit is looking at the quality of pain patients at risk of obstructive sleep apnoea. Zealand College of Anaesthetists (ANZCA) relief, and side-effects from sublingual All patients recruited undergo a preoperative 2013 Annual Scientific Meeting ketamine. There is a paucity of literature on sleep study, and additional postoperative Honorary Secretary Victorian Regional the use of ketamine sublingually, and this monitoring on the ward. Committee, ANZCA audit aims to describe a cohort of patients receiving ketamine for ward procedures like Postoperative respiratory complications Andrew Jeffreys dressing changes. pose a significant safety risk in patients with obstructive sleep apnoea. This study will Member Victorian Regional Committee The use of sublingual ketamine may provide help direct safe post-operative monitoring ANZCA a safe, effective method of analgesia for practices to minimise these risk. Chair, ANZCA Association of Anaesthesia patients, without the need for resource- Directors intensive anaesthesia intervention. Collaborators: Dr David Bramley Richard Horton Using Non-Invasive Measurement Regional Education Officer ANZCA Victorian of Cardiac Output Devices during Our Researchers Regional Committee Cardiopulmonary Exercise Testing ANZCA College Examiner Assoc. Prof Bernard Riedel, Dr Andrew Jeffreys: Director, Anaesthesia and Pain Management Dr Hilmy Ismail, Dr Bob Smith Umraniker A: ANZCA College examiner Dr David Bramley: Deputy Director, This study is correlating the outputs of Elizabeth Hessian: Member Western Health Anaesthesia and Pain Management newer non-invasive cardiac output monitors Low Risk Research Panel with validated measures of cardiac output Dr Bronwen Evans: Consultant like cardiopulmonary exercise tests. Angela Marsiglio: Member Western Health Anaesthetist, Coordinator Acute Pain Low Risk Research Panel Evaluating simpler forms of equipment Management Service that measure cardiac output may allow Bronwen Evans: Member Western Health Dr Elizabeth Hessian: Consultant less invasive techniques to be used in Pain Management Committee Anaesthetist anaesthesia, reducing both risks to patients and cost to the health care system. Bronwen Evans: Member Western Health Dr Bob Smith: Consultant Anaesthetist Working Party for Delirium Management. Dr Adriano Cocciante: Consultant Anaesthetist Research Output Dr Zamil Karim: Consultant Anaesthetist, Consultant Pain Specialist Publications: 1 Book chapters: 1 Ms Ellen Kinkel: Research Coordinator Presentations: 7

Ms Jill Woods: CNC Pain Management Service

Ms Davina Taylor: CNC Pain Management Service

WESTERN HEALTH RESEARCH REPORT 2012 024 Cardiology

Research has become a major focus in The Cardiology Research Symposium Current Clinical trials being the Cardiology Department over the last held in October 2012 set the themes and undertaken in Cardiology two years. This has been evident through strategy for future cardiovascular research our active participation in national and at Western Health. We aim to excel in FOURIER 20110118: Further international collaboration trials and strong the research of cardiovascular imaging, Cardiovascular OUtcomes Research With involvement of junior and senior staff in treatment of heart failure, preventative PCSK9 Inhibition in Subjects With Elevated locally initiated research studies. Major cardiology and management of acute Risk trials we participated in were NHMRC coronary syndrome, through collaboration Dr Nicholas Cox funded SAFETY trial evaluating the home with other health networks. We are also based management of atrial fibrillation, hopeful to attract postgraduate students Standard versus Atrial Fibrillation spEcific AVOID trial evaluating the effect of oxygen doing cardiovascular research at Western managemenT studY (SAFETY) supplementation in acute MI, AMI Pre- Health in years to come. A. Prof. Chiew Wong notification study (PNS) evaluating the CL2-16257-101 (Yet to be named): Use of benefit of MICA faxing STEMI ECG en route Ivabradine in patients with Heart Failure to PCI centre, CANTOS trial evaluating the Our Researchers and Preserved Left Ventricular Ejection use of monoclonal antibody Canakinumab as Fraction an anti-inflammatory agent in the coronary Dr Nicholas Cox: Director of Centre A. Prof. Chiew Wong thrombosis, FOURIER and GLAGOV trials of Cardiovascular Therapeutics evaluating the use of PCSK-9 monoclonal Associate Professor Chiew Wong: Head GLAGOV 20120153: GLobal Assessment of antibody AMGEN 145 as a new therapeutic of Non-invasive Cardiac Investigations plaque reGression with a PCSK9 antibOdy agent for reducing LDL-cholesterol and as measured by intraVascular ultrasound promoting coronary plaque regression. PNS Associate Professor David Eccleston: A. Prof. Kean Soon trial confirmed that STEMI pre-notification Interventional Cardiologist resulted in marked reduction of door-to- Ambulance Pre-Notification of STEMI balloon time in the treatment of AMI. Pre- Associate Professor Kean Soon: (PNS trial) notification of STEMI has become a standard Interventional Cardiologist A. Prof. Kean Soon practice throughout Victoria. Dr Salvatore Rametta: Interventional CANTOS CACZ885M2301: Canakinumab Our significant contribution in multicentre Cardiologist ANti-inflammatory Thrombosis Outcomes trials has put Western Health on the Study world map of cardiovascular research and Dr Dinesh Natarajan: Cardiology Registrar A.Prof. David Eccleston attracted further invitations to take part in major commercial and non-commercial Dr Alex Adel: Cardiology Registrar AVOID: Randomised Trial of Oxygen research. Our locally initiated studies in Therapy vs No oxygen therapy In STEMI Dr Steve Marasovic: Cardiology Registrar the fields of cardiac CT imaging, heart Dr Sal Rametta failure and acute coronary syndrome, Dr Tumur Odgerel: Medical Registrar promote closer collaboration between in house departments, and result in Dr Sinjini Biswas: Medical Resident Research Output abstracts presentations at major cardiology conferences and several peer-review Our Research Nurse Publications: 11 publications. Book chapters: 1 RN Vanessa Lee Presentations: 9

Our Research Students Mr John Du: Medical Research Student

Ms Wan Nurulfaiza Akmal Wan Salam: Medical Research Student

WESTERN HEALTH RESEARCH REPORT 2012 WHICH way is best for patients?

Western Health’s Western Health’s Director of “Cardiovascular disease and its “By integrating things like Cardiology Department Non-Interventional Cardiology, most common manifestation, home visits from cardiac Associate Professor Chiew heart disease, affect more nurses, particularly for older is participating in an Wong is taking the lead in Australians than any other patients in non-metropolitan exciting new study, Western Health’s participation, disease type, including cancer. areas and those in high risk along with Dr Nick Cox, In 2011-2012 around 1500 groups, and implementing with over $1.8 million Director of Cardiology and admissions to Western Health structured telephone support, funding from the Professor Edward Janus who had a diagnosis of heart failure. we can improve outcomes for NHMRC. see many potential participants patients.” through the Cardiology and “The study will involve the comparison of outcomes “One of the outcomes I am The multicentre, randomised General Medicine streams. between patients who most looking forward to from ‘WHICH? II Trial’, will see “The ‘WHICH? II Trial’ has the receive a standard, post- the ‘WHICH? II Trial’ is the 600 patients (200 patients potential to show us the most discharge chronic heart impact it will have on our ability apiece from Western Health, cost-effective way to optimise failure management program, to offer patients more choice St Vincent’s in Sydney and chronic heart failure outcomes, and patients who receive a in how they receive their care. Queen Elizabeth Hospital in and explore patient preferences more intensive program of Some patients dislike hospitals. WA) recruited with a view to on how they receive their management. Maybe in the future we can do building upon the results of management programs,” more to deliver their care at the previously NHMRC funded says A/Prof Wong. home or in their community,” ‘WHICH? Trial’, led by the Baker said A/Prof Wong. IDI Heart and Diabetes Institute.

Associate Professor Chiew Wong with a cardiology patient.

WESTERN HEALTH RESEARCH REPORT 2012 026 Drug Health Services

A key research direction for 2013 lies in the Managing Co-Morbid Substance Use and evaluation of care models. The primary one Mental Health within the Tertiary Hospital Research in the Drug Health will be the development of a model of care Setting: A Cross Sectional Screening Services for the 2012 year reflecting the Chronic Disease Management Survey Model being implemented with the drug and Dr Helen Sweeting, Sharon Desmond, has been focused on quality alcohol/addiction field. The assessment of Dr Mike McDonough, Simon Edward assurance program evaluation priority areas is in progress. Drug Health This project aims to estimate the prevalence activities with a focus on Services will be conducting a research mapping exercise in collaboration with of harmful and dependent substance use examining what we do and Associate Professor Craig Fry in 2013. It is in patients presenting to Western Hospital. To estimate the prevalence of co-morbid how we do it, as well as anticipated that the results will reflect the multidisciplinary nature of the team and high prevalence/low impact mental health identifying service gaps and work done at Drug Health Services. disorders in the population identified with harmful and dependent substance use. improvements. The state-wide To understand the current service gap drug and alcohol sector has Current Research in delivery of advice and management been undergoing a period of expertise to other disciplines caring for The great debate: clients and clinicians patients with harmful and dependent major reflection of the best and their perceptions of in-patient drug substance use within Western Health treatment options and how treatment (detoxification/withdrawal units) hospitals. Given the preliminary prevalence Ruben Ruolle rates of alcohol and tobacco use, there to give our clients the best may be value in using a brief screening evidenced based treatment, The Spirit of the Act: Critically Reflecting questionnaire for all patients within Western on the Severe Substance Dependence Health hospitals, and an expanded Addiction so the research projects of Treatment Act 2010 Medicine / Drug Health Consultation Liaison 2012 fit in with this broad Brad Roberg and Scott Withy Service at Western Health. sector agenda of service Mindfulness Group Evaluation within improvement. There were four the DASWest Adult withdrawal Unit Our Researchers Ben Williams research/QA projects in 2012 Ruben Ruolle: Acting Community Programs Collaborators: Liz Cooper and these are still currently Manager, Drug Health Services Nurse Practitioner (Drug and Alcohol) underway. Dr Helen Sweeting: Addiction Medicine Homeless Persons Drug Treatment Clinics Specialist Marcus Forsythe and Scott Withy Brad Roberg: Team Leader Specialist The aim of this project is to provide drug Services, Drug Health Services. treatment to the homeless population in West Melbourne at a homeless service and Scott Withy: Clinician, Specialist to assess the viability and effectiveness Pharmacotherapy Program. of this new service. This is a significantly marginalised group in the community who Ben Williams: Clinician, Intake Team, find it difficult to access drug treatment Drug Health Services services via the usual pathway. Marcus Forsythe: Nurse Practitioner

WESTERN HEALTH RESEARCH REPORT 2012 027

Research Output This year, we focused upon prescription Also, during 2012, Dr Sweeting undertook opioids and their use in treating chronic, a survey of substance use within hospital Presentations: 5 non-cancer pain; also we looked at inpatients at Western Hospital. The findings methadone which is increasingly used to will be presented at Grand Rounds in treat both pain and addiction problems. February 2013. Thereafter, a further survey is Addiction Medicine Dr McDonough collaborated with Dr Jenny planned for Sunshine Hospital and later, all Pilgrim (Victorian Institute of Forensic data analysed and presented for publication. & Toxicology Medicine) to review methadone related deaths in Victoria with results now The Department of Addiction Medicine & submitted for publication; collaborated in Research Output Toxicology sits within Western Health’s a research project on alcohol related ABI broader Drug Health Services, the latter issues with Prof Joe Ibraham and a resulting also including a range of community-based Publications: 2 paper is pending publication; published two Presentations: 2 programs. Our research activities relate to papers (see below) and presented a detailed common clinical treatment concerns that case series on Cannabis and Hyperemesis relate to a large section of patients referred at the annual meeting of the European Our Researchers to our Unit; in particular, there is a National Association of Poisons Centre’s and Clinical Prescription Drug Initiative, and a major Dr Mike McDonough: Head of Unit Toxicologists in London. Dr McDonough concern within this relates to dramatically and rotating Registrar, Dr Simon Edward, increased rates of prescribing of opioid Dr Helen Sweeting: Addiction Medicine collected a case series of patients presented analgesics for non-cancer pain within the Specialist with agitated delirium and are preparing this general population. During the last few as a paper for publication. Dr Simon Edward: Registrar years, we have been seeing much increased numbers of patients who have prescription drug problems, many of whom are using large doses of opioid analgesics.

WESTERN HEALTH RESEARCH REPORT 2012 028 Gastroenterology & Endoscopic Services

The main research activities undertaken A Phase 2 Randomised, Open-Label, Our Researchers in the department of Gastroenterology are Exploratory Trial of GS-5885, GS-9451 clinical trials in relation to new therapies. with Peginterferon Alfa 2a (PEG) and Dr Ian J Kronborg: Director of Therefore we can offer suitable patients an Ribavirin (RBV) in Treatment-Naïve Gastroenterology Department opportunity to receive new therapies under Subjects with Chronic Genotype 1 strict guidelines which would be normally Hepatitis C Virus and IL28B CC A/ Prof.Alex Boussioutas: unavailable for several years. Genotype (GS-US-248-0121) Consultant Gastroenterologist Dr I J Kronborg, Dr N Arachchi. Dr Niranjan Arachchi: Consultant In 2012 we had several trials for the new Sponsor: Gilead direct acting antiviral for chronic hepatitis C Gastroenterologist which was a wonderful opportunity to offer A Phase 4, Randomised, Open-label, Dr Alan Moss: Director Endoscopic Services this to our clinic patients. Active-Controlled, Superiority Study to Evaluate the Efficacy and Safety of Marian Croft: Clinical Research Co-ordinator Tenofovir Disoproxil Fumarate (TDF) Current Research in Combination with Peginterferon Kerrie Curin: Research nurse ?-2a (Pegasys®) versus Standard of A phase IIIb, multinational, randomised, Care Tenofovir Disoproxil Fumarate Our Research Students double-blind, placebo-controlled trial Monotherapy or Peginterferon ?-2a Liz Hristov: Nurse Endoscopist Trainee to assess the efficacy and safety of Monotherapy for 48 Weeks in Non- certolizumab pegol, a pegylated Fab’ Cirrhotic Subjects with HBeAg-Positive fragment of a humanized anti-TNF-alpha or HBeAg-Negative Chronic Hepatitis B. O ur AwARDS and Grants monoclonal antibody, administered (GS-US-174-0149) subcutaneously at weeks 0, 2 and 4 in Dr I J Kronborg, Dr N Arachchi. Dr Allan Moss: The 2012 leading reviewer subjects with moderately to severely Sponsor: Gilead (world-wide) for Endoscopy Journal active Crohn’s disease. Dr I J Kronborg. Sponsor: UCB A randomised, double blind, controlled Boussioutas, A (CIH) Establishment of a evaluation of Tenofovir DF versus Adefovir biomarker to test molecular risk of Gastric A phase IIIb, multinational, open-label, Dipivoxil for the treatment of HbeAg Cancer. NHMRC Project Grant APP1030980: follow-on trial to C87085 designed positive chronic Hepatitis B $806,000 (2012-2014). to assess the long-term safety of (GS-US-174-0103) certolizumab pegol, a pegylated Fab’ Dr I J Kronborg, Dr N Arachchi. Boussioutas, A (CIB) Cancer Australia fragment of a humanized antiTNFalpha Sponsor: Gilead Project Grant APP1024096. $558,264 (2012- monoclonal antibody, administered at 2014) weeks 0, 2 and 4, and then every 4 weeks thereafter, in subjects with moderately to severely active Crohn’s disease who have Research Output participated in study (C87085) Dr I J Kronborg. Sponsor: UCB Publications: 5 Book chapters: 1 A Phase 3 Open-label Study to Determine Presentations: 12 the Long-Term Safety and Efficacy of MLN0002 in Participants with Ulcerative Colitis and Crohn’s Dr Ian J Kronborg, Dr Shamilah Lachal. Sponsor: Millenium

WESTERN HEALTH RESEARCH REPORT 2012 029

Our Professional and Dr Ian Kronborg Dr Alan Moss Community Engagement Drug & Alcohol Clinical Advisory Service for Appointed to Editorial Board of “Endoscopy” Associate Professor Alex Boussioutas Victoria & Tasmania, Journal for 2012-2015 Board of management First Step Drug & Gut Club Victoria; Australian & NZ leaders Member of NHMRC Grant Review Panel Alcohol treatment agency Forum NHMRC Grants Reviewer Melbourne Study of Hepatocellular Journal reviewer of: Gastroenterology, NMRC Singapore Grants Reviewer Carcinoma (MESH) Gastrointestinal Endoscopy, Gut, Health Review Board of Ireland Grant American Society of Liver Disease (AASLD) Inflammatory Bowel Disease, Endoscopy Reviewer European Society of Liver Disease (EASL) and Clinical Gastroenterology & Hepatology Member and Reviewer for the Faculty 1000 American society of Addiction Medicine Medical experts Gut Club Victoria Editorial Board: Journal of Gastroenterology Melbourne Liver group and Hepatology Member of Human Research Ethics Committee, Melbourne Health Member of NHMRC GRP Member, Cancer Council of Victoria Hereditary Bowel Cancer Group Examiner for Australian Medical Council

WESTERN HEALTH RESEARCH REPORT 2012 030 General Internal Medicine

Our Research Information gained was used to generate Dr Karunajeewa continues international more specific research questions, collaborative research on malaria and clinical The Department of General Medicine future prospective studies and modified research into infectious diseases in the Asia- manages approximately 3400 inpatients interventions to improve effectiveness Pacific region. As part of a collaboration with annually, mainly elderly (40% aged over 80) and efficiency in patient management. the Walter and Eliza Hall Institute (WEHI) and with multiple co-morbidities and complex This has already informed the projects for the World Health Organisation, and a grant care needs. Often inadequate evidence 2013, including collaboration with Monash from the Asia-Pacific malaria elimination supports clinical decision making for this University’s college of pharmacy on a multi- network, he is working on evaluations of population, even for common clinical centre study of hospital prescribing practice drug treatments for malaria in Vanuatu and scenarios. for acute coronary syndromes. the Solomon Islands that have the ultimate eventual aim of completely eliminating In 2012 the Advanced Trainees in General In an NHMRC Partnership Grant (Deakin, malaria from some of the small countries Medicine undertook a number of projects Flinders & Melbourne Universities, Victorian of the South Pacific. With collaborators primarily under the direction of Dr and South Australian Governments and from the University of Melbourne and WEHI Harin Karunajeewa. Cohorts of patients Diabetes Australia) Professors Janus and he is developing novel diagnostic systems with community acquired pneumonia, Ebeling work on a gestational diabetes for diarrhoeal disease and gastrointestinal chronic obstructive airways disease register to ensure long term follow up and an pathogens. exacerbations, congestive cardiac failure, intervention (MAGDA) to decrease progression acute coronary syndromes, undifferentiated of GDM mothers to type 2 diabetes. Julie fever and sepsis, urinary tract infection, Nunn is RA for the Sunshine site. Research highlights musculoskeletal problems and bariatric EPI-FIND - Epigenetic Factors in Diabetes surgery were studied with a focus on patient Best Poster Prize Award: Tim Bennett - is a spin off project currently underway to population characteristics, determinants for: An audit of patients managed for identify epigenetic (environmental) effects of adverse outcomes and where possible musculoskeletal problems by the General on gene expression in the development to critically evaluate our management Medical inpatient service at Western Health. of diabetes during pregnancy. Prof Peter compared to existing consensus guidelines. Internal Medicine Society of Australia and Ebeling and Prof Edward Janus are New Zealand Annual Scientific meeting, Analysis of management and outcomes investigators with University of Melbourne Queenstown, New Zealand, September 2012 before and after implementation of hospital and Deakin University colleagues and the guidelines for both community acquired subjects are drawn from Western Health Runner-up Best Poster Prize: Adam pneumonia and congestive cardiac failure, Gestational Diabetes and Non Gestational Pastor for: A Retrospective Cohort Audit conditions was specifically carried out to Diabetes Clinics. of Acute Coronary Syndromes managed evaluate effectiveness of these interventions by an Australian General Medicine Unit. in terms of improving patient outcomes. Professor Janus also works on MDPS Internal Medicine Society of Australia and (NHMRC Melbourne Diabetes Prevention New Zealand Annual Scientific meeting, Project) and Diabetes Australia’s Life! : Queenstown, New Zealand, September Program for Diabetes Prevention in 25,000 2012. Victorians. He collaborates on The Hong Kong Cardiovascular Risk Factor Study, which he set up in 1994 -1996. It has completed its 12 year follow up and resulted in many publications.

WESTERN HEALTH RESEARCH REPORT 2012 031

OUR RESEARCHERS Our Grants and Awards Dr Mahesan Anpalahan

Professor Edward Janus: Head of Unit NHMRC Project Grant 2009-11(extended Reviewer for Age (The Journal of the to 2013): JA Dunbar, RC Carter, ED Janus, American Ageing Association), Clinical Dr Harin Karunajeewa: Physician, SK Lo, P Reddy, E Vartianen, Life! vs Medicine Insights, Experimental Gerontology Director of Research: Division of Medicine Usual Care in Diabetes Prevention: a Critical and Internal Medicine Journal. Evaluation. $833,125 Dr Mahesan Anpalahan: Physician Dr Harin Karunajeewa: NHMRC Partnership Grant 2010-14: Dr Elke Hendrich: Director of Physician Academic Journal Editor: PLoS One Dunbar JA, Best JD, Janus ED, Carter R, Training A/Prof Vicki Levidiotis: President Australian Oats J, Reddy P, Carnie J and Phillips P. and New Zealand Society of Nephrology Ebeling P, Rando L, Preventing Diabetes Dr Albert Leung: see under Rheumatology (2010-2012) in Pregnancy from Progressing to Type 2 Chair of the Local Organizing Committee Dr Craig Nelson: Physician: see under Diabetes: Macro-Level System Change in for the 2014 ANZSN Meeting Nephrology South Australia and Victoria. $1,292,000 KHA (Kidney Health Australia) Medical Associate Professor Vicki Levidiotis: Awards - see above under research and Scientific Advisory Committee (MSAC) Physician: see under Nephrology highlights. FRACP STAC/SAC Committee.

Dr Kushma Nand: Physician: see under Nephrology Research Output

Dr Adrian Tramontana: Physician: see under Publications: 9 Infectious Diseases Book chapters: 1 Presentations: 13 Dr Adam Pastor: Advanced Trainee

Dr Julia Girdwood: Advanced Trainee Our Professional and Community Engagement Dr Adrian Chazan: Advanced Trainee Professor Edward Janus Dr Timothy Bennett: Advanced Trainee President Heart Research Centre Board Dr Eloise Williams: Basic Trainee Melbourne Ms Julie Nunn: Research assistant NHMRC Treasurer Asian Pacific Society of MAGDA Study (Mothers after gestational Atherosclerosis and Vascular Diseases diabetes in Australia) Associate Editor, Journal of Atherosclerosis and Thrombosis (Japan) Reviewer NHMRC grants Reviewer Hong Kong Government Health and Medical Research Fund Reviewer Australian Journal of Rural Health, BMC Public Health, Internal Medicine Journal, Journal of Diabetes Investigation, Medical Journal of Australia, Nutrition Journal, Preventive Medicine Chairman of Review of Australian Community Centre for Diabetes ACCD for Victoria University, Melbourne 2012

WESTERN HEALTH RESEARCH REPORT 2012 032 Geriatric Medicine

We work collaboratively with nursing Our Research and allied health and have been actively The Department of Geriatric involved in the Better Care of Older People Delirium Point Prevalence Audit Medicine has undertaken a (BCOP) projects and the development and Dr Claire McKie, Dr Stephanie Ward implementation of pressure care guidelines number of research activities for Western Health. In 2013 the focus is on in 2012 aimed at improving the the management of delirium. We are also Our Researchers care of older people admitted involved with the care of older people in the community as part of the Aged Care Associate Professor Jenny Schwartz: to Western Health. The focus is Assessment Service (ACAS). The Western Head, Geriatric Medicine Health ACAS has been instrumental in on the key Geriatric Medicine Dr Mahesan Anpalahan: Consultant developing guidelines for the management Geriatrician syndromes, which include of hoarding and squalor in association with falls and fractures, delirium, community care providers and now provides Dr Mark Johannesen: Consultant a dedicated team of workers aimed at Geriatrician dementia, incontinence, supporting these clients in the community. pressure wounds and frailty. Dr Sook Meng Lee: Consultant Geriatrician Our registrars are actively involved in quality All of these syndromes are audits to improve current practice. In 2012 Dr Claire McKie: Consultant Geriatrician associated with functional their projects included an assessment of the appropriate use of continence aids/pads, the Dr Stephanie Ward: Consultant Geriatrician decline, prolonged periods of utility of a range of pain assessment scales hospitalisation and the risk of in the elderly including those with cognitive impairment and assessment of cognitive Research Output transition to residential care. impairment in people above the age of 65 with Chronic Kidney Disease. Publications: 6 Presentations: 2

Our Professional and Community Engagement

Stephanie Ward, Member of ANZSGM 2014 ASM Conference Convening Committee

Mahesan Anpalahan: Reviewed manuscripts for Experimental Gerontology, Age (The Journal of the American Ageing Association), Clinical Medicine Insights, and Internal Medicine Journal.

Over 40% of Western Health patients are aged over 80, with multiple co-morbidities and complex care needs.

WESTERN HEALTH RESEARCH REPORT 2012 033 Infectious Diseases

Feasibility of Early Discharge Strategies Research Output for Febrile Neutropenia in Australian Research within the Infectious Healthcare Facilities: Outcomes of a Publications: 3 Diseases unit has focused Victorian Organisational Readiness Assessment on topics directly relevant to Dr Stephen Guy, Dr Michael Green, Our Professional and the population of Western Dr William Renwick, Ms Angela Mellerick Community Engagement

Melbourne whom we care for, Collaborator: Peter MacCallum Cancer Stephen Guy: Member of Australasian as well as some collaborative Institute Society for Infectious Diseases Clinical Trials Network Steering Group on Infections in work with other centres. Diabetic Feet. Research in the form of quality Our Researchers Adrian Tramontana: Member of assurance audits provides A/Prof Garry Lane: Clinical Services Australasian Society for Infectious Diseases stimulus for improvement of Director (Medicine, Cancer and Emergency), Clinical Trials Network Steering Group on Head of Unit Infectious Diseases and Tuberculosis. care based on local patterns Infection Control of disease, such as review of Dr Stephen Guy: Infectious Diseases current antimicrobial therapy Physician guidelines. Dr Adrian Tramontana: Infectious Diseases and General Medicine Physician

Future directions include a more active Dr Cristina Mateevici: Infectious Diseases research component to our service by Registrar participating in multi-centre research Dr Ohide Otome: Infectious Diseases organisations such as the Australasian Registrar Society for Infectious Diseases clinical research networks, as well as ongoing audit of activities at Western Health.

Our Research

ESBL Infections at Western Health Dr Cristina Mateevici, Dr Stephen Guy, Dr Garry Lane, Dr Adrian Tramontana

Collaborator: Melbourne Health Pathology Department

Staph Aureus Endocarditis in Injecting Drug Users Dr Ohide Otome, Dr Stephen Guy, Dr Garry Lane, Dr Adrian Tramontana

WESTERN HEALTH RESEARCH REPORT 2012 034 Intensive Care Unit

The Western Health Intensive Care Unit Current Research STandaRd Issue TrANsfusion versuS (ICU) continues to achieve its objective Fresher red blood cell Use in intenSive of promoting excellence in critical care ANZICS Clinical Trials Group Point carE (TRANSFUSE) – a randomised medicine through collaborative clinical Prevalence Program (PPP) – 2012 controlled trial. research focused on improving patient A/Prof. Craig French. A/Prof Craig French, Dr John Mulder, centred outcomes. The ICU is proud to have Dr Sathyajith Velandy Koottayi, been involved with the completion and Collaborators: ANZIC Research Centre Dr Forbes McGain, Dr Zia Ansari notable publication of the C.H.E.S.T study A randomised blinded placebo controlled in the New England Journal of Medicine in Collaborators: ANZICS Clinical Trials Group, trial of hydrocortisone in critically ill October 2012. The study was the largest NHMRC, HRCNZ patients with septic shock (the ADRENAL randomised controlled trial ever conducted study). A Trial of Early Activity and Mobility in ICU in intensive care units. This research work A/Prof. Craig French, Dr John Mulder, (the TEAM study). has provided an important contribution Dr Sathyajith Velandy Koottayi, Dr Elizabeth Skinner, Ms Clare to fluid resuscitation management of Dr Forbes McGain, Dr Zia Ansari Holdsworth, Mrs Samantha Bates the critically ill on a global scale, adding evidence to suggest that crystalloids have Collaborators: The George Institute for Collaborators: Intensive Care Foundation; significant advantages over certain colloids Global Health National Health and Medical ANZIC Research Centre, Monash University in fluid therapy. Research Council (NHMRC) and Health Research Council of New Zealand (HRCNZ) Western Health remains consistent strong Our Research recruiters in trials coordinated by the Crystalloid versus Hydroxyethyl Starch Australian and New Zealand Intensive trial (C.H.E.S.T) A Multi-centre randomised A Multi-Centre Randomised Controlled Care Society (ANZICS) Clinical Trials Group controlled trial of fluid resuscitation with Trial of early Goal Directed Therapy in (CTG). The CTG is highly recognised and starch (6% hydroxyethyl starch 130/0.4) Patients presenting to the Emergency acknowledged internationally for providing compared to saline (0.9% sodium chloride) Department with Severe Sepsis in high quality, fundamental research which in intensive care patients on mortality. Australasia (the ARISE study). has a high impact on direct clinical practice. A/Prof. Craig French, Dr John Mulder, A/Prof Craig French, Dr John Mulder, Our commitment to improving research Dr Sathyajith Velandy Koottayi, Dr Sathyajith Velandy Koottayi, links was also strengthened in 2012 by the Dr Forbes McGain Dr Forbes McGain, Dr Anne-Maree Kelly, employment of a Data Manager for the ICU. Dr Menon Shymon This role has helped to markedly improve Collaborators: ANZICS Clinical Trials Group, the clinical data that Western Health submits The George Institute for Global Health Collaborators: ANZICS Clinical Trials to the ANZICS CORE database, a quality Group, Australasian College for Emergency assurance program which provides audit and HEAT: A clinical trial investigating the Medicine (ACEM) Clinical Trials Group analysis of the performance of Australian effect of paracetamol on the outcomes and New Zealand intensive care units. This of Intensive Care patients with fever and When a person has severe sepsis they have a invaluable database guides epidemiological suspected infection. severe infection and their body reacts to the research, and a greater understanding of A/Prof. Craig French, Dr John Mulder, infection, which is known as inflammation. critical illness management and outcomes. Dr Sathyajith Velandy Koottayi, This inflammation can affect important Dr Forbes McGain organs in the body such as the heart and We have maintained collaborative study lungs. The purpose of this research project partnerships with Emergency Medicine, Collaborators: The George Institute for is to find out if a treatment plan known as Physiotherapy and the Blood Bank Global Health; HRCNZ, Waikato Medical “Early Goal Directed Therapy” is different service. We also continue to participate in Research Foundation from standard treatment for patients commercial pharmaceutical studies and with severe sepsis. In Australia, standard Organ Donation Understanding investigator driven studies. Severe sepsis treatment involves treatment with fluids Family Decisions. remains the predominant area of research given into a vein and medications to support Dr Forbes McGain leading into 2013. the blood pressure and keep the heart Collaborators: St Vincent’s Hospital, working properly. A study performed at one Melbourne hospital in the United States has shown that giving standard fluids and medications for the treatment of severe sepsis works better when a strict protocol is followed. This new way of administering these standard

WESTERN HEALTH RESEARCH REPORT 2012 035

treatments is called early goal directed it is currently used ‘off-label’ for intubated Funding Grant: Funding to Establish the therapy (EGDT). Recruitment started in non-surgical patients for durations longer Centre for Research Excellence for Patient November 2009 and is ongoing with 400 than 24 hours, and at higher doses than Blood Management in Critical Illness patients left to recruit. To date, Western those approved, such use is not widespread and Trauma at Monash University - (The Health has recruited 15 patients. This and is supported by minimal evidence. This Blood-CRE). Co-Investigator - A/Prof research is integral to guiding physicians’ trial aims to determine the effectiveness and Craig French National Health and Medical practice and management of treatment safety of dexmedetomidine compared to Research Council (NHMRC) $2,500,000 patients with severe sepsis. placebo, when added to standard care, for (2012-2017) the treatment of ICU-associated delirium and A Multicentre, Randomised, Double-Blind, agitation in patients currently undergoing ANZCA Project Grant: A Life-cycle Placebo-controlled Phase IIb Study to sedation and mechanical ventilation. Both Assessment of Reusable and Single- Compare the Efficacy and Safety of Two dexmedetomidine and normal saline use Laryngoscopes. Dr Forbes McGain, Dosing Regiments of Intravenous Infusions placebo will be given by continuous infusion. Australian and New Zealand College of of CytoFab (AZD9773) in Adult Patients Recruitment is ongoing and to date we Anaesthetists (ANZCA) $10,200 (2012) With Severe Sepsis and/or Septic Shock. have recruited 1 patient. This research is Dr Forbes McGain, A/Prof Craig French, integral to guiding physicians practice and Dr John Mulder, Dr Sathyajith Velandy management of patients with delirium and to Research Output Koottayi, Dr Zia Ansari further define the use of dexmedetomidine. Publications: 6 Sponsored Drug Trial - Astra Zeneca Presentations: 3

Severe sepsis is an important cause of Our Researchers morbidity and mortality in ICUs despite Our Professional and A/Professor Craig French: Director current treatment and management. The Community Engagement of Intensive Care primary objective of this study is to evaluate Craig French the effect of two different doses of AZD9773 Dr John Mulder: Associate Director (recombinant TNF alpha) versus placebo on of Intensive Care ventilator free days over 28 days in patients Treasurer, ANZICS Clinical Trials Group Co Chair Australian and New Zealand Society with severe sepsis and/or septic shock. Dr Sathyajith Velandy Koottayi: Intensivist The recruitment period for this study was of Blood Transfusion (NHMRC/National limited, and Western Hospital was able to Dr Forbes McGain: Intensivist/Anaesthetist Blood Authority) Expert Advisory Group & recruit 1 patient. This was a phase II study Clinical/Consumer Reference Group Dr Zia Ansari: Intensivist in 300 patients. This research will aim to Co Chair, Management Committee, EPO-TBI help improve mortality and morbidity rates study Samantha Bates: Research Coordinator in patients with severe sepsis through Member, Management Committee TRANSFUSE study developing a potential new treatment Anna Tippett: Research Coordinator option. McGain FM: Member, Melbourne Health Anna Lidgett: Data Manager Human Research Ethics Committee A Randomised, Double-blind, multi- Sathyajith Velandy Koottayi: Member, centre placebo controlled trial of Western Health Low Risk Ethics Panel dexmedetomidine for patients with O ur AwARDS and Grants agitation and delirium in the intensive care unit (the DAHLIA study) Project Grant - TRANSFUSE Study. Dr John Mulder, A/Prof Craig French, Co-Investigator - A/Prof Craig French Dr Sathyajith Velandy Koottayi, National Health and Medical Research Dr Forbes McGain Council $2,761,870 Health Research Council of New Zealand $775,723 Collaborators: Prof Michael Reade (Royal Brisbane and Women’s Hospital); ANZICS Project Grant - Erythropoietin in Clinical Trials Group; Hospira Pty Ltd Traumatic Brain Injury EPO-TBI Study. Co-Investigator - A/Prof Craig French DaHLIA is a multicentre, placebo-controlled National Health and Medical Research trial comparing dexmed-etomidine and Council $1,848,475; Victorian Neurotrauma placebo for the management of ICU- Initiative $1,416,130 (2009-2014) associated delirium and agitation. Although

WESTERN HEALTH RESEARCH REPORT 2012 036 Joseph Epstein Centre for Emergency Medicine Research

The Joseph Epstein Centre for Emergency Nursing Handover in ED Research Output Medicine Research focuses on research Professor Anne-Maree Kelly, Sharon Klim, questions relevant to the clinical care of Publications: 8 Collaborators: Dr Debra Kerr, Professor emergency patients. Some of our work is Books Chapters: 3 conducted solely at Western Health but a Terry McCann, Victoria University Presentations: 5 significant proportion is done in partnership The DAVROS project with other researchers both in Australia Professor Steve Goodacre (UK), UK Our Researchers and internationally. Current collaborations and HK collaborators, Professor Anne- include University of Sheffield UK, Aarborg Maree Kelly Professor Anne-Maree Kelly: Director, University Denmark and Lund University JECEMR Sweden. Collaborators: University of Sheffield Sharon Klim: Research Co-ordinator There have been three major streams of Blood Cultures in Community work in 2012: Acquired Pneumonia Kerrie Russell: Research Officer (Part-time) 1. Validating approaches to early rule out of Dr Mark Patterson, Prof Anne-Maree Kelly acute coronary syndrome in Emergency Clinical decision rules for investigation Our Professional and Department chest pain patients for subarachnoid haemorrhage Community Engagement 2. Arteriovenous blood gas agreement in Professor Anne-Maree Kelly, patients with severe respiratory disease Dr Simon Edwards Anne-Maree Kelly 3. Improving the quality of nursing handover Senior Clinical Advisor to the Emergency in ED. Our Research Care Improvement and Innovation Clinical Network (Dept Health Victoria). Our Current Research Arteriovenous Agreement of Blood Gases Editorial Boards of Journals: Annals of in Patients Undergoing Non-invasive Emergency Medicine; Emergency Medicine A multicentre randomised controlled trial Ventilation in ED Australasia; Hong Kong Journal of of early goal directed therapy in patients Professor Anne-Maree Kelly, Sharon Klim Emergency Medicine presenting to the Emergency Department with severe sepsis in Australasia (the This study is exploring the potential role of ARISE trial) venous blood gas analysis as a substitute for Associate Professor Craig French, arterial sampling in patients requiring non- Dr John Mulder, Dr Sathyajith Velandy invasive support of ventilation. If successful, Koottayi, Dr Forbes McGain, Professor we may able to reduce the number of painful Anne-Maree Kelly, Dr John Loy arterial tests that patients undergo.

Collaborators: ANZ Intensive Care Society Validating Approaches to Early Rule out of Clinical Trials Group Acute Coronary Syndrome in Emergency Department Chest Pain Patients Venous Versus Arterial Blood Sampling Professor Anne-Maree Kelly, Sharon Klim in Exacerbations of COPD; A Prospective Cohort Study Validating approaches to early rule out of Professor Anne-Maree Kelly. acute coronary syndrome in emergency department chest pain patients. This project Collaborators: Dr Dominic Shaw, is exploring whether heart attack can be Nottingham University Hospitals NHS Trust ruled out more quickly in patients coming to ED with chest pain. If successful, this work could result in shorter hospital stays; good for the patient and for the hospital.

WESTERN HEALTH RESEARCH REPORT 2012 On a typical day 336 patients attend one of Western Health’s three Emergency Departments.

WESTERN HEALTH RESEARCH REPORT 2012 038 Nephrology

In 2012, the Department of Nephrology at Honeypot Trial: A randomised, The IMPROVE-CKD trial: A randomised, Western Health has continued to participate controlled trial of exit site application of double-blind, placebo-controlled trial to in national trials co-ordinated by the MEDIHONEY™ Antibacterial Wound Gel assess the effect of phosphate reduction Australasian Kidney Trials Network adding for the prevention of catheter-associated with lanthanum carbonate on arterial to the existing trials the IMPROVE trial. infections in peritoneal dialysis patients. compliance and vascular calcification Associate Professor Nigel Toussaint, as The HONEYPOT Study in patients with chronic kidney disease the national lead investigator of this trial, A/Prof. Vicki Levidiotis stages 3-4 secured $1.58 Million NHMRC funding for National Lead Researcher: A/Prof Nigel this project in 2012. The Western Health RCT Collaborators: Australasian Kidney Trials Toussaint PI: Dr Craig Nelson eMAN Anaemia: Chronic Kidney Disease Network (CKD) which aimed to assess the effect of Collaborators: Australasian Kidney Trials EMAN - Anaemia Pilot Project: An Open a synchronised process of administration Network Labelled Randomised Control trial of the of Erythropoiesis-stimulating agents on synchronized Electronic MANagement This project aims to test if phosphate binders anaemia endpoints in CKD patients finished of Anaemia in Chronic Kidney Disease without calcium have an impact on vascular in December 2012. Hui Liew our advanced (CKD) compared to Usual Care Anaemia calcification before the commencement of trainee, presented preliminary results at the Management dialysis therapy. Cardiovascular disease is Western Health Research Week, and won Dr Craig Nelson the number one cause of death in patients the Neville Yeoman’s Prize. The Primary with kidney disease and this may be Care project eMAP CKD: VIC a collaborative Collaborators: Roche Pharmaceuticals contributed to by vascular calcification. project between Western Health, Kidney Health Australia (KHA), General Practice CERA in CKD; Meta-analysis Favoured Trial: A randomised, double- Victoria (GPV), Macedon Ranges & North Kushma Nand. blind, placebo-controlled, factorial-design Western Melbourne Medicare Local trial to assess the effect of aspirin and Collaborators: Cochrane Renal Group (MRNWML), funded by the Department fish oil (omega-3 fatty acids) in the of Health in Victoria Renal Health and prevention of early thrombosis in arterio- Aboriginal Health Clinical Networks, Effects of type and dose of phosphate binders on metabolic acidosis in venous fistulae in patients with Stage commenced in 2012 with greater than 20 IV or V chronic kidney disease requiring Primary Care practices recruited, and more patients with End Stage Kidney Disease on maintenance haemodialysis: A haemodialysis than 300,000 active patients. Funding was A/Prof. Vicki Levidiotis also secured in 2012 for a pilot telehealth retrospective observational study Craig Nelson. project in Home Dialysis through the This project aims to assess if aspirin and fish Department of Health, Victoria. Collaborators: RMH Department oil will help prevent thrombosis of dialysis of Nephrology fistulas. People on Dialysis have improved outcomes if they commence dialysis with Our Research Changes in QTc intervals and QTc a functioning fistula rather than temporary dispersion with dialysis between long access. Favoured Trial: A randomised, double- break (LB) (72-hour interdialytic period) blind, placebo-controlled, factorial-design versus short break (SB) (48-hour EMAN-Anaemia Pilot Project: An Open trial to assess the effect of aspirin and interdialytic period) Labelled Randomised Control trial of the fish oil (omega-3 fatty acids) in the Craig Nelson. synchronized Electronic MANagement prevention of early thrombosis in arterio- of Anaemia in Chronic Kidney Disease venous fistulae in patients with Stage Collaborators: Department of Cardiology, (CKD) compared to Usual Care Anaemia IV or V chronic kidney disease requiring Western Health Management haemodialysis Craig Nelson. A/Prof. Vicki Levidiotis This project aims to improve CKD Anaemia Collaborators: Australasian Kidney Trials targets by a synchronised electronic process Network to enable people to be cared for in their community rather than hospital outpatients. This project aims to prove that better care can be delivered and be more cost-effective if we monitor our patients by efficient processes in the community.

WESTERN HEALTH RESEARCH REPORT 2012 039

EMAP-CKD VIC: Electronic Mapping Dr Leny Hidayati: Advanced Trainee, Our Professional and and Assistance to Primary Care in CKD Nephrology Community Engagement Detection and Management in Victoria - A Pilot project Debbie Broomfield: Renal Research Craig Nelson Craig Nelson Coordinator Executive, Asian Pacific Society of Collaborators: Department of Health Marie McIntosh: eMAP CKD: VIC Project Nephrology Victoria/MRNWML/KHA/GPV Manager Department of Health Renal Clinical network - Strategic Action Group and Renal Catherine Blackmore: HUG Project Manager This project aims to detect unrecognised Leadership Group CKD in the community and provide Kidney Health Australia - KCAT Committee Connie Karschimkus: eMAN Anaemia management strategies via outreach from Kidney Health Australia - Guidelines for Project Manager the health service to primary care using Primary Care Development Group electronic processes, to improve CKD care Victorian Health Monitor - Renal Survey in Primary Care. Western Health has a large Our Research Output Development Group: burden of Chronic Disease in its catchment; Journal Reviews: cJASN, Nephrology this project aims at establishing processes Grant Reviews: NHMRC to reduce the burden and late presentation Publications: 11 Presentations: 9 of kidney disease to our health service, Vicki Levidiotis and to establish a WH catchment CKD data repository. O ur AwARDS and Grants Australian and New Zealand Society of Nephrology President HUG Project - Home dialysis Utilising IMPROVE Trial. PI: Nigel Toussaint, NHMRC Chair of the Local Organizing Committee Telehealth Guidance -$1,500,000 (2012-2015) for the 2014 ANZSN Meeting Craig Nelson, Department of Health Victoria KHA (Kidney Health Australia) Medical HUG Project - Home Dialysis Utilising and Scientific Advisory Committee (MSAC) This project aims to the increase support Telehealth Guidance Department of Health FRACP STAC/SAC Committee and monitoring of patients by using Victoria. PI: Craig Nelson RHCN $250,000 Journal Reviewers/Editorial membership telehealth solutions to enable patients to (2012-2013) in 2012: Reviews for Kidney International, safely perform home dialysis. We aim to Nephrology, American Journal of provide real-time answers to questions via EMAN-Anaemia Pilot Project: An Open Transplantation the telehealth solution in multiple different Labelled Randomised Control Trial of the Grant Reviews: NHMRC, FRACP Jacquot, languages and to offer real-time video links Synchronized Electronic MANagement KHA Grants, DART Grants for technical trouble shooting 24 hrs per day of Anaemia in Chronic Kidney Disease to further assist people in our community. (CKD) compared to Usual Care Anaemia Nigel Toussaint Management. PI: Craig Nelson. Roche Pharmaceuticals Research Grant $350,000 Chair SAC Nephrology. Our Researchers (2010-2012) HUG (Home Dialysis Utilising Telehealth Guidance and Monitoring) Project – a Dr Craig Nelson: Director Investigator Initiated Multi-centre telehealth pilot in home dialysis at Randomised Controlled Trial of Lanthanum Western Health A/Prof Vicki Levidiotis: Staff Specialist Carbonate in Chronic Kidney Disease PI: Nigel Toussaint. Shire Pharmaceuticals A/Prof Nigel Toussaint: Staff Specialist Research Grant: $1.5 Million (2010 – 2013)

Dr Sandra Crikis: Staff Specialist EMAP-CKD VIC: Electronic Management and Assistance to Primary Care in CKD Detection Dr John Katsoulous: Staff Specialist and Management in Victoria – A Pilot project. Dr Kushma Nand: Staff Specialist PI: Craig Nelson. Department of Health Dr Rosemary Masterson: Staff Specialist Victoria - RHCN and Aboriginal Health - $560, 000 (2011 – 2013) Dr Solomon Cohney: Staff Specialist

Dr Hui Liew: Advanced Trainee, Nephrology

WESTERN HEALTH RESEARCH REPORT 2012 Telehealth solutions make home dialysis possible for more Victorians

WESTERN HEALTH RESEARCH REPORT 2012 041

In an Australian first, Western “HUG is based on a UK model which “For most patients, hospital-based dialysis found that using telehealth for cardiology involves travelling to a hospital three times Health’s Department of patients resulted in a huge reduction in a week with treatment lasting four hours. Nephrology is using innovative Emergency Department presentations and Factoring in travel time and the possibility hospitalisation. We’re hoping to replicate that they may not feel 100 per cent after the telehealth solutions to provide that here,” Western Health’s Head of session, and many patients will tell you it greater levels of support Nephrology, Associate Professor Craig can knock out the entire day for them three and monitoring, enabling Nelson said. times a week. It can make maintaining employment very difficult, if not impossible, more patients in Victoria to “Telemedicine is in its infancy in Australia, for some patients,” Catherine said. and has recently been identified as a national undertake home dialysis. health priority within the National Broadband “Patients who dialyse at home often have Network rollout agenda and with the better outcomes. They can fit their treatment The Home Dialysis Utilising creation of Medicare Benefit Scheme item around their own lifestyle needs, feel much numbers for telemedicine consults. more in control of managing their condition Telehealth Guidance and and avoid coming into hospitals Monitoring Project (HUG) “Current rates of home dialysis in Australia are greater than most other countries, “I really believe in this project. It’s about project was made possible although rates differ significantly between making sure those patients who are by a $250,000 home dialysis states in Australia, with Victoria achieving competent to undertake home dialysis are lower rates than elsewhere,” A/Prof Nelson also confident to do it. The HUG project, project grant from the said. I believe, bridges that gap beautifully. Victorian Government. HUG Project Officer, Catherine Blackamore, “They might be feeling like they’ve grasped has been recruiting the first patients to take how it works when they do their home part in the HUG pilot . dialysis training in the hospital but all of a sudden they’re home, and they don’t know “Nothing that a person ever comes across what to do. in their life prepares them for dialysis, particularly dialysis in the home. People “It’s about building a patient’s confidence worry about what the impact might be if over a period of time using the telehealth they do something ‘wrong’. There are lots of device. HUG gives patients the security of things they need to be aware of, for instance knowing that every day their health and well their weight and their blood pressure, and being are being monitored. there are lots of decisions that need to be made on a daily basis, particularly in those “There are also home health questionnaire early stages. that have been developed, with simple ‘yes’ or ‘no’ answers. This will help us assess on a daily basis whether patients need us to contact them or whether they are tracking along well. If we need to we can video conference them, ask more detailed questions and decide if they need to come into the hospital,” Catherine said.

Western Health dialysis patient Kate Parkinson was one of the first patients to be recruited to the HUG project.

WESTERN HEALTH RESEARCH REPORT 2012 042 Neurology

Western Health Neuroscience Research Current Research TASTE Study: Imaging based, Unit conducts clinical research in various international, multicenter, randomised, disciples of neurology including stroke, START- EXTEND Study: International, double blind study on novel thrombolytic multiple sclerosis, epilepsy and movement multicenter, randomised, double blind agent TNK in acute ischemic stroke disorders. It is one of the busiest clinical study on extending time window up to Tissa Wijeratne, Co- researchers trial centres in acute stroke research in nine hours on the basis of imaging based Victor Chong, Zelko Matkovic, Simon Australia. Many patients have been recruited ischemic penumbra. Li, Grant Scott, Surangi Somaratne, in international, randomised, double blind Tissa Wijeratne, Co- researchers Natalie Teasdale, Sena Gocuk, trials, including acute stroke clinical trials Victor Chong, Zelko Matkovic, Simon Kar Yan Lo, Elizabeth Mackey and trials in multiple sclerosis. The Unit’s Li, Grant Scott, Surangi Somaratne, research activity ranges from collaboration Natalie Teasdale, Sena Gocuk, TIPS: Cluster randomised trial on in international research trials to laboratory Kar Yan Lo, Elizabeth Mackey implementation of thrombolysis in based cellular work. The basis for the acute ischemic stroke research is our drive to improve clinical START- PREPARE Study: Biomarker study Tissa Wijeratne, Co- researchers service and patient outcomes. We have arm in acute ischemic stroke in parallel to Victor Chong, Zelko Matkovic, Simon been enriched by visiting international START –EXTEND Li, Grant Scott, Surangi Somaratne, experts and researchers, including Professor Tissa Wijeratne, Co- researchers Natalie Teasdale, Sena Gocuk, Werne Hacker from Germany. The strong Victor Chong, Zelko Matkovic, Simon Kar Yan Lo, Elizabeth Mackey collaboration with Asia Pacific region, Sri Li, Grant Scott, Surangi Somaratne, AFFINITY Study: International, multicenter, Lanka and India in particular, has been Natalie Teasdale, Sena Gocuk, randomised double blind trial on SSRI and maintained and we plan to embark on Kar Yan Lo, Elizabeth Mackey acute stroke rehabilitation several collaborative research projects in START-EXTEND IA: International, Tissa Wijeratne, Co- researchers the future. In addition we will continue to multicenter, randomised, double blind Victor Chong, Zelko Matkovic, Simon foster collaborations with the leading local study on imaging based IA therapy in acute Li, Grant Scott, Surangi Somaratne, academic institutions, including University of ischemic stroke. Natalie Teasdale, Sena Gocuk, Kar Yan Lo Melbourne, Victoria University and Monash Tissa Wijeratne, Co- researchers University, to strengthen neurosciences Victor Chong, Zelko Matkovic, Simon Li, RENEW Study: An observational study on research in the Western region. Grant Scott, Surangi Somaratne, multiple sclerosis patients who are being Natalie Teasdale, Sena Gocuk, treated with Rebif new formula as the Kar Yan Lo, Elizabeth Mackey immunotherapy Tissa Wijeratne, Co- researchers Victor ENCHANTED Study: International, Chong, Zelko Matkovic, Simon Li, multicenter, randomised, double blind Grant Scott, Surangi Somaratne, study on 0.6mg/Kg IV tPA versus 0.9mg/ Natalie Teasdale, Sena Gocuk, Kar Yan Lo Kg and acute blood pressure lowering in acute ischemic stroke study IRIS Study: An international, multicenter, Tissa Wijeratne, Co- researchers double blind trial on insulin resistance, Victor Chong, Zelko Matkovic, Simon Li, acute cerebral vascular events and Grant Scott, Surangi Somaratne, pioglitazone therapy, a collaborative study Natalie Teasdale, Sena Gocuk, with Yale University , USA Kar Yan Lo, Elizabeth Mackey Tissa Wijeratne, Co- researchers Victor Chong, Zelko Matkovic, Simon Li, Grant Scott, Surangi Somaratne, Natalie Teasdale, Sena Gocuk, Kar Yan Lo

WESTERN HEALTH RESEARCH REPORT 2012 043

AVERT Study: An international, double Diabetic Neuropathic Pain Study: The utility of 2 channels EEG system blind, multicenter trial in acute very early an observational study on Diabetic for ICU EEG monitoring rehabilitation in acute stroke neuropathic pain (clinical and Simon Li Tissa Wijeratne, Co- researchers Surangi neurophysiological features) Somaratne, Natalie Teasdale, Sena Gocuk, among diabetes outpatients Comparing rostral and caudal PPN Kar Yan Lo, Elizabeth Mackey Tissa Wijeratne, Henry Zhao, Kar Yan stimulation for gait and balance in PD Lo, Hasanthi, Surangi Somaratne, Wesley Thevathasan WESHENS Study: Western Health Cynthia Cheng Neurophobia survey among medical Pull test study assessing impact of PPN students and RMOs VST- Mastoid Air Cell Abnormalities Study: stimulation for postural instability in PD Tissa Wijeratne, Co-researchers Leon Yap, an observational study on venous sinus Wesley Thevathasan Ms Mei Yan Ngun thrombosis and radiological abnormalities Forceplate study assessing impact of PPN in mastoid air cells to see whether there stimulation for balance impairment in PD Good Mood Study; a randomised study on is a cause /effect relationship Wesley Thevathasan motivational interviewing and prevention Tissa Wijeratne, Mahi Jasinarachchi, John of post stroke depression Fitzgerald, Mobin Masters Pallidal stimulation for cervical dystonia - Debra Kerr, Justine Mizen, clinical study Elizabeth Mackey, Tissa Wijeratne Western Health ICH Study: a retrospective, observational study on acute ICH cases Comparing 60Hz Vs 130Hz DBS for Gait and Balance in minor strokes and TIAs from 2006-2012 with a view to validate primary dystonia - a multicentre RCT Study; an observational study in gait and the SMASH-U classification of ICH Wesley Thevathasan balance issues in minor strokes and TIAs Tissa Wijeratne, Kar Yan Lo Frances Bachelor, Sandra Petty, Epilepsy and Bone Health - Investigating Tissa Wijeratne Western Health Neurocysticorsis Study: Cellular Electrophysiology A retrospective, observational study Sandra Petty Western Health Central Post Stroke Pain on patients with neurocysticorsis who Study (an observational study on CPSP admitted to Western health from 2000- and neurophysiological features in CPSP 2012 Tissa Wijeratne, Ashwini Chandra, Tissa Wijeratne, Surangi Somaratne, Natalie Teasdale, Robert D Helme Hasanthi

Western Health Post Stroke Sexual Interact-2: A randomised, multicenter, Function Study (an observational survey international, double blind study on acute on post stroke sexual function among blood pressure lowering in acute ICH western health patients with a view to find Tissa Wijeratne, Co- researchers Victor out the epidemiology of post stroke sexual Chong, Zelko Matkovic, Simon Li, Grant dysfunction and key determinants in a Scott, Surangi Somaratne, Natalie cohort of patients, Teasdale, Sena Gocuk, Kar Yan Lo, Tissa Wijeratne, Mahi Jazinarchchi, Elizabeth Mackey Debra Kerr, Sherisse Celestino, Sena Gocuk, Surangi Somaratne, Kar Yan Lo, Cynthia Cheng

WESTERN HEALTH RESEARCH REPORT 2012 044 Neurology (cont.)

Our Researchers Dr Sandra Petty: MBC Postdoctoral International Advisor, Indian Stroke Research Fellowship . RACP Servier Barry Association Dr Tissa Wijeratne: Director, Neuroscience Young Fellowship in Neuroscience: $50,000 Council Member, Stroke Prevention, Research Unit American Stroke Association Dr Sandra Petty: Thwaites Gutch Fellow Editor, Parkinson’s Research Review Ms Natalie Teasdale: Research Coordinator in Physiology. Ormond College Australia Active Reviewer for Neurology, Neurology Ms Sherisse Celestino: Research Wesley Thevathasan: Early career in Clinical Practice, Stroke, Epilepsy and Coordinator fellowship. NHMRC (National Health and Behavior, Medical Education, Journal of Medical Research Council, Australia): Clinical Neurosciences, Basal Gangli Ms Sena Gocuk: Research Coordinator $215,738 (2013-2017)

Ms Hasanthi: Research Assistant

Ms Surangi Somaratne: Research Fellow Our Professional and Dr Wesley Thevathasan Community Engagement NRU is fully supported by all the neurology International taskforce for PPN stimulation consultants, registrars and advanced trainee Dr Tissa Wijeratne for Parkinson’s disease and Progressive in the Department of Neurology, Western supranuclear palsy Membership/ Committee Representation Hospital. Endorsed by the International Movement 2012 Disorder Society. Ambassador; Asia Pacific Region, World O ur AwARDS and Grants Federation of Neurorehabilitation Chair, Western Health Low Risk Ethics Panel Dr Tissa Wijeratne, Dr. Frances Bachelor Chair, Education committee, Stroke Society and Dr Sandra Petty Gait and Balance Study Australasia in the TIA Clinic Cohort at Western Health Chair and delegate, International Working National Stroke Foundation $20,000 Group for Young Neurologists and Trainees, World Federation of Neurology Dr Tissa Wijeratne and Dr Debra Kerr, Member, Education Committee, World Victoria University Good Mood Study Federation of Neurology (a randomised study in motivational Member, Advocacy and Public Awareness interviewing and prevention of depression Committee, World Federation of Neurology among acute stroke patients at Stroke Unit, Member, Asia Pacific Stroke Advocacy Union Western Hospital). Victoria University early Chair, Young Neurologists Special carrier research grant: $29,000 (2012) Interest Group, World Congress of Neurorehabilitation, 2012, Melbourne Good Mood Study (a randomised study in Chair, Geoff Donnan Stephen Davis Stroke motivational interviewing and prevention Advocacy Leadership Forum, Asia Oceania of depression among acute stroke patients Congress of Neurology, 2012, Melbourne at Stroke Unit, Western Hospital). National Chair, Asia Pacific Young Neurologists and Stroke Foundation: $20,000 (2012) Trainees workshop, Asia Oceania Congress of Neurology, 2012, Melbourne Member, Education Committee, RACP, Australia Member, Policy and Advocacy Committee, RACP, Australia Membership Officer, Stroke Society of Australia Public Officer, Stroke Society of Australia Member, Education and Learning Committee, RACP (also a Member for Curriculum Development Committee, BPT, RACP Representing the Education Committee)

WESTERN HEALTH RESEARCH REPORT 2012 045 North West Academic Centre

The NorthWest Academic Centre is part of Our Current Research Osteocalcin and glycaemic control The University of Melbourne’s Faculty of P Ebeling Medicine, Dentistry & Health Sciences. The Risk Factors for aged care assessment: Centre is the operational hub, incorporating Development of predictive tool Collaborators: Institute for Sport, Exercise staff from the Melbourne Medical School and Haslinda Gould and Active Living (ISEAL), Victoria University; other schools and departments at Western The University of Melbourne; Austin Health Hospital and the Western Centre for Health Human Osteoblast Biology on Novel Vitamin D, physiological and Research and Education facility (WCHRE) at Implantable Scaffolds biomechanical assessments, and risk Sunshine Hospital. Tania Fernandes of falls in osteoarthritis Research at the NorthWest Academic Centre Elucidating biomarkers of bone resorption K. Sanders, P.Ebeling is aligned with The Departments of Medicine, and exercise by NMR and MS based Collaborators: Institute for Sport, Exercise Endocrinology, and Surgery at Western metabolomics and Active Living (ISEAL), Victoria University; Health along with collaborative partnerships John Sheedy The University of Melbourne with universities across Australia and at key Osteo-cise: Strong Bones for Life. centres around the world. The NorthWest An Inclusive Evidence-based Multi- The associations between characteristics Academic Centre is also a foundation component Exercise, Falls Prevention of sarcopenia, vitamin D and falls in member of The Australian Institute for and Osteoporosis Education/Awareness community-dwelling older adults Musculoskeletal Science (AIMSS). Program D.Scott, K.Sanders, P.Ebeling, E. Skinner Jenny Gianoudis Our research incorporates a broad range of Aetiology and Prognosis of interests including, osteoporosis, falls and Sunlight exposure and risk of type 2 Femoroacetabular Impingement fractures, vitamin D and health, diabetes diabetes in skeletally mature and immature mellitus, colon cancer and the genetics Catherine Shore-Lorenti individuals of cancer metastasis, health economics, C.Fary, P.Tran, J.O’Donnell the epidemiology of disease and social Barriers and enablers to treatment disparities in healthcare. We also have and prevention of fracture: Exploring Collaborators: The University of Melbourne, a growing interest in Maternal Foetal knowledge, beliefs, attitudes and cultural St Vincent’s Institute Medicine, and Paediatric Endocrinology with models of osteoporosis The effect of moderate-intensity key appointments in 2013 supporting further Renee Otmar research growth. cardiovascular fitness training compared to Does teriparatide reverse osteonecrosis standard care in people with a diagnosis of Our future research objectives are to expand of the jaw in patients with cancer? stroke: a pilot randomised controlled trial our research by joining forces with Western A randomised controlled trial H.Reynolds, S.Kenny, J.Tillyard, E.Skinner. Health and Victoria University to form the Ie-Wen Sim Australian Institute of Musculoskeletal Collaborators: Institute for Sport, Exercise Science, and also to continue to perform Effects of low or high dietary calcium and Active Living (ISEAL), Victoria University; collaborative research with the research intake on bone density and fractures in The University of Melbourne team involved in the NHMRC Centre for a population-based longitudinal cohort Objective assessment of physical activity Research Excellence in Sun and Health, Belal Khan with members being associated with QUT in older adult populations and associations and QIMR in Queensland, ANU in Canberra The cost and quality of life associated with health and physical performance. and the University of Melbourne at Western with fractures at sites other than hip, D.Scott Health. We are also consolidating our links spine and wrist Collaborators: Institute for Sport, Exercise with Victoria University to expand our Yu Zhang and Active Living (ISEAL), Victoria University; research into colon cancer. Born small and exercise; can exercise The University of Melbourne in those who were born small normalise bone and glucose homeostasis? P.Ebeling, Institute for Sport, Exercise and Active Living (ISEAL), Victoria University; The University of Melbourne

WESTERN HEALTH RESEARCH REPORT 2012 046 North West Academic Centre (cont.)

The validity and reliability of a Our Research Students Project Grant: The association between 3-dimensional body scanner for evaluating Haslinda Gould: PhD socio-economic status and total joint body composition. replacement across Australia. 2013 Arthritis P. Ebeling, D.Scott. Tania Julie Fernandes: PhD Australia Grant-in-aid funded by Zimmer Australia: $10,000 (2012) Collaborators: Institute for Sport, Exercise John Robert Sheedy: PhD and Active Living (ISEAL), Victoria University; Victorian Orthopedic Association Research The University of Melbourne Jenny Gianoudis: PhD Grant: Social and geographic associations with shoulder joint replacement Australia- Renee Otmar: PhD Role of the Eph/Ephrin cell signalling wide 2006-2011Victorian Orthopedic system in the progression and metastasis Association: $9,100 (2012) Belal Ahmad Khan: PhD of colon cancer P Senior, S Chan Dyason Fellowship: Social and ethnic Yu Zhang: PhD disparities in the uptake of bone density Collaborators: Victoria University Catherine Shore-Lorenti: PhD testing and osteoporosis therapies pre and post-fracture. The University of Melbourne: Dr Ie-Wen Sim: PhD $5,000 (2012) Our Researchers Dr Cherng Huei (Joe) Kong: NHMRC Training Fellowship (1012472) Professor Peter Ebeling: Chair NorthWest Master of Surgery Investigating the psychosocial and Academic Centre socioeconomic predictors of osteoporosis. NHMRC: $290,032 S.Brennan and Associate Professor Kerrie Sanders: Our Research Output G. Nicholson Principal Scientist K.Sanders Dr Sharon Brennan: Research Fellow Publications: 60 Presentations: 3 The Australian Study of Cost and Utilities Related to Osteoporotic Fractures. Merck, Dr David Scott: Postdoctoral Fellow Sharp & Dohme (Australia) Ltd. $150,000 O ur AwARDS and Grants Dr Ie-Wen Sim: Endocrinologist Consultant P. Ebeling S. Brennan Professor Steven Chan: Professor of NHMRC Project Grant (1030371) Surgery Gibson Scientific Research Award, P. Ebeling, G.Borromeo and J.Seymour: Australian: RM Sex bias in referral for bone Does Teriparatide Reverse Osteonecrosis Dr Paul Senior: Senior Research Fellow densitometry in adults aged 50 years and of the Jaw in Patients with Cancer? A RCT over: 2003-10. Association of Gerontology: (2012-2014) NHMRC: $385,000 Mr Ian Faragher: Colorectal Surgeon $3,128 (2011-12) NHMRC Project Grant (1022660). Mr Felix Behan: Plastic Surgeon Strategic Grant (Early Career Grant): A.Carr, J.Hoy, P.Ebeling, N.Pocock. Sex bias in referral for bone densitometry: Bisphosphonate Therapy with Zoledronate A/Prof Trevor Jones: Clinical 1991-98 to 2003-1 0. The University of or Tenofovir Switching to Improve Low Bone (Associate Professor) Melbourne: $38,173 (2011-12) Mineral Density in HIV-Infected Adults: a Randomised Trial. NHMRC: $687,807 A/Prof Steven McLaughlin: Clinical Project Grant: The association between (2012-2014) (Associate Professor) socioeconomic status and utilization of total hip and knee joint replacement across A/Prof Graeme Thompson: Clinical Australia. Arthritis Victoria: $19,862 (Associate Professor) (2011-12). A/Prof Val Usatoff: Clinical (Associate Professor)

A/Prof Arun Chandu: Clinical (Associate Professor)

WESTERN HEALTH RESEARCH REPORT 2012 WESTERN HEALTH RESEARCH REPORT 2012 048 North West Academic Centre (cont.)

NHMRC Centre for Research Excellence AIMSS Seed Funding D.Scott, E.Skinner, Our Professional and in Sun and Health M.Kimlin, D.Whiteman, P.Levinger, T.Haines, P.Ebeling, K.Sanders. Community Engagement R.Lucas, C.Sinclair, R.Neale, P.Ebeling, The associations between characteristics P.Youl, L.Gordon, M.Janda of sarcopenia, vitamin D and falls in Peter Ebeling NHMRC Centre for Research Excellence community-dwelling older adults. AIMSS: in Sun and Health. NHMRC: $2,379,750 $20,000 (2012-2013) Medical Director, Osteoporosis Australia (2010-2015) Councillor, American Society for Bone and The Faculty Of Health, Engineering & Mineral Research NH&MRC Project Grant (1046681). Science Collaborative Research Grants Board Member, International Osteoporosis R.Neale, B.Armstrong, P.Ebeling, Scheme K Nurgali, P Senior. The role Foundation, Geneva D.English, M.Kimlin, A.Venn, J. van der of EphB4 receptor in the development Co-Chair, American Society for Bone and Pols, R. O’Connell. D-Health: A randomised and spread of colorectal cancer Victoria Mineral Research Annual Scientific Meeting trial of vitamin D for prevention of cancer University: $15,000 (2013) President Endocrine Society of Australia and mortality. NHMRC: $2,930,705 Scientific Journal Editorial Boards MSD-ANZBMS Clinical Research Excellence Associate Editor, Journal of Bone and AIMSS Seed Funding. Award, Mineral Research C.Fary, P.Tran, J.O’Donnell, N.Sims, B.Khan. Long term high dietary calcium Member, Editorial Board, Osteoporosis A.Takla, Aetiology and Prognosis of intake and its association with fractures and International Femoroacetabular Impingement in skeletally cardiovascular events in a population based Member, Editorial Board, Clinical mature and immature individuals. AIMSS: prospective cohort study. 1st Asia-Pacific Endocrinology (Oxford) $6,650 (2012-2013) Bone and Mineral Research Meeting and the ANZBMS 22nd Annual Scientific Meeting. Kerrie Sanders Collaborative Research Network Start- up Funds A.Hayes, P.Levinger, R.Begg, Editorial member, Journal Bone and Mineral A.Petersen, K.Sanders, F.Cicuttini. Optimal Research exercise and nutritional strategies to improve bone/muscle strength and gait function for falls prevention. Victoria University. $18,000 (2012-2013)

Collaborative Research Network Start- up Funds G.McConell, G.Kaur, P.Ebeling, M.Wlodek, A.McAinch, P.Sinnayah. Born small and exercise (Can exercise in those who were born small normalise bone and glucose homeostasis?) Victoria University; $15,000 (2012-2013)

WESTERN HEALTH RESEARCH REPORT 2012 049 Nursing

Focus group methodology evaluated two Current Research specific education programs: ‘STRIPE For the first time, there Simulation Based Education Program’ and Standardised handover to improve nursing was a dedicated session the ‘Best Care for Older People (BCOP) care in the Emergency Department. Nursing Projects Program’. The STRIPE Debra Kerr, Klim S, Kelly A.M, for nursing research during program was developed as a multi-faceted Terence McCann, Sallie Wood. Research Week in 2012. This inter-professional program to prepare Collaborators: Nurses Board of Victoria, was an exciting presentation undergraduate students from different health disciplines for practice, using simulation Victoria University of nursing and midwifery learning approaches. Two focus groups and Effects of early motivational interviewing a survey included undergraduate students research activities ranging on post-stroke depressive symptoms: (medical, nursing, physiotherapy, social Randomised controlled trial of the Good from breastfeeding, to falls, work) who had participated in the STRIPE Mood Intervention program. program. Participants were very positive to intranasal medication. Debra Kerr, Terence McCann, Justine about the STRIPE program and three Mizen, Elizabeth Mackey, Tissa Wijeratne, Successful projects include: main themes were identified: enhanced Victoria University, Western Health, self-awareness about response to real life Intranasal fentanyl for women National Stroke Foundation. situations, opportunity to practice with in childbirth; effectiveness interdisciplinary health team members, A study of post stroke sexual function. of bedside handover in the and increased confidence to practice after Dr. Mahi Jasinarachchi, Dr. Toby emergency department, graduation. Cumming, Dr. Debra Kerr, Dr. Kar Yan Lo, Ms. Sherisse Celestino, Dr. Manoji Evaluation of the BCOP program found evaluation of medication Pathirage. Victoria University, that participants recognised significant Western Health endorsement for Division 2 personal growth as a direct consequence Registered Nurses, and falls in of enrolment in the program, including The STRIPE Project - A Collaborative enhanced leadership and self-confidence the sub-acute care setting. Interprofessional Simulation-Based skills. Support from leaders within the training program. organisation encouraged the participants to Janet Beer, Clare Holdsworth, David manage projects that had the potential to Mai, Debra Kerr. Western Health, improve the quality of healthcare for patients Victoria University within and beyond their clinical environment. An Evaluation of the Best Care for Older Receipt of two competitive grants (Stroke People (PCOP) Nursing Projects Program Foundation Grant and Victoria University Kathy Kirby, Kate Mangion, Debra Kerr. Internal Grant) will support the study titled: Western Health, Victoria University ‘Effects of early motivational interviewing on post-stroke depressive symptoms: Pilot Prevalence of Falls for Hospitalised Elderly randomised controlled trial of the Good Patients in Sub-Acute Care Mood Intervention program.’ This study will Ghada Elias, Debra Kerr, Doug Mill. evaluate the effectiveness of a nurse-led Western Health, Victoria University motivational interviewing technique to prevent mood disturbances after acute How Do Women Achieve Wellness After stroke. Breast Cancer Treatment? Susan Cipolla, Debra Kerr, Leanne Storer, Terence McCann. Western Health, Victoria University,

WESTERN HEALTH RESEARCH REPORT 2012 WESTERN HEALTH RESEARCH REPORT 2012 051

Our Research Evaluation of the Best Care for Older Our Research Students People Program. Ms Ghada Elias: Bachelor of Nursing Move to the Cube: Developing a Kathy Kirby, Kate Mangion, Debra Kerr (Honours) Framework for Nursing Handover in the Emergency Department: An Individualised The aim of this study was to explore the Ms Susan Cipolla: Bachelor of Nursing and Systematic Approach opinions of candidates regarding the ‘Best (Honours) Debra Kerr, Sharon Klim, Ann- Care of Older People: Nursing Projects Maree Kelly, Terence McCann, Sallie Program in relation to professional Wood. Nurses Board of Victoria, development, program structure and Our Publications Victoria University redesign activities.’

Western Health has embedded the ‘Best This project aims to develop, implement and Our Research Output evaluate a standardised nursing handover Care for Older People Everywhere’ toolkit model for the ED setting. Preliminary to inform models of care via the Best Care Publications: 6 evidence suggests that bedside handover for Older People (BCOP) Nursing Projects Presentations: 3 is an acceptable method of performing Program. This program aims to achieve two handover for patients in the ED. In addition, key requirements: to minimise functional improvements were observed for standards decline for older people and professional O ur AwARDS and Grants of nursing care and documentation. Bedside development to support workforce capacity nursing handover is a relatively new strategy building Project Grant in EDs. There is a lack of research that has Dr Debra Kerr Professor Terence McCann: been carried out in relation to handover in Effects of early motivational interviewing on the ED setting. Our Researchers post stroke depressive symptoms. Victoria Prevalence of Falls for Hospitalised Elderly Dr Debra Kerr: Senior Lecturer; Honours University: $29,989 (2012) Patients in Sub-Acute Care Coordinator, Victoria University Dr Debra Kerr, Professor Terence McCann: Ghada Elias, Debra Kerr, Doug Mill. Effects of early motivational interviewing on Victoria University Ms Louise McKinlay: Manager, Education, Victoria University post stroke depressive symptoms National The primary aim of this study was to Stroke Foundation: $20,000 (2012-2013) prospectively measure the prevalence of falls Mr Doug Mill: Director of Nursing, and falls risk factors for hospitalised elderly Williamstown Hospital patients in sub-acute care. A secondary Our Professional and Ms Ghada Elias: Registered Nurse; Ward 2C aim was to measure the use of appropriate Community Engagement footwear during ambulation for patients Justine Mizen: Nurse Unit Manager; Debra Kerr during hospitalisation. Ward 3A Member, Australian Nursing Federation Falls have become the highest reported Elizabeth Mackey: Registered Nurse; (ANF) causes of unintended harm and leading Ward 3A Deputy Chair, Western Health Low Risk cause of death for elderly patients. There Ethics Panel is a lack of evidence in the Australian Davina Taylor: Clinical Nurse Consultant Member, Victoria University Human literature on prevalence of falls and factors Research Ethics Committee contributing to falls in the sub-acute care Kathy Kirby: Project Manager, Best Care Member, Victoria University Post Graduate setting. Previous research has found that for Older People, Division of Sub-acute & Research Committee inappropriate footwear is associated with an Aged Care Member, Research Advisory Committee - increased risk of falling for elderly patients. Kate Mangion: Manager Best Care for Older Western Health. People, Division of Sub-acute & Aged Care

Janet Beer: Simulation Coordinator

WESTERN HEALTH RESEARCH REPORT 2012 052 Oncology Haematology Unit

Research within Cancer Services at Western Our Research Health focuses on the predominant tumour Cancer Services at Western streams; Colorectal, Genitourinary, Lung, Circulating Tumour DNA as a Marker of Health is a founding Upper Gastrointestinal, Gynaecological, Complete Pathological Response and Breast and Haematology. In 2012, 23 clinical Long Term Outcome for Locally Advanced member of the clinical trial trials were open to accrual across these Rectal Cancer Treated with Pre-operative management organisation tumour streams. These trials were both Chemoradiotherapy Cancer Trials Australia. Our commercially sponsored and unsponsored Dr Jeanne Tie, Associate Professor Peter scientific group studies. 125 patients were Gibbs, Dr Ben Tran, Dr Suzy Kosmider, other important clinical trial enrolled and participated in clinical trials Dr Jayesh Desai partnerships include, the within this department; 80% of the clinical trial participants were colorectal cancer This study aims to further develop Australian Gastrointestinal patients. circulating tumour DNA (ctDNA) as a specific and sensitive blood biomarker test Trials Group, Australia and Cancer Services at Western Health for colorectal cancer. The current tools for New Zealand Breast Cancer received a Victorian Cancer Agency grant disease assessment in colorectal cancer, Trials Group, International in 2012, the aim of which is to increase serum CEA and radiological imaging have our clinical trial capacity. The grant has significant limitations. The stage II colon Breast Cancer Study Group, been utilised to increase clinician’s time cancer cohort allows exploration of ctDNA Australia and New Zealand as principal investigators, including as a marker of residual cancer, the efficacy developing clinicians as first time principal of adjuvant therapy and early detection of Germ Cell Trials Group and investigators, increasing the research cancer recurrence. The stage IV colorectal Australasian Leukaemia & clinical and administrative staff, and to cancer cohort allows further exploration of embark on clinical research that is not ctDNA as an early indicator of treatment Lymphoma Study Groups. supported by commercial sponsorship. The failure. This will be the first large prospective grant is specifically aimed at consolidating study evaluating the use of serial ctDNA the clinical trial work within the colorectal samples, with comprehensive patient cancer stream, and to build the capacity of data being collected using mostly existing the Haematology tumour stream to perform resources, where all pathology samples are clinical trials. reviewed and where patients are managed according to standard protocols. These Our future objectives are to increase our studies lay the foundation for future studies research capacity and provide access exploring changes in treatment based on to clinical trials for all Oncology and ctDNA results. The persistence of tumour Haematology patients within the health DNA in the blood following surgery for network. primary bowel cancer promises to be a very sensitive and specific marker of residual cancer, which would permit more informed decisions regarding chemotherapy treatment and benefit. In patients with advanced (stage IV) colorectal cancer, ctDNA could allow early assessment of treatment resistance, allowing earlier cessation of ineffective and often costly therapy and an early switch to an alternative strategy. ctDNA has many potential applications across the spectrum of cancers.

WESTERN HEALTH RESEARCH REPORT 2012 053

Circulating Tumour DNA as a Marker of CATChEz: Continuous Access to advanced Evaluate the Prognostic Role of Complete Pathological Response and Long and metastatic renal cell Carcinoma Inflammatory Markers in Patients with Term Outcome in Colorectal Cancer Liver therapy with Everolimus post pazopanib Metastatic Colorectal Cancer Treated with Metastases treatment Bevacizumab (Avastin™) [ASCENT] Dr Jeanne Tie, Associate Professor Peter Dr Shirley Wong, Dr David Campbell Associate Professor Peter Gibbs, Dr Ben Gibbs, Dr Ben Tran, Dr Suzy Kosmider, Tran, Dr Suzy Kosmider, Dr Jayesh Desai, Dr Jayesh Desai The aim of this trial is to assess the safety Dr Jeanne Tie and efficacy of sequential treatment The potential roles of ctDNA as a non- with pazopanib, followed by everolimus, An open-label phase IIIb study of invasive biomarker in colorectal cancer for advanced and metastatic renal cell regorafenib in patients with metastatic will be explored utilising prospective blood carcinoma. Improved treatment outcomes colorectal cancer (CRC) who have sample collection and comprehensive for patients with Metastatic renal cell progressed after standard therapy treatment and outcome data in patients with carcinoma Associate Professor Peter Gibbs, Dr Ben resectable liver secondaries treated in a Tran, Dr Suzy Kosmider, Dr Jayesh standardized fashion. Serial measurements A randomised Phase III Trial to assess Desai,Dr Jeanne Tie of ctDNA will address the value of ctDNA response adapted therapy using 2-[F- as a marker for occult disease and early 18]fluoro-2-deoxy-d-glucose positron A randomised phase II double-blind detection of recurrence. The current emission tomography (FDG-PET) imaging placebo-controlled study of regorafenib in approach of recommending 6 months in patients with newly diagnosed, refractory Advanced Oesophago-Gastric of chemotherapy to patients undergoing advanced Hodgkin Lymphoma Cancer (AOGC) INTEGRATE resection of liver metastases, with the hope Dr William Renwick, Dr Duncan Carradice Associate Professor Lara Lipton, of eradicating any occult disease in some Dr Sumitra Ananda Circulating Tumour DNA as a Marker of patients is very inefficient. The vast majority Complete Pathological Response and Long Phase II trial to evaluate the potential of treated patients are undertaking 6 months Term Outcome in Stage II and Metastatic molecular profile of biliary tract cancer and of therapy from which they will not benefit. Colorectal Cancer also examine the clinical benefit and safety The ability to accurately define patients that Dr Jeanne Tie, Associate Professor Peter of panitumumab, cisplatin and gemcitabine may not need treatment and those that do Gibbs, Dr Ben Tran, Dr Suzy Kosmider, in the treatment of biliary tract cancer would have many potential advantages. Dr Jayesh Desai (TACTIC) A Randomised Double-blind Phase III Trial Associate Professor Lara Lipton, A phase III prospective, two-cohort non- of FOLF(HA)Iri vs FOLFIRI for Second or Dr Sumitra Ananda randomised, multi-centre, multinational, Third Line Therapy in Irinotecan-naive open label study to assess the safety Phase 3, Multicenter, Randomised, Open- Patients With Metastatic Colorectal Cancer of assisted- and self-administered Label, Parallel-Group Study Of The Efficacy Associate Professor Peter Gibbs, Dr Ben subcutaneous Trastuzumab as adjuvant & Safety Of Lenalidomide (Revlimid®) Vs. Tran, Dr Suzy Kosmider, Dr Jayesh Desai, therapy in patients with operable her2- Chlorambucil as First-Line Therapy for Dr Jeanne Tie positive early breast cancer Previously Untreated Elderly Patients with This study aims to see if the addition of Professor Michael Green, Dr Shirley Wong, B-Cell Chronic Lymphocytic Leukaemia Hyaluronic acid to Irinotecan reduces the Dr Catherine Oakman, Dr David Campbell, Dr William Renwick, Dr Duncan Carradice, toxicity and adverse event profile whilst Dr Frances Barnett Dr Nicholas Murphy maintaining optimal disease response. The Randomised Comparative Study Of An Australasian, Phase III, Multicentre, aim of the study is to improve treatment Folfox6m Plus Sir-Spheres® Microspheres Randomised Trial Comparing Lenalidomide regimens for patients who have progressed Versus Folfox6m Alone As First Line Consolidation Vs No Consolidation in after first line treatment for metastatic Treatment In Patients With Non-resectable Patients with Chronic Lymphocytic cancer. Liver Metastases From Primary Colorectal Leukaemia and Residual Disease Carcinoma (Other IDs: STX0206). Following Induction Chemotherapy CLL6 Associate Professor Peter Gibbs, Dr Ben Dr William Renwick, Dr Duncan Carradice, Tran, Dr Suzy Kosmider, Dr Jayesh Desai, Dr Nicholas Murphy Dr Jeanne Tie

WESTERN HEALTH RESEARCH REPORT 2012 054 Oncology Haematology Unit (cont.)

A Randomised, Controlled, Double-Blind A Phase 3, Randomised, Double-Blind Dr Nicholas Murphy: Consultant Phase III Trial to Compare the Efficacy, Trial of Weekly Paclitaxel Plus AMG 386 or Haematologist Safety and Pharmacokinetics of GP2013 Placebo in Women With Recurrent Partially vs. MabThera® in Patients with Previously Platinum Sensitive or Resistant Epithelial Dr Ben Tran: Consultant Oncologist Untreated, Advanced Stage Follicular Ovarian, Primary Peritoneal or Fallopian Dr Catherine Oakman: Consultant Lymphoma Tube Cancers TRINOVA 1 Oncologist Dr William Renwick, Dr Duncan Carradice, Dr Shirley Wong, Dr David Campbell, Dr Nicholas Murphy Dr Sumitra Ananda Dr Richard De Boer: Consultant Oncologist

A Phase II, Double-Blind, Placebo- Dr David Campbell: Consultant Oncologist Controlled, Randomised Study Evaluating the Safety and Efficacy Of Carboplatin/ A Randomised, Open Label Phase 3 Study Dr Frances Barnett: Consultant Oncologist Paclitaxel and Carboplatin /Paclitaxel / of MM-398 versus 5-Fluorouracil and Bevacizumab With and Without GDC-0941 Leucovorin in Patients With Metastatic Dr Sheau Wen Lok: Oncology Research in Patients With Previously Untreated Pancreatic Cancer Fellow Advanced Or Recurrent Non-small Cell Associate Professor Lara Lipton, Advanced Trainee Lung Cancer Dr Sumitra Ananda Dr Sally Greenberg: Oncology Dr Dishan Gunawardana, Dr Catherine Oakman, Dr Jeanne Tie, Dr Suzy Kosmider Our Researchers Helen Brasier: Oncology Research Manager A double blind placebo controlled Angela Baugh: Clinical Research Nurse randomised trial of pf-804 in patients with Professor Michael Green: Director of Cancer services incurable stage iiib/iv non-small cell lung Catherine Morton: Clinical Research Nurse cancer after failure of standard therapy for Dr Dishan Gunawardana: Deputy Director advanced or metastatic disease BR.26 Lisa Wilkinson: Study Coordinator of Cancer Services Dr Dishan Gunawardana, Dr Catherine Oakman, Dr Jeanne Tie, Dr Suzy Kosmider Siobhan Rainford: Clinical Research Nurse Dr Sumitra Ananda: Associate Site Director Cancer Trials Australia, Consultant A Randomised, Open-label, Phase 3 Georgina Akers: Clinical Research Nurse Oncologist Study of Carfilzomib Plus Dexamethasone Jessica Mifsud: Clinical Research Nurse vs. Bortezomib Plus Dexamethasone in Dr S T Fan: Consultant Oncologist Patients With Relapsed Multiple Myeloma Nathan Hope: Clinical Research Nurse (Other ID’s: 2011-003, 2012-000128-16) Dr J C Ding: Consultant Oncologist Dr William Renwick, Dr Duncan Carradice, Dr Nicholas Murphy A/Professor Peter Gibbs: Consultant Our Research Output Oncologist A Phase 3, Randomised, Double-Blind Trial of Pegylated Liposomal Doxorubicin A/Professor Lara Lipton: Consultant Publications: 28 Presentations: 5 (PLD) Plus AMG 386 or Placebo in Oncologist Women With Recurrent Partially Platinum Sensitive or Resistant Epithelial Ovarian, Dr Shirley Wong: Consultant Oncologist Primary Peritoneal, or Fallopian Tube Dr Jayesh Desai: Consultant Oncologist Cancer Dr Shirley Wong, Dr David Campbell, Dr Jeanne Tie: Consultant Oncologist Dr Sumitra Ananda Dr Suzanne Kosmider: Consultant An Open-Label Phase I/II Study of Oncologist GSK2110183 in Combination with Carboplatin and Paclitaxel in Subjects with Dr William Renwick: Consultant Platinum-Resistant Ovarian Cancer Haematologist Dr Shirley Wong, Dr David Campbell, Dr Sumitra Ananda Dr Duncan Carradice: Consultant Haematologist

WESTERN HEALTH RESEARCH REPORT 2012 O ur AwARDS and Grants Ben Tran - Using the tumour associated Western Health Oncology/ Michael Green inflammatory response to personalize - Integrating practice across hospital and Dr Jeanne Tie - Circulating Tumour DNA treatement in colorectal cancer. DW Keir community settings by the establishment of as a Marker of Complete Pathological Fellowship: $175,000 (2012-2014). a multidisciplinary Palliative Care Symptom Response and Long Term Outcome for Control Model. WCMICS Grant: $50,000 Locally Advanced Rectal Cancer Treated with Western Health Oncology/ Michael (2012-2013). Pre-operative Chemoradiotherapy. Green - Lymphoedema Feasibility Project. National Health and Medical Research Department of Health Grant: $150,000 Western Health Oncology/ Michael Green Council (NHMRC): $592,407(2011-2013) (2012-2013) - Development and piloting of a model of care for the follow-up of cancer survivors Lara Lipton, Oliver Sieber - Inherited Western Health Oncology/ Michael following completion of active treatment. Genetic Variants as prognostic markers for Green - Patient Pathways Project WCMICS Grant: $135,000 (2012-2013). colorectal cancer. NHMRC: $575,000 (2011- (Gynaecology, Genitourinary & CNS) Victorian 2013) Comprehensive Cancer Centre Grant: Western Health Oncology/ Michael Green $75,000 (2012-2013). - Development of a clinical information Lara Lipton, Oliver Sieber, Dmitri system for Western Health Cancer Services – Moueodov - Discovery of Colorectal Cancer Western Health Oncology/ Michael Green Ascribe. WCMICS Grant: $140,000 (2012- Subtype Associated Tumour Suppressor - Research – Trial Capacity Building Project 2013). Genes Using Next - Generation Sequencing (Colorectal & Haematology). Victorian Cancer and High Throughput Functional Genomics. Agency Grant: $250,000 (2012-2014). Cancer Australia: $450,000 (2012-2014). Our Professional and Western Health Oncology/ Michael Green Community Engagement William Renwick, Duncan Carradice - - Day Oncology Re-Design Project. Roche Analysis and establishment of an integrated Grant: $15,000 (2012-2013). Lipton, L clinical service model for Haematology Reviewer for: Journal of Clinical Oncology; Western Health Oncology/ Michael Green - services at Western Health. Western Central JNCI; Human Mutation Analysis and establishment of an integrated Melbourne Integrated Cancer Services Member of COSA, MOGA, ASCO, In SIGHT, clinical service model for Haematology (WCMICS): $24,000 (2012) AGITG, AMA services at Western Health. WCMICS Grant: $24,000 (2012-2013). Carradice, D - Low grade lymphoma/ CLL disease committee group – Australasian Leukemia and Lymphoma Group

WESTERN HEALTH RESEARCH REPORT 2012 WESTERN HEALTH RESEARCH REPORT 2012 Victorian Cancer Agency Grant enables greater participation in cancer trials

In 2012 Western Health “The aim of the grant is to “The purpose of doing these welcomed the award of provide funds to develop an clinical trials is obviously funding from the Victorian infrastructure so that clinical to offer patients newer Government as part of the trials can be further developed medications, the best types Victorian Cancer Agency’s at Western Health and in of treatment according to Clinical Trial Capacity Building the Western region,” said international standards but Grants program. Professor Green. also to provide a high degree of quality for our cancer Professor Michael Green, “To this end, we are focusing treatments. Director Oncology at Western on two tumour streams, one Health, was awarded is colorectal and the other is “Cancer treatments are $250,000 to increase Western a new stream of haemotology. developed by investigating Health’s capability to conduct The aim is to increase the new medications and new research that can be put into number of patients recruited strategies in clinical trials, and practice at the bedside, and to clinical trials - often clinical those of us who participate in enable participation in more trials with a high degree of clinical trials feel that we are trials in the Western Region. sophistication - which will be offering patients the latest This will be done by expanding done here at Western Health. developments in the care of Western Health’s existing their disease.” research programs and promoting developing tumour Western Health and Peter Mac streams. are two of eight members of the Victorian Comprehensive Cancer Centre (VCCC), a $1 billion initiative which aspires to be one of the best cancer centres in the world.

Sunshine Hospital Radiation Therapy Centre brings together the expertise of Western Health, the major public provider of acute health services throughout Western metropolitan Melbourne and the excellence of Peter MacCallum Cancer centre.

WESTERN HEALTH RESEARCH REPORT 2012 058 Orthopaedic Unit

There were 7 research projects during 2012; Our Research a couple which were presented at seminars The Orthopaedic Unit at and conferences. The position of the Aetiology and Prognosis of Western Health is actively research coordinator was created to meet Femoroacetabular Impingement the growth in clinical research within the unit in Skeletally Mature and Immature involved in clinical research. in the future, which translates the demands Individuals Our goal is to advance for ethics applications, project management, Cam Fary grant applications and data management. orthopaedic care through An abnormally shaped femoral head with seeking answers and a bony bump (or Cam Lesion) inside a Current Research normal spherically shaped acetabular resolutions that will ultimately socket will cause impingement as it goes impact the diagnosis, RCT-Immobilisation of ORIF Distal Radius through a range of motion. This is known as Femoroacetabular Impingement (FAI) and treatment and quality of life Narelle Watson, Phong Tran (Physiotherapy, Orthopaedics) it increases the risk of early damage to the for the orthopaedic patients. labrum and cartilage. FAI is thought to be Developing online MCQ Database for a factor in the early onset of osteoarthritis Research is an integral part of Orthopaedic Training and ultimately to early total hip replacement. any department for continuing Peter Moore, Phong Tran Advances in hip arthroscopy allow this improved patient care and is bump to be successfully removed using Prospective correlation between MRI and minimally invasive techniques with excellent pivotal in achieving our vision Hip Arthroscopy outcomes. As a result younger symptomatic Lucas Annabell, Phong Tran, Vahid Master, of providing better health for patients that are skeletally immature are Alex Rhodes being treated. In the skeletally immature our community. It also allows the femoral bump that is routinely removed The Effects of Emu Oil on Patients contains the open upper femoral epiphysis. patients the opportunity to Suffering from Joint Pain An open growth plate is capable of forming Rekha Ganeshalingham, Phong Tran participate in the trialling of bone and is hypothesised as a cause of new procedures and devices. Assessment of the Quality of Web-based FAI. Despite this theory there has been no Information on Bunions histological and immunological research into Yew Ming Chong, Phong Tran the growth plate and its relationship to the formation of the femoral bony “bump”. Orthofracs - Registrar Training Website Phong Tran, Adam Levy (AOA, Pre and Post Operatively Gait Analysis and Orthopaedics) Pressure. Do patients’ gait improve? Mr Phong Tran Popart Project Virginia Plunkett, Phong Tran Collaborators: A Prof. John O’Donnell (St. Vincent’s Private Hospital); A Prof. Natalie MSA Bone Remodelling Study Sims (St. Vincent’s Institute/ University of Phong Tran, Justin Lade, Richard Melbourne); A Prof Amir Takla - Department Freeman, Brett Jackson, Robert Pianta, of Physiotherapy, University of Melbourne Ray Crowe, Simon Talbot, Chris Haw, Rags Unni, Ish Hussaini. Orthopaedics; Global This research has not been performed Orthopaedics internationally yet to our knowledge. FAI is associated with early onset arthritis. Advances in surgery have allowed us to treat skeletally immature patients. This gives us the ability to examine the impinging bony bump before it has turned to bone, i.e. assess possible causes for the bump formation. This will give us the power to predict and hopefully develop preventative strategies to avoid formation of the bump. Long term outcome studies will enable us to assess prognosis after treatment.

WESTERN HEALTH RESEARCH REPORT 2012 059

Orthopaedic Unit Website Portal Using this project as a platform, our future Research Output Liam Halliday, Phong Tran directive is to incorporate PROMs on a national level into the AOA National Joint Publications: 3 Communicating efficiently and effectively Registry, for use by all in the orthopaedic Presentations: 9 throughout an orthopaedic team is the key field. Collating a PROM database will allow to ensuring consistency in practice across auditing and evaluation of patient outcomes campuses, and resident rotations. A surgical following orthopaedic procedures to ensure O ur AwARDS and Grants team handbook is an out-dated, inaccessible the above five points are met. Additionally, it AIMSS Seed Funding Camdon Fary: and un-editable tool that for years been will encourage surgeon self-evaluation and Aetiology and Prognosis of Femoracetabular the mainstay of communication to a new allow Australian orthopaedic surgeons to Impingement in Skeletally Mature and member of a surgical unit. compare results on a world scale. Immature Individuals, Australian Institute We designed a simple, easily editable for Musculoskeletal Science: $6650 website portal to meet the growing demands Our Researchers of a high turnover, education and research Simon Talbot: A Novel Web-support Intervention to Promote Recovery Following rich orthopaedic unit. The portal gives Mr Phong Tran: Head of Orthopaedic Unit, Anterior Cruciate Ligament Reconstruction: residents access to arthroplasty protocols, Orthopaedic Consultant pre-admission guidelines, a rolling handover, $10,000 and direct links to online orthopaedic Mr Cam Fary: Orthopaedic Consultant Western Health Award-Victorian Public textbooks. Registrars can access our Healthcare Award- SILVER: Phong Tran: trauma guidelines, an up-to-date handover, Mr Justin Lade: Orthopaedic Consultant OrthoAnswer consignment orthopaedic instruments Mr Richard Freeman: Orthopaedic and prostheses, surgical techniques and Consultant Tass Paxinos Award for Excellence consultant contact details. in Orthopaedic Teaching: Justin Lade Mr Brett Jackson: Orthopaedic Consultant (winner); Audi Widjaja (runner up) This can be accessed from any computer, tablet or smartphone and can also be edited Mr Simon Talbot: Orthopaedic Consultant by members of the orthopaedic team. A Our Professional and surgical unit website portal goes beyond a Mr Chris Haw: Orthopaedic Consultant Community Engagement digital handbook, it offers an outstanding Mr Robert Pianta: Orthopaedic Consultant method for developing consistent patient Chris Harris: Member of APOS, ALLARS; pathways, increasing resident resources, Review Submissions of Journals for STLR improving research, and is extremely Mr Raymond Crowe: Orthopaedic Consultant useable, accessible and editable. Phong Tran: Scientific Secretary Victorian AOA Patient Reported Outcome Mr Ish Hussaini: Orthopaedic Consultant Measures (PROMs) Medical panels Mr Rags Unni: Orthopaedic Consultant Chris Haw: Amy Gibbens, Phong Tran Medical Advisory Dr Rekha Ganeshalingham: Orthopaedic Richard Freeman: To apply validated and appropriately selected Registrar Committee Member of Essendon Patient Reported Outcome Measures Private Hospital (PROMs) to patients undergoing Orthopaedic Narelle Watson: Coordinator Advanced procedures, to assess functional outcome, Practice Allied Health symptom relief, quality of life (QoL) and ultimately treatment success from the Dr Amy Gibbens: Resident patients’ perspective. Whilst our primary objective is patient-focused care through Dr Peter Moore: Orthopaedic Registrar ongoing audit of symptom relief, function Dr Lucas Annabell: Resident and QoL measures, our second objective is to build an extensive information database Liam Halliday: Orthopaedic Registrar for future research. The information collated will allow analysis of the effect of patient Brett Moirera: Intern factors and demographics on pathological processes, best treatment practice, prognosis and future practices.

WESTERN HEALTH RESEARCH REPORT 2012 060 Paediatric Emergency Medicine

Head injury in children is common. Serious Our Current Research Detecting Non-Accidental Injury in the head injury is a leading cause of mortality Emergency Department and morbidity. Clinical decision rules have CRIB 2 - Treatments Given: Trusha Brys Amanda Gwee, David Krieser. been developed to reduce unnecessary CT scans. We are auditing the number of brain CRIB 2 - ICU Admission and ICU Collaborators: Anne Smith, Cate Raynor, CTs performed in Sunshine Emergency Management: Vi Chong Ben Coghlan Department and will compare CT brain rate CRIB 3 - Viral Pathogens across Australia We audited the documentation practices over time. Head injury is also the focus of and New Zealand: Natalie Phillips in Sunshine Hospital ED for children under Coco Bernard’s Monash PhD research in 3 years of age who are at greatest risk. predictors of poor outcome in the medium Child Concussion Study: Coco Bernard Fortnightly review of case notes was to long-term. undertaken. The quality of documentation ED Management of Head Injury - CT Audit: was assessed. 47% more cases that were The Extended Scope of Practice Paediatric Rachel May Nurse (ESPPN) project was funded by a suspicious for physical abuse were identified. grant from Health Workforce Australia Complementary and Alternative Identification of injuries that suggest child (HWA), and has recruited four senior nurses. Medication Use in Paediatric Emergency: physical abuse is an important role of The ESPPN will initiate the clinical encounter David Taylor the ED. While a variety of strategies have and provide management within defined been employed, including check lists and guidelines. The project will be evaluated Off Label Medication Use in Paediatric education, improving the documentation in 2013 by HWA with an aim to develop Emergency Medicine: David Taylor is difficult. a similar role in other mixed emergency Extended Scope of Practice Paediatric departments around Australia. Nurse Project: David Krieser, Extended Scope of Practice Paediatric Nurse Project Dr Amanda Gwee undertook an audit of Theresa Wilkie David Krieser, Theresa Wilkie. documentation in children under the age of Case Report - Mastoiditis (In press): three, presenting with injury to Sunshine Thalia Lammers, David Krieser Collaborators: Health Workforce Australia Hospital Emergency Department. Using a novel review system, where suspicious CRIB Study (Comparative Re-hydration in Experienced ED nursing staff will be trained cases were then referred to the Victorian Bronchiolitis) to initially asses and manage paediatric Forensic Paediatric Medical Service for David Krieser. patients with lower acuity presentations assessment, an increase in identification to the ED. They will work within a specific of suspected child abuse was identified. Collaborators: Ed Oakley, Meredith Borland, scope of practice according to developed Jocelyn Neutze, Jason Acworth, Stuart guidelines. The development of guidelines, Professor David Taylor of Austin Health Dalziel, Andrew Davidson, Susan Donath, educational materials and clinical is leading a group auditing the use of Kim Jachno, Mike South, Theane Theophilos, information will inform the development Complementary and Alternative Medicine Franz Babl of similar roles around Australia. We hope and the use of Off-label prescribing in to improve triage target time performance children presenting to the Emergency The hospital length of stay for a baby with in the relevant ATS categories. Timely Department (ED). The Austin, Monash bronchiolitis was the same for intravenous assessment of patients in the ED is Medical Centre, Royal Children’s Hospital hydration and nasogastric hydration. There associated with better care and less and Sunshine Hospital are participating. was no difference in complications between aggression. By establishing clinical practices the two methods. It was more likely that a for nurses working in paediatrics we will nasogastric tube will be inserted on the first develop a skilled workforce to perform initial attempt than an intravenous line. assessment and initiate management in lower acuity patients. This, in turn, should allow medical staff to more rapidly see higher acuity patients.

WESTERN HEALTH RESEARCH REPORT 2012 061

Our Researchers Our Research Students Our Research Output Coco Bernard: PhD David Krieser: Paediatric Emergency Publications: 2 Physician Thalia Lammers: MB BS (Dutch equivalent) Presentation: 2

Theresa Wilkie: Clinical Nurse Educator, Paul Joffe: Advanced Paediatrc Registrar Associate Nurse Unit Manager, Project O ur AwARDS and Grants Officer Rachel May: Advanced Paediatric Emergency Medicine Trainee Dr David Krieser, Extended Scope of Ilse Spillane: Paediatric Emergency Practice Paediatric Nurse. Health Workforce Physician Australia ($350,000)

Dr David Krieser, Comparative Rehydration in Bronchiolitis (CRIB) Study. Western Health Research Week Best Poster Prize ($1,500)

WESTERN HEALTH RESEARCH REPORT 2012 WESTERN HEALTH RESEARCH REPORT 2012 Best Research Poster Prize for multicentre CRIB study

Each year Sunshine Hospital’s “The CRIB (Comparative “This was the first randomised Emergency Department sees Rehydration In Bronchiolitis) study comparing hydration around 20,000 paediatric study was a multicentre, methods in bronchiolitis. It patients. open, randomised trial which provides evidence to support Sunshine Hospital participated the use of nasogastric Bronchiolitis, a common lower in, along with six other hydration rather than respiratory tract infection in hospitals throughout Australia intravenous hydration in our infants, is the leading cause of and New Zealand. The community. hospitalisation during the first PREDICT (Paediatric Research year of a child’s life and can in Emergency Departments “While both methods of be extremely concerning for International Collaborative) achieving hydration are safe parents. network is our major research and effective interventions for partner” Dr Krieser said. infants admitted to hospital Dr David Krieser, Paediatric with bronchiolitis, the fact that Emergency Physician and “The aim of the CRIB study the insertion of nasogastric Director of Paediatric was to establish whether tubes appears to require fewer Education at Sunshine nasogastric hydration (which attempts for success will be Hospital, was the winner of can be easier to achieve in less stressful for the infants the Best Research Poster young children) would result in and may assist in recovery. Prize during Western Health any difference in outcome to The risks of water intoxication Research Week 2012, for intravenous hydration which with intravenous fluids will be his research comparing is the more typical way of negated,” Dr Krieser said. nasogastric hydration with achieving hydration. intravenous hydration in The Comparative Rehydration infants with bronchiolitis. “When comparing intravenous in Bronchiolitis (CRIB) to nasogastric hydration in was published in Lancet infants hospitalised with Respiratory Medicine in bronchiolitis, this study March 2013. demonstrated no clinically or statistically significant difference in length of stay. For intravenous hydration, failure to initiate the assigned treatment was more likely, and initiation required more attempts to achieve success. Dr David Krieser with a patient in Sunshine Hospital’s Emergency Department.

WESTERN HEALTH RESEARCH REPORT 2012 064

Pharmacy

The Pharmacy Departments One such project was the ongoing work Our future research objectives involve around analysing institutional use of the collaborating with relevant units in of Western Health aim to drug libraries within Alaris IV smartpumps. assessing clinical practice where medication support clinical practice This provided an insight into the practices and patient safety outcomes are paramount. of delivering intravenous drug infusions Projects currently underway include and medication safety by and provided a means of analysing the assessing, developing and facilitating safe participating in evidence effectiveness of such technology in handling guidelines for new anti-cancer based research, thereby optimising safe medication delivery, along molecules for hospital personnel, and with potential pitfalls. Results were fed back collaboration with the Medication Safety aligning with the strategic to key stakeholders to promote best practice Committee to assess the completion of priorities of Western Health. while the drug library was subsequently inpatient medication charts. improved. This information was presented The Pharmacy service at the Society of Hospital Pharmacists has adopted a strategy Medicines Management Conference 2012, Our Research which was warmly received and is currently of collaboration with being considered for pharmaceutical journal “Development and promulgation of safe clinical units and tertiary publication. The intravenous infusion handling and distribution guidelines for drug library released by Western Health “new” anticancer molecules by hospital institutions. This facilitates was amongst the most comprehensive in personnel, including pharmacy, nursing the achievement of current Australia at that time. and medical personnel” - Research on handling safety of monoclonal antibodies. and relevant research, whilst The majority of other research initiatives Professor Michael Green, Sue Kirsa, continuing to strive for centred around assessing and improving Julie King, Kent MacMillan. departmental and institutional practice. excellence amongst available Collaboration on projects include LEAN Collaborators: WCMICS, Peter MacCallum resources. Oncology – evaluating flow processes Cancer Centre affecting day oncology patients to improve An audit of the use of a smart infusion service efficiency and their experience within pump’s drug libraries at an Australian the unit, and SMART Clinic - integrating metropolitan hospital practice across hospital and community Ivy Tan, Nhi Dinh, Ray Kong, Kent environments by the establishment of a MacMillan and Dr Forbes McGain multidisciplinary palliative care pathway involving clinical pharmacist clinic input. Integrating practice across hospital Another project centred on assessing the and community environments by the effectiveness of educational interventions establishment of a multidisciplinary on improving adherence to local community palliative care pathway. acquired pneumonia treatment guidelines in Professor Michael Green, Dr Adrian an effort to optimise rational antimicrobial Dabscheck, Karen Court, Li-Ling Ng. prescribing. WCMICS

WESTERN HEALTH RESEARCH REPORT 2012 Western Hospital Pharmacy.

An environmental improvement plan in the Our Research Output Nhi Dinh: Australian Health Practitioner delivery of pharmaceutical supplies to a Regulation Agency (AHPRA) Pharmacy Victorian metropolitan hospital Presentations: 5 Board National Registration Examiner Nhi Dinh; Forbes McGain (Intensive Care Department) Ivy Tan: Member of Central and Western Professional and CPN Strategic Project – Clinical Supervison Improving adherence to local guidelines Community Engagement Education Working Group, Subject Matter for community acquired pneumonia Expert for Community Services & Health through multifaceted interventions. Victor Reginato: President, Association Industry Skills Council Pharmacy Support Mimi Jiao, Harin Karunajeewa, Edward of Hospital Pharmacists Victoria, HSU4 Review Group, Member of SHPA PEP Janus, Stephen Guy, Garry Lane, Anne Working Party President, Association Marie Southcott, Kent MacMillan, Li-Fen Julie King: Vice of Hospital Pharmacists Victoria, HSU4 Feng, John Katsoulis, Alexandra Gorelik, David Kong Joanna Edwards: Agenda Secretary, Victoria Branch Society of Hospital Glass recycling - saving more than energy Pharmacists (SHPA) at a Victorian metropolitan hospital Nhi Dinh; Forbes McGain (Intensive Care Department)

WESTERN HEALTH RESEARCH REPORT 2012 066 Respiratory and Sleep Disorders Medicine

Respiratory and Sleep Disorders Medicine Our Research A randomised active controlled, double- offers inpatient and outpatient investigation blind, double-dummy, parallel group and management of patients with respiratory Perioperative assessment of patients design, multi-centre trial to compare and sleep disorders. The most common suspected of having OSA undergoing the efficacy and safety of 2.5 µg and respiratory conditions dealt with are Chronic orthopaedic surgery 5 µg Tiotropium Solution delivered by Obstructive Pulmonary Disease (COPD), L Sheers, AM Southcott, D Bramley, the Respimat® Inhaler with Tiotropium Asthma, Lung Cancer, Pulmonary venous L Bendon, E Kinkel, L Reid-Price inhalation capsules 18 µg delivered by thrombo-embolic disease and pneumonia. the Handihaler® The most common sleep disorders are Outcomes of OSA patients undergoing AM Southcott, M Lim, L Sheers, obstructive sleep apnoea syndrome surgery: An audit T Basnayake, S Casanelia. Sponsor: and insomnia. The Respiratory Function T Basnayake, AM Southcott Boehringer-Ingelheim Laboratory is accredited by the Thoracic A Phase III Multicenter, Randomised, Society of Australia and New Zealand as a Tiotropium is a long acting reliever Parallel Group, Controlled, Double Blind category 4 (complex test) laboratory. The medication for the treatment of COPD. A Study to Investigate the Safety and Efficacy Sleep Disorders Laboratory is accredited new formulation in a mist is being trialled of Inhaled Mannitol over 12 months in by the Australasian Sleep Association to which is delivered via a novel inhaler device. the Treatment of Bronchiectasis. Protocol perform complex sleep studies. The Migrant The study will test if a substantially smaller Number DPM-B-305 Screening Clinic coordinates tuberculosis dose is as effective and safe when compared AM Southcott, S Casanelia, G McHaileh. health undertakings for new arrivals and with the current product equivalent. Efficacy Sponsor: Pharmaxis Ltd visa applicants for all adults in Victoria. and safety of new drugs is imperative and this long term two year study will address The aim of this research is to determine if The research conducted within the the issue of safety in more than 16,000 the well known sugar-molecule, Mannitol department relates to these clinical patients world-wide. A new device delivering can effectively thin lung secretions which are activities. a smaller dose of the drug which is still thickened and excessive in Bronchiectasis. effective will provide ongoing benefits to This would therefore allow the lung 1. Clinical trial of long acting anti - patients with least dose possible. muscarinic bronchodilator in COPD. secretions to be cleared more easily and thus leave the patients with less troublesome 2. Clinical trial changes in exercise A Clinical Outcomes Study to compare the cough and help prevent recurrent chest endurance with combination long acting effect of Fluticasone Furoate/Vilanterol infections. Effective treatments for this anti-muscarinic bronchodilator and ultra Inhalation Powder 100/25 mcg with condition are currently limited and this long-acting beta agonist bronchodilator placebo on Survival in Subjects with re-defined use of this medication will be in COPD. moderate Chronic Obstructive Pulmonary potentially beneficial to this patient group Disease (COPD) and a history of or at 3. Clinical trial of inhaled mannitol in in helping lessen daily symptoms, reducing increased risk for cardiovascular disease. bronchiectasis. infections and flare-ups and thus slowing the AM Southcott, T Basnayake, S Casanelia. 4. Clinical trial of ultra long acting beta progress of the lung damage. Sponsored by GSK agonist bronchodilator and novel inhaled corticosteroid on cardiovascular COPD is recently considered to be an outcomes in moderate COPD. inflammatory disease of more than just 5. Management of central sleep apnoea. the lungs. This study specifically looks at patients with known cardio-vascular 6. Adverse outcome audit of obstructive disease or risk factors who also have COPD. sleep apnoea patients who have had A new therapy of long-acting reliever and surgery. inhaled steroid therapy which may benefit 7. with suspected Obstructive sleep apnoea this group of patients in term of survival having orthopaedic surgery. is being undertaken over a 3-4 year time frame. Treatments for COPD predominantly aim to attenuate symptoms; this study also looks at longer term survival outcomes as an endpoint. A treatment with benefits for longevity and symptom management is a further step in future care of this group of patients.

WESTERN HEALTH RESEARCH REPORT 2012 067

A randomised, double-blind, 5 treatment Case series of patients with Central sleep Our Research Output arms, 4-period, incomplete cross-over apnoea. Dead space ventilation as a study to determine the effect of 6 weeks possible treatment. Publications: 3 of treatment of rally inhaled tiotropium + T Basnayake, AM Southcott, S Frenkel, Presentations: 4 olodaterol fixed dose combination (FSC) S Bastiampillai (2.5/5 µg : and 5/5 µg) (delivered by the Respimat® Inhaler) compared with Central sleep apnoea (CSA) is a less Our Professional and tiotropium (5 µg), olodaterol (5 µg ) and common form of sleep related breathing Community Engagement placebo (delivered by the Respimat® disorder which often does not respond AM Southcott: Reviewer for Internal Inhaler) on lung hyperinflation and to standard Continuous Positive airway Medicine Journal exercise endurance time during constant pressure (CPAP). This project analysed a work rate cycle ergonometry in patients series of CSA patients and their responses with Chronic Obstructive Pulmonary to alternative styles of positive airway Disease (COPD). pressure. Current treatment for CSA is AM Southcott, S Frenkel, L Reid-Price, difficult and modalities such as Adaptive R McConnell, S Casanelia. Sponsor: servo ventilation are expensive. Dead space Boehringer-Ingelheim ventilation if effective is cheaper and more accessible for our patient population. In this study the new mist formulation of Tiotropium is combined with a new long acting once a day reliever drug which is Our Researchers believed to have a positive benefit on lung hyperinflation and exercise tolerance in Dr Anne Marie Southcott: Head of Unit, COPD patients. This rigorous study tests Respiratory and Sleep Disorders Medicine the hypothesis by exposing patients to 4 (commenced November 2009) different treatment groups including the Ms Sue Casanelia: Respiratory Outreach individual component and two differing Nurse/Research Coordinator doses of both drugs for 6 weeks blocks, then assessing response to exercise using Lynnette Reid-Price: Sleep Scientist in constant cycle work rate ergonometry. Charge Improving patient quality of life is critical to overall well-being and a potential drug to Dr Thilini Basnayake: Registrar (2012) improve a patient’s ability to exercise offers greater opportunities in allowing them to Dr Simon Frenkel: Respiratory and Sleep participate more actively in their desired Physician activities. Dr Laina Sheers: Registrar (2010-Feb 2012)

Dr Shalini Bastiampillai: Respiratory and Sleep Physician

Rachel McConnell: Respiratory and Sleep Scientist

Lyn Bendon: Sleep Scientist and Registered Nurse

Dr Melvin Lim: Registrar (2010-Feb 2012)

WESTERN HEALTH RESEARCH REPORT 2012 068 Rheumatology

Our research is clinically orientated with the We have interesting preliminary data ethos of improving our understanding and that will be presented at international The Rheumatology management in order to optimise care of the conferences with abstracts and articles Department has a strong most common rheumatological problem we to follow. We are also in the process of encounter in clinical practice. translating commonly used questionnaires research interest in into Vietnamese, reflecting the osteoarthritis and pain We strive to become national and regional demographics of our hospital community. leaders in this field and as the first step of evaluation, a common problem this process, some of our unit members Our vision for the department is to be at the in our obesity epidemic and play active roles in the newly-formed Asia forefront of osteoarthritis clinical research Osteoarthritis Network. This network as well as providing our trainees with the ageing population. provides a collaborative, regional approach best advance training across the Melbourne to foster a better understanding and hospitals. It is hoped that our trainees approach to managing osteoarthritis and develop a strong appreciation of clinical pain. Our Head of Unit, Associate Professor and research practices. Keith Lim, has been invited to many local and international conferences to share our clinical research experiences. Our Research

The Effects of Intra-articular Steroid Injections in Hip and Knee Osteoarthritis Nava Ferdowsi, Albert Leung, Keith Lim.

Collaborators: Carolyn Page (SVH), Michelle Dowsey (SVH), Peter Choong (SVH), Danny Liew (RMH)

Quantitative Sensory Testing as a Predictor of Response in Knee Arthroplasty Kristy Yap, Albert Leung, Shom Bhattacharjee, Keith Lim.

Collborators: Paul Dieppe (UK), Tissa Wijeratne (Neurology WH), Phong Tran (WH)

The Department of Rheumatology works closely with Physiotherapy and Orthopedic Surgery to ensure patients receive the right treatment at the right time.

WESTERN HEALTH RESEARCH REPORT 2012 069

The Role of Joint Aspiration in The Use of QST to Predict Response to Our Researchers Osteoarthritis Outcome Steroid Injections in Knee Osteoarthritis Albert Leung, Joanna Hall, Phuong Tran, Albert Leung, Shom Bhattacharjee, Kristy Associate Professor Keith Lim: Head of Keith Lim, Danny Liew (RMH) Yap, Joanna Hall, Keith Lim Department

QST and Epidural Injections for Sciatica Collaborators: Prof Paul Dieppe (UK), Tissa Dr Albert Leung: Rheumatology Consultant Shom Bhattacharjee, Albert Leung, Wijeratne (WH), Danny Liew (RMH) Kristy Yap, Joanna Hall, Keith Lim, Tissa Mrs Phuong Tran: Clinical Research Nurse Wijeratne (Neurology WH), Danny Liew Unloader Knee Brace in Osteoarthritis Stephanie Low: Medical student (RMH) of the Knee Kristy Yap, Joanna Hall, Phuong Tran, Ron Glick: Medical student Audit of Epidural Injection Waiting Times Albert Leung, Keith Lim to Optimise Efficient Use of the Day Collaborators: Carolyn Page (SVH) Paul Silk Procedure Unit Our Research Output Kristy Yap, Shom Bhattacharjee, (Physiotherapy WH) Albert Leung, Lilian Kuan, Keith Lim This study evaluates the use of the unloader Publications: 2 Surgical Outcomes in Patients who are knee brace in patients with osteoarthritis Presentations: 3 Managed in an Orthopaedic Waitlist as a non-pharmacological and non-surgical option in pain management. Osteoarthritis Program Our Professional and is a common problem with increasing Joanna Hall, Albert Leung, Carolyn Page, Community Engagement Keith Lim. prevalence. This study could provide evidence for the use of a special knee brace A/Prof. Keith Lim Collaborators: Michelle Dowsey, Peter as another treatment option. Choong (SVH), Danny Liew (RMH) Senior Editor: International Journal of Vietnamese translation of the HOOs Rheumatology This study evaluates the benefits of and KOOs Osteoarthritis Questionnaire Vice-President: Asia Osteoarthritis Network a dedicated multidisciplinary clinic to Nicole Lioufas, Albert Leung, Danny Liew, (Founding Chairman) streamline the orthopaedic waiting list for Phuong Tran, Stephanie Low, Keith Lim Member: The Australia OA Summit knee and hip arthroplasty. This study is Scientific Advisory: APLAR Congress Collaborators: Prof Eva Roos (Lund important for reducing the waiting time for Philippines 2014 University Sweden) public patients awaiting arthroplasties by Asia Chapter: Osteoarthritis and Research optimising their pre-operative condition Osteoarthritis questionnaires incorporating Society International OARSI (2012) Invited and identifying patients who are ready for pain and function are commonly used in Member. operative management. evaluating patients with osteoarthritis. The Dr Albert Leung Differences between Patients with Hip and Western Health catchment area includes Knee Osteoarthritis a large Vietnamese community. We are Reviewer: International Journal of Kim Le Marshall, Bernard Yee, Paul translating commonly used questionnaires Rheumatology Dieppe, Albert Leung, Carolyn Page, Peter to facilitate a more accurate evaluation of Committee Member: Asia Osteoarthritis Choong, Sharmayne Brady, Keith Lim our Vietnamese patients. Network

This study provides new insight into the By validating this questionnaire, we are clinical characteristics of patients with providing our Vietnamese patients with a hip and knee osteoarthritis. Our initial more accurate and realistic assessment analysis shows that patients with hip OA of their osteoarthritis pain and function. present later, compared with knee OA. This study can provide clinicians with a greater understanding about the natural history of hip and knee osteoarthritis, thereby tailoring treatment accordingly.

Collaborators: Carolyn Page (SVH), Prof. Peter Choong (SVH), Bernard Yee (UK), Prof. Paul Dieppe (UK).

WESTERN HEALTH RESEARCH REPORT 2012 WESTERN HEALTH RESEARCH REPORT 2012 071 The Australian Institute for Musculoskeletal Science (AIMSS)

We are predominantly interested in Cancer and Exercise: using exercise to conditions related to chronic disease and treat cancer and treatment related side The Australian Institute for ageing such as osteoporosis, arthritis effects Musculoskeletal Science is and sarcopenia. Our expertise spans bone E. Hanson, A.Hayes, S.Sakkal, S. Baindur- mineral density and fracture risk, falls, Hudson, G. McConell, C.Dass, Victoria a collaborative institute for fragility, muscle mass and function, the University; D.Travis, Western Health research into disorders of impact of nutrition and exercise on muscle The associations between characteristics bone, muscle and joint; and and bone, and the downstream effect that this has on musculoskeletal disease and of sarcopenia, vitamin D and falls in the promotion of disease other markers of health. community-dwelling older adults D.Scott, The University of Melbourne; prevention and evidence- AIMSS is truly multi-disciplinary, drawing K.Sanders, P.Ebeling, The University of based interventions including on endocrinologists, geriatricians, Melbourne/Western Health; E.Skinner, orthopaedic surgeons, physiotherapists, and Western Health; P.Levinger, Victoria exercise and nutrition. through our foundation partners, Victoria University University and The University of Melbourne, exercise science, nutrition and ageing, A novel web-support intervention to gait and balance, biomedical engineering, promote recovery following Anterior computational modelling, health economics, Cruciate Ligament Reconstruction and epidemiology of musculoskeletal P.Levinger, K.Hallam, Victoria University; disease. S.Talbot, R.Pile, D.Fraser, Western Health

Aetiology and Prognosis of Current Collaborative Femoroacetabular Impingement Research in skeletally mature and immature individuals, Born small and exercise; can exercise C.Fary, P.Tran, J.O’Donnell, Western in those who were born small normalise Health; N.Sims, A.Takla, The University bone and glucose homeostasis? of Melbourne G. McConell, G.Kaur, Victoria University; The effect of moderate-intensity P.Ebeling, The University of Melbourne/ cardiovascular fitness training compared Western Health to standard care in people with a diagnosis Osteocalcin and glycaemic control of stroke: a pilot randomised controlled I.Levinger, G. McConell, N. Stepto, D. Hare, trial Victoria University; E. Seeman, P. Ebeling, H.Reynolds, S.Kenny, J.Tillyard, E.Skinner, The University of Melbourne Western Health; A/Prof Andy Stewart, Victoria University Vitamin D, physiological and biomechanical assessments, and risk Objective assessment of physical activity of falls in osteoarthritis in older adult populations and associations R. Begg, A.Hayes, P.Levinger, G.McConell, with health and physical performance, P.McLaughlin, A.Petersen, Victoria D.Scott, The University of Melbourne; University; K. Sanders, P.Ebeling, The R. Polman, I. Selva-Raj, J. Van Uffelen, University of Melbourne/Western Health Victoria University

The validity and reliability of a 3-dimensional body scanner for evaluating body composition P.Ebeling, The University of Melbourne/ Western Health; R. Polman, I. Selva-Raj, Victoria University; D.Scott, The University of Melbourne

WESTERN HEALTH RESEARCH REPORT 2012 072 The Australian Institute for Musculoskeletal Science (AIMSS) (cont.)

Our Researchers Our Research Students Yu Zhang: The primary aim of our study Masters is to determine the cost and quality of life Senior Staff / Partner Organisation associated with fractures at sites other Tiffany Mann: A study of childhood obesity than hip, spine and wrist, The University Professor Peter Ebeling: The University optimising exercise in treating the condition, of Melbourne of Melbourne/Western Health Victoria University Hong Yet Hoi: How does nitric oxide Professor Glenn McConell: Victoria PhD regulate skeletal muscle glucose uptake University during exercise? Victoria University Haslinda Gould: Risk factors for aged care Professor Rezaul Begg: Victoria University assessment: Development of predictive tool, Scott Betteridge: The effect of nitrates on exercise efficiency and metabolism, Professor Michael McKenna: Victoria The University of Melbourne University Victoria University Tania Fernandes: Human Osteoblast Effect of exercise intensity Associate Professor Alan Hayes: Victoria Biology on Novel Implantable Scaffolds, Adam Trewin: University The University of Melbourne on skeletal muscle mitochondrial efficiency during exercise, Victoria University Associate Professor Kerrie Sanders: John Sheedy: Elucidating biomarkers of Western Health/The University of Melbourne bone resorption and exercise by NMR and Chris Hedges: Effect of pH on skeletal MS based metabolomics, The University muscle mitochondrial efficiency during of Melbourne exercise, Victoria University; Associate Staff / Partner Organisation supervisor, Victoria University Dr Matt Cooke: Victoria University Jenny Gianoudis: Osteo-cise: Strong Bones for Life. An Inclusive Evidence-based Tracy Gerber: The effects of continuous Dr Itamar Levinger: Victoria University Multi-component Exercise, Falls Prevention vs. high-intensity intermittent exercise and Osteoporosis Education/ Awareness on substrate utilisation during exercise Dr Patrick McLaughlin: Victoria University Program, The University of Melbourne and recovery in healthy and obese adults, Dr Aaron Petersen: Victoria University Victoria University Catherine Shore-Lorenti: Sunlight exposure Dr Chris Stathis: Victoria University and risk of type 2 diabetes, The University Christopher Lillico: The effect of a novel of Melbourne high performance suit on speed, power and muscular strength, Victoria University Post-doctoral Fellows Renee Otmar: Barriers and enablers to Dr Raul Bescos: Victoria University treatment and prevention of fracture: Nancy Capitanio: The Effects of Dietary Exploring knowledge, beliefs, attitudes Supplements on Mitochondrial and Dr Andrew Betik: Victoria University and cultural models of osteoporosis, Sarcoplasmic Reticulum Function in type 2 The University of Melbourne Diabetic Rats: Victoria University Dr Sharon Brennan: The University of Melbourne Ie-Wen Sim: Does teriparatide reverse Deanna Horvath: The effect of taurine osteonecrosis of the jaw in patients with on dystrophic muscle tissue function, Dr Erik Hanson: Victoria University cancer? A randomised controlled trial, Victoria University. Dr Gunveen Kaur: Victoria University The University of Melbourne

Dr Pazit Levinger: Victoria University Belal Khan: Effects of low or high dietary calcium intake on bone density and fractures Dr David Scott: The University of Melbourne in a population-based longitudinal cohort. The University of Melbourne Dr Mary Zhang: Victoria University

WESTERN HEALTH RESEARCH REPORT 2012 073

O ur AwARDS and Grants Grants Active in 2012 A.Carr, J.Hoy, P.Ebeling, N.Pocock. S. Brennan ($3,128). RM Gibson Scientific ($687,807) NHMRC Project Grant (1022660). A wARDS Research Award, Australian Association of Bisphosphonate Therapy with Zoledronate or Tenofovir Switching to Improve Low Bone S.Brennan: RM Gibson Scientific Research Gerontology. 2011-12. Sex bias in referral for Mineral Density in HIV-Infected Adults: a Award, Australian Association of bone densitometry in adults aged 50 years Strategic, Randomised Trial 2012-2014 Gerontology. Gender bias in referral for bone and over: 2003-10. densitometry in patients aged ≥50 years: S. Brennan ($38,173). University of P. Ebeling, G. Borromeo and J Seymour. 2003-10. Melbourne Strategic Grant (Early Career ($346,175) NHMRC Project Grant (1030371). A randomised controlled trial of a bone P.Levinger: Best Early Career Research Grant). 2011-12. Sex bias in referral for bone formation stimulating hormone to reverse Presentation Award, 18th Annual Scientific densitometry: 1991-98 to 2003-10. osteonecrosis of the jaw in cancer patients. Meeting of the Australian New Zealand S.Brennan ($19,862). Arthritis Victoria. Orthopedic Research Society. Lower 2011-12. The association between M.Kimlin, D.Whiteman, R.Lucas, C.Sinclair, limb biomechanical changes that impair socioeconomic status and utilization of R.Neale, P.Ebeling, P.Youl, L.Gordon, gait performance following total knee total hip and knee joint replacement across M.Janda. ($2,379,750). NHMRC Centre for replacement surgery. Australia. Research Excellence in Sun and Health. 2010-2015. G.McConell: Victoria University Vice- G. McConell and S. Rattigan ($543,390). chancellor’s Peak award for Excellence in NHMRC Project Grant (1012181). Does Grants Awarded in 2012 Research and Research Training (Research exercise increase skeletal muscle insulin Staff). 2012. R.Neale, B.Armstrong, P.Ebeling, sensitivity via nitric oxide? 2011-2013 D.English, M.Kimlin, A.Venn, J. van der B.Khan: MSD-ANZBMS Clinical Research Pols, R. O’Connell. ($2,930,705) NH&MRC D. Kennaway, G.McConell, J.Owens Excellence Award,1st Asia-Pacific Bone Project Grant (1046681) D-Health: A ($605,050). NHMRC Project Grant (1029869). and Mineral Research Meeting and the randomised trial of vitamin D for prevention Circadian rhythm disruption and metabolic ANZBMS 22nd Annual Scientific Meeting. of cancer and mortality. function. 2012-2014 Long term high dietary calcium intake and its S.Brennan. ($10,000) 2013 Arthritis association with fractures and cardiovascular S.Brennan and G. Nicholson ($290,032). Australia Grant-in-aid funded by Zimmer events in a population based prospective NHMRC Training Fellowship (1012472). Australia. The association between cohort study. Investigating the psychosocial and socioeconomic status and total joint socioeconomic predictors of osteoporosis. replacement across Australia. K.Sanders. ($150,000). Merck, Sharp & S. Brennan. ($9,100) Victorian Orthopedic Dohme (Australia) Ltd. The Australian Study Association Research Grant. Social and of Cost and Utilities Related to Osteoporotic geographic associations with shoulder joint Fractures. replacement Australia-wide 2006-2011

WESTERN HEALTH RESEARCH REPORT 2012 074 The Australian Institute for Musculoskeletal Science (AIMSS) (cont.)

S.Brennan. ($5,000) Dyason Fellowshop; N.Stepto, C.Shaw, A.McAinch, M.Cooke, Our Professional and The University of Melbourne. Social and C.Stathis, R.Polman, L.Banting, Community Engagement ethnic disparities in the uptake of bone M.McKenna, H.Teede, J.Hawley, L.Parker. density testing and osteoporosis therapies ($15,000) Role of an active lifestyle on P.Ebeling: Medical Director, Osteoporosis pre and post-fracture functional limitation and cognitive functioning Australia in ageing individuals and neurological C.Fary, P.Tran, J.O’Donnell, N.Sims, disease P.Ebeling: Councillor, American Society for A.Takla. ($6,650) AIMSS Seed Bone and Mineral Research Funding. Aetiology and Prognosis of A. Betik, E. Hanson, A.Hayes. ($4000) Femoroacetabular Impingement in skeletally BioLED small grant; Victoria University. Role P.Ebeling: Board Member, International mature and immature individuals. of Testosterone and Protein Supplementation Osteoporosis Foundation, Geneva in the Maintenance and Regrowth of Skeletal P.Ebeling: Co-Chair, American Society for E.Hanson, S.Sakkal, S.Baindur-Hudson, Muscle. G.McConell, A.Hayes, M.Grossman, Bone and Mineral Research Annual Scientific C.Battaglini, G.Duchesne, D.Travis Zhang, M. ($2000) BioLED small grant; Meeting ($18,000). CRN Start Up Grant. Cancer and Victoria University. Role of Nitric Oxide (NO) P.Ebeling: President Endocrine Society of Exercise (Using exercise to treat cancer and in increase in insulin sensitivity flowing Australia treatment related side effects) muscle contractions

A.Hayes, P.Levinger, R.Begg, A.Petersen, Scientific Journal Editorial Boards: K.Sanders, F.Cicuttini. ($18,000) CRN Start Our Research Output P.Ebeling: Associate Editor, Journal of Bone Up Grant. Optimal exercise and nutritional and Mineral Research strategies to improve bone/muscle strength Publications: 67 P.Ebeling: Member, Editorial Board, and gait function for falls prevention. Presentations: 3 Osteoporosis International P.Levinger, S.Talbot, C.Ardern, K.Hallam, D.Fraser, R.Pile. ($10,000) AIMSS Seed P.Ebeling: Member, Editorial Board, Clinical Funding. A novel web-support intervention to Endocrinology (Oxford) promote recovery following Anterior Cruciate Ligament Reconstruction. G.McConell: Journal of Applied Physiology

G.McConell, G.Kaur, P.Ebeling, M.Wlodek, G.McConell: Clinical and Experimental A.McAinch, P.Sinnayah. ($15,000) CRN Pharmacology and Physiology (CEPP) Start Up Grant. Born small and exercise K.Sanders: Editorial member, Journal Bone (Can exercise in those who were born small and Mineral Research normalise bone and glucose homeostasis?)

D.Scott, E.Skinner, P.Levinger, T.Haines, P.Ebeling, K.Sanders. AIMSS Seed Funding. The associations between characteristics of sarcopenia, vitamin D and falls in community-dwelling older adults.

WESTERN HEALTH RESEARCH REPORT 2012 075 Melbourne Neuropsychiatry Centre

The Melbourne Neuropsychiatry Centre mood and anxiety disorders. They use through NHMRC, with additional support (MNC) is a clinical research centre of The fMRI in combination with experimental from the Pratt Foundation. University of Melbourne and Melbourne psychological approaches to study changes Health and is based in three sites: (1) in the activity of brain networks. During This is a unique resource in Australia, National Neuroscience Facility (NNF), 2012, the group has established a base at providing researchers nationally and Alan Gilbert Building, Parkville; (2) WCHRE and Sunshine Headspace, involving internationally with data to address Neuropsychiatry Unit, Royal Melbourne recruitment and treatment of young people important questions about the neurobiology Hospital, Parkville; (3) Western Centre for with affective disorders and with brain of schizophrenia. Health Research & Education (WCHRE), imaging using the latest MRI scanning The OPTiMiSE Study Sunshine Hospital. at Sunshine Hospital. Christos Pantelis, Patrick McGorry, The Centre was established in 2004 and The other streams of MNC are mainly based Dr. Marc Seal, Chad Bousman, Aswin focuses on understanding the neurobiology in Parkville: Ratheesh, Sashin Kumar. of mental disorders from childhood to Collaborators: The OPTiMiSE Consortium, adulthood. The Centre consists of over 80 The Clinical Neuropsychiatry team at RMH Europe ORYGEN Youth Health, The people, including research staff, students investigates the link between psychiatric Melbourne Clinic, Southern Health. and professional staff. The Centre receives and neurological disorders. A focus has been the relationship of schizophrenia to support from major grants from NHMRC and The OPTiMiSE study focuses on two frontal-temporal dementia (FTD), including ARC (including, Program, Project, Enabling goals: i) optimising current treatments recruitment of patients in the West. and collaborative grants with the EU, as well in schizophrenia and ii) exploring novel as Fellowships), as well as other national Addiction Neuropsychiatry team therapeutic options for schizophrenia. and international funding agencies. Since investigates the neurobiological and Recruitment at a number of services around 2004, the Centre has received $9.3million in psychological factors involved in addictive Melbourne has recently commenced. It direct grant funding and over $30million in behaviours and associated conditions. This is expected that the project will lead to collaborative grants and has produced over includes the effects of chronic drug use on evidence that is directly applicable to 470 publications. Details of the Centre can be brain and behaviour. treatment guidelines, and will identify found at http://www.psychiatry.unimelb.edu. potential mechanisms for new drug au/centres-units/mnc/. The Centre consists Systems Neuropsychiatry is focused on development. of four interdigitating streams, as follows: the application of new methods to map the human connectome, to examine brain The CRC Psychosis Study Psychosis and Developmental connectivity organisation and maturation Christos Pantelis, Ian Everall, Brian Dean, Neuropsychiatry seeks to understand and how brain connectivity is disrupted Chad Bousman, Suresh Sundram. the neurobiology of disorders emerging by mental illness. This is computationally in childhood and adolescence, including Collaborators: MNC @ Melbourne demanding, requiring computer clusters psychotic disorders, particularly University, Monash University, National for analysis. schizophrenia. Our studies investigate Institute of Mental Health (NIMH), these disorders longitudinally, and within Washington DC (Dr Nitin Gogtay). the context of brain maturation. We seek Current Research to identify neurobiological and genetic This project will use blood-based molecular markers of these illnesses related to onset and neuroimaging techniques to identify Australian Schizophrenia Research Bank of the illness or its progression. A major clinical biomarkers of treatment-resistant (ASRB) component of this work is undertaken at schizophrenia and other psychotic disorders. Vaughan Carr, Ulrich Schall, Rodney Scott, WCHRE, involving recruitment of patients Biomarker discovery offers the advantage Assen Jablensky, Bryan Mowry, Patricia with psychotic illnesses, and studies in of facilitating early diagnosis and novel Michie, Stan Catts, Frank Henskens, children with developmental disorders, treatment strategies using objective Christos Pantelis. including autism spectrum and children with techniques, recognised as being critical for schizotypal features. Collaborators: Involves key schizophrenia improving long-term clinical outcomes. research centres across Australia. The Affective Neuropsychiatry group is interested in how the brain supports This is a national initiative to establish complex human emotional experiences an Australian bank of clinical, and behaviours. This research is primarily neuropsychological, brain imaging and focused towards how alterations in normal genetic data on patients with established function may contribute to common schizophrenia. The initiative has been funded

WESTERN HEALTH RESEARCH REPORT 2012 076 Melbourne Neuropsychiatry Centre (cont.)

An investigation of pervasive, social and will be identified as important from mood and anxiety. This may lead to the interpersonal difficulties in childhood: preliminary analysis of AGRE data from the development of better treatments for cognitive, motor, language and US (www.agre.org; Melbourne University people who suffer from mood and anxiety neurological functioning. Human Research Ethics Committee disorders and increase awareness within Renee Testa, Harvey Jones (student), Approval Number 0932503.1), and also the community. Nola Ross, Marc Seal, Bruce Tonge, additional relevant and more detailed Christos Pantelis. variables identified via literature review. An investigation into the cognitive skills It is hypothesised that cluster analysis of underpinning single word decoding in The first aim of this study is to characterise cognitive, behavioural, developmental, and children with reading disorders. the clinical phenotype of children with medical variables for individuals with ASD Renee Testa, Amy Lee, Nola Ross, pervasive, social and interpersonal without cognitive impairment will produce Jennie Ponsford. difficulties in childhood (and who are at least two clusters that are different in Collaborators: MNC @ Melbourne considered to have a schizotypal condition). a clinically meaningful way. Furthermore, University, Monash University. This analysis will focus on clinical, it is predicted that the clusters will differ behavioural and cognitive features of in their receptive language and pragmatic Collaborators: MNC @ Melbourne presenting children. communication ability, their pattern of University, Monash University, National restricted and repetitive behaviours and The second aim of this study is to assess the Institute of Mental Health (NIMH), interests, and also in the ratio of affected clinical utility of an assessment tool that has Washington DC (Dr Nitin Gogtay). males to females. This work will examine been developed to identify and characterise and detail the characteristics of children An investigation of pervasive, social and children with SPD features (The Melbourne with high functioning Autism. This work interpersonal difficulties in childhood: Assessment of Schizotopy in Kids [MASK]). follows on from our initial study published in cognitive, motor, language and Thirdly, we aim to use functional brain Molecular Psychiatry (Skafidas et al, 2012), neurological functioning. imaging (fMRI) to examine the brain which defined a genetic classifier for ASD. Renee Testa, Harvey Jones (student), networks (default mode network) in children Further work will examine genetic markers Nola Ross, Marc Seal, Bruce Tonge, demonstrating a pre-occupation with an relevant to different subtypes of ASD. MNC Christos Pantelis. imaginative and fantasy world, comprising @ Melbourne University, Centre for Neural A cluster analysis exploration of the of magical thinking and odd or unusual Engineering @ Melbourne University, characteristics of high-functioning ideas and themes. This study will define Monash University. subgroups within the autism spectrum the features and condition of schizotypy in A neuroimaging study of anxiety in children aged 8-12 years. children and examine their brain function. and mood regulation in youth. Renee Testa, Felicity Klopper (student), We aim to follow these children into Ben Harrison, Christopher Davey, Christos Pantelis, Bruce Tonge, Stan adolescence to assess outcome. The MASK Christos Pantelis, Patrick McGorry, Skafidas. has proved successful and is already being Rebecca Kerestes, Chad Bousman, utilised by our collaborator, Dr Nitin Gogtay Katerina Stephanou. Collaborators: MNC @ Melbourne in the US. University, Centre for Neural Engineering @ The primary objective of this study is to Melbourne University, Monash University. A cluster analysis exploration of the systematically investigate how the brain characteristics of high-functioning regulates mood and anxiety in healthy subgroups within the autism spectrum individuals. We will address this by utilising in children aged 8-12 years. three tasks that are designed to activate the Renee Testa, Felicity Klopper (student), emotion regulation neural circuitry. We will Christos Pantelis, Bruce Tonge, use fMRI-based methods such as functional Stan Skafidas. connectivity to examine the relationship The primary objective of this study is to between anterior insular cortex activity and employ the statistical technique of cluster individual differences in anxiety sensitivity. analysis to explore whether children with We will also examine connectivity patterns high-functioning Autism Spectrum Disorder in medial network areas during the three (ASD) can be differentiated into clinically tasks, and assess whether connectivity and meaningful subgroups on the basis of activation in these regions is associated cognitive, behavioural, developmental, with measures of rumination and depressive and medical variables. These variables symptoms. This project aims to increase our understanding of how the brain regulates

WESTERN HEALTH RESEARCH REPORT 2012 077

Identifying neuroimaging biomarkers Christina Phassouliotis: Post-doctoral O ur AwARDS and Grants of psychosis onset and relapse. Fellow Christos Pantelis, Richard Banati, Vanessa Senior Principal Research Fellowship, Cropley, James Olver, Paul Amminger, Rebecca Kerestes: Post-doctoral Fellow Professor Christos Pantelis, Understanding Christopher Rowe, Graeme O’Keefe, Ian Brain Changes in Adolescence and Tony Dann: Professional Staff Everall, Dennis Velakoulis, Mario Jimenez- Neuropsychiatric Disorders. NHMRC: $841,250 (2010-2014) Alvarez, Barnaby Nelson, Alison Yung, Chester Kang: Professional Staff Uwe Ackermann, John Sachinidis, Gordon Training Fellowship, Dr Vanessa Cropley, Chan, Sharon Naismith, Tim Rolfe, Lee Barbara Stachlewski: Professional Staff Allen, Chad Bousman, Stephen Wood, SPECT imaging of cortical muscarinic Malcolm Hopwood, Andrea Polari, Patrick Antonia Merritt: Research Officer acetylcholine receptors in schizophrenia: McGorry, Ian Hickie. Is it a useful biomarker? NHMRC: $290,032 Hannah Cross: Research Officer (2011- 2014) Collaborators: Austin PET Centre & Austin Hospital, ORYGEN Youth Health, Brain & Annabel Burnside: Research Officer Clinical Career Development Award, Mind Research Institute, NSW. This study Dr Ben Harrison, Cortico-Striatal Network Michelle Lamblin: Research Officer was commencing in 2012, with initial PET Alterations in Obsessive-Compulsive Disorder. NHMRC: $377,000 (2010–2013) scans planned for early 2013. Maria Di Biase: Research Officer NARSAD Distinguished Investigator Grant, A neuroimaging study of anxiety and mood Steven Tahtalian: Research Officer regulation in youth. Prof Christos Pantelis, Neuroimaging Ben Harrison, Christopher Davey, Sarah Gale: Research Officer Biomarkers of Psychosis Onset” - PET study Christos Pantelis, Patrick McGorry, examining inflammatory markers (microglial activity) in the CNS of patients developing Rebecca Kerestes, Chad Bousman, Our Research Students Katerina Stephanou. acute psychosis. The Brain & Behavior Mr Harvey Jones: DPsych(Clinical Research Foundation in the US: $100,000 Neuropsychology) (USD) (2011-2012) Our Researchers Ms Felicity Klopper: DPsych(Clinical NHMRC-EU Grant, Prof Christos Pantelis, Neuropsychology) Christos Pantelis: Professor of Prof Patrick McGorry, Dr. Marc Seal, Dr Chad Bousman, Dr Aswin Ratheesh, Neuropsychiatry & Scientific Director, Ms Hui Minn Chan: DPsych(Clinical Dr Sashin Kumar, Optimising current NHMRC Senior Principal Research Fellow Neuropsychology) therapeutic approaches to schizophrenia: Ben Harrison: Post-doctoral Fellow, NHMRC Ms Amy Lee: DPsych(Clinical The OPTiMiSE consortium. NHMRC: $979,375 Clinical Career Development Fellowship Neuropsychology) (2010-2014)

Chris Davey: Consultant Psychiatrist & Mr Jeggan Tiego: DPsych(Clinical NHMRC-EU Grant, Prof Patrick McGorry, Research Fellow Neuropsychology) Prof Christos Pantelis, Gene - environment interactions as predictors of clinical outcome Renee Testa: Child neuropsychologist & Ms Katerina Stephanou: Doctor of in the At Risk Mental State. NHMRC: Research Fellow Philosophy $997,875 (2010-2014)

Vanessa Cropley: Post-doctoral Fellow, NHMRC Post-Doctoral Training Clinical Fellow

WESTERN HEALTH RESEARCH REPORT 2012 078 Melbourne Neuropsychiatry Centre (cont.)

NHMRC Enabling Grant (extended Program Grant, Prof. Patrick McGorry, Our Research Output funding), Carr V, Schall U, Scott R, Prof Antony Jorm, Prof. Ian Hickie, Prof Jablensky A, Mowry B, Michie P, Catts Christos Pantelis, Prof. Alison Yung, Publications: 43 S, Henskens F, Pantelis C, Australian Emerging Mental Disorders in Young Presentations: 19 Schizophrenia Research Bank (ASRB) People: Using Clinical Staging for Prediction, NHMRC: $440,650 (2011-2012) Prevention and Early Intervention NHMRC: $1,460,000 (2009-2013) Our Professional and CRC for Mental Health, Christos Community Engagement Pantelis, Ian Everall, Brian Dean, Chad Project Grant, Dr Christopher Davey, Bousman, Suresh Sundram, Identification Prof Patrick McGorry, A/P Andrew Chris Pantelis of biomarkers of treatment-resistant Chanen, Dr Sarah Hetrick, Dr K Yuen, Member of the Scientific Advisory Councils schizophrenia and other psychotic disorders: Youth depression alleviation: a randomised of Neurosciences Victoria (since 2006) and Can we predict clozapine response? CRC for controlled trial of cognitive behavioural the Illawarra Institute for Mental Health Mental Health: $330,000 (2011-2012) therapy with fluoxetine or placebo NHMRC: (since 2010). $1,200,000 (2012-2017) Instituto de Salud Carlos III, Ministry of Member of Editorial Boards of Science and Innovation, Carles Soriano- Project Grant, A/Prof Ben Harrison, Australian & NZ Journal of Psychiatry, Mas, Jesus Pujol, Benjamin Harrison, Prof Prof Murat Yucel, Dr Chris Davey, Jesus Journal of Cognitive Neuropsychiatry Christos Pantelis, Functional connectivity Pujol, Prof Nick Allen, Dr Alex Fornito, International Review of Psychiatry, Acta in fronto-striatal networks in the obsessive- A brain-based measure of anxiety sensitivity. Neuropsychiatrica, Psychiatriki and Brazilian compulsive disorder subtypes, Fondo de NHMRC: $265,000 (2012-2014) Journal of Psychiatry, Schizophrenia Investigación Sanitaria (FIS) – Spain: 86,515 Research, Schizophrenia Bulletin and (€) (2010-2012) Project Grant, A/P Murat Yucel, A/Prof Biological Psychiatry. Ben Harrison, A/P Rob Hester, Jesus Project Grant, Bryan Mowry, Liz Holliday, Pujol, Prof Michael Breakspear. Cognitive Vanessa Cropley Peter Visscher, Matthew Brown, Stephen control and brain connectivity disturbances NHMRC Postgraduate Scholarship panel Rose, Prof Christos Pantelis, Identifying in schizophrenia and obsessive-compulsive Expert grant reviewer for the NHMRC (x2) eQTLs and endophenotyping known CNVs disorder; Clarifying their nature, specificity, and the ARC Linkage Scheme. in a large Australian schizophrenia simple and consequences. NHMRC: $358, 348 Adhoc reviewer for several leading national NHMRC: $876,750 (2010-2012) (2011-2014) and international journals including: Brain and Cognition, Neurobiology of Aging, Psychiatry Research, Archives of General Psychiatry, Biological Psychiatry, PLoS ONE, Schizophrenia Bulletin, Australian and New Zealand Journal of Psychiatry and Psychopharmacology.

WESTERN HEALTH RESEARCH REPORT 2012 WESTERN HEALTH RESEARCH REPORT 2012 080 Victoria University at Western Centre for Health Research and Education

Research in the School of Biomedical and Our Research Food for Thought: Eating for your Baby Health Sciences and Nursing and School Associate Professor Mary Carolan of Nursing and Midwifery at the WCHRE Nurse-sensitive Indicators – A Survey of is predominantly undertaken within the Nurses at Western Health Collaborators: Victoria University, ACCD, Biomedical and Lifestyle Diseases Unit Associate Professor Liza Heslop, Western Health and the Clinical and Community Care Unit. Wendy Calder (WH) Lucy Lu and Jane Xu This follow on project aims to develop The Biomedical and Lifestyle Diseases a new self-management program for Unit research is focused on expanding An Exploratory Study of Care Coordination high-risk (disadvantaged/ethnic) women our knowledge on the role that lifestyle Work Practice and Activity with gestational diabetes mellitus (GDM). associated diseases play in limiting not Rebecca Power (WH), Kate Cranwell (WH), This program focuses on successful GDM only our lifespan but also our quality Prue Deckert (WH), Abby Bean (WH), self-care and behavioural change such as, of life. Our ability to age well and age Liza Heslop healthy eating, being active and reducing productively is affected by a number Care Coordination Experienced Based Co- pregnancy morbidity. It will include touch of health issues, including: obesity, Design Project screens and web-based online materials diabetes, cardiovascular disease, cancer, Rebecca Power (WH), Kate Cranwell (WH), aimed at addressing low health literacy. inflammation, gastrointestinal issues Prue Deckert (WH), Abby Bean (WH), No such program is available in Australia. (including irritable bowel, GIT diseases, Liza Heslop, John Bamberg and appetite regulation), musculoskeletal This research aims to develop resources health (including physical functioning and Investigating the Educational Needs to assist women with low levels of literacy sarcopenia). To expand our knowledge, of High Risk Women with Gestational to better self-manage their condition. the Biomedical and Lifestyle Diseases Unit Diabetes Mellitus (GDM) utilises laboratory based scientific inquiry Associate Professor Mary Carolan, Older Maternal Age and Pregnancy as well as applied clinical and therapeutic Dr Maureen Farrell, Ms Cheryl Steele Outcomes Predictors of Perinatal Morbidity interventions to promote health and prevent illness, restore health, and promote the Collaborators: Victoria University, ACCD, Collaborators: Consultative Committee on wellbeing of individuals. Western Health Perinatal and Maternal Morbidity (CCOPMM) Monash University, LaTrobe Mother Child Researchers in the Clinical & Community Developing an Innovative Educational research Health Research Unit carry out research in Program for High Risk Women with key programs with the following themes: Gestational Diabetes Mellitus (GDM) This work clearly aimed to examine utilising health information technology, Phases 1 and 2 maternal age related perinatal morbidity. promoting health and wellbeing, improving Associate Professor Mary Carolan, It established that older maternal age is the quality of care, and providing culturally Dr Gurjeet Gill, Ms Cheryl Steele associated with increased rates of caesarean sensitive care. Mental health research section and induction of labour especially focuses on three main areas: prevention Collaborators: Victoria University, ACCD, among private patients in Victoria. It also and early intervention in people with mental Western Health examined, for the first time, the implications health problems, including alcohol and drug of both older maternal age and ethnicity This project aimed to develop GDM self- misuse issues; promotion of recovery in on GDM rates among Victorian women management resources (information sheets) people with severe and enduring mental (Australia) and found that ethnicity was an for high-risk (disadvantaged/ethnic) women illness; and promotion of primary caregiver/ independent risk factor for GDM and also with gestational diabetes mellitus (GDM). family coping and wellbeing. Pregnancy that this risk increased dramatically as The ultimate aim is to educate and empower research focuses on women’s pregnancy women aged. Maternal age is increasing women to understand and develop skills experiences, adverse outcomes and risk in and it is important that services understand to self-manage their GDM. Touch screen pregnancy, perinatal health and morbidity, the needs of this new group of childbearing online resources will be available for testing gestational diabetes, older maternal age, women. at the Diabetes clinic early 2013. GDM is and sexual health. Acute and chronic illness one of the biggest health challenges of the research concentrates on investigating 21st century, and rates in Australia have interventions which will enhance standards increased dramatically in the past decade. of community and hospital care in Disadvantaged/ethnic women are most at collaboration with health service providers, risk developing and mismanaging GDM. This in particular, evaluation of current practice research aims to develop resources to assist and the generation and use of evidence to women with low levels of literacy to better improve patient outcomes. understand their condition.

WESTERN HEALTH RESEARCH REPORT 2012 081

Our Researchers Our Research Students Research Development Grant: Dr Aaron Jane Xu PhD Petersen, Associate Professor Alan Hayes, Professor Greg Blatch: Head of School Professor Greg Blatch, Dr Eva Pesce Heat Philip Shields PhD Treatment as a Therapy for Muscle Wasting Professor Glenn McConell: Exercise Science in the Elderly, Victoria University. $27,981 Research Leader Mahdi Bazaragalani PhD Dr Erik Hanson, Dr Swati Baindur- Associate Professor Alan Hayes: Assistant Ms Dorota Frankowska PhD Hudson, Professor Glenn McConell, Dean Professor Claudio Battaglini, Dr Gillian Ms Robyn Fairhall PhD Duchesne, Professor Stuart Phillips, Professor Terence McCann: Research Associate Professor Alan Hayes. Does Professor Ms Denise Cornall PhD Protein Supplementation and Resistance Associate Professor Mary Carolan: Ms Astri Maijid PhD Exercise Protect Against Muscle Atrophy Academic During Prostate Cancer Treatment? Victoria Ms Minerva Kyei-Nimakoh PhD University. $28,735 Associate Professor Liza Heslop: Academic Ms Nancy Capitanio PhD Dr Debra Kerr: Academic Our Professional and Ms Tracey Gerber PhD Community Engagement Dr Kulmira Nurgali: Academic Ms Jessica Danaher PhD Liza Heslop Dr Anthony Zulli: Academic Ms Cara Timpani PhD Statutory Committee Membership Dr Elizabeth Verghese: Academic Ms Rachel McQuade PhD Member Clinical Advisory Committee Dr Matthew Cooke: Academic Independent Hospital Pricing Authority Ms Vanesa Jovanovska Honours (IHPA) – five year term Dr Christos Stathis: Academic Joint working party of the Australian Safety Ms Emma Tuckett Honours and Quality in Health Care (ACSQHC) Dr Samy Sakkal: Academic Ms Elife Kadife Honours Mary Carolan Dr Emma Rybalka: Academic Ms Sarah Miller Honours Member, International Confederation Dr Swati Baindur-Hudson: Academic of Midwives (ICM); Perinatal Society of Mr Troy Gosetti Honours Australia and New Zealand (PSANZ), and Dr Ahmed Rahman: Postdoctoral Research Australian College of Midwives Incorporated Fellow (ACMI). Sub-editor: Women & Birth Journal. Our Research Output Dr Simona Carbone: Postdoctoral Research Fellow Publications: 11 Book Chapters: 1 Dr Erik Hanson: Postdoctoral Research Presentations: 7 Fellow

Dr Gunveen Kaur: Postdoctoral Research O ur AwARDS and Grants Fellow Associate Professor Mary Carolan, Dr Mary Zhang: Postdoctoral Research Developing an Innovative Educational Fellow Program for High Risk Women with Gestational Diabetes Mellitus (GDM) Phase 2. Dr Eva-Rachele Pesce: Postdoctoral Ian Potter Foundation. $50,000. (2012-2013) Research Fellow Associate Professor Mary Carolan, Food for Dr Mridula Bandyopadhyay: Postdoctoral Thought: Eating for your Baby. Diabetes Research Fellow Australia. $59,000. (2012)

WESTERN HEALTH RESEARCH REPORT 2012 082 Our Partners

University of Manitoba, Nottingham Winnipeg Canada University Hospitals NHS Trust (UK) Population Health Research Institute Oxford University (PHRI) McMaster The University University, Ontario of Sheffield, UK Canada Universities of Exeter & Plymouth (UK)

Mayo Clinic, MN

Harvard Instituto de Salud University of University, MA Carlos III. Ministry California, San of Science and Francisco Yale University, CT Innovation Fondo The Brain & de Investigación Behavior Research Sanitaria, Spain Foundation, New York USA National Institute of Mental Health (NIMH), Washington DC

WESTERN HEALTH RESEARCH REPORT 2012 Lund University, Sweden

Aarborg University, Denmark Queen Mary Hospital, Hong Kong World Health Organisation, The University Switzerland of Hong Kong

Asia Pacific Stroke Association, India

Queensland Institute of Medical Research (QIMR) Queensland University of Technology (QUT)

National Stroke Royal Brisbane Association Hospital (RBH) of Sri Lanka The University Flinders University University of of Queensland Colombo, Sri Lanka SA Health Kidsfirst Kindergartens, University of South New Zealand Australia Starship Children’s Health, New Zealand

Princess Margaret Hospital for University of Children Newcastle The George Institute Australian National for Global Health University The University of Australian Research Sydney Council (ARC) Wollongong Australian Sports Hospital Medicine Association Youth Health, Brain Cooperative & Mind Research Research Centres Institute (CRC) National Health and Medical Research Victoria - Pg 84 Council (NHMRC)

WESTERN HEALTH RESEARCH REPORT 2012 084 Our Partners - Victoria

SPONSORS Gilead PPD Australia

GlaxoSmithKline Roche Pharmaceuticals Abraxis BioScience ImClone Sanofi-Aventis AstraZeneca Intensive Care Foundation Servier Australia Amgen Australia Pty Ltd Jannsen-Cilag Shire Pharmaceuticals Boehringer-Ingelheim SIRTeX Medical Ltd Jansen & Millinium Bayer Australia Ltd Victorian Cancer Agency (VCA) Covance Novartis Oncology Australia Windermere Foundation Covidien Merck, Sharp and Dohme (MSD) Western and Central Melbourne Integrated Dorevitch Pathology Ormond College Cancer Service (WCMICS) Eli Lilly Australia Pfizer Oncology Western Region Health Centre Ethicon Pharmaxis Wyeth Australia Pty Ltd

LODDON MURRAY WIMMERA MALLEE GOULBURN MURRAY

Horsham Bendigo

GOULBURN RIVER GRAMPIANS AND RANGES PYRENEES THE GOLDFIELDS

Ballarat

Melbourne GREAT SOUTH MELBOURNE COAST GEELONG & METROPOLITAN SURROUNDS Geelong

Warnambool

WESTERN HEALTH RESEARCH REPORT 2012 COLLABORATORS CRC for Mental Health Osteoporosis Australia Dorevitch Pathology Peter MacCallum Cancer Centre Alfred Health Deakin University Royal Australasian College of Ambulance Victoria General Practitioners (RACGP) Department of Health, Victoria ANZ Breast Cancer Trials Group Royal Australasian College of Physicians Diabetes Australia (Victoria) (RACP) ANZ Intensive Care Society Clinical Diabetes Australia Research Foundation Trials Group (ANZICS CTG) Royal Melbourne Hospital (RMH) Eastern Health ANZ Intensive Care Research Centre Royal Melbourne Institute of Technology (ANZICRC) Florey Neurosciences Institutes (RMIT) Asia Pacific Association of Young Geelong Hospital St Vincent Hospital (SVH) Neurologists and Trainees General Practice Victoria Stroke Society of Australasia Austin Health Kidney Health Australia The Cancer Council of Victoria (CCV) Australasian College for Emergency Medicine (ACEM) Clinical Trials Group LaTrobe University The Heart Foundation Australasian Leukemia & Lymphoma Group Ludwig Institute of Cancer Research The Royal Women’s Hospital (RWH) Australian Medical Association, Macedon Ranges and North Western The Royal Children’s Hospital (RCH) Melbourne Medicare Local Victorian Branch (AMA) The University of Melbourne Melbourne Neuroscience Institute Australian Sports Medicine Association The Victorian Forensic Paediatric Melbourne Brain Centre Australasian Kidney Trials Network Medical Service (VFPMS) MonashHeart, Southern Health Australian Lung Trials Group Victorian and Interstate Health Services (MMC) Baker IDI Heart and Diabetes Institute Victoria University Wodonga Monash University Beyond Blue Victorian Cancer Agency (VCA) Murdoch Children Research Institute Bio21 Cluster Victorian Comprehensive Cancer Centre NORTH National Stroke Research Institute (VCCC) EAST BioGrid Neuroscience Trials Australia (NTA) Victorian Stroke Clinical Network Cancer Trials Australia (CTA) North-East Health Wangaratta Walter and Eliza Hall Institute (WEHI) Cochrane Renal Group Nurses Board of Victoria Wangaratta Hospital College of Intensive Care Medicine of Australia and New Zealand ORYGEN Western Region Health Centre

GIPPSLAND

Bairnsdale

WESTERN HEALTH RESEARCH REPORT 2012 WESTERN HOSPITAL SUNBURY DAY HOSPITAL Gordon Street 7 Macedon Road Footscray VIC 3011 Sunbury VIC 3429 Locked Bag 2, Footscray VIC 3011 9732 8600 8345 6666 WILLIAMSTOWN HOSPITAL SUNSHINE HOSPITAL Railway Crescent Furlong Road Williamstown VIC 3016 St Albans VIC 3021 9393 0100 PO Box 294, St Albans VIC 3021 8345 1333 DRUG HEALTH SERVICES 3-7 Eleanor Street SUNSHINE HOSPITAL RADIATION Footscray VIC 3011 THERAPY CENTRE 8345 6682 176 Furlong Road St Albans VIC 3021 HAZELDEAN TRANSITION CARE 8395 9999 211-215 Osborne Street Williamstown VIC 3016 WESTERN CENTRE FOR HEALTH 9397 3167 RESEARCH AND EDUCATION Sunshine Hospital REG GEARY HOUSE Furlong Road 54 Pinnacle Crescent St Albans VIC 3021 Melton South VIC 3338 8345 1333 9747 0533

www.westernhealth.org.au

Together, caring for the West