1. health and fitness

Eastern Health
Research Report
2009–2010
Eastern Health Research Report 2009-10 1
Contents
3
10
62
70
Chief Executive and Board Chair’s report
4 Research focus and governance
6 Eastern Health Library Service
7 Research & Ethics Committee
Medicine
12 Eastern Health Clinical School
23 Haematology Clinical Trials Unit ECRU
25 Breast oncology
29 Endocrinology and diabetes
31 Gastroenterology and hepatology
33 Neurosciences
40 Respiratory and sleep
42 Renal
44 Cardiology
47 Geriatric
52 Intensive care
56 Palliative care
59 Obstetrics and gynaecology
60 Surgery
61 Rheumatology
Nursing and Midwifery
Allied Health
80 Mental Health
83 Pharmacy
85 Health Promotion Unit
87 Turning Point Alcohol and Drug Centre
2 Eastern Health Research Report 2009-10
Chief Executive and
Board Chair’s report
>
Now in its third edition, the annual
Eastern Health Research Report continues
to evolve and showcase the diversity,
depth and breadth of research activity
undertaken in association with our university
partners, public and private collaborators
and other organisations.
This report is a comprehensive record of
research activity across the professional
disciplines of medicine, nursing & midwifery
and allied health. This year, the Research
Report also showcases the research activity of
Turning Point Alcohol and Drug Centre which
formally amalgamated with Eastern Health
in late 2009.
The Research Report is one of a suite of
annual documents published by Eastern
Health including the Eastern Health Annual
Report and Quality of Care Report. All
three reports demonstrate Eastern Health’s
dedication to the provision of quality,
patient-centred care and reinforce our
commitment and mission that supports
great health and wellbeing.
Eastern Health has much to be proud of
in terms of our commitment to research,
education and training programs. The
establishment of the Eastern Health Clinical
School 2008; the high quality and quantity
of research being pursued in all professional
disciplines; our well established and
rewarding university partnerships; and the
appointment of an inaugural Director of
Research and University Relations Prof David
Taylor in mid-2010 are all terrific examples of
how we have actively pursued our research
and education endeavours. Under the
guidance and leadership of Prof David Taylor,
Eastern Health’s enviable reputation amongst
our peers in pursuing research excellence will
undoubtedly flourish.
Alan Lilly, Chief Executive
Eastern Health
The diversity, depth and inquisitive nature
of research activity being undertaken across
Eastern Health with our partners is recognised
both nationally and internationally. This is
evidenced by the number of publications,
presentations and awards received by Eastern
Health staff cited throughout this Research
Report. We extend our sincere congratulations
to all staff who have received this recognition
over the last 12 months.
Eastern Health remains committed to
research activity which underpins our role
in supporting excellence in patient care,
teaching, training and research. Ultimately,
this leads to improved outcomes for our
patients and the communities we serve
and tangibly reinforces Eastern Health’s
commitment to great health and wellbeing.
We commend the 2009/10 Eastern Health
Research Report to you.
Joanna Flynn, board Chair,
Eastern Health
Eastern Health Research Report 2009-10 3
Research focus
and governance
>
Given the size of this report, it is difficult
to believe that this is only the third Eastern
Health Research Report. Each edition has
been larger than the preceding one and
clearly illustrates that Eastern Health has a very
proud history of research and a great future.
appointment as the inaugural Director of
Building on the past research success is
inherent in many of the strategic directions
and strategic goals articulated in the Eastern
Health Strategic Plan 2010-2015. We are
fortunate that the clear link and focus on
education and research across Eastern Health
is enhanced by the strong partnerships with
some of Australia’s top universities, such as
Monash, Deakin and La Trobe universities, and
educational institutions.
an ethical manner by educating about and
The establishment of the Eastern Health
Office of Research and Ethics and my recent
are followed. It is therefore planned that
Research and University Relations clearly
demonstrate Eastern Health’s commitment
to strengthening research and education.
The focus of the Office of Research and Ethics
is to enhance good research undertaken in
enabling research. This will be achieved by strengthening the
Ethics Office functions and establishing a
Research Office stream within the Office
of Research and Ethics. Accompanying the
privilege of undertaking research is the
responsibility to ensure that recommended
research guidelines and best practices
procedures surrounding research and ethics
governance will be seamlessly incorporated in
the usual research activities.
From this report it is clear that the focus
of research at Eastern Health has centred
on understanding and improving clinical
outcomes. The enthusiasm and expertise
of Eastern Health staff in all disciplines
ensures that this will continue. Eastern
Health will maintain the focus on clinical
outcomes and where appropriate this will
involve intradisciplinary and interdisciplinary
collaboration to maximise those outcomes.
Thank you to all the Eastern Health
researchers who have contributed to this
report. In addition the efforts and considered
decisions of the Human Research and Ethics
Committee together with those of the Ethics
Office are to be applauded.
Prof David Taylor
Director of Research
and University Relations
4 Eastern Health Research Report 2009-10
Research focus and governance
•Prof David Taylor
Director of Research and University Relations, Eastern Health
Prof David Taylor commenced his research career as an honours and
then PhD student in the Department of Pharmacology, University
of Melbourne, studying the neurochemical changes following
cannabis administration in laboratory animals. This kindled an
interest in the pharmacology of drugs of addiction which continues
today. David has published in excess of 50 publications and over
120 presentations. His most cited publication (over 170 citations)
appeared in the highly-ranked British Journal of Pharmacology
and reported on the discrete site in the hypothalamus that the
endogenous cannabinoid, anandamide, induces an increase
in appetite. This has implications in the appetite stimulating
effect of cannabis and the possible involvement of endogenous
cannabinoids in obesity. At Monash University he has also worked
collaboratively with different groups in medicinal chemistry,
pharmacy practice and pharmaceutics which support’s basic
research translation into practice.
In addition to being an active researcher and teacher, David has
held significant administrative research roles including from 2002 to
2010 Associate Dean Research Training for the Faculty of Pharmacy
and Pharmaceutical Sciences, Monash University.
Upon commencing with Eastern Health in mid 2010, David is
focused on enhancing the research activities throughout Eastern
Health by strengthening the organisational support offered to
researchers in both research and ethics. He will also look to pursue
his research interests in drug addiction and mental health.
Eastern Health Research Report 2009-10 5
> Eastern Health Library Service
The Eastern Health Library Service (EHLS)
supports research professionals across all
Eastern Health sites and services with highly
trained information professionals available to
collaborate on research projects.
(recommended for mental health research).
In addition, Informit Health is also available
which provides unique coverage of many
Australian resources.
To service such a large, geographically
Department of Health’s Clinicians Health
Over the past 12 months, requests for research
service assistance have approximately
doubled which is particularly noticeable in the
discipline of allied health.
Also utilised in support of evidence-based
research is The Cochrane Library, The Joanna
Briggs Institute, PEDro (physiotherapy),
OTseeker (occupational therapy) and
SpeechBITE (speech pathology).
Researchers have access to a multitude
of hardcopy and electronic databases to
support literature searches such as Medline
(the premier bibliographic database covering
the field of Medicine), CINAHL (a key
resource for Nursing & Allied Health), Embase
(essential for Pharmacology research and
European medical literature), and PsycInfo
EHLS provides a document delivery service and
supplies articles, books, reports and audiovisual
material in a timely manner to researchers.
This is done in the most cost-effective manner
possible for Eastern Health through our
membership of Gratisnet, the health libraries’
co-operative network, as well as Eastern
Health’s partnerships with affiliated universities.
6 Eastern Health Research Report 2009-10
dispersed staff, EHLS continues to purchase
an increasing number of electronic resources.
These resources augment those of the
Channel. The combined suite of databases,
online textbooks and over 6000 full text
electronic journals are available both on and
off campus for the convenience of researchers
and other staff.
Eastern Health staff, including our researchers,
can access virtual and physical campus library
services 24 hours a day, seven days a week
and site-based libraries provide a haven for
research and study.
> Research & Ethics Committee
The Eastern Health Research and Ethics
Committee plays a major role in providing
scientific and ethical reviews of all research
projects involving Eastern Health staff and
patients. It provides ongoing supervision of
research projects from initial ethics approval
to project completion. This is carried out
by monitoring annual progress reports and
periodic safety reports.
In October 2009, Turning Point Alcohol and
Drug Centre amalgamated with Eastern
Health and a number of ongoing research
projects have been transferred to the Eastern
Health Research and Ethics Committee for
continuing oversight.
Over the 12 months from 1 July 2009 to 30
June 2010, 189 projects have received ethics
approval to be conducted at Eastern Health.
This includes 101 moderate-to-high-risk
projects and 88 projects that are considered
as negligible risk, low-risk or quality assurance
activities. The risk level is determined by
criteria set by the National Statement on
Ethical Conduct in Human Research (2007).
The number of moderate to high risk research
projects that were processed by the Ethics
Committee has been stable at around 110
to 120 per year in the past several years.
However, since the launch of the Eastern
Health Research Policy in March 2009, the
Committee has experienced a three-fold
increase in the number of low-risk research
projects submitted for ethical review. This has
resulted in greater governance by Eastern
Health for low-risk projects and clinical
audits. The number of moderate-to-high-risk
projects has started to decrease with the
implementation of the Victorian Single Ethical
Review Program in November 2009 (more
information below).
The full committee meets 11 times per year.
In addition to reviewing new projects, it
reviews final progress reports and business
arising from previous meetings. Its subcommittee also meets monthly to review
documents such as safety notifications,
annual progress reports and protocol
amendments. The Ethics Chair provides
regular out-of-session review at least twice
weekly, to provide timely response and advice
to researchers between formal meetings.
Membership
Composition and minimum membership
of all Human Research Ethics Committees
are governed by the National Statement
on Ethical Conduct in Human Research.
The Eastern Health Research and Ethics
Committee membership complies with the
National Statement recommendation. As of
June 2010, there were 21 regular members
on the Committee including six job shares,
one back up and three members serving on
the sub-committee. Additionally there are
two experts who provide advice on request in
their respective areas of expertise.
Members of the Committee are encouraged
and have attended a number of internal
seminars and external study days to keep
abreast of relevant issues in the area of
research ethics and research legislation.
Administrative support for the Committee
is provided by personnel in the Office
of Research and Ethics. The Office is also
responsible for ensuring compliance
with relevant legislation, regulations and
guidelines. This is carried out through having
staff trained in research-related legislation and
guidelines and through maintaining close
relationships with the hospital insurers, the
Victorian Department of Health and internal
and external legal advisors.
Office personnel in 2009-10 included Lai Wan
Reid (manager), Pat Sterling, Gavin Davies and
Virginia Ma, a final year student from the Royal
Melbourne Institute of Technology (RMIT) in
Pharmaceutical Sciences.
Single Ethical Review Program
In November 2009, Eastern Health became a
partner of the Single Ethical Review Program
established by the Victorian Government.
Under this new system, projects to be
undertaken in multiple centres are allocated
to one ethics committee for ethical review.
The ethical review and decision are accepted
by other partner organisations. As a partner
of the new system, Eastern Health does not
undertake further ethical review. Instead it
carries out site specific assessment of the
projects prior to authorising projects to be
conducted at Eastern Health.
In the seven months since its inception,
there have been 12 new projects registered.
Five of these have received Eastern Health
authorisation. Under the new system, a new
state-wide database called the Australian
Ethics Database (or AURED) has been
implemented across all partner hospitals. The
database will provide a common information
technology platform across Victorian
hospitals. Migration of existing electronic data
will occur later in 2010.
In June 2010, the inaugural Director of
Research Prof David Taylor commenced
employment at Eastern Health. Under his
leadership, the Office of Research and Ethics
will increase its function from processing
ethics applications to also providing
assistance in research education and grant
applications. It is anticipated that research
activity will increase and will be enhanced.
Eastern Health Research Report 2009-10 7
Research & Ethics Committee
•Adrienne Patterson
Community member, Eastern Health Research & Ethics Committee
Adrienne Patterson worked in governance and compliance at the
Royal Melbourne Institute of Technology (RMIT) for more than 12
years. For part of that time she managed the affairs of the RMIT
Human Research Ethics Committee where she developed an
interest in the ethical issues that arise in human research. Adrienne
has been active in various school and community groups wherever
her family lived. Adrienne has served in the Eastern Health Research
and Ethics Committee for 18 months.
Adrienne believes that the lay members of the committee represent
community opinion and have a role as advocates for those who may
8 Eastern Health Research Report 2009-10
be asked to take part in research. The lay members help to ensure
that those invited to participate receive sufficient information, at a
level they can understand, to make a properly informed decision
whether or not to take part in a research trial. This work is seen as
one small component in Eastern Health’s commitment to quality
clinical services and research that respects the individual.
Recently Adrienne retired from paid work and she now intends to
combine voluntary roles like this one with increased leisure and
travel. She is married and has four grown-up children.
Research & Ethics Committee
Main Committee membership
Chairs
Dr Patricia Molloy (Chair to April 2010)
Prof Bridie Kent, Dr Colin Feekery, Prof Peter Gibson & Prof Nicolas Taylor
(Acting Chairs from May 2010)
Community members
Mr Shane Milroy
Ms Elspeth McLeod
Mr Ray Jones
Mr John Currey
Ms Adrienne Patterson
Person in pastoral care
Reverend Glen Wegner
(Reverend Ann Wakeling as standby)
Lawyers
Ms Deborah Foy (up to February 2010)
Mr Tim Adam
Ms Carolyn Ford
Researchers
Dr Murray Gerstman (to April 2010)
Dr Trish Livingston (to December 2009)
Ms Amy Clark
Prof Bridie Kent
A/Prof David Ernest (to May 2010 )
Dr Sean Mackay
Prof Lawrence McMahon (from February 2010)
Ms Amy Pennay (from October 2009)
Ms Sharon Matthews (from October 2009)
Persons with professional
care experience
Ms Paula Lee
Mr Ashley Lewis (to September 2009)
Ms Anna Boltong (from December 2009)
Ms Anne Thompson (from November 2009)
Experts as required
Prof Marlene Drysdale (indigenous studies)
Mr Jason Ferris (statistics, from March 2010)
Sub-committee
Dr Patricia Molloy (to April 2010)
Prof Peter Gibson
Dr Louise Roberts
Dr Jacqui Chirgwin
In addition, Dr David Taylor (Inaugural Director of Research) attends
Committee meetings as an attendee from June 2010
Eastern Health Research Report 2009-10 9
1010Eastern
Eastern
Health
Health
Research
Research
Report
Report
2009-10
2009-10
Medicine
Research and
learning
in context
Highlights
Over 150 clinical trials ongoing
at any one time
Staff present their research at
international, national and local
conferences and forums
More than 300 peer-reviewed
papers published
Eastern Health staff receive national
and international recognition
Eastern
Eastern
Health
Health
Research
Research
Report
Report
2009-10
2009-101111
medicine eastern health clinical school
> Eastern Health Clinical School
The Eastern Health Clinical School has four major divisions
• Medical Student Programs
• Research
• Eastern Clinical Research Unit (ECRU)
• Turning Point Alcohol & Drug Centre (see pg 87).
All divisions are active in research that includes educational, translational, clinical research, epidemiological
research and laboratory-based research. Research from the divisions is presented separately.
Medical Student Programs
Medical Student Programs (MSP) is one of the
key activity areas within the Eastern Health
Clinical School. The principal focus for MSP
over the two years since its inception has
been the development and implementation
of educational programs for medical student
placements at Eastern Health for Monash
University and Deakin University. MSP is
currently developing an educational research
strategy and program of research in medical
education with the theme ‘learning in context’.
The MSP research team currently includes the
Director, Medical Student Programs
(A/Prof Jenepher Martin), Senior Lecturer in
Medical Education (Mr Noel Roberts), Lecturer
in Clinical Skills (Dr Susan Irvine) and Senior
Lecturers, Clinical Supervision (Dr Phillip
Parente, Dr Michael Law, Dr Jennifer Cooke).
Current collaborative projects with Monash
University and University of Melbourne are
focused on evaluation of the use of clinical
teaching associates in women’s health.
Major achievement
For the fledgling MSP research effort, the
successful and on-time submission of the
first BMed Sci thesis in medical education
for Eastern Health Clinical School is a major
achievement for 2009/10. In mid-2009, faculty
suggested that it might accommodate a
student Katherine Dutton, who was deferring
her medical studies after semester one.
Katherine was interested in further developing
and evaluating a series of worksheets she had
used in her own study which were designed to
aid student learning of history taking, physical
examination and clinical reasoning. The
12 Eastern Health Research Report 2009-10
learning curve for the student (and supervisor)
was steep and timelines short. Katherine,
who had not undertaken any research before,
designed her own study, negotiated access
to the required subjects, completed the
ethics submission, developed and validated
the clinical reasoning worksheets (a novel
learning tool), undertook the evaluation
and completed the BMed Sci requirements.
Along the way she ventured well out of her
comfort zone, grappling with effective written
communication, qualitative methodology
and the time demands of research. Having
submitted her thesis (A Medical Education Aid:
The case-based clinical reasoning worksheet),
Katherine is currently working on a number
of publications with her supervisor and will
submit an abstract to a national or international
meeting in 2011.
Research projects in progress
The well-woman examination (WWE):
Learning with clinical teaching associates
(CTAs). Cardozo C, Schmidt E, Wilkins D, Coles
J, Kiegaldie D, Paul A, Martin J. Collaboration
with Monash University investigating the
effectiveness of the WWE program on the
development of students’ relevant clinical
skills, students’ assessments of their own
performance and participants’ perceptions
about the program.
and evaluation of a novel aid for medical
students’ learning in the clinical environment.
The project included a systematic literature
review of learning aids for medical history and
physical examination, a thematic literature
review of medical students’ and junior doctors’
clinical competence as well as the evaluation
research described above.
Perceptions of the learning and teaching
environment in an Australian health service.
Roberts N, Leong K, Martin J. Survey-based
evaluation undertaken in 2009 to clarify
the way in which medical students
experienced the learning environment
within Eastern Health. Information from the
evaluation has been used to improve the
educational programs for medical students
at Eastern Health.
Future research direction
The research interests of the members of
the MSP research team include program
evaluation, faculty development, assessment,
clinical skills acquisition and curriculum
innovation. The research theme ‘learning in
context’ will be developed to explore further
how medical students learn in the clinical
context, the influence of different contexts
on learning and the enablers/barriers that
operate in the students’ learning contexts. The
interests of the members of the MSP will be
incorporated into this program.
Research projects completed
A medical education aid: The case-based
clinical Reasoning worksheet. Dutton K,
Martin J. Completed as a requirement of
Dutton’s BMed Sci (Honours Degree). The
research entailed development, validation
Publications
Published
Martin J, Blennerhassett J, Hardman D,
Mundy J. Development of the surgical science
eastern health clinical school medicine
examination of the Royal Australasian College
of Surgeons, Surgical Education and Training
program: Putting the Chicken Before the Egg.
ANZ Journal of Surgery 2009;79:169-174.
Presentations
International
Roberts N, Leong K, Martin J. Perceptions
of the learning and teaching environment
in an Australian health service. Association
for Medical Education in Europe (AMEE) 14th
Ottawa Conference. Miami, USA, May 2010.
Research training
Honours
• Dutton K, Monash University, F/T
Division of Research
The Division of Research is focused on
diet, intestinal health and chronic intestinal
diseases. The research spans from laboratory
research to epidemiology, to clinical research
to interventional clinical trials. Leading
research are Dr Jane Muir, a senior scientist
and dietician and Prof Peter Gibson, a clinical
researcher and gastroenterologist. Other
senior members of the team are Dr Susan
Shepherd and Dr Jacqueline Barrett who are
both clinical researchers and dieticians. There
are five large programs within the division:
Fermentable Oligo-Di- and Mono-saccharides
And Polyols (FODMAPs), gluten (non-coeliac),
coeliac, inflammatory bowel disease and
functional gut disorders programs. There is a
degree of overlap of the programs.
Major achievement
While much attention has been focused
nationally and internationally on the division’s
innovative concepts of dietary FODMAPs,
work on examining whether gluten can cause
gut and systemic symptoms in the absence
of coeliac disease (so-called ‘non-coeliac
gluten intolerance’ or NCGI) has gained
considerable recognition. Initial randomised
placebo-controlled rechallenge in patients
who believe they have NCGI clearly showed
that gluten can specifically induce gut and
systemic symptoms. The mechanism for this
remains uncertain. This research provides
the first valid set of data upon which we are
now building a whole program of work. The
significance of the results is that this has been
a highly controversial area where emotive
views and opinions have had no science
to back them up. Innovations in the NCGI
and FODMAP areas have led to a successful
application for an Australian Reseach Council
(ARC) Linkage grant with George Weston
Foods to develop breads that are tolerated by
people with functional gut disorders.
Research projects in progress
FODMAP Program
The role of dietary FODMAPs in the genesis
of symptoms in patients with irritable bowel
syndrome and Crohn’s disease. Halmos E,
Muir JG, Power V, Barrett J, Shepherd S, Gibson
P. This project is aimed at understanding
the role that dietary FODMAPs may have
in gastrointestinal symptoms associated
with IBS and Crohn’s disease. FODMAPs are
carbohydrates that can be poorly absorbed
in the small intestine and include fructose,
fructans, lactose, galacto-oligosaccharides
and sugar polyols.
Malabsorption of the sugar polyols –
mannitol and sorbitol in healthy individuals
and patients with irritable bowel syndrome
(IBS). Yao CK, Tan HL, Barrett J, Gibson P, Muir
J. Malabsorption of dietary polyols can induce
gastrointestinal symptoms in patients with
IBS. Sorbitol and mannitol are found widely
distributed in food. The aim of this study is to
compare the absorption patterns of sorbitol
and mannitol in patients with IBS compared
with healthy controls.
The role of dietary FODMAPs in the genesis
of symptoms associated with infantile
colic. Iacovou M, Truby H, Walker K, Wilkins
D, Gibson P, Muir J. Infant colic is the most
common complaint for which parents seek
professional advice during the first year
of life. We recently isolated FODMAPs in
infant formulae and breast milk. If we can
demonstrate that the low FODMAP diet
provides relief for infants with colic then
this provides a strong evidence base for
promoting this type of approach as primary
therapy for managing infantile colic.
FODMAP composition of Australian foods.
Rose R, Rosella N, Liels K, Biesiekierski J, Muir
J, Gibson P. Our team has developed the
analytical methods for quantifying the major
FODMAPs in foods. We are currently analysing a
wide range of foods (fruit, vegetables and grain
and cereal products) for FODMAP content.
Comprehensive food composition data can be
used to guide patients with IBS and assist our
research into understanding the importance of
dietary FODMAPs in health and disease.
Gluten (Non-Coeliac) Program
Understanding wheat and gluten
intolerance: development of wheat-gluten
free cereal and products. Muir J, Biesiekierski
J, Ku C, Mills J, Barrett J, Rose R, Rosella N, Suter
D, Bekes F, Gibson P. Many Australians claim
to have wheat or gluten intolerances and this
has led to the growing demand for wheatand gluten-free grain products. The most
common problems reported by individuals
relate to gut symptoms (bloating and wind)
and chronic fatigue. Built upon our work in
identifying FODMAPs and gluten as triggers
for such symptoms, this project aims to gain a
better understanding about wheat and gluten
intolerance and also develop novel cereal
grain products that will be better tolerated.
The role of wheat gluten in the genesis
of gastrointestinal symptoms and fatigue
in patients with non-coeliac gluten
intolerance: Investigation of the gluten
‘intolerance’ threshold level. Biesiekierski J,
Newnham E, Shepherd S, Yelland G, Muir JG,
Gibson P. In a recently completed study, we
provided (for the first time) good evidence
that wheat-derived gluten may also trigger
gastrointestinal-type symptoms and fatigue
in individuals who claim to be wheat- and
gluten-intolerant but do not to have coeliac
disease. The aim of this new project is to
confirm that wheat-derived gluten can cause
gastrointestinal symptoms and fatigue in
some individuals who do not have coeliac
disease and to establish the lower threshold
of gluten that may be tolerated by glutenintolerant individuals.
Coeliac Disease Program
The development of non-invasive markers
of intestinal healing in coeliac disease.
Newnham E, Shepherd S, Yelland G, Gibson
P. Healing of the injured intestinal mucosa is
a key end-point of therapy in coeliac disease
however this required endoscopic biopsies
of the duodenum. This study is examining
a range of non-invasive markers from novel
epithelial markers to inflammatory indices to
cognitive performance (in conjunction with
the School of Psychology and Psychiatry,
Monash University).
Eastern Health Research Report 2009-10 13
medicine eastern health clinical school
The cognitive effects of gluten ingestion in
patients with coeliac disease treated with
a gluten-free diet. Newnham E, Shepherd S,
Yelland G, Gibson P. Brain fog is commonly
reported in patients with coeliac disease
who inadvertently ingest gluten. If indeed
cognitive function is impaired under such
conditions, there are multiple implications for
all people with coeliac disease who require
sharp cognitive abilities during, for example,
their employment. This study uses innovative
cognitive tests developed at the School of
Psychology and Psychiatry, Monash University
to address this issue.
A randomised placebo-controlled trial
of oral budesonide in healing newly
diagnosed coeliac disease treated with a
gluten-free diet. Newnham E, Shepherd S,
Gibson P. Healing of the intestinal mucosa
in coeliac disease occurs in only 38 per cent
of patients after one year of gluten-free diet.
This innovative pilot study is examining a
new approach – to induce rapid healing
with topical corticosteroids. If successful, this
study will shift the paradigms of treatment for
coeliac disease.
A follow up study of patients five years after
the diagnosis of coeliac disease. Newnham
E, Shepherd S, Gibson P. This is a detailed
body composition, biochemical, serological
and histological follow-up of patients who
participated in the one-year study of patients
previously performed.
Inflammatory Bowel
Disease (IBD) Program
Fatigue in Crohn’s disease. Van Langenberg
D, Russell A, Gibson P. Fatigue is a very
common symptom of Crohn’s disease
and persists in more than half of patients
despite successful treatment of the intestinal
inflammation. Therapy is generally ineffective.
This study aims to dissect fatigue in patients
with Crohn’s disease using objective and
subjective measures and to assess muscle
function and biology in conjunction with Dr
A. Russell from Deakin University with a view
to designing future therapeutic approaches.
Use of prescribing habits and prescription
data to assess quality of care in IBD across
Australia. Van Langenberg D, Foley A, Gibson
P. There are currently few ways available of
assessing the quality of management being
delivered to people with IBD. We are taking
the novel approach of using data from
14 Eastern Health Research Report 2009-10
prescriptions filled across Australia together
with PBS data to define prescribing and
compliance patterns. Completed work to date
shows geographical heterogeneity of the use
of therapies for distal colitis, reflecting patchy
use of current guidelines of management.
Pain in IBD. Morrison G, van Langenberg D,
Gibson S, Gibson P. Pain is a common problem
in patients with IBD however we have little
information on its prevalence, management
or coping strategies taken by patients. This
questionnaire study is revealing interesting
drug usage patterns and coping strategies. It
is performed with the help of Prof S Gibson at
the National Ageing Research Institute (NARI).
Functional Gastrointestinal
Disorders Program
The use of a probiotic to correct small
intestinal bacterial overgrowth in
patients with irritable bowel syndrome - a
randomised placebo-controlled trial. Barrett
J, Yao CK, Gibson P. Our novel observation
in an open-label study that Yakult daily
reverses breath-test findings of small intestinal
bacterial overgrowth (SIBO) in patients with
IBS has led to this randomised controlled trial
of Yakult in a large population of patients with
SIBO and IBS.
An evaluation of semi-quantitative
breath hydrogen testing for carbohydrate
malabsorption. Barrett JS, Kalubowila
U, Gibson P. Current breath testing
methodology gives a yes/no answer as to
whether an individual has fructose or lactose
malabsorption. By applying quantitative
methodologies, it appears that semiquantitative analysis is feasible and provides
more useful information on the degree of
malabsorption. Further work will be done to
validate the methodology that we have used.
A pilot study of methylnaltrexone in
patients with narcotic bowel syndrome.
Morrison G, Gibson P. Narcotic bowel
syndrome is a major problem in patients who
need to take opiates chronically. It causes
abdominal pain and other disturbances.
Management is difficult. This open-label study
is examining whether blocking the gut effects
of opiates without affecting analgesia effects
by using methylnaltrexone is tolerated and
has any apparent impact on the abdominal
and systemic symptomatology.
Research projects completed
FODMAP Program
Dietary poorly absorbed, short-chain
carbohydrates increase delivery of water
and fermentable substrates to the proximal
colon. Barrett JS, Gearry R, Muir J, Irving P,
Rose R, Rosella O, Haines M, Shepherd S,
Gibson P. Functional gut symptoms are
induced by inclusion and reduced by dietary
restriction of poorly absorbed short-chain
carbohydrates (FODMAPs) however the
mechanisms of action remain untested.
Twelve ileostomates without evidence of
small intestinal disease undertook two fourday dietary periods, comprising diets differing
only in FODMAP content in a randomised,
crossover, single-blinded intervention study.
More ingested FODMAPs were recovered
in the high FODMAP diet effluent. Effluent
collection weight increased by a mean of 22
per cent, water content by 20 per cent and
dry weight by 24 per cent compared to low
FODMAP diet arm. These data support the
hypothetical mechanism – FODMAPs increase
delivery of water and fermentable substrates
to the proximal colon.
Manipulation of dietary short chain
carbohydrates alters the pattern of gas
production and genesis of symptoms in
irritable bowel syndrome. Ong D, Mitchell
S, Barrett J, Shepherd S, Irving P, Biesiekierski
J, Smith S, Gibson P, Muir J. A study was
undertaken to compare the patterns of breath
hydrogen and methane and symptoms
produced in response to diets that differed
only in FODMAP content. Fifteen healthy
subjects and 15 with IBS undertook a singleblind, crossover intervention trial involving
consuming provided diets that were either
low or high in FODMAPs for two days. Dietary
FODMAPs induce prolonged hydrogen
production in the intestine that is greater
in IBS, influence the amount of methane
produced and induce gastrointestinal and
systemic symptoms experienced by patients
with IBS. The results offer mechanisms
underlying the efficacy of the low FODMAP
diet in IBS.
Diarrhoea during enteral nutrition may be
predicted by the poorly absorbed shortchain carbohydrate (FODMAP) content
of the formula. Halmos E, Muir J, Barrett J,
Shepherd S, Gibson P. Diarrhoea commonly
complicates enteral nutrition (EN), however
causes are unknown. This study aimed to
eastern health clinical school medicine
identify factors associated with diarrhoea in
patients receiving EN with specific attention
to formula composition. Formulas were
classified according to osmolality, fibre and
FODMAP content. Of 160 patients receiving
EN, 61 per cent had diarrhoea. After adjusting
for influencing variables being initiated
on Isosource® 1.5 showed a greater than
five fold reduction in risk of developing
diarrhoea (P=0.029; estimated OR 0.18). The
only characteristic unique to this formula
was its FODMAP content was lower than
any other formula. This study suggested
that LOS (length of stay) and EN duration
independently predicted development of
diarrhoea, while being initiated on a lower
FODMAP formula reduced the likelihood
of diarrhoea. An interventional study
investigating FODMAPs in enteral formula
is indicated.
Development and validation of a
comprehensive semi-quantitative food
frequency questionnaire that includes
FODMAP intake, glycaemic index and
glycaemic load. Barrett J, Gibson P. Because
of the need to be able to assess dietary intake
of poorly absorbed short-chain carbohydrates
(FODMAPs) and the lack of ability to assess
GI status of food intake, both important for
epidemiological studies, a Food Frequency
Questionnaire (FFQ) was developed and
assessed in a large cohort of volunteers
who intermittently kept food-diaries and
completed versions of the questionnaire over
one year. The ability of the comprehensive
FFQ to accurately reflect actual intake was
confirmed in this detailed study. The FFQ will
now be an important tool in future studies.
Gluten (Non-Coeliac) Program
Gluten causes gastrointestinal symptoms in
subjects without coeliac disease: a double
blind randomised placebo controlled trial.
Biesiekierski J, Newnham E, Irving P, Barrett J,
Haines M, Doecke J, Shepherd S, Muir J, Gibson
P. This study investigated if gluten ingestion
can induce symptoms in non-coeliac
individuals and to examine the mechanism.
Thirty-four volunteers (with irritable bowel
syndrome in whom coeliac disease was
excluded and who were symptomatically
controlled on a gluten-free diet) took part in a
double-blind, randomised, placebo-controlled
rechallenge trial. Participants received gluten
or placebo with a gluten-free diet for up to six
weeks. Thirteen of 19 patients (68 per cent) in
the gluten group reported symptoms were
not adequately controlled compared to 6
of 15 (40 per cent) on placebo (P=0.0001).
On a visual analogue scale, patients were
significantly worse with gluten within one
week for overall symptoms. We concluded
that ‘non-coeliac gluten-intolerance’ may
exist, but no clues to the mechanism
were elucidated.
Coeliac Disease Program
Cross-sectional and one-year follow-up
of patients with newly diagnosed coeliac
disease. Shepherd S, Strauss B, Newnham E,
Burgell R, Foley A, Gibson P. Analysis of this
comprehensive study is now completed.
It has shown that under nutrition is very
uncommon in people being diagnosed with
coeliac disease today, (in fact 25 per cent were
overweight or obese); that intestinal healing
is uncommon (one in three) after 12 months
despite adherence to the gluten-free diet;
that HLA-DQ analysis can identify those less
likely to heal; and that reduced bone mineral
density is a common problem but improves
with treatment. Importantly, it clearly showed
that symptoms and serology are no guide to
the status of the intestinal healing, showing
that current beliefs and clinical practices are
flawed. In addition, the study showed that
abnormalities of liver function tests and low
neutrophil counts are common despite being
well on a gluten-free diet, challenging the
concept that a person who is asymptomatic
on a gluten-free diet can be considered
‘normal’ again. The large body of data is being
submitted in several manuscripts to journals
for publication.
Nutritional adequacy of the gluten-free diet.
Shepherd S, Strauss B, Gibson P. This detailed
analysis of actual food intake prior to and one
year after diagnosis of coeliac disease in a
matched population of patients with coeliac
disease on a gluten-free diet for more than
two years has revealed nutritional inadequacy
on the basis of two major factors: poor
food choice independent of the gluten-free
diet and the lack of fortification of glutenfree foods with thiamine and folate. These
results have implications for how the diet is
taught and for the food industry (manuscript
submitted).
Inflammatory Bowel
Disease Program
The effect of dietary fibre on the colonic
luminal environment. James S, Muir J,
Gibson P. Ulcerative colitis is a chronic
inflammatory disease of the large bowel
where the risk of colorectal neoplasia is
elevated and proximal constipation is
common (see below). The use of dietary
fibre to create a more anti-inflammatory and
anti-neoplastic colonic luminal environment
and to hasten transit through the gut would
seem ideal in such patients. Building upon the
previous work by Dr Muir, who identified that
a combination of wheat bran and resistant
starch as the ideal supplement in healthy
volunteers to achieve these effects, two
studies were performed. The first was a pilot
to examine the effect of these supplements
and a probiotic mixture on colonic physiology
– this showed that probiotics added little
to the fibre. The second, a randomised
controlled crossover intervention study was
then designed to concentrate on the effect of
fibre. This showed that the fibre combination
normalised gut transit in the patients but
had a much weaker effect on changing
the luminal environment than seen in the
controls. The effects observed have potential
therapeutic benefits.
Dietary carbohydrate intake of patients
with IBD. James S, Barrett J, Muir J, Gibson
P. This study was the first to use the Food
Frequency Questionnaire developed by
Barrett and Gibson (see above) to examine
FODMAP and fibre (the target of interest in
this study) in a patient population. The data
showed that FODMAP intake was similar
to that of the healthy population and that
fibre intake was low, but similar to that of the
healthy population.
A clinical study of proximal constipation
in ulcerative colitis. James S, Gibson P.
Functional gastrointestinal symptoms are
common in patients with ulcerative colitis and
one such condition is proximal constipation.
Its incidence, detection and therapy are
surprisingly poorly understood. This study of a
large cohort of patients with ulcerative colitis
showed it to be common and, as anticipated,
more frequently associated with active
distal colitis but still occurring in those with
quiescent disease. For the first time, it provides
insight into its incidence and proposed
diagnostic criteria to assist with
its recognition.
Severe fatigue induced by thiopurines. Lee T,
Iser J, Sparrow M, Newnham E, Headon B,
Gibson P. This report of five patients with
severe fatigue almost certainly causally
Eastern Health Research Report 2009-10 15
medicine eastern health clinical school
related to therapy with azathioprine and sixmercaptopurine alerted gastroenterologists
to this adverse effect that had not previously
been documented.
Clinical usefulness of therapeutic drug
monitoring of thiopurines in patients with
inadequately controlled inflammatory
bowel disease. Haines M, Ajlouni Y, Irving P,
Sparrow M, Rose R, Gearry R, Gibson P. The
application of thiopurine metabolite testing
to clinical practice in patients with IBD (where
thiopurines are a cornerstone of long-term
management) is controversial. We set up
such testing in our laboratory and examined
the impact that it had on 62 patients not
adequately responding to thiopurine therapy.
Measurement of metabolities had a major
impact on patient outcomes and clinical
decisions. This study will provide important
evidence to support the widespread use of
such testing in clinical practice.
Self-administered inhaled methoxyflurane
significantly improves patient comfort
during nasoduodenal intubation for
computed tomography enteroclysis
(CTE) for suspected small bowel disease:
a randomised, double-blind, placebo
controlled trial. Moss A, Parrish F, Naidoo
P, Upton A, Prime H, Leaney B, Gibson P.
Our previous study of CT enteroclysis, an
imaging technique for the small bowel that
involves the passage of a nasoduodenal tube
to infuse contrast material directly into the
small bowel, showed it to be of great clinical
value however patients rated it as extremely
unpleasant. We subsequently undertook
this randomised placebo-controlled trial
of inhaled methoxyfluorane (Penthrox)
to determine if it could improve patient
experience. Indeed, it markedly improved
the patient experience of the nasodudenal
intubation, although the experience overall
was not improved. Tolerance and safety
were excellent.
Vaccination and screening for infections in
patients with inflammatory bowel disease:
a survey of Australian gastroenterologists.
Gupta A, Macrae F, Gibson P. The risk of
infection associated with immune modulating
therapy, commonly used in patients with
IBD, warrants preventive measures being
taken and guidelines have now been created
for this. This survey gauged the attitudes
towards and actual practice of Australian
gastroenterologists with respect to screening
for infections and vaccination profiles of
16 Eastern Health Research Report 2009-10
patients. The findings indicated deficiencies
and the need for changes in practice.
The relationship of overseas deployment
and doxycycline use for malarial prophylaxis
to the development of functional bowel
disorders and inflammatory bowel disease
in staff of the Australian Federal Police.
Lee T, Russell L, Deng G, Gibson P. In response
to suggestions that staff of the Australian
Federal Police had developed IBD because
of overseas deployment and prolonged
doxycycline therapy as prophylaxis for malaria,
a web-based questionnaire was developed
and sent to all current and past members of
the Australian Federal Police Association. The
interesting results will be released shortly.
Functional Gastrointestinal
Disorders Program
Comparison of the prevalence of fructose
and lactose malabsorption across chronic
intestinal disorders. Barrett J, Irving P,
Shepherd S, Muir J, Gibson P. This study of
a large number of patients having breath
hydrogen tests showed that fructose and
lactose malabsorption are findings that occur
as commonly in healthy as they do in patients
with functional gut problems. The study
found they are more common in patients
with inflammatory bowel disease. It also
provided evidence that lactose malabsorption
is not more common in untreated coeliac
disease as is current dogma.
Benefits of breath hydrogen testing
following lactulose administration in
analysing carbohydrate malabsorption.
Bate J, Irving P, Barrett J, Gibson P. This study
showed the value of performing breath
hydrogen testing with lactulose prior to
testing with fructose, lactose or other sugars. It
helps understand the speed of transit through
the gut in the individual, the magnitude of
the hydrogen response and detects situations
where small intestinal bacterial overgrowth
may be present.
The relevance of immediate and delayed
gastrointestinal symptoms in patients
undertaking fructose breath hydrogen
testing. Ng PS, Muir J, Barrett J, Smith S,
Gibson P. This study examined the
controversial area of documenting symptoms
induced or exaggerated by the fructose during
a fructose breath hydrogen testing. With
volunteers following strict dietary regimens to
reduce potential confounding variables, the
study showed that detection of symptoms
during the test is of fair accuracy in association
with the presence of fructose malabsorption,
but symptoms over the ensuing 36 hours were
totally unreliable. This study highlights the
minimal value of symptom induction during
breath hydrogen testing.
Future research direction
This division will continue to focus on
short-chain, poorly absorbed carbohydrates
(FODMAPs) and their role in the genesis of
functional gut symptoms associated with
IBS and IBD. We hope to gain a greater
understanding of the factors associated with
wheat and gluten intolerance in individuals
who do not have coeliac disease. The current
focus of our coeliac disease research will
continue. In IBD, a new area of work will be
to look at cardiovascular risks in patients with
Crohn’s disease with a particular focus of
choline, an essential nutrient that has never
been studied in this population and that
theoretically has a major role to play. We will
also be pursuing methodologies to examine
quality in ambulatory care management of
patients with IBD and will be looking at the
utility of faecal calprotectin in improving
the quality of clinical decision-making. In
functional gastrointestinal disorders, we will be
directing more attention to predictive factors
(including novel biomarkers) for response or
otherwise to the low FODMAP diet.
Publications
Published
Barrett J, Shepherd S, Gibson P. Strategies
to manage gastrointestinal symptoms
complicating enteral feeding. J Parent Enter
Nutr 2009;33:21-6.
Andrews J, Travis S, Gibson P, Gasche C.
Systematic review: Concurrent therapy with
5-ASA and immunomodulators in IBD. Aliment
Pharmacol Ther 2009;9:459-69.
Mikocka-Walus, A, Clarke D, Gibson P.
Can antidepressants influence the course
of inflammatory bowel disease (IBD)? The
current state of research. Eur Gastroenterol
Hepatol Rev 2009;5(1). (in press)
Gibson P. Overview of inflammatory bowel
disease in Australia in the last 50 years. J
Gastroenterol Hepatol 2009;24 Suppl 3:S63-8.
Gibson P, Shepherd S. Evidence-based
dietary management of functional
eastern health clinical school medicine
gastrointestinal disorders. The FODMAP
approach. J Gastroenterol Hepatol 2010;
25(2):252-8.
lactoferrin in the evaluation of hospitalised
patients with diarrhea. Intern Med J 22 Oct
2009. [Epub ahead of print]
Morrison G, Headon B, Gibson P. Update
in inflammatory bowel disease. Aust Fam
Phys 2009.
Ooi C, Fock K, Makharia G, Goh K, Ling K,
Hilmi I, Lim W, Kelvin T, Gibson P, Gearry R,
Ouyang Q, Sollano J, Manatsathit S,
Rerknimitr R, Wei S, Leung W, de Silva H,
Leong R; Asia Pacific Association of
Gastroenterology Working Group on
Inflammatory Bowel Disease. The Asia-Pacific
consensus on ulcerative colitis. J Gastroenterol
Hepatol 2010;25:453-68.
Gupta A, Macrae F, Gibson P. Vaccination
and screening for infections in patients with
inflammatory bowel disease: a survey of
Australian gastroenterologists. Intern Med J
2009 Oct 22. [Epub ahead of print]
Barrett J, Muir J, Gibson P. Pre and probiotics.
Medicine Today. Accepted for publication.
van Langenberg D, Gibson P. Systematic
review: fatigue in inflammatory bowel disease.
Aliment Pharmacol Ther 2010;31:131-143.
Muir J, Rose R, Rosella O, Liels K, Shepherd S,
Barrett J, Gibson P. Measurement of shortchain carbohydrates (FODMAPs) in common
Australian vegetables and fruit by high
performance liquid chromatography (HPLC)
with evaporative light-scattering detection
(ELSD). J Agric Food Chem 2009, 57, 554-565.
Moss A, Parrish F, Irving P, Haines M,
Gibson P. Quality, clinical impact and
tolerance of CT enteroclysis in patients with
suspected small bowel disease. Int Med J
2009 Nov;39(11):733-43.
Haines M, Gibson P. Delayed adverse
reactions to total dose intravenous iron
polymaltose. Intern Med J 2009;39:252-5.
Gearry R, Irving P, Barrett J, Nathan D,
Shepherd S, Gibson P. Reduction of dietary
FODMAPs improves abdominal symptoms in
patients with inflammatory bowel disease. J
Crohn’s Colitis 2009;3:8-14.
Lee T, Iser J, Sparrow M, Newnham E,
Headon B, Gibson P. Thiopurines, a previously
unrecognised cause for fatigue in patients
with inflammatory bowel disease. J Crohn’s
Colitis 2009;3:196-9.
Barrett J, Irving P, Shepherd S, Muir J,
Gibson P. Comparison of the prevalence of
fructose and lactose malabsorption across
chronic intestinal disorders. Aliment
Pharmacol Therap 2009; 30:165-174.
Reid L, Chivers S, Plummer V, Gibson P.
Inflammatory bowel disease management:
a review of nurses’ roles in Australia and
the United Kingdom. Aust J Adv Nurs
2009;27:19-26.
van Langenberg D, Gearry R, Wong H,
Ward M, Parker F, Gibson P. The role of faecal
Friedman A, Chan A, Deen A, Hammerschlag
G, Lee M, Liddell J, Loh K, Moore E, Ng J,
Gibson P. The use and abuse of faecal occult
blood tests in an acute hospital inpatient
setting. Intern Med J 2010;40:107-11.
Bate J, Irving P, Barrett J, Gibson P. Benefits of
breath hydrogen testing following lactulose
administration in analysing carbohydrate
malabsorption. Eur J Gastroenterol Hepatol
2010 Mar;22(3):318-26.
Tan V, Ching S-L, Anderson R, Gibson P.
Increased risk of positive coeliac serology in
patients presenting with non-axial fracture,
but not axial fractures or depression. Intern
Med J 2010;40:225-7.
Barrett J, Gearry R, Muir J, Irving P, Rose R,
Rosella O, Haines M, Shepherd S, Gibson P.
Dietary poorly absorbed, short-chain
carbohydrates increase delivery of water and
fermentable substrates to the proximal colon.
Aliment Pharmacol Therap 2010;31:874-82.
Ong D, Mitchell S, Barrett J, Shepherd S,
Irving P, Biesiekierski J, Smith S, Gibson P,
Muir J. Manipulation of dietary short-chain
carbohydrates alters the pattern of gas
production and genesis of symptoms in
irritable bowel syndrome. J Gastroenterol
Hepatol 2010;25:1366-73. (See editorial
comment)
Newnham E, Gearry R, Gibson P. Factors
associated with radiation exposure in patients
with inflammatory bowel disease. Aliment
Pharmacol Therap 2010;31:534-5.
Foley A, Gibson P. Bowel habit change in
a woman in her late fifties. Medicine Today
2009;10:83-4.
Morrison G, Headon B, Gibson P. Update in
inflammatory bowel disease. Aust Fam Phys
2009;38:956-61.
Garg M, Morrison G, Friedman A, Lau A,
Lau D, Gibson P. A rapid-infusion protocol
is safe for total dose iron polymaltose:
time for change. Intern Med J (accepted for
publication)
Barrett J, Gibson P. Development and
validation of a comprehensive semiquantitative food frequency questionnaire
that includes FODMAP intake, glycaemic
index and glycaemic load. J Am Diet Ass.
(Accepted for publication)
Haines M, Ajlouni Y, Irving P, Sparrow M,
Rose R, Gearry R, Gibson P. Clinical usefulness
of therapeutic drug monitoring of thiopurines
in patients with inadequately controlled
inflammatory bowel disease. Inflamm Bowel Dis
Halmos E, Muir J, Barrett J, Shepherd S,
Gibson P. Diarrhoea during enteral nutrition
is predicted by the poorly absorbed shortchain carbohydrate (FODMAP) content of
the formula. Aliment Pharmacol Therap Jul 28.
[Epub ahead of print]
Moss A, Parrish F, Naidoo P, Upton A, Prime H,
Leaney B, Gibson P. Self-administered inhaled
methoxyflurane significantly improves patient
comfort during nasoduodenal intubation for
computed tomography enteroclysis (CTE) for
suspected small bowel disease: A randomised,
double-blind, placebo controlled trial.
Clin Radiol (Accepted for publication)
Gibson P, Gearry R. Optimising thiopurine
therapy – more weight to the metabolite
argument. J Gastroenterol Hepatol.
Gibson P, Shepherd S. Lessening symptoms
in IBS and IBD by food choice. In: Bayless TM,
Hanauer SB. Advanced therapy in inflammatory
bowel disease. 3rd edition.
Foley A, Gibson P. Optimising the use of
methotrexate in IBD. In: Rampton D, Irving P,
Shanahan F (eds) 50 Clinical Dilemmas in
IBD - 2. Blackwell, Oxford 2010.
Presentations
In press
Gibson P, Barrett J. The concept of small
intestinal bacterial overgrowth in relation to
functional gastrointestinal disorders. Nutrition
2010 Apr 24. [Epub ahead of print]
International
Muir JG. The role of fermentable
carbohydrates in the health of the
gastrointestinal tract. American Association
Eastern Health Research Report 2009-10 17
medicine eastern health clinical school
of Cereal Chemists International Annual
Meeting, Honolulu, Hawaii, USA 2008.
Addenbrooke Hospital. Cambridge, UK,
March 2010.
Muir JG. Manipulating dietary intake of
poorly absorbed and fermentable short-chain
carbohydrates (FODMAPs): Implications for
gastrointestinal health. 9th Vahouny Fiber
Symposium, Bethesda North, Maryland,
USA 2010.
Gibson PR. Fructose, sorbitol and poorly
absorbed carbohydrates: culprits or innocent
bystanders? Digestive Diseases Week. New
Orleans, Louisiana, USA, March 2010.
Gibson PR. Mechanism of action of FODMAPs.
International Organisation for Inflammatory
Bowel Diseases. Phoenix, Arizona, USA,
March 2009.
Gibson PR. (1) Advances in the management
of inflammatory bowel disease, (2) Dietary
management of irritable bowel syndrome.
Children’s Hospital and 1st Hospital. Wuhan,
China, November 2009.
Gibson PR. (1) Changing concepts in
coeliac disease. (2) Optimising therapy in
inflammatory bowel disease. (3) The use of
biological therapy in inflammatory bowel
disease. Biennial Scientific Meeting of the
Jordanian Society of Gastroenterology.
Amman, Jordan, March 2010.
Gibson PR. Food choice – the key to
management of functional gut symptoms.
Shepherd SJ. Body composition changes
over the first year in patients newly diagnosed
coeliac disease. 13th International Coeliac
Disease Symposium. Amsterdam, April 2009.
National
Muir JG. Poorly absorbed short-chain
carbohydrates are substrates for colonic
fermentation: Important implications for
gastrointestinal health. 59th Australian Cereal
Chemistry Conference, Wagga Wagga,
NSW 2009.
Gibson PR. Infections occurring in
immunosuppressed patients. Australian
Gastroenterology Week. Brisbane,
October 2009.
Gibson PR. Methotrexate therapy – oral or
parenteral? Raising Expectations Symposium.
Sydney, March 2010.
Gibson PR. (1) New concepts in coeliac
disease. (2) Food choice – the key to
management of functional gut symptoms.
The Canberra Hospital. Canberra,
May 2010.
Shepherd SJ. Dietary management of
symptoms of IBS: the FODMAP approach.
Dieticians Association of Australia (state
branch) Symposia presented in Canberra,
Adelaide, Sydney, Brisbane, Tamworth,
Wagga Wagga, 2009-2010.
Shepherd SJ. Dietary management
of symptoms of IBS: the FODMAP
approach. AstraZeneca Sponsored GP and
Gastroenterologist Professional Development
Information Seminars Gold Coast, Townsville,
Melbourne, Sunshine Coast, Adelaide 2009-10
Shepherd SJ. Hydrogen breath testing and
malabsorption syndromes. Gastroenterology
Nursing Council of Australia (GENCA).
Melbourne, February 2009.
Shepherd SJ. IBS and FODMAPS in
gastroenterology – a windy tale. Gut Club.
Canberra, ACT, April 2009.
Shepherd SJ. The FODMAP approach for
dietary management of IBS. Australian Society
for Immunology. Melbourne, July 2009.
•Dr Daniel van Langenberg
Consultant Gastroenterologist (VMO) Eastern Health
Focusing on Inflammatory Bowel Diseases (IBD) (Gastroenterology)
Dr Daniel van Langenberg began his career as an intern at Eastern
Health in 2002 and completed the majority of his physician training
years at Eastern Health, during which time he developed an
interest in medical research. In February 2009 Daniel commenced
full-time clinical research in the Department of Gastroenterology/
Hepatology, Box Hill Hospital under the supervision of Professor
Peter Gibson, towards a PhD (Monash University). His primary
research focus is ‘Demystifying fatigue in Crohn’s disease’, given that
fatigue is a common, debilitating yet under-recognised symptom
in patients with Crohn’s disease. Through this research he hopes to
18 Eastern Health Research Report 2009-10
gain a better understanding of the prevalence, causative factors
and potentially ameliorative approaches in fatigue in Crohn’s
disease. Over 170 patients from the Box Hill Hospital IBD clinic are
participating in this study.
Daniel has been awarded an NHMRC medical postgraduate
scholarship in order to perform this research, which is partly
supported also by an unrestricted grant from Orphan Australia. His
other research interests include the investigation of chronic pain
and other quality-of-life related challenges in patients with IBD.
eastern health clinical school medicine
Shepherd SJ. Dietary management of
symptoms of IBS: the FODMAP approach.
AstraZeneca GP Post Graduate GI Symposium.
Melbourne, September 2009.
in patients with functional gut symptoms
Shepherd SJ. Dietary factors and abdominal
pain - is there a dietary component to IBS?
Continence Foundation of Australia 18th
National Conference on Incontinence.
Adelaide, November 2009.
randomised, double-blind, placebo-controlled
Shepherd SJ. Coeliac disease and fructose
intolerance – its effects on diabetes
management: how much are we absorbing?
National Diabetes Health Professional
Symposium (Baker IDI Heart & Diabetes
Institute and Diabetes Australia). Melbourne,
May 2009.
Gibson PR. Optimising therapy in Crohn’s
disease. Tasmanian Gut Club. Launceston,
September 2009.
Awards
Jessica Biesiekierski: Douglas Piper Young
Investigator Award, Gastroenterological
Society of Australia, 2009
Prof Peter Gibson: Distinguished Research
Prize, Gastroenterological Society of
Australia, 2010.
Dr Sue Shepherd: State finalist for Telstra
Australian Businesswoman of the Year 2009
and an early rise of breath hydrogen after
lactulose. $298,200.
Falk Pharma (2010-11) A phase II,
study to evaluate the efficacy and safety of
oral effervescent budesonide in the induction
of mucosal healing in newly diagnosed
coeliac disease. $150,000.
Wyeth (2009) Methylnaltrexone in narcotic
bowel syndrome. $5,000.
Vifor International (2009) Safety of rapid
infusion of iron polymaltose. $5,000.
Scholarships:
• Halmos E, Eastern Health Clinical
School,Postgraduate scholarship
• Biesiekierski J, Faculty of Medicine, Nursing
and Health Sciences, Postgraduate
scholarship
• Van Langenberg D, NHMRC, Postgraduate
scholarship
• Newnham E, Gastroenterological Society of
Australia, Postgraduate scholarship
Research training
PhD
• Halmos E, Monash University, F/T
Grants
NHMRC Project Grant (2008-2010) The
role of dietary FODMAPs in the genesis of
symptoms in patients with irritable bowel
syndrome and Crohn’s disease. Gibson PR,
Muir JG, Shepherd SJ, Smith S. $130,000 pa.
ARC Linkage (2010-2013) Development of
novel cereal grain products for wheat- and
gluten-intolerant Australians. Muir JG, Gibson
PR, Suter D, Bekes F. $100,000 pa.
Coeliac Research Fund Inc. (2010) An
evaluation of cognitive changes in response
to gluten challenge in patients with coeliac
disease on a strict gluten-free diet. $40,000.
Eva & Les Erdi Foundation (2005-9) Defining
the Western factor in the susceptibility to
Crohn’s disease. $25,000 pa
Yakult Australia (2010-11) Randomised,
placebo-controlled trial, followed by openlabel treatment and withdrawal phases, of
the effect of Yakult on fermentation patterns
• Biesiekierski J, Monash University, F/T
Eastern Clinical
Research Unit
The Eastern Health Clinical School, Eastern
Clinical Research Unit (ECRU) division has two
major areas of research.
(1) The performance of clinical drug trials
is the core activity upon which ECRU
was created. The clinical trials are mostly
multicentre and pharmaceutically sponsored
trials. Most are phase III or III although we
are starting to perform phase I studies.
Occasionally phase IV are done. ECRU has
a wide skill base capable of designing
and evaluating clinical trials, however the
predominant activity is in the recruitment,
assessment and therapy of patients within
clinical trial protocols. There is a large
staff of principal investigators, clinical trial
coordinators (mostly nurse specialists) and
administrative staff.
(2) ECRU Biotech was conceived in response
to a recognised need to expand the activities
of ECRU beyond the clinical sphere and into
the fields of basic and more translational
research. Modern biotechnology programs
require a broad range of research activities
spanning evaluation of existing agents
with potential application to novel clinical
scenarios to design, development and
testing of novel agents in pre-clinical
models of disease.
• Van Langenberg D, Monash University, F/T
Major Achievement
• Newnham E, Monash University, F/T (P/T
The highlight of the year has been the move
to 5 Arnold Street where excellent facilities for
seeing participants in clinical trials has markedly
improved. An essential part of a successful
clinical trial group is that the experience of a
person volunteering to participate is warm,
pleasant and friendly. This has indeed been
achieved by the facility on Level 1, where a
receptionist can greet the patient who can wait
in a comfortable reception area. Conditions
for staff have also improved considerably with
better laboratory facilities and office conditions.
This facility reflects the excellent cooperative
spirit between Monash University and
Eastern Health.
from early 2010)
• James SL, Monash University, P/T
• Mond M, Monash University, F/T
Masters
• Ward S, Monash University, P/T
• Dandie L, Monash University, P/T
• Mills J, Monash University, F/T
Honours students
• Yao CK, Monash University, 2009
• Tan HL, Monash University, 2009
• Power V, Monash University, 2009-2010
• Iacovou M, Monash University, 2010
• Ku C, 2010, Monash University, 2010
• Moltzen A, Monash University, 2010
Research projects in progress
(1) CLINICAL DRUG TRIALS
More than 100 active drug trials are currently
in progress at ECRU sites at 5 Arnold Street
Eastern Health Research Report 2009-10 19
medicine eastern health clinical school
opposite Box Hill Hospital and at our facility
at Ware Crescent opposite Maroondah
Hospital. Trials span most specialities including
haematology (A/Prof Paul Coughlin,
Prof Hatem Salem and Associate Prof Michael
Leyden), oncology (Dr Phil Parente and
Assoc Prof Joe McKendrick), endocrinology
and diabetes (Associate Prof Richard Simpson
and Dr Murray Gerstman), neurology
(Prof Chris Bladin and Dr Helmut Butzkueven),
gastroenterology (Prof Peter Gibson and
Dr Sanjay Nandurkar), respiratory medicine
(Assoc Prof Frank Thien), nephrology
(Prof Lawrence McMahon), rheumatology
(Dr Christopher Fong) and dermatology
(Dr John Su). There are approximately 50
research nurse coordinators employed.
The income generated from the trials is
about $3 million per year. See speciality
report for further information.
(2) ECRU BIOTECH
Therapeutic use of novel histone
deacetylase inhibitors (HDACi) in breast
carcinoma. Dear A, Anderson E.
Peter MacCallum Cancer Research Institute,
Melbourne, Australia.
Evaluation of matrix metalloproteinase and
urokinase inhibitors in abdominal aortic
aneurism and neointimal hyperplasia.
Dear A, Widdop R (Department of
Pharmacology, Monash University), Grigg M
(ECRU/Monash University, Departments of
Surgery, Box Hill Hospital).
Evaluation of gene expression profiles
associated with abdominal aortic aneurism
formation and progression. Dear A,
Golledge J (James Cook University, Townsville,
Queensland, Australia).
Molecular regulation of the orphan nuclear
receptor Nur77 by thiazolidinediones:
identification of new therapeutic targets
in endothelial cell dysfunction. Dear A,
Simpson R (Box Hill Hospital, Department of
Endocrinology).
of vascular disease. Dear A, Simpson R,
Knudsen L (Novo Nordisk).
Identification and characterisation of novel
epigenetic treatments for myelodysplastic
syndrome and multiple myeloma. Dear A,
Voso MT, McKendrick J, Spencer A, Lynch K
(Celgene), Heise C (MethylGene).
Identification and characterisation of the
molecular mechanisms responsible for
histone deacetylase inhibitor activity in
malignant lymphoma. Dear A, Johnstone R
(Peter MacCallum Cancer Centre).
Effects of novel HDAC inhibitors on
HIV latency. Dear A, Lewin S (Burnet
Research Institute).
Research projects completed
(1) CLINICAL DRUG TRIALS
Clinical trial completed can be seen under
entries from individual specialties.
(2) ECRU BIOTECH
Molecular regulation of vascular adhesion
molecules and plasminogen activator
inhibitor type 1 (PAI-1) expression by
glucagon like peptide-1 (GLP-1)/liraglutide
and sitagliptin in in vitro and in vivo models
of vascular disease. Anthony D, Simpson R,
Knudsen L (Novo Nordisk). Within the
sphere of diabetes research, several novel
observations have been made including
identification of previously unrecognised
potential benefits of diabetic agents in the
prevention of atherosclerosis in the vulnerable
diabetic population. These observations
have been presented at several international
scientific meetings and published in
international scientific journals (Liu et al,
J Endocrinol 2009).
Effects of thiazolidinediones and
GLP-1 analogues on severity of acute
thromboembolic cerebrovascular
accident. Dear A, Bladin C (Box Hill Hospital,
Department of Neurology).
Evaluation of gene expression profiles
associated with abdominal aortic aneurism
formation and progression. Dear A, Golledge J
(James Cook University, Townsville). Work
performed in collaboration with Prof Jon
Golledge of James Cook University has aided
clarification of the potential benefits of statin
prescription in patients with abdominal
aneurysm (Ferguson C et al Am Heart J 2010).
Molecular regulation of vascular adhesion
molecules and plasminogen activator
inhibitor type 1 (PAI-1) expression by
glucagon like peptide-1 (GLP-1)/liraglutide
and sitagliptin in in vitro and in vivo models
Identification and characterisation of novel
epigenetic treatments for myelodysplastic
syndrome and multiple myeloma. Dear A,
Voso MT, McKendrick J, Spencer A, Lynch K
(Celgene), Heise C (MethylGene).
20 Eastern Health Research Report 2009-10
Therapeutic use of novel histone
deacetylase inhibitors (HDACi) in breast
carcinoma. Dear A, Anderson R,
(Peter MacCallum Cancer Centre)
Melbourne, Australia.
Effects of novel HDAC inhibitors on
HIV latency. Dear A, Lewin S (Burnet
Research Institute). The unit’s interest
in the evaluation of the novel class of
therapeutic agents, Histone Deacetylase
Inhibitors (HDACi) has resulted in important
observations regarding the mechanism of
action of the novel HDACis, including MCT-1
recently identified in the laboratory (Dear et al,
Org and Biomol Chem 2006) and MGCD0103 in
myelodysplasia (Liu et al, Int J Onc 2009) and
breast cancer (Restall et al, Int J Cancer (2009).
Additional observations pertaining to the
potential therapeutic benefits of HDACi in HIV
AIDS have also been investigated (ShehuXhilaga M et al, AIDS 2009).
Future research direction
The unit has a broad range of biotechnology
research interests. Recent focus has been
on the evaluation of Histone Deacetylase
Inhibitors (HDACi) in multiple models of
disease including lymphoma, leukaemia,
viral infection and vascular disease. In
addition, the expansion of the diabetes
research program has afforded evaluation
of compounds recently released into the
marketplace in models of atherogenesis.
Future research directions for the unit will
include ongoing evaluation of HDACi activity
in disease states including solid tumours,
neurological conditions such as Huntington’s
disease and renal diseases together with
expansion of the in vivo evaluation of existing
agents in the treatment of diabetes.
Publications
Published
(1) CLINICAL DRUG TRIALS: see under
individual specialties for presentations
(2) ECRU BIOTECH
Liu HB, Voso MT, Gumiero D, Doung J,
McKendrick JJ, Dear AE. The anti-leukemic
effect of a novel histone deacetylase inhibitor
MCT-1 and azacytidine involves induction of
Nur77 and inhibition of MMP-9 expression.
Int J Onc 2009;34:573-9.
eastern health clinical school medicine
Restall C, Doherty J, Genovese R, Liu H,
Anderson R and Dear A. A novel histone
deacetylase inhibitor, MCT-1, augments
Tamoxifen-mediated inhibition of breast
carcinoma growth in vivo. Int J Cancer
2009;125:483-487.
Liu H, Knudsen L, Simpson R, Dear A. A long
acting GLP-1 analogue inhibits induction
of PAI-1 and vascular adhesion molecule
expression. J Endo 2009;201:59-66.
Shehu-Xhilaga M, Rhodes D, Wightman F,
Liu H, Solomon A, Saleh, S, Dear A,
Cameron P, Lewin S.. Novel HDAC inhibitors
MCT-1 and MCT-3 have potent activity on
HIV-1 transcription in latently infected cells.
AIDS 2009;23:2047-50.
Ferguson C, Clancy P, Bourke B, Walker P,
Dear AE, Buckenham T, Norman P,
Golledge J. Association of statin prescription
with small abdominal aortic aneurysm
progression. Am Heart J 2010;159:307-13.
Ferguson C, Clancy P, Bourke B, Walker P,
Dear A, Buckenham T, Norman P,
Golledge J. Epigenetic mechanisms and their
possible role in abdominal aortic aneurysm.
Atherosclerosis 2010 Mar 6. [Epub ahead
of print].
In press
Dick R, Dear A, Byron K. Clopidogrel
resistance: case reports of CYP2C19 gene
variants in suspected coronary stent
thrombosis. Heart Lung and Circulation
(June 2010).
Abstracts
Dear A, Liu H, Knudsen L, Simpson R.
Liraglutide-mediated inhibition of PAI-1 and
vascular adhesion molecules is associated
with attenuation of Nur77 expression.
J Diabetes 2009:1:Suppl 1:A63.
Liu H, Hu Y, Simpson R, Dear A.
PPARγ Independent mechanisms of
thiazolidinedione inhibition of PAI-1
expression in vascular endothelial cells.
Diabetes and Vascular Disease Research 2010
7:73:87-88.
In Press
Simpson R, Liu H, Gaspari T, Welungoda I,
Widdop R, Knudsen L, Dear A. Liraglutide
inhibits endothelial cell dysfunction and
reduces expression of adhesion molecules
associated with atherogenesis. Diabete.
(June 2010)
Outcomes from
collaborative research
(1) CLINICAL DRUG TRIALS: see under
individual specialties
(2) ECRU BIOTECH
Schulman S, Kearon C, Kakkar A, Mismetti P,
Schellong S, Eriksson H, Baanstra D, Schnee
J, Goldhaber SZ; RE-COVER study group.
Dabigatran versus warfarin in the treatment of
acute venous thromboembolism. New Eng
J Med 2009:361:2342-52.
Paty I, Trellu M, Destors J, Cortez P, Boëlle E,
Sanderink G; EQUINOX sub-study.
Reversibility of the anti-FXa activity of
idrabiotaparinux (biotinylated idraparinux)
by intravenous avidin infusion. J Throm Haem
2010:8:722-9.
De Silva D, Brekenfeld C, Ebinger M,
Christensen S, Barber P, Butcher K, Levi C,
Parsons M, Bladin C, Donnan G, Davis S;
Echoplanar imaging thrombolytic
evaluation trial (EPITHET) Investigators. The
benefits of intravenous thrombolysis relate
to the site of baseline arterial occlusion in the
echoplanar imaging thrombolytic evaluation
trial (EPITHET). Stroke. 2010:41:295-9.
NAVIGATOR study group, Holman RR,
Haffner S, McMurray J, Bethel M,
Holzhauer B, Hua T, Belenkov Y, Boolell M,
Buse J, Buckley B, Chacra A, Chiang F et al.
Effect of nateglinide on the incidence of
diabetes and cardiovascular events. New Eng
J Med 2010:362:1463-76.
NAVIGATOR study group, McMurray J,
Holman R, Haffner S, Bethel M, Holzhauer B,
Hua T, Belenkov Y, Boolell M, Buse J,
Buckley B, Chacra A, Chiang F. Effect of
valsartan on the incidence of diabetes
and cardiovascular events. New Eng J Med
2010:362:1477-90.
Hanley A, Zinman B, Sheridan P, Yusuf S,
Gerstein H; Diabetes reduction assessment
with ramipril and rosiglitazone medication
(DREAM) investigators. Effect of Rosiglitazone
and Ramipril on {beta}-cell function in people
with impaired glucose tolerance or impaired
fasting glucose: the DREAM trial. Diabetes Care
2010:33:608-13.
Buse J, Wolffenbuttel B, Herman W,
Shemonsky N, Jiang H, Fahrbach J,
Scism-Bacon J, Martin S. Durability of
basal versus lispro mix 75/25 insulin
efficacy (DURABLE) trial 24-week results:
safety and efficacy of insulin lispro mix
75/25 versus insulin glargine added to oral
antihyperglycemic drugs in patients with type
2 diabetes. Diabetes Care 2009:32:1007-13.
Nauck M, Frid A, Hermansen K, Shah N,
Tankova T, Mitha I, Zdravkovic M, Düring M,
Matthews D; LEAD-2 study group. Efficacy
and safety comparison of liraglutide,
glimepiride, and placebo, all in combination
with metformin, in type 2 diabetes: the LEAD
(liraglutide effect and action in diabetes)-2
study. Diabetes Care 2009:1:84-90.
Moses R, Bartley P, Lunt H, O’Brien RC,
Donnelly T, Gall MA, Vesterager A, Wollmer P,
Roberts A. Safety and efficacy of inhaled
insulin (AERx iDMS) compared with
subcutaneous insulin therapy in patients
with type 1 diabetes: One-year data from a
randomised, parallel group trial. Diabetes
Med 2009:26:260-7.
Presentations
International
(1) CLINICAL DRUG TRIALS: see under
individual specialties for presentations
(2) ECRU BIOTECH
International
Dear A, Liu H, Knudsen L, Simpson R.
Liraglutide-mediated inhibition of PAI-1 and
vascular adhesion molecules is associated
with attenuation of Nur77 expression. In
Proceedings 3rd International Congress on
Prediabetes and the Metabolic Syndrome.
Nice, France, April 2009.
Liu H, Hu Y, Simpson R, Dear A.
PPARγ Independent mechanisms of
thiazolidinedione inhibition of PAI-1
expression in vascular endothelial cells. In
Proceedings: 7th Annual World Congress on
Insulin Resistance. San Francisco, CA, USA,
November 2009.
Simpson R, Liu H, Gaspari T, Welungoda I,
Widdop R, Knudsen L, Dear A. Liraglutide
inhibits endothelial cell dysfunction and
reduces expression of adhesion molecules
associated with atherogenesis. In Proceedings
American Diabetes Association 70th Scientific
Sessions. Orlando, Florida, USA, June 2010.
Eastern Health Research Report 2009-10 21
medicine eastern health clinical school
National
Shehu-Xhilaga M, Rhodes D, Wightman F,
Liu H, Solomon A, Saleh S, Dear A,
Cameron P, Lewin SR.. Novel HDAC Inhibitors
MCT-1 and MCT-3 have potent activity on
HIV-1 transcription in latently infected cells. In
Proceedings: Australian HIV/AIDS conference.
Brisbane, September 2009.
Dear A, Deam D, Tanti T, Byron K. The
pharnacogenetic basis of clopidogrel
resistance: CYP2C19 genotype in a suspected
myocardial event population. In Proceedings:
Haematology Society of Australia and
New Zealand Annual Conference. Adelaide,
October 2009.
Local
Liu HB, Mayes PA, Perlmutter P,
McKendrick JJ and Dear AE. Novel Histone
22 Eastern Health Research Report 2009-10
deacetylase inhibitors MCT-3 and MGCD0103
regulate cell cycle and apoptosis associated
genes and suppress Induction of MMP-9
expression by azacitidine in HL-60 Cells. In
Proceedings: 21st Lorne Cancer Conference.
Lorne, June 2009.
Liu HB, Mayes PA, Perlmutter P,
McKendrick JJ and Dear AE. Effects
of novel hydroxamate and benzamide
histone deacetylase inhibitors alone and in
combination with azacytidine. In Proceedings:
22nd Lorne Cancer Conference. Lorne,
June 2010.
Grants
Novo Nordisk Characterisation of the in vitro
and in vivo effects of liraglutide on vascular
disease progression, Dear AE, Simpson RW,
$350,000.
Merck Sharpe & Dohme Characterisation of
the in vitro and in vivo effects of sitagliptin
on vascular disease progression. Dear AE,
Simpson RW, $196,000.
Victorian Cancer Agency Translational
Cancer Research Grant. Epigenetics and
cancer therapy. Multi-institutional funding,
$2,000,000.
Research training
Phd
• Chandran C, Monash University, F/T
• Lam YM, Monash University, F/T
Haematology Clinical Trials Unit ECRU medicine
> Haematology Clinical Trials Unit ECRU
Eastern Clinical Research Unit (ECRU)
haematology conducts clinical trials in the
area of both malignant and non-malignant
disorders of the blood. The unit currently
has 25 active studies with many others in
follow up. The diseases under investigation
in these clinical trials are many and include
thrombosis (prevention and treatment of PE
and DVT), multiple myeloma, leukaemias,
myelodysplasic disorders and lymphomas.
ECRU haematology is guided by Prof Hatem
Salem, A/Prof Paul Coughlin and more
recently A/Prof Anthony Schwarer. These
investigators are supported by a full-time
equivalent staff of six, including nurses
Claire Gollogly, Brenda Niessner, Maria di
Staso and Yvonne Chan who all perform
study coordinator activities, Rosemary Petrie
(data manager), Bronwen Williamson (ethics
secretary), Robyn Batrouney (administration
support) and Lesley Poulton (division
manager). ECRU haematology is affiliated
with the Australian Centre for Blood Diseases
and the Australasian Leukaemia and
Lymphoma Group.
Major achievement
Rivaroxaban is a new oral anticoagulant. This
Factor Xa inhibitor is now available to people
undergoing hip and knee replacement
surgery, for the prevention of venous
thromboembolism. Box Hill Hospital and the
Eastern Clinical Research Unit Haematology
Division contributed in a small way to this
drug becoming available to the greater public
by collaborating in several of the clinical
trials on which the FDA and TGA based their
approval for the use of this new drug in
this indication.
Rivaroxaban is also currently under study at
Box Hill Hospital and ECRU haematology in
the clinical trial “Einstein”. This study compares
the new drug rivaroxaban to standard
treatment with low molecular weight heparin
(clexane) and warfarin for the treatment
of pulmonary embolism and deep vein
thrombosis. To date the ongoing efficacy
and safety analysis is extremely promising.
Box Hill Hospital is the leading recruiter in the
Asia/Pacific area with 75 patients. This study
is expected to continue to recruit until the
end of 2010. We also conducted the sister
study “Einstein Extension”, the results of which
were presented at the 2009 meeting of the
American Society of Haematology
(see abstracts).
Onyx VTE orthopaedic surgery prevention
study (150–CL–040)
Research projects in progress
SAVE-ONCO VTE Prevention in
chemotherapy (EFC 6521)
The unit is solely a clinical trial unit and a list
of the many ongoing projects/studies follow.
As a clinical trial unit, the protocol summaries
and other trial information can be reviewed
online at the internationally accredited NIH
Clinical Trials Registry. Enter the study keyword
and the protocol number (shown in brackets
above) at http://clinicaltrials.gov/ct2/search.
Adopt VTE medical prevention study
(CV185036)
Amplify VTE treatment study (CV185056)
Amplify extension (CV185057)
Romiplostim: ITP bone marrow (Amgen
Protocol 20080009)
“Remedy” extended prevention of VTE
recurrence (1160.47)
Recover 2” VTE treatment study (1160.46)
SAVE-ABDO VTE Prevention in abdominal
surgery (EFC 6520)
AmBisome Primary prophylaxis of fungal
infection in AML (IN-AU-131-0176)
AML M12 Idrarubicin escalation in
consolidation therapy in AML (Amgen
protocol numbers: 20020394/20040199)
AML M13 High dose cytarabine and
flurabine in AML (Amgen protocol number:
20020400)
Antisoma Amonafide L-Malate in
secondary AML (0001A3-300-GL) Vidaza and
Thalidomide in Myelodysplastic Syndromes
(MDS3)
Aristotle thromboembolic event prevention
in AF (CV185030)
Revlimid TCL Revlimid in relapsed T-cell
Non-Hodgkin’s Lymphoma (CC-5013TCL-001)
Borealis thromboembolic event prevention
in AF (EFC10295)
RAD001 Adjuvant therapy in diffuse large
B-Cell lymphoma (CRAD001N2301)
Einstein VTE treatment study (IMP No.
11702)
PRIMA Rituximab maintenance therapy in
follicular lymphoma (NHL16-PRIMA)
ASPIRE extended prevention of VTE
recurrence (CTC0005)
BOMeR Velcade and dexamethasone in
multiple myeloma relapse (NCT00335348)
COMFORT-I Myelofibrosis treatment
with JAK inhibitor (INCB 18424-351):
“Magellan” VTE medical prevention study
(BAY59/7939/11289)
Vantage vorinostat and bortizimab
treatment of multiple myeloma – blinded
(MK 0683 088)
Vantage vorinostat and bortizimab
treatment of multiple myeloma – open
(MK 0683 095)
Research projects completed
Amg 531 ITP (20030212)
RE-NOVATE II (1160.64)
Einstein-Extension (IMP No. 11899)
Recover (1160.53)
Advance 3 (CV185035)
SAVE-KNEE (EFC 10571)
Eastern Health Research Report 2009-10 23
medicine Haematology Clinical Trials Unit ECRU
Future research direction
By continuing to conduct clinical trials in
haematology, our aim is to ensure that the
best available new treatments and therapies
are available to Eastern Health patients
without undue delay
Outcomes from research
collaboration
Schulman S, Kearon C, Kakkar AK,
Mismetti P, Schellong S, Eriksson H,
Baanstra D, Schnee J, Goldhaber SZ for the
RE-COVER Study Group. Dabigatran versus
warfarin in the treatment of acute venous
thromboembolism, N Engl J Med 2009 Dec
10;361(24):2342-52.
Lassen MR, Raskob GE, Gallus A, Pineo G,
Chen D, Hornick P for the ADVANCE-2
investigators. Apixaban versus enoxaparin for
thromboprophylaxis after knee replacement
(ADVANCE-2): a randomised double-blind trial.
Lancet 2010 Mar 6;375(9717):807-15.
Presentations
International
Buller HD, On behalf of the Einstein
investigators Once-daily oral rivaroxaban
versus placebo in the long-term prevention
of recurrent symptomatic venous
thromboembolism. The Einstein-extension
study, 52 ASH Annual Meeting, December
2009.
Harrison SJ, Quach H, Dean J, Milner A,
Copeman MC, Prince HM. Bortezomib and
dexamethasone from cycle 1 as treatment
and maintenance for multiple myeloma
relapse (The BoMeR trial): Impact on response
and time to progression Journal of Clinical
Oncology, 2010 ASCO Annual Meeting
Proceedings (Post-Meeting Edition). Vol 28, No
15-suppl (May 20 Supplement), 2010: 8151
2010 American Society of Clinical Oncology.
Huo M. A phase III randomised, parallel
group, double-blind, active controlled study
to investigate the efficacy and safety of
oral 220 mg dabigatran etexilate (110 mg
on the day of surgery followed by 220 mg
once daily) compared to subcutaneous 40
mg enoxaparin once daily for 28-35 days in
prevention of venous thromboembolism
in patients following primary elective total
hip arthroplasty (RE-NOVATE II), European
Haematology Association. Barcelona,
July 2010.
•Brenda Niessner
Study Coordinator, Haematology Clinical Trials Unit (ECRU)
Focused on supporting patients through their journey
Brenda has a long association with Box Hill Hospital having
commenced as a ward support before completing her nursing
training in 1973. Brenda’s nursing career has seen her work in many
departments of the hospital including midwifery, emergency and
on the stroke unit. She has further taken charge of the hospital after
hours as the hospital coordinator and supported other nurses in
training as a nurse educator.
Ready to take on a new change and a new challenge, four years
ago Brenda moved into the area of clinical research as a study
coordinator with the Haematology Clinical Trials Unit (ECRU).
24 Eastern Health Research Report 2009-10
Working in the field of clinical trials has brought with it many new
challenges for Brenda, but her focus as always remains on the
wellbeing of her patients who she regularly meets and supports
through their journeys. For Brenda some of these people have been
the most remarkable people she has ever met.
Upon reflection of her many and varied nursing roles and
responsibilities, Brenda continues to build upon the foundation of
her years of experience by sharing and transferring her skills and
knowledge in the field of clinical trials.
Breast oncology medicine
> Breast oncology
Research undertaken by breast oncology is
predominantly in the form of multicentre
phase II to IV clinical trials. There have
also been a number of locally developed
retrospective reviews and service provision
studies undertaken in the last few years.
Medical oncologists Drs. Jacquie Chirgwin
(principal investigator), Sue Chua, Laura
Pellegrini, Serene Foo, Geraldine Goss (coinvestigators) and breast surgeons Mr. Michael
Law and Rick Masters (principal investigators),
David Stoney, Sunny Jassal, Suzanne Moore,
Jennepher Martin and Michael Cheng (coinvestigators) have been involved in 15 trials
in the last two years at both Box Hill and
Maroondah hospitals, recruiting 100 new
patients and following up 384 patients.
During 2009, the three oncology registrars
employed at Eastern Health were involved
in a retrospective review of chemotherapy
dose intensity in the cohort of breast cancer
patients treated across Eastern Health in
2008, supported by Dr. Jacquie Chirgwin
and Deakin University researchers Drs. Trish
Livingston and Melinda Craike. Current
oncology registrars are undertaking a review
of survival outcomes for patients treated for
metastatic breast cancer at Eastern Health
since 2003.
Breast oncology research is supported by
two full-time research nurses Julie Dryden
and Danielle Rapson and a part-time
administrative assistant Angeline Thompson.
Major achievement
EMBRACE Study (Eribulin – EISAI) This
study was for patients with metastatic breast
cancer who had received several lines of
prior treatment. Patients were randomised to
receive a new chemotherapy agent eribulin or
standard care according to physician choice.
This study was undertaken at Maroondah
Hospital and nine patients were entered. This
was an international study and overall 762
patients were entered with 28 from Australia.
The results were recently presented in an oral
session at the American Society of Clinical
Oncology (ASCO) and were considered one of
the highlights of the meeting as a significant
overall survival benefit was demonstrated for
the patients treated with eribulin. The holy
grail of survival benefit is hard to achieve in
the setting of metastatic breast cancer where
survival is often long and affected by the use
of multiple lines of active treatment.
Research projects in progress
The following studies are currently recruiting
patients (or about to open):
Cooperative Group Studies
IBCSG 22-00 Maintenance chemotherapy in
hormone non-responsive breast cancer
IBCSG 34-05 / SWOG S0230 POEMS
Prevention of early menopause study
Local studies
Five-year survival outcome study
Survival outcome in metastatic breast cancer
Taxol premedication study
Research projects completed
The following studies completed
recruitment in the last 12 months:
ANZ 0601 CIRG/TORI 010. AMG 706 in
metastatic breast cancer: AMG 706 not
of value
A6181064 (Pfizer) Sunitinib breast cancer
study: Sunitinib not of value in metastatic
breast cancer
EMBRACE Eribulin in metastatic breast cancer:
See above
IBCSG 35-07/BIG 1-07 SOLE: Extended
adjuvant letrozole
The following studies require continued follow up
or further analysis before results will be available:
ANZ 0501 LATER: Late adjuvant letrozole
IBCSG 24-02/BIG 2-02-Suppression of
Ovarian Function Trial (SOFT)
ALCC 04.02 BATMAN Bisphosphonate
And anastrozole trial: algorithm for the
management of bone density
Goserelin: Quality of life study in young
women choosing adjuvant ovarian
suppression in preference to chemotherapy
IBCSG 24 sub study: Co-SOFT study of
cognitive function effects of endocrine
adjuvant breast cancer treatment.
NZ 0502 NEOGEM Neoadjuvant taxotere
and gemcitabine
ANZ 02P2/IBIS II Breast cancer
prevention study
ANZ 0702/ BIG 2-06 ALTTO Adjuvant
lapatinib and/or trastuzumab
ANZ 0802 CIRG/TRIO 012 Docetaxel +/Imclone CP12-0606 (angiogenesis inhibitor)
in metastatic breast cancer
PO5048 BACH Adjuvant trastuzumab
and caelyx
Pharmaceutical sponsored studies
EGF 108919 COMPLETE Study Trastuzumab
versus lapatanib as first line treatment of HER2
positive metastatic breast cancer
SHERSig Study Study of molecular biomarkers
during treatment of metastatic HER2 positive
breast cancer
D-CARE Study of adjuvant Denosumab
Thyroid Study A local study investigating any
association of thyroid dysfunction with breast
cancer or its treatment
Study of multidisciplinary team meeting
value A local study assessing value of MDM
via staff questionnaire
IMPACT Observational study of
neutropenia and anaemia management
in subjects with solid tumours receiving
myelotoxic chemotherapy
Eastern Health Research Report 2009-10 25
medicine Breast oncology
Future research direction
The unit will continue to be involved with a
wide range of clinical trials in breast cancer
and a further study will be undertaken by the
oncology registrars which is intended to be an
annual ongoing activity. The unit will continue
to collaborate in further studies with Deakin
School of Nursing researchers.
Publications
In press
Bae S, Yeung Y, Ng S, Craike M, Livingston PM,
Chirgwin J. A retrospective review of breast
cancer chemotherapy dose intensity. COSA
2010 Abstract and oral presentation.
Outcomes from research
collaboration
Viale G, Giobbie-Hurder A, Gusterson B,
Maiorano E, Mastropasqua MG, Sonzogni A,
Mallon E, Colleoni M, Castiglione-Gertsch M,
Regan M, Price K, Brown R, Golouh R,
Crivellari D, Karlsson P, Öhlschlegel C,
Gelber R, Goldhirsch A, Coates A. Adverse
prognostic value of peritumoral vascular
invasion: is it abrogated by adequate
endocrine adjuvant therapy? Results from
two International Breast Cancer Study
Group randomised trials of chemoendocrine
adjuvant therapy for early breast cancer. Ann
Oncol 2010; 21:245-254.
Sestak I, Distler W, Forbes J, Dowsett M,
Howell A, Cuzick J. Effect of body mass
index on recurrences in tamoxifen and
anastrozole treated women: an exploratory
analysis from the ATAC trial. J Clin Oncol 2010;
28(21):3411-3415.
Procter M, Suter T, de Azambuja E, Dafni U,
van Dooren V, Muehlbauer S, Climent MA,
Rechberger E, Liu WT-W, Toi M, Coombes R,
Dodwell D, Pagani O, Madrid J, Hall M,
Chen S-C, Focan C, Muschol M,
van Veldhuisen D, Piccart-Gebhart M.
Longer-term assessment of trastuzumabrelated cardiac adverse events in the
herceptin adjuvant (HERA) trial. J Clin Oncol
2010; 28(21):3422-3428.
Phillips K-A, Ribi K, Sun Z, Stephens A,
Thompson A, Harvey V, Thülimann B,
Cardoso F, Pagani O, Coates A, Goldhirsch A,
Price KN, Gelber R, Bernhard J. Cognitive
function in postmenopausal women receiving
adjuvant letrozole or tamoxifen for breast
26 Eastern Health Research Report 2009-10
cancer in the BIG 1-98 randomised trial.
The Breast 2010; (in press)
Paridaens R, Gelber S, Cole B, Gelber RD,
Thürlimann B, Price K, Holmberg S,
Crivellari D, Coates A, Goldhirsch A.
Adjuvant!© Online estimation of
chemotherapy effectiveness when added to
ovarian function suppression plus tamoxifen
for premenopausal women with estrogenreceptor-positive breast cancer. Breast Cancer
Res Treat 2010; 123:303-310.
Maiorano E, Regan M, Viale G,
Mastropasqua M, Colleoni M, CastiglioneGertsch M, Price K, Gelber R, Goldhirsch A,
Coates AS. Prognostic and predictive impact
of central necrosis and fibrosis in early breast
cancer: Results from two International Breast
Cancer Study Group randomised trials of
chemoendocrine adjuvant therapy. Breast
Cancer Res Treat 2010; 121:211-218.
Lee C, Stockler M, Coates A, Gebski V,
Lord S, Simes R on behalf of Australian
New Zealand Breast Cancer Trials Group.
Self-reported health-related quality of life is
an independent predictor of chemotherapy
treatment benefit and toxicity in women with
advanced breast cancer. BJC 2010; Online
advanced:1-7.
Lee C, Lord S, Stockler M, Coates A, Gebski V,
Simes R. Historical cross-trial comparisons for
competing treatments in advanced breast
cancer - an empirical analysis of bias.
Eur J Cancer 2010; 46:541-548.
Dowsett M, Cuzick J, Wale C, Forbes J,
Mallon E, Salter J, Quinn E, Dunbier A,
Baum M, Buzdar A, Howell A, Bugarini R,
Baehner FL, Shak S. Prediction of risk of
distant recurrence using the 21-gene
recurrence score in node-negative and
node-positive postmenopausal patients
with breast cancer treated with anastrozole
or tamoxifen: A TransATAC study. J Clin Oncol
2010; 28(11):1829-1834.
Dowsett M, Cuzick J, Ingle J, Coates A,
Forbes J, Bliss J, Buyse M, Baum M, Buzdar A,
Colleoni M, Coombes C, Snowdon C,
Grant M, Jakesz R, Kaufmann M, Boccardo F,
Godwin J, Davies C, Peto R. Meta-analysis of
breast cancer outcomes in adjuvant trials of
aromatase inhibitors versus tamoxifen.
J Clin Oncol 2010; 28(3):509-518.
de Azambuja E, McCaskill-Stevens W,
Francis P, Quinaux E, Crown JPA, Vicente M,
Giuliani R, Nordenskjöld B, Gutiérez J,
Andersson M, Vila MM, Jakesz R, Demol J,
Dewar J, Santoro A, Lluch A, Olsen S,
Gelber RD, Di Leo A, Piccart-Gebhart M.
The effect of body mass index on overall
and disease-free survival in node-positive
breast cancer patients treated with docetaxel
and doxorubicin-containing adjuvant
chemotherapy: the experience of the BIG
02-98 trial. Breast Cancer Res Treat 2010;
119:145-153.
Colleoni M, Cole B, Viale G, Regan M, Price K,
Maiorano E, Mastropasqua M, Crivellari D,
Gelber R, Goldhirsch A, Coates AS,
Gusterson B. Classical cyclophosphamide,
methotrexate, and fluorouracil chemotherapy
is more effective in triple-negative,
node-negative breast cancer: results
from two randomised trials of adjuvant
chemoendocrine therapy for nodenegative breast cancer. J Clin Oncol 2010;
28(18):2966-2973.
Antonov J, Popovici V, Delorenzi M, Wirapati P,
Baltzer A, Oberli A, Thürlimann B, GiobbieHurder A, Viale G, Altermatt HJ, Aebi S,
Jaggi R. Molecular risk assessment of BIG 1-98
participants by expression profiling using
RNA from archival tissue. BMC Cancer 2010;
10(37):1-13.
Thürlimann B, Price K, Gelber R, Holmberg S,
Crivellari D, Colleoni M, Collins J, Forbes J,
Castiglione-Gertsch M, Coates A,
Goldhirsch A. Is chemotherapy necessary for
premenopausal women with lower-risk nodepositive, endocrine responsive breast cancer?
10-year update of International Breast Cancer
Study Group Trial 11-93. Breast Cancer Res Treat
2009; 113(1):137-144.
Sestak I, Sapunar F, Cuzick J. Aromatase
inhibitor-induced carpal tunnel syndrome:
results from the ATAC trial. .J Clin Oncol 2009;
27(30):4961-4965.
Sestak I, Distler W, Forbes J, Howell A, Cuzick J.
Effect of body mass index on recurrence in
hormone receptor positive early breast cancer
– a retrospective exploratory analysis from
the ATAC trial. Cancer Research 2009; 69(24
Suppl):553S, 1047.
Ruhstaller T, von Moos R, Rufibach K, Ribi K,
Glaus A, Spaeti B, Koeberle D, Mueller U,
Hoefliger M, Hess D, Boehme C, Thürlimann B.
Breast cancer patients on endocrine therapy
reveal more symptoms when self-reporting
than in pivotal trials: an outcome research
study. Oncology 2009; 76:142-148.
Breast oncology medicine
Rabaglio M, Sun Z, Price K, CastiglioneGertsch M, Hawle H, Thürlimann B,
Mouridsen H, Campone M, Forbes J,
Paridaens RJ, Colleoni M, Pienkowski T,
Nogaret J-M, Láng I, Smith I, Gelber R,
Goldhirsch A, Coates A, for the BIG 1-98
Collaborative and International Breast
Cancer Study Groups. Bone fractures among
postmenopausal patients with endocrineresponsive early breast cancer treated with
five years of letrozole or tamoxifen in the BIG
1-98 trial. Ann Oncol 2009; 20(9):1489-1498.
Pagani O, Price K, Gelber R, CastiglioneGertsch M, Holmberg S, Lindtner J,
Thürlimann B, Collins J, Fey M, Coates A,
Goldhirsch A, International Breast Cancer
Study Group (IBCSG). Patterns of recurrence
of early breast cancer according to estrogen
receptor status: a therapeutic target for a
quarter of a century. Breast Cancer Res Treat
2009; 117:319-324.
Pagani O, Gelber S, Simoncini E, CastiglioneGertsch M, Price K, Gelber R, Holmberg S,
Crivellari D, Collins J, Lindtner J, Thürlimann B,
Fey M, Murray E, Forbes J, Coates A,
Goldhirsch A, for the International
Breast Cancer Study Group. Is adjuvant
chemotherapy of benefit for postmenopausal
women who receive endocrine treatment for
highly endocrine-responsive, node-positive
breast cancer? International Breast Cancer
Study Group Trials VII and 12-93. Breast Cancer
Res Treat 2009; 116:491-500.
Mouridsen H, Giobbie-Hurder A, Mauriac L,
Paridaens R, Colleoni M, Thürlimann B,
Forbes J, Gelber R, Wardley A, Smith I,
Price K, Coates A, Goldhirsch A, BIG 1-98
Collaborative and the International
Breast Cancer Study Group. BIG 1-98: A
randomised double-blind phase III study
evaluating letrozole and tamoxifen given
in sequence as adjuvant endocrine therapy
for postmenopausal women with receptorpositive breast cancer. Cancer Research 2009;
69(2 Supplement), 13.
Mouridsen H, Giobbie-Hurder A,
Goldhirsch A, Thürlimann B, Paridaens R,
Smith I, Mauriac L, Forbes J, Price K,
Regan M, Gelber R, Coates A. Letrozole
therapy alone or in sequence with tamoxifen
in women with breast cancer. NEJM 2009;
361(8):766-776.
Joerger M, Thürlimann B. Update of the BIG
1-98 Trial: Where do we stand? The Breast 2009;
S3:S78-S82.
Grant C, Ingle J, Suman V, Dumesic D,
Wickerham D, Gelber R, Flynn P, Weir L,
Intra M, Jones W, Perez E, Hartmann L.
Menstrual cycle and surgical treatment
of breast cancer: findings from the
NCCTG N9431 study. J Clin Oncol 2009;
27(22):3620-3626.
Giobbie-Hurder A, Price K, Gelber R, for the
International Breast Cancer Study Group
and BIG 1-98 Collaborative Group. Design,
conduct and analyses of Breast International
Group (BIG) 1-98: A randomised, doubleblind, phase-III study comparing letrozole
and tamoxifen as adjuvant endocrine therapy
for postmenopausal women with receptorpositive, early breast cancer. Clinical Trials
2009; 6(3):272-286.
Gianni L, Gelber S, Ravaioli A, Price K,
Panzini I, Fantini M, Castiglione-Gertsch M,
Pagani O, Simoncini E, Gelber R, Coates A,
Goldhirsch A. Second non-breast primary
cancer following adjuvant therapy for early
breast cancer: A report from the International
Breast Cancer Study Group. Eur J Cancer 2009;
45(4):561-571.
Dowsett M, Procter M, McCaskill-Stevens W,
de Azambuja E, Dafni U, Rueschoff J,
Jordan B, Dolci S, Abramovitz M, Stoss O,
Viale G, Gelber RD, Piccart-Gebhart M,
Leyland-Jones B. Disease-free survival
according to degree of HER2 amplification for
patients treated with adjuvant chemotherapy
with or without one year of trastuzumab: The
HERA Trial. J Clin Oncol 2009; 27(18):2962-2969.
Dowsett M, Cuzick J, Wales C, Forbes J,
Mallon L, Salter J, Quinn E, Bugarini R,
Baehner FL, Shak S, on behalf of the ATAC
Trialists’ Group. Cancer Research 2009.
Risk of distant recurrence using oncotype
DX in postmenopausal primary breast
cancer patients treated with anastrozole
or tamoxifen: a TransATAC study.; 69(2
Supplement):75S-76S, 53.
Desmedt C, Giobbie-Hurder A, Neven P,
Paridaens R, Christiaens M-R, Smeets A,
Lallemand F, Haibe-Kains B, Viale G, Gelber R,
Piccart M, Sotiriou C. The gene expression
grade index: a potential predictor of relapse
for endocrine-treated breast cancer patients
in the BIG 1-98 trial. BMC Medical Genomics
2009; 2:40.
Cuzick J, Dowsett M, Wale C, Salter J, Quinn E,
Zabaglo L, Howell A, Buzdar A, Forbes JF.
Prognostic value of a combined ER, PgR, Ki67,
HER2 immunohistochemical (IHC4) score and
comparison with the GHI Recurrence Score results from TransATAC. Cancer Research 2009;
69(24 Suppl):503S, 74.
Colleoni M, Sun Z, Martinelli G, Basser R,
Coates A, Gelber R, Green M, Peccatori F,
Cinieri S, Aebi S, Viale G, Price K, Goldhirsch A,
for the International Breast Cancer
Study Group. The effect of endocrine
responsiveness on high-risk breast cancer
treated with dose-intensive chemotherapy:
results of International Breast Cancer Study
Group Trial 15-95 after prolonged follow-up.
Ann Oncol 2009; 20:1344-1351.
Abstracts
Robert N, Martin M, Stockler M, Kaufmann M.
Efficacy of first-line capecitabine 1000mg/m2
b.i.d. in patients with metastatic breast cancer
(MBC). EBCC 2010; 478.
Metzger O, de Azambuja E, Quinaux E,
Francis P, Buyse M, Crown J, Andersson M,
Di Leo A, Piccart-Gebhart M Lymph node
ratio is an independent risk classifier in node
positive breast cancer patients: results of the
phase III BIG 0298 trial. EBCC 2010; 11.
Colleoni M, Giobbie-Hurder A, Smith I,
Mouridsen H, Romieu G, Neven P, Rabaglio M,
Price K, Regan M, Coates A. Safety of letrozole
and tamoxifen monotherapy: updated BIG
198. EBCC 2010; 353.
Viale G, Regan M, Dell’Orto P, Mastropasqua M,
Rasmussen B, MacGrogan G, Braye S,
Orosz Z, Giobbie-Hurder A, Neven P, Knox F,
Oehlschlegel C, Thürlimann B, Coates A,
Goldhirsch A. Central review of ER, PgR and
HER2 in BIG 1-98 evaluating letrozole versus
letrozole followed by tamoxifen versus
tamoxifen followed by letrozole as adjuvant
endocrine therapy for postmenopausal
women with hormone receptor-positive
breast cancer, BIG 1-98 Collaborative and
International Breast Cancer Study Groups.
SABCS 2009; 76.
Ribi K, Phillips K-A, Sun Z, Stephens A,
Thompson A, Harvey V, Thürlimann B,
Cardoso F, Coates A, Bernhard J. Cognitive
function in postmenopausal women receiving
adjuvant letrozole or tamoxifen in the Breast
International Group (BIG) 1-98 trial.
ASCO 2009; 510.
Regan M, Colleoni M, Giobbie-Hurder A,
Thürlimann B, Mouridsen H, Mauriac L,
Paridaens R, Forbes J, Wardley A, Smith I,
Price K, Goldhirsch A, Coates A, Gelber R,
Eastern Health Research Report 2009-10 27
medicine Breast oncology
BIG 1-98 Collaborative and International
Breast Cancer Study Groups. Adjusting for
selective crossover in analyses of letrozole
(Let) versus tamoxifen (Tam) in the BIG 1-98
trial. SABCS 2009; 16.
Paridaens R, Gelber S, Cole B, Gelber R,
Thürlimann B, Price K, Holmberg S,
Crivellari D, Coates AS, Goldhirsch A.
Evaluation of Adjuvant! online to predict the
effect of optimal endocrine therapy (ovarian
function suppression plus tamoxifen) for
premenopausal breast cancer patients with
estrogen-receptor-positive breast cancer
ASCO 2009; 585.
Martin M, Hurvitz S, Kennedy J, Forbes J,
Roché H, Pinter T, Eiermann W, Buyse M,
Rupin M, Mackey J. CIRG/TORI 010: first
analysis of a randomised phase II trial of
motesanib plus weekly paclitaxel (P) as
first line therapy in HER2-negative
metastatic breast cancer (MBC).
ECCO/ESMO 2009; 5001.
Mackey J, Hurvitz S, Crown J, Forbes J,
Roché H, Pinter T, Eiermann W, Kennedy MJ,
Priou F, Provencher L, Adrover E,
Pienkowski T, Houé V, Rupin M, Martin M.
CIRG/TORI 010: 10-month analysis of a
randomised phase II trial of motesanib plus
weekly paclitaxel as first line therapy in HER2negative metastatic breast cancer (MBC).
SABCS 2009; 47.
28 Eastern Health Research Report 2009-10
Lee C, Stockler M, Hudson M, Coates A,
Gebski V, Lord SJ, Simes RJ, on behalf of
Australian New Zealand Breast Cancer Trials
Group. Predicting survival time in women
starting first line chemotherapy for advanced
breast cancer. SABCS 2009; 4066.
Lee C, Lord S, Stockler M, Gebski V, Coates A,
Simes R, on behalf of Australian and
New Zealand Breast Cancer Trials Group
(ANZ BCTG). Historical cross-trial comparisons
for competing treatments in advanced breast
cancer - an empirical analysis of bias.
ASBD 2009.
Lee C, Stockler M, Gebski V, Coates A,
Simes R, on behalf of Australian and
New Zealand Breast Cancer Trials Group
(ANZ BCTG) and NHMRC Clinical Trials
Centre. Outcomes of first line chemotherapy
for advanced breast cancer in women with
good versus poor quality of life at baseline.
ASCO 2009; 1036.
Howell A, Forbes J, Cuzick J, on behalf of the
ATAC investigators. Initial adjuvant therapy
with anastrozole - early and late-event data
from the arimidex, tamoxifen, alone or in
combination (ATAC) trial in the hormoneresponsive population. SABCS 2009; 0130
Di Leo A, Francis P, Crown J, de Azambuja E,
Quinaux E, Gutierrez J, Nordenskjold B,
Andersson M, Vila M, Jakesz R, Olsen S,
Viale G, Piccart-Gebhart M, on behalf of the
BIG 2-98 collaborative investigators. Overall
survival benefit for sequential doxorubicindocetaxel compared to concomitant
doxorubicin and docetaxel in node-positive
breast cancer. Eight-year results of the Breast
International Group (BIG) 2-98 phase III
adjuvant trial. SABCS 2009; 601.
Twelves C, Loesch D, Blum L, Vahdat L,
Petrakova K, Chollet P, Akerele C, Seegobin S,
Wanders J, Cortes J on behalf of the
Study 305 investigators. A phase III study
(EMBRACE) of eribulin mesylate versus
treatment of physician’s choice in patients
with locally recurrent or metastatic breast
cancer previously treated with anthracycline
and taxane. ASCO 2010; CRA 1004.
Bergh J, Greil R, Voytko N, Makhson A,
Cortes J, Lortholary A, Huang C, Giorgetti C,
Kern K, Lichinister M. Sunitinib in
combination with docetaxel versus docetaxel
alone for the first line treatment of advanced
breast cancer. ASCO 2010; LBA1010
Grants
Amgen A retrospective review of breast
cancer chemotherapy dose intensity.
Chirgwin J, $8000.
Cancer Council of Victoria Support for breast
cancer clinical trials program at Eastern
Health, $35,000.
Endocrinology and diabetes medicine
> Endocrinology and diabetes
The Endocrinology and diabetes unit consists
of a clinical service working in parallel with
Eastern Clinical Research Unit (ECRU) that
operates under the auspices of Monash
University. The director of endocrinology
(Eastern Health) is A/Prof Chris Gilfillan and
the director of the ECRU (Endocrinology) is
A/Prof Richard Simpson. Dr Murray Gerstman
runs the Maroondah Hospital ECRU research
program. The unit is supported by
Dr Mathis Grossmann, Dr Sylvia Lim-Tio and
Dr Jonathan Taft at Box Hill Hospital, Dr Shirley
Elkassaby and Maroondah Hospital and
Dr Indra Jayasuriya at Angliss Hospital. Nursing
and allied health personnel are an integral
part of the unit and contribute directly to the
research effort. The diabetes education team
at Box Hill Hospital is led by Shanne Kast and
supported by Francesca Man. The clinical
research program is executed by a team of
research coordinators lead by Joanne Phillips
and include Adriana Chronopoulos, Caroline
Harris, Gabby Phillips, Vanessa Viola, Leanne
Auchterlonie, Sally Kidd, Joan Green and
Luke Martin.
and specific translocations such as PAX8-PPAR
gamma and the RET-PTC rearrangement.
These mutations will be sought in the
tumours where they have prognostic
implications and will also be sought in the
FNA biopsy specimens where it is hoped they
will improve the specificity of the diagnosis.
This work is being undertaken by Dr Michael
Mond, the first PhD student undertaking
his studies under the supervision of Eastern
Health endocrinology.
The focus of the unit’s research program
includes clinical research in gestational
diabetes, clinical trials in diabetes
management, treatment of diabetes
complications and weight control as well
as research into the genetic pathology of
thyroid cancer.
DPP4 study. Simpson R, Gilfillan C and
ECRU. A multicentre, randomised, doubleblind, clinical trial to evaluate the safety
and tolerability of 24-weeks’ treatment with
vildagliptin (50 mg qd or 100 mg qd) versus
placebo in patients with type 2 diabetes and
moderate renal insufficiency.
Major achievement
Over the past two years a thyroid tumour
tissue bank has been established at Eastern
Health and is now established at Frankston
Hospital, Monash Medical Centre and will
soon include Epworth Eastern and Alfred
hospitals. Over 100 thyroid tumour samples
and fine needle aspiration biopsy specimens
have been collected and work has begun
on analysing these for common oncogenic
mutations in the components of the Akt
growth signalling pathway. Activating
mutations have been detected in B-RAF and
work is ongoing refining techniques to enable
detection of mutations in the RAS kinases
Research projects in progress
Sleep study. Effect of n-CPAP treatment on
glycaemic control in patients with type 2
diabetes mellitus and obstructive sleep apnea.
GLP-1 study. Simpson R, Gilfillan C and ECRU.
A randomised, double-blind, placebocontrolled parallel-group, multicentre,
24-week study followed by an extension
assessing the efficacy and safety of AVE0010
on top of metformin in patients with type 2
diabetes not adequately controlled
with metformin.
Insulin study. Simpson R, Gilfillan C and
ECRU. An extension trial comparing efficacy
and safety of NN5401 plus meal‑time insulin
as part for the remaining meals with insulin
detemir plus meal‑time insulin aspart in
type 1 diabetes.
GLP-1 study. Simpson R, Gilfillan C and ECRU.
A randomised, double-blind, placebocontrolled parallel group, multicentre,
24-week study assessing the efficacy and
safety of AVE0010 on top of metformin in
patients with type 2 diabetes not adequately
controlled with metformin.
DPP4 study. Simpson R, Gilfillan C and
ECRU. A multicentre, randomised, phase IV,
double-blind, study to evaluate cardiovascular
outcomes following treatment with study
drug or placebo in addition to standard of
care in subjects with type 2 diabetes and
CVD risk.
Neuropathy. Simpson R, Gilfillan C and ECRU.
A multicentre, randomised, double-blind,
parallel group comparison of the efficacy
and safety of new medication and placebo
in patients with diabetic peripheral
neuropathic pain.
Lilly HMGQ Neuropathy. Simpson R, Gilfillan
C and ECRU. Use of two different agents in
monotherapy versus combination therapy of
both drugs in patients with painful diabetic
neuropathy. A randomised, placebocontrolled, double-blind trial to assess the
safety and glucose-lowering efficacy of study
drug in participants with type 2 diabetes.
DPP4 study. Simpson R, Gilfillan C and
ECRU. A phase III, randomised, clinical trial
to evaluate the safety and efficacy of the
addition of sitagliptin in patients with type
2 diabetes mellitus who have inadequate
glycemic control on a sulfonylurea in
combination with metformin.
11 beta hydroxysteroid dehydrogenase type
1 inhibitor study. Simpson R, Gilfillan C and
ECRU. A double-blind, placebo-controlled
parallel group, randomised-multiple dose
study to evaluate the safety, tolerability
pharmacokinetics and pharmacodynamics of
study drug in subjects with type 2 diabetes
who have inadequate glycemic control
on either diet and exercise alone or on a
background of metformin.
GLP-1 study. Simpson R, Gilfillan C and
ECRU. A randomised, double-blind,
placebo-controlled clinical trial to assess
the effects of study drug on cardiovascular
outcomes in subjects with inadequately
controlled type 2 diabetes and established
cardiovascular disease.
GLP-1 study. Simpson R, Gilfillan C and ECRU.
A randomised, open-label, parallel‑group,
multicentre study to determine the efficacy
Eastern Health Research Report 2009-10 29
medicine Endocrinology and diabetes
and safety of study drug as compared with
liraglutide in subjects with type 2 diabetes
mellitus.
cent) found in men with type 2 diabetes, and
are independently associated with insulin
resistance and anaemia.
GLP-1 study. Simpson R, Gilfillan C and
ECRU. A randomised, double-blind, activecontrolled, parallel‑group, multicenter study
to determine the efficacy and safety of
study drug as compared with sitagliptin in
subjects with type 2 diabetes mellitus with
renal impairment.
Endocrine side effects of androgen
deprivation therapy in men with prostate
cancer. Grossmann M. Androgen deprivation
therapy given to men with prostate cancer,
induces profound hypogonadism. In
longitudinal studies, we have shown that this
leads to microarchitectural decay of bone,
as well as accumulation of visceral fat and
insulin resistance.
GLP-1 study. Simpson R, Gilfillan C and ECRU.
The impact of study drug versus glargine in
combination with insulin in people with
type 2 diabetes.
Published
GLP-1 study. Simpson R, Gilfillan C and ECRU.
Safety and efficacy of once weekly study
drug versus liraglutide in subjects with type
2 diabetes and inadequate glycemic control
treated with lifestyle modification and oral
antidiabetic medications.
Grossmann M, et al. 2008 Low testosterone
levels are common and associated with
insulin resistance in men with diabetes.
J Clin Endocrinol Metab 93: 1834-40. (Impact
Factor: 5.49).
Defining the genetic pathology of epithelial
thyroid tumours to improve diagnosis
and the prediction of tumour behaviour.
Gilfillan C, Mond M. Laboratory research now
underway at Prince Henry’s Institute. Methods
for extraction of nucleic material and controls
for mutation detection now established.
Series of benign tumours and small sample of
malignant tumours screened.
Pilot Evaluation Report. Shepherd L, Wilton A.
Improving the journey (a focus on improving
the management of type 2 diabetes in the
EMR), May 2009.
Low testosterone levels in men with
type 2 diabetes. Grossmann M. In crosssectional studies we have shown that low
testosterone levels are commonly (30-50per
30 Eastern Health Research Report 2009-10
Verma S, Gilfillan CP, Martin C. Attitudes
to lifestyle modification in women at risk for
gestational Australia Diabetes Society annual
scientific. Sydney, September 2010.
Presentations
International
Publications
SGLT2 inhibitor. Simpson R, Gilfillan C and
ECRU. A randomised, double-blind, parallel,
placebo-controlled, multicenter study of
the effects of study drug on cardiovascular
outcomes in adult subjects with type 2
diabetes mellitus.
Attitudes to lifestyle modification in women
at risk for gestational diabetes. Gilfillan C,
Verma S, Martin C. A survey of women
undergoing antenatal care at Box Hill Hospital
seeking to inform the design of a larger study
of lifestyle intervention in these women.
Hamilton EJ, Grossmann M. Cortical structure
decay in men with prostate cancer treated
with androgen deprivation therapy. 91st
Annual Meeting of the US Endocrine Society.
Washington DC, USA, June 2009
Gilfillan CP. The molecular pathology of
thyroid tumours: defining the diagnosis and
prognosis review. Australia and New Zealand
Journal of Surgery January, 2010.
Grossmann M, et al. 2009 Low testosterone
and anaemia in men with type 2 diabetes. Clin
Endocrinol 70: 547-53 (Impact Factor: 3.37).
In press
Grossmann MG, Hamilton EJ, Gilfillan CP
et al. Bone and metabolic health in patients
with non-metastatic prostate cancer receiving
androgen deprivation therapy – management
guidelines on behalf of the Endocrine Society
of Australia, the Australian and New Zealand
Bone and Mineral Society, and the Urological
Society of Australia and New Zealand MJA.
Grossmann M, et al. 2010. Androgens and
Diabetes. Curr. Opin. Endo. Diab.
Abstracts
Published
Kaminski M, Frescos N, Tucker S. Prevalence
of risk factors for foot ulceration in patients
with end stage renal disease on haemodialysis.
8th National Australian Wound Management
Association Conference, Perth, March 2010.
Grossmann M. Low testosterone levels in
men with type 2 diabetes. US Endocrine
Society Meeting. San Diego, USA, June 2010.
National
Gilfillan C. Bones for the gastroenterologist.
Gastroenterology clinical weekend, Manly,
September 2010.
Local
Gilfillan C The genetic pathology of thyroid
tumours. MCCC Monash cancer cooperative,
Clayton, 2010.
Gilfillan C Thyroid disease for the generalist,
CLIMATE general medicine meeting, Torquay,
2010.
Awards
Kaminski M (Graduate Podiatrists) Australian
Wound Management Association “Aaxis New
Investigator Award for the best new scientific
presentation” at the AWMA Conference,
March 2010.
Grants
Victorian Cancer Agency The genetic
pathology of thyroid tumours, Gilfillan C.
$197,000
Research training
PhD
• Mond M, Monash University, F/T
Gastroenterology and hepatology medicine
> Gastroenterology and hepatology
The research performed by the Department
of Gastroenterology and Hepatology overlaps
considerably with that of Eastern Health
Clinical School where the majority of the
research programs in chronic intestinal
diseases are outlined. The three primary
researchers are Prof Peter Gibson who
supervises trainees in clinical audit activities
or small clinical interventional trials; Dr Sanjay
Nandurkar who has established a program
of audit of investigative procedures and a
program in oesophageal diseases; and recent
appointee Dr John Lubel who is establishing a
clinical hepatology program. All three are also
involved in pharma-sponsored clinical trials of
new drugs.
Major achievement
The unit received repeated referrals for
colonoscopy after inappropriate faecal
occult blood testing was performed. Dr
Antony Friedman, then as a basic physician
trainee, organised a team of HMOs to review
several hundred tests done on in-patients
across Eastern Health. The findings showed
inappropriate use of the test across all areas of
the hospital with the results leading to delays
in or inappropriate clinical decisions being
made. The study was published in the Internal
Medicine Journal and received an editorial
commending the study and reinforcing the
notation that such a test is inappropriate
in the in-patient setting. The paper is being
used in many hospitals to modify practice.
This is an example of how a clinical audit
well performed may have major impact on
practice across the country.
Research projects in progress
See also Eastern Health Clinical
School Division of Research
Pancreatic exocrine insufficiency after major
upper gastrointestinal surgery. Ward S,
Mackay S, Cade R, Hassen S, Gibson P. The
ability of dietary fat to be digested and
absorbed after major upper gastrointestinal
surgery is being investigated using the
novel 13C mixed triglyceride breath
test. The test itself is being refined.
This is a collaborative study between
Upper Gastrointestinal Surgery and
Gastroenterology.
Clinical trials of new agents for Crohn’s
disease and inflammatory bowel disease
Gibson P. There are several clinical trials
ongoing for patients with poorly controlled
Crohn’s disease and ulcerative colitis
evaluation new agents. These studies are
being conducted via ECRU. These are all
multicentre international trials. In addition,
trials of different treatment algorithms in
prevention of post-operative recurrence of
Crohn’s disease is being performed. This is a
multicentre Australian study.
Clinical trials in functional gut disorders and
diverticulitis. Nandurkar S. Trials are currently
running for agents for constipation and for
preventions of recurrence of diverticulitis.
These are being performed via ECRU. These
are multicentre trials.
Research projects completed
See also Eastern Health Clinical
School Division of Research
The use and abuse of faecal occult blood
tests in an acute hospital inpatient setting.
Friedman A, Chan A, Deen A, Hammerschlag G,
Lee M, Liddell J, Loh K, Moore E, Ng J, Gibson P.
As described in achievements above.
Studies of the safety of total dose iron
infusions. Garg M, Morrison G, Friedman A,
Lau A, Lau D, Haines M, Gibson P. Total-dose
infusions of iron polymaltose are effective
means of repleting iron stores in patients with
iron deficiency. The safety of this therapy was
prospectively studied by Dr Melissa Haines.
Dr Mayur Garg subsequently used this data
as a benchmark for evaluating 100 infusions
of iron polymaltose using a rapid infusion
protocol in contrast the standard five-hour
infusion. The study was performed across
Eastern Health and at Frankston Hospital. The
safety of this protocol was established. This
will encourage others to use rapid infusions
across the country.
Uptake of hepatitis B screening prior to
cytotoxic chemotherapy for lymphoma.
Ward M, Asthana A, Lubel J. This study aimed
to examine the current hepatitis B screening
practices in patients receiving cytotoxic
chemotherapy for non-Hodgkin lymphoma in
a tertiary teaching hospital in a geographical
area of high hepatitis B endemicity. Eightythree per cent of patients with hepatitis
B serology had not been appropriately
tested for hepatitis B core antibody. This has
important implications for future practice.
The ability of routine CT abdomen
in predicting the presence of colonic
pathology. Lau D, Loh K, Uda Y, Iser J,
Nandurkar S. Although previous studies
have suggested that colonic wall thickening
reported on abdominal CT scans is
an important finding, it is debatable if
endoscopic evaluation is justified in
every case. A retrospective study (January
2007-December 2008) was conducted that
aims to correlate CT findings of colonic
thickening with endoscopic and histological
findings and identify if clinical parameters can
predict likelihood of abnormal findings. In this
study, colitis reported on CT scans was rarely
observed at endoscopy and the prediction of
colonic cancer based on CT report has a 10
per cent yield. Appropriate triaging of patients
to colonoscopy will avoid unnecessary
procedures and better resource allocation.
Patient outcomes post CT colonography
after failed colonoscopy. Chung A, John N,
Leaney B, Prime H, Nandurkar S. CT
colonography is currently indicated in
Australia for exclusion of colorectal neoplasia
in symptomatic or high-risk patients within
three months of an incomplete colonoscopy.
A retrospective review was conducted on all
patients undergoing CT colonography from
1 January 2008 to 31 December 2009 at MIA
Epworth Eastern, Box Hill. It demonstrated
high positive predictive value for detecting
polyps and lesions. While the negative
predictive value could not be determined
Eastern Health Research Report 2009-10 31
medicine Gastroenterology and hepatology
from the study, clinicians and their patients
were reassured by normal results and did
not undertake any further investigation
of the colon. Thus CT colonography was
instrumental in the development of a
strategic patient management plan.
Clinical characteristics, histopathological
audit, and misclassification errors in serrated
polyps: a single centre experience. Cui J,
Foley A, Hosking P, Nandurkar S. Classification
of colonic polyps has become more complex
in recent years with the recognition of the
importance of serrated polyps and the role
of these polyps in the serrated neoplasia
pathway. A retrospective study was
conducted to determine the characteristics of
serrated polyps in terms of size, distribution,
histopathological features and microsatellite
instability and the accuracy of reporting. There
was considerable interobserver variation
with regard to the histological classification
of polyps with concordance in 86.3 per cent
of cases. Hyperplastic polyps are usually
small left-sided polyps. Traditional serrated
adenomas were consistently larger left-sided
polyps. Sessile serrated polyps although larger,
occurred almost exclusively in the right colon
and have the potential to become dysplastic.
Future research direction
The program of audit and clinical review will
be continuing. Targeted areas include aspects
of performance in the Inflammatory Bowel
Disease Clinic; of outcomes and issues in the
management of patients with hepatitis C and
B; and into quality performance of endoscopic
procedures. Involvement in cutting edge
clinical trials will continue.
Publications
Published
See also Eastern Health Clinical
School Division of Research
Foley A, Gibson P. Bowel habit change in
a woman in her late fifties. Medicine Today
2009;10:83-4.
32 Eastern Health Research Report 2009-10
Eggleston A, Katelaris P, Nandurkar S,
Thorpe P, Holtmann G; Treat Study Group.
Clinical trial: the treatment of gastrooesophageal reflux disease in primary
care-prospective randomised comparison
of rabeprazole 20 mg with esomeprazole
20 and 40 mg. Aliment Pharmacol Ther
2009;29:967-78.
Morrison G, Headon B, Gibson P. Update in
inflammatory bowel disease. Aust Fam Phys
2009;38:956-61.
Friedman A, Chan A, Deen A,
Hammerschlag G, Lee M, Liddell J, Loh K,
Moore E, Ng J, Gibson P. The use and abuse of
faecal occult blood tests in an acute hospital
inpatient setting. Intern Med J 2010;40:107-11.
Moss A, Parrish F, Irving P, Haines M, Gibson P.
Quality, clinical impact and tolerance of
CT enteroclysis in patients with suspected
small bowel disease. Int Med J 2009
Nov;39(11):733-43.
Haines M, Gibson P. Delayed adverse
reactions to total dose intravenous iron
polymaltose. Intern Med J 2009;39:252-5.
Lee TWT, Iser J, Sparrow M, Newnham E,
Headon B, Gibson P. Thiopurines, a previously
unrecognised cause for fatigue in patients
with inflammatory bowel disease. J Crohn’s
Colitis 2009;3:196-9.
In press
Krieger-Grübel C, Hiscock R, Nandurkar S,
Heddle R, Hebbard G. Physiology of diffuse
esophageal spasm (DES) - when normal
swallows are not normal. Neurogastroenterol
Motil. 2010 Jun 21.
Morrison G, Headon B, Gibson P. Update in
inflammatory bowel disease. Aust Fam
Phys 2009.
Garg M, Morrison G, Friedman A, Lau A,
Lau D, Gibson P. A rapid-infusion protocol
is safe for total dose iron polymaltose: time
for change. Intern Med J. (Accepted for
publication)
Haines M, Ajlouni Y, Irving P, Sparrow M,
Rose R, Gearry R, Gibson P. Clinical usefulness
of therapeutic drug monitoring of thiopurines
in patients with inadequately controlled
inflammatory bowel disease. Inflamm
Bowel Dis.
Moss A, Parrish F, Naidoo P, Upton A, Prime H,
Leaney B, Gibson P. Self-administered inhaled
methoxyflurane significantly improves patient
comfort during nasoduodenal intubation for
computed tomography enteroclysis (CTE) for
suspected small bowel disease: A randomised,
double-blind, placebo controlled trial.
Clin Radiol. (Accepted for publication)
Foley A, Gibson P. Optimising the use of
methotrexate in IBD. In: Rampton D, Irving P,
Shanahan F (eds) 50 Clinical Dilemmas in
IBD - 2. Blackwell, Oxford 2010.
Grübel C, Hiscock R, Nandurkar S, Heddle H,
Hebbard G. Physiology of Diffuse Esophageal
Spasm (DES) - when normal swallows are not
normal. Neurogastroenterol Motil 2010 (Epub
ahead of print).
Presentations
See Eastern Health Clinical
School Division of Research
Awards
See Eastern Health Clinical
School Division of Research
Grants
See Eastern Health Clinical
School Division of Research
Research Training
See Eastern Health Clinical
School Division of Research
Neurosciences medicine
> Neurosciences
The Eastern Health Department of
Neurosciences research activities include
laboratory-based scientific research,
pharmaceutical clinical trials, epidemiological
and clinical investigator-driven research
studies. Research into acute stroke care is
a strong focus including thrombolysis with
tPA within 4.5 hours, or thrombolysis with
a number of other thrombolytic research
drugs up to nine hours from onset of stroke
symptoms. Secondary stroke prevention
is initiated during admission to the acute
stroke ward; patients are then considered
for secondary prevention stroke trials if they
meet the inclusion/exclusion criteria. Patients
are given the research study information and
given time to consider their participation after
discussion with family and their GP. The unit
is also involved in community-based research
involving care after discharge from hospital
and global emerging risk factors in different
regions of the world. The unit is currently
expanding the Cognitive Disorders Clinic
dealing with the ever increasing incidence of
dementia and its burden on the community
and healthcare. Research is progressing into a
drug that possibly provides passive immunity
in Alzheimer’s diseases. There is also an
epilepsy clinic and involvement in epilepsy
pharmaceutical clinical trials.
The staff includes neurologists, Prof
Chris Bladin (director of Eastern Health
neurosciences), Dr Amanda Gilligan, Dr Poh
Sien Loh, Dr Thomas Chemmanam (research
fellow), Dr Darshan Ghia (registrar), Dr Amy
Brodtmann (cognitive disorders neurology
specialist) Tracey Wardill and Helen Clausen
(neuro psychologists), Melissa Kettle (cognitive
disorders nurse specialist), Dr Saul Mullen and
Dr Patrick Carney (neurologists specialising in
epilepsy). As well as Zofia Ross, Paula Eustace
and Jenny Bortoli (research coordinators), Skye
Coote and Kelly Coughlan, the acute stroke
nurses who attend all emergency admissions
with acute stroke for quick assessment for
thrombolysis. Janet Bray (senior academic
researcher) is involved in ambulance and GP
awareness in recognising acute stroke and
Sam Daly is a second-year medical student
involved in a one-year placement (B Medical
research science student). RMIT students
Virginia Ma and Ema Rashidi are undertaking
a year-long academic research placement
looking at global emerging risk factors in
different regions of the world.
To achieve these research goals, collaborative
partners include Monash University,
Melbourne University, RMIT, Eastern
Health, Yale University, The Baker Institute
(Alfred Hospital/Monash University) and
the Canadian Institute of Health Research
Hamilton.
Major achievement
Thrombolysis in acute strokes With greater
understanding of the need for timely access
to brain CT following stroke including
transport via paramedics to emergency
departments and appropriate triaging now
allows correct treatment to be initiated, be
it receiving thrombolysis within 4.5 hours or
research trials thrombolysis up to 9 hours,
followed by care in the Acute Stroke Ward has
been a significant achievement for the unit.
In addition the unit have been looking at
glucose homeostasis and have had our
b medical research science student Sam
Daly, supervised by Prof Chris Bladin and A/
Prof Richard Simpson, conduct an academic
pilot study using exenatide (a common
hypoglycaemic drug) in acute ischaemic
stroke. Sam is studying the effect on cerebral
inflammation and glucose homeostasis in
acute stroke. The unit has recruited all the
acute stroke patients required to allow data
to be collected and research findings are
currently being written up.
Research projects in progress
ROCKET-AF Rivaroxiban in AF-related stroke
(collaboration with Johnson and Johnson).
IRIS Pioglitazone in stroke (Yale).
ARCH Prevention of stroke with aortic
atheroma – member of Steering Committee.
ICSS International carotid stenting study
(MRC-UK).
ENOS GTN for hypertension in acute
haemorrhagic stroke (MRC-UK).
IST3 International Stroke Trial3 (MRC-UK).
VITATOPS Vitamins in stroke prevention.
TNK Tenecteplase in acute ischaemic stroke.
Stroke Genetics Genetic polymorphisms
in the native thrombolytic and thrombotic
systems as risk factors for ischaemic stroke.
Pioglitazone Pioglitazone in acute
ischaemic stroke.
INTERACT2 Blood pressure management in
haemorrhagic stroke.
PERFORM Prevention of cerebrovascular and
cardiovascular events of ischaemic origin
with teruteban in patients with a history of
ischaemic stroke or transient ischaemic attack.
FAST Fast Access to Stroke Thrombolysis
(Eastern Melbourne Neurosciences/
Box Hill Hospital).
Exenatide Exenatide in acute ischaemic
stroke – effect on cerebral inflammation and
glucose homeostasis.
Telacris T05018-1001 A-phase I/IIa, open
label, dose escalation, safety of study of
intra-thrombus plasmin (human)
administration in acute, middle cerebral
artery, ischaemic stroke.
Interstroke Importance of conventional and
emerging risk factors for stroke in different
regions of the world and in different ethnic
groups: a case-control study.
STAND FIRM Shared team approach between
nurses and doctors for improved risk
factor management for stroke patients – a
randomised controlled trial.
DIAS3 Desmoteplase in acute stroke
(Lundbeck).
Eastern Health Research Report 2009-10 33
medicine Neurosciences
Dementia trials
LZAN H8A-MC –LZAN Solanezumab
LY2062430 Effect of passive immunisation
on the progress of Alzheimer’s disease
versus placebo.
relate to the site of baseline arterial
occlusion in the Echoplanar Imaging
Thrombolytic Evaluation Trial (EPITHET). Stroke
2010;41(2):295-9.
Epilepsy
Dewey HM, Churilov L, Blacker D, Bladin C,
Davis SM, Donnan GA, et al. Response to
“A graphic reanalysis of the NINDS Trial”. Ann
Emerg Med;55(2):227-9.
Lacosamide protocol SP 902 An historiccontrolled, multicentre, double-blind,
randomised trial to assess the efficacy and
safety of conversion to lacosamide 400mgs/
day monotherapy in subjects with partialonset seizures.
Parsons MW, Christensen S, McElduff P,
Levi CR, Butcher KS, De Silva DA, et al.
Pretreatment diffusion- and perfusion-MR
lesion volumes have a crucial influence on
clinical response to stroke thrombolysis.
J Cereb Blood Flow Metab 2010;30(6):1214-25.
Lacosamide protocol SP 904 A multicentre,
open label extension trial to assess the long
term use of lacosamide monotherapy and
safety of lacosamide monotherapy and
adjunctive therapy in subjects with partial
onset seizures.
Bray J, Coughlan K, Barger B, Bladin C.
Paramedic diagnosis of stroke: Examining
long-term use of the Melbourne Ambulance
Stroke Screen (MASS) in the field. Stroke
2010:41:1363-66.
LZAO Open label LY206243 post LZAN.
Research projects completed
Stroke
CT Perfusion Acute Stroke: imaging the
ischaemic penumbra with perfusion CT.
DICE Dextran In Carotid Endarterectomy
(National Stroke Research Institute) –
NHMRC funded.
ROCKET-AF Rivaroxiban in AF related stroke
(Johnson and Johnson).
PERFORM Prevention of cerebrovascular and
cardiovascular events of ischaemic origin with
terutroban in patients with a history of
ischaemic stroke or transient ischaemic attack.
ARCH Prevention of stroke with aortic
atheroma – member of Steering Committee.
Future research direction
Research Interests
Metabolic Syndrome
Brain imaging in acute stroke
Glucose management in acute stroke
TIA assessment and management
Publications
De Silva DA, Brekenfeld C, Ebinger M,
Christensen S, Barber PA, Butcher KS, et al.
The benefits of intravenous thrombolysis
34 Eastern Health Research Report 2009-10
Bray J, Bladin C. Success with paramedic
diagnosis of stroke. Stroke 2009: 40(5):e398.
Butcher K, Christensen S, Parsons M,
De Silva D, Ebinger M, Levi C, Barber A,
Peeters A, Bladin C, Chalk J, Fink J,
Donnan G, Davis S for the EPITHET
Investigators. Post-treatment blood
pressure control predicts thrombolysis
related haemorrhagic transformation. Stroke
2009;40:48.
Bray J, O’Connell B, Gilligan A, Livingston T,
Bladin C. Do mass media campaigns capture
and describe the experience of stroke
symptoms? Stroke 2009 40;80.
Tan A, Coughlan K, Bray J, Parsons M,
Bladin C. CT angiography and CT perfusion:
single or dual imaging targets – Which is
better for stroke thrombolysis?
Stroke 2009;40:58.
Christensen S, Parsons M, De Silva D,
Ebinger M, Butcher K, Fink J, Desmond P,
Barber A, Bladin F, Levi C, Chalk J, Donnan GA,
Davis SM. Fully automated program for rapid
analysis of diffusion and perfusion optimising
MR criteria for penumbral selection trials.
Stroke 2009;40:57
Ninomiya T, Donnan G, Anderson N, Bladin C,
Chambers B, Gordon G, Sharpe N, Chalmers
J, Woodward M, Neal B. PROGRESS
Collaborative Group. Effects of the end point
adjudication process on the results of the
perindopril protection against recurrent stroke
study (PROGRESS). Stroke 2009; 6:2111-5.
Price C, Blacker D, Grimley R, Dewey H,
Gerraty R, Koblar S, Denisenko S, Storey C,
Bladin C, Hill K. National survey of
management of transient ischaemic attack
in Australia: Take Immediate Action.
Med J Aust 2009;1:17-20.
Ederle J, Featherstone R, Brown M. CAVATAS
collaborators. Long-term outcome of
endovascular treatment versus medical care
for carotid artery stenosis in patients not
suitable for surgery and randomised in the
Carotid and Vertebral Artery Transluminal
Angioplasty study (CAVATAS). Cerebrovasc Dis.
2009;28(1):1-7.
Bousser M, Amarenco P, Chamorro A,
Fisher M, Ford I, Fox K, Hennerici M, Mattle H,
Rothwell P. PERFORM Study Investigators.
Rationale and design of a randomised,
double-blind, parallel-group study of
terutroban 30 mg/day versus aspirin 100
mg/day in stroke patients: the prevention of
cerebrovascular and cardiovascular events of
ischemic origin with terutroban in patients
with a history of ischemic stroke or transient
ischemic attack (PERFORM) study. Cerebrovasc
Dis. 2009;27(5):509-18.
Ebinger M, Christensen S, DeSilva D,
Parsons M, Levi C, Butcher K, Bladin C,
Barber P, Donnan G, Davis S. Expediting
MRI-based proof of concept stroke trials using
an earlier imaging endpoint. Stroke 2009
Apr;40(4):1353-8.
DeSilva D, Fink J, Christensen S, Ebinger M,
Bladin C, Levi C, Parsons M, Butcher K,
Barber P, Donnan G, Davis S. Assessing
reperfusion and recanalisation as markers
of clinical outcomes following intravenous
thrombolysis in the Echoplanar Imaging
Thrombolytic Evaluation Trial (EPITHET).
Stroke. 2009 May; 40(8):2872-4.
Ebinger M, Iwanaga T, Prosser J, De Silva D,
Christensen S, Collins M, Parsons M, Levi C,
Bladin C, Barber A, Donnan G, Davis S, for
the EPITHET investigators. Clinical-diffusion
mismatch and benefit from thrombolysis
3-6 hours after stroke. Stroke. 2009
Jul;40(7):2572-4.
Szoeke C, Bladin C, Gordon A, Mackay M.
Stroke presenting under three hours in
patients younger than 18 years of age.
J Clin Neurosci. 2009 Nov;16(11):1481-2.
Kase C, Albers G, Bladin C, Fieschi C,
Gabbai A, O’Riordan W, Pineo G on behalf
of the PREVAIL Investigators. Neurological
Neurosciences medicine
outcomes in patients with ischemic stroke
receiving enoxaparin or heparin for venous
thromboembolism prophylaxis. Subanalysis
of the prevention of VTE after acute ischemic
stroke with LMWH (PREVAIL) study. Stroke
2009;40:3532-3540.
De Silva D, Ebinger M, Christensen S,
Parsons M, Levi C, Butcher K, Barber P,
Bladin C, Donnan G, Davis S. Baseline
diabetic status and admission blood glucose
were poor prognostic factors in the EPITHET
trial. Cerebrovasc Dis 2009 Nov 5;29(1):14-21.
Bonati L, Ederle J, McCabe D, Dobson J,
Featherstone R, Gaines P, Beard J, Venables G,
Markus H, Clifton A, Sandercock P, Brown M,
CAVATAS Investigators. Long-term risk
of carotid restenosis in patients randomly
assigned to endovascular treatment
or endarterectomy in the carotid and
vertebral artery transluminal angioplasty
study (CAVATAS): long-term follow-up of
a randomised trial. Lancet Neurol 2009
Oct;8(10):908-17.
Ederle J, Bonati L, Dobson J, Featherstone R,
Gaines P, Beard J, Venables G, Markus H,
Clifton A, Sandercock P, Brown M, CAVATAS
Investigators. Endovascular treatment
with angioplasty or stenting versus
endarterectomy in patients with carotid artery
stenosis in the Carotid and Vertebral Artery
Transluminal Angioplasty Study (CAVATAS):
long-term follow-up of a randomised trial.
Lancet Neurol 2009;8(10):898-907.
Butcher K, Christensen S, Parsons M,
De Silva D, Ebinger M, Levi C, et al.
Post-thrombolysis blood pressure elevation is
associated with hemorrhagic transformation.
Stroke 2010;41(1):72-7.
Campbell B, Christensen S, Butcher K,
Gordon I, Parsons M, Desmond P, et al.
Regional very low cerebral blood volume
predicts hemorrhagic transformation better
than diffusion-weighted imaging volume and
thresholded apparent diffusion coefficient in
acute ischemic stroke. Stroke 2010;41(1):82-8.
EPITHET Investigators. Ischemic diffusion
lesion reversal is uncommon and rarely alters
perfusion-diffusion mismatch. Neurology 2010.
Simpson M, Dewey H, Churilov L, Ahmed N,
Bladin C, Schulz D, Markus R, Sturm J, Levi C,
Blacker D, Jannes J, Lindley R, Parsons M.
Thrombolysis for acute stroke in Australia:
experience from the safe implementation of
thrombolysis in stroke register (2002-2008).
MJA 2010.
Coulton B, Bray J, Tan A, Bladin C. Discharge
planning after stroke thrombolysis; what is the
short-term prognosis? International Journal of
Stroke 2009, Vol 4:Supp1:12.
Bray J, O’Connell B, Gilligan A, Livingston P,
Bladin C. Is FAST stroke smart: does the
language used in public education campaigns
describe the experience of stroke symptoms?
International Journal of Stroke 2010.
Simpson M, Dewey H, Churilov L, Bladin C,
Markus R, Ahmed N, Parson M. Thrombolysis
for acute stroke in Australia; experience from
the SITS-International Stroke Thrombolysis
Register 2002-2008. International Journal of
Stroke 2009, Vol 4:Supp1:13.
Abstracts
Bray J, O’Connell B, Gilligan A, Livingston P,
Bladin C. Exploring key decision-making
processes that lead to hospital presentations
for stroke symptoms. International Journal of
Stroke 2009, Vol 4:Supp1:14.
Butcher K, Christensen S, Parsons M,
De Silva D, Ebinger M, Levi C, Barber A,
Peeters A, Bladin C, Chalk J, Fink J, Donnan
G, Davis S, for the EPITHET Investigators.
Post-treatment blood pressure control
predicts thrombolysis related hemorrhagic
transformation. Stroke. 2009;40:48
Bray J, O’Connell B, Gilligan A, Livingston T,
Bladin C. Do mass media campaigns capture
and describe the experience of stroke
symptoms? Stroke 2009 40;80.
Tan A, Coughlan K, Bray J, Parsons M,
Bladin C. CT angiography and CT perfusion:
single or dual imaging targets – Which is
better for stroke thrombolysis?
Stroke 2009;40:58.
Christensen S, Parsons M, De Silva D,
Ebinger M, Butcher K, Fink J, Desmond P,
Barber A, Bladin C, Levi C, Chalk J, Donnan G,
Davis S. Fully automated program for rapid
analysis of diffusion and perfusion optimising
MR criteria for penumbral selection trials.
Stroke 2009;40:57.
Publications in press
Campbell B, Christensen S, Butcher K,
Parsons M, Desmond P, Gordon I, Barber A,
Aland P, Levi C, Bladin C, De Silva D,
Peeters A, Doonan G, Davis S for Epithet
Investigators. Prediction of haemorrhagic
transformation after stroke thrombolysis;
very low cerebral blood volume (VLCBV)
outperforms DWI/ADC lesion volume.
International Journal of Stroke 2009,
Vol 4:Supp1:7.
Chemmanam T, Campbell B, Christensen S,
Nagakane Y, Desmond P, Bladin C, Parsons M,
Levi C, Barber P, Donnan G, Davis, for the
Tu H, Campbell B, Christensen S, Butcher K,
Collins M, Parsons M, Desmond P, Barber A,
Levi C, Bladin C, De Silva D, Peeters A,
Carotid Stenting Guidelines Committee.
Guidelines for patient selection and
performance of carotid artery stenting.
J Med Imaging Radiat Oncol 2009;53(6):538-45.
Donnan G, Davis S. Atrial fibrillation is
associated with increased infarct size,
hemorrhagic transformation and worse
outcome in patients with ischaemic stroke.
International Journal of Stroke 2009,
Vol 4:Supp1:7.
Bladin C, Fullerton S, Chapman M, Ryan C.
Introduction of the Liverpool care pathway for
the dying patient improved the care of dying
patients and their families in an acute stroke
unit. International Journal of Stroke 2009, Vol
4:Supp1:23.
Bray J, O’Connell B, Gilligan A, Livingston P,
Bladin C. Illness perceptions of the acute
stroke event. International Journal of Stroke
2009, Vol 4:Supp1:26.
Bray J, Coughlan K, Wright M, Barger B,
Bladin C. Paramedic diagnosis of stroke:
examining use of the Melbourne Ambulance
Stroke Scale in the field. International Journal
of Stroke, 2009, Vol 4:Supp1:26.
Bray J, Coulton B, Coughlan K, Bladin C.
The ongoing dilemma: poor utilisation of
an ABCD2-based transient ischaemic attack
pathway in the emergency department.
International Journal of Stroke 2009,
Vol 4:Supp1:27.
Chemmanam T, Coulton B, Bray J, Bladin C.
Metabolic syndrome is an independent
prognostic factor for poor outcome
in ischaemic stroke patients receiving
intravenous thrombolysis. International Journal
of Stroke 2009, Vol 4:Supp1:30.
Levi C, Chambers B, Young D, Stork J,
Abbott A, Wlodarczek J, Churilov L, Fell G,
Bladin C, Grigg M, Davis S, Frydman G,
Parsons M, Dunbabin D, Donnan G on
behalf of the DICE Investigators. The efficacy
Eastern Health Research Report 2009-10 35
medicine Neurosciences
and safety of 10 per cent dextran 40 in the
prevention of stroke complicating carotid
endarterectomy – the dextran in carotid
endarterectomy (dice) trial. Cerebrovascular
Diseases 2010, Supplement 2;29; p32.
Bray J, O’Connell B, Gilligan A, Livingston P,
Bladin C. The definition of prehospital delay
matters when exploring factors related
to delay in stroke. Cerebrovascular Diseases
2010.
Campbell B, Christensen S, Desmond P,
Parsons M, Barber P, De Silva D, Levi C,
Bladin C, Donnan G, Davis S, EPITHET
Investigators. Major infarct growth beyond
six hours is associated with collateral
circulation failure. Cerebrovascular Diseases
2010, Supplement 2; 29; p9
Pérez de la Ossa N, Chandra R, Campbell B,
Christensen S, Collins M, Parsons M, Levi C,
Bladin C, Barber P, Desmond P, Donnan G,
Davis S, for the EPITHET investigators,
Leukoaraiosis is not an independent risk
factor for parenchymal haemorrhage after
thrombolysis. Cerebrovascular Diseases 2010,
Supplement 2; 29;p13.
Bray J, O’Connell B, Gilligan A, Livingston P,
Bladin C. Do acute stroke symptoms present
as expected by patients and bystanders?
Cerebrovascular Diseases 2010
Outcomes from research
collaboration
Pioglitazone Study completed recruitment
and is now in the data analysis phase.
Exenatide Study Completed recruitment and
final data collection will occur in November
2010 and the data analysis will occur.
TIA Increased awareness of ABCD score in
accident and emergency and early disposition
of TIAs according to factors with early review
in the TIA clinic within seven days with
investigations results available.
Metabolic Syndrome Prospective collection
of data on 100 patients identified areas of
improved care is required.
Presentations
Bray J, Bailey M, Mosley I, Barger B, Bladin C.
Have the National Stroke Foundation’s public
awareness campaigns increased ambulance
dispatches for stroke in Melbourne? Annual
Meeting of The Australasian Stroke Society
36 Eastern Health Research Report 2009-10
and Nursing Symposium 2010. International
Journal of Stroke 2010 (in press).
Bray JE, Cui J, O’Connell B, Gilligan A,
Livingston P, Bladin C. An examination of
factors related to patients’ delay in presenting
to hospital for stroke symptoms. Annual
Meeting of The Australasian Stroke Society
and Nursing Symposium 2010. International
Journal of Stroke 2010 (in press).
Bray J, Wright M, Gilligan A, Burke M,
Bladin C. Do GP triage protocols address
stroke as a medical emergency? Annual
Meeting of The Australasian Stroke Society
and Nursing Symposium 2010. International
Journal of Stroke 2010 (in press).
Bray J, O’Connell B, Gilligan A, Livingston P,
Bladin C. Exploring key decision-making
processes that lead to hospital presentations
for stroke symptoms. (Oral presentation)
The Australasian Stroke Society and Nursing
Symposium 2009 International Journal of
Stroke 2009;4.
Bray J, O’Connell B, Gilligan A, Livingston P,
Bladin C. Illness Perceptions of the Acute
Stroke Event. (Poster presentation) The
Australasian Stroke Society and Nursing
Symposium 2009. International Journal of
Stroke 2009; 4.
Bray J, Coughlan K, Wright M, Barger B,
Bladin C. Paramedic diagnosis of stroke:
Examining use of the Melbourne Ambulance
Stroke Scale (MASS) in the field. (Poster
presentation) The Australasian Stroke Society
and Nursing Symposium 2009. International
Journal of Stroke 2009; 4.
Bray J, Coulton B, Tan A, Bladin C. Discharge
planning after stroke thrombolysis: what is
the short-term prognosis? (Oral presentation)
The Australasian Stroke Society and Nursing
Symposium 2009. International Journal of
Stroke 2009; 4.
Bray J, Coulton B, Tan A, Bladin C. The
ongoing dilemma: Poor utilisation of an
ABCD2-based TIA pathway in the ED. (Poster
presentation) The Australasian Stroke Society
and Nursing Symposium 2009. International
Journal of Stroke 2009; 4.
Bray J, O’Connell B, Gilligan A, Livingston P,
Bladin C. The definition of prehospital delay
matters when exploring factors related to
delay in stroke. European Stroke Conference,
Barcelona, Spain, June 2010.
Bray J, O’Connell B, Gilligan A, Livingston P,
Bladin C. Do acute stroke symptoms present
as expected by patients and bystanders?
European Stroke Conference, Barcelona, Spain
June 2010.
Bray J, Coughlan K, Wright M, Barger B,
Bladin C. EMS diagnosis of stroke: Is it
sustained two-years after implementation
of stroke education and prehospital stroke
scale? (Poster presentation) European
Stroke Conference, Sweden, May 2009.
Cerebrovascular Diseases 2009; 27 (s6).
Bray J, O’Connell B, Gilligan A, Livingston P,
Bladin C. Where does the time go? What do
patients and witnesses do before presenting
to hospital for stroke symptoms. (Poster
presentation) European Stroke Conference,
Sweden, May 2009. Cerebrovascular Diseases
2009; 27 (s6).
Bray J, Tan A, Bladin C. Recovery after stroke
thrombolysis: Is three-month outcome review
necessary in all patients? (Oral presentation)
European Stroke Conference, Sweden, May
2009. Cerebrovascular Diseases 2009; 27 (s6).
Bladin C, Bray J, Coulton B. Do gender
differences in treatment with thrombolytic
therapy exist? (Poster presentation) European
Stroke Conference, Sweden, May 2009.
Cerebrovascular Diseases 2009; 27 (s6).
Awards
Janet Bray, Senior Acute Stroke Research
Fellow (Neurosciences) Box Hill Hospital/PhD,
2010 International Conference for Emergency
Medicine, “Best Emergency Prehospital Paper”;
2009 Stroke Society of Australasia, “New
Investigator Award”; 2009 Stroke Society of
Australasia Nursing Scientific Award
Grants
Project Grant ID: 510722 Low-dose
tenecteplase versus standard-dose alteplase
for acute ischaemic stroke: an imaging
based safety and efficacy, Parsons M, Davis
S, Bladin C, Markus R, Dewey H, Levi C,
$445,500 (2008/$168,500; 2009/$138,500;
2010/$138,500).
Project Grant ID: 510721 Intravascular
cooling in the treatment of stroke, Levi
C, Parsons M, Spratt N, Bladin C, $265,500
(2008/$88,500; 2009/$88,500; 2010/$88,500). Department of Human Services,
Victorian Government, NSW Health,
NSW Government National Stroke
Foundation, Ambulance Victoria, Ambulance
NSW. Application ID: 549410, Investigating
telemedicine services in regional Australia
Neurosciences medicine
to treat acute stroke patients: a prospective,
controlled, intervention, Bladin C, $3,308,200.
National Stroke Foundation, NSW
Cardiovascular Research Network – National
Heart Foundation, Stroke Services NSW
(NSW GMCT Stroke), Victorian Stroke Care
Network Grant ID: 569328 Evaluating the
effectiveness of a strategy to increase the
adoption of best evidence practice. A cluster
randomised controlled trial in acute stroke
care. Bladin C, Sanson-Fisher R, Ingelheim B,
$1,586,790.
Grant ID: 586605 Shared team approach
between nurses and doctors for improved
risk factor management (STAND FIRM) for
stroke patients – A randomised controlled trial
(RCT), Thrift A, Cadhilac D, Nelson M, Srikanth
V, Bladin C, Gerraty R, Phan T, 2009 $409,900;
2010 $468,900; 2011 $533,900; 2012 $403,900;
2013 $286,850.
Victorian Stroke Clinical Network ‘Enhancing
Stroke Care’. Are acute stroke patients assessed
by ambulance transported to specialist stroke
centres? 2010, $10,652.
Current Submission – NHMRC 2010
Cadilhac D, Thrift A, Srikanth V, Levi C,
Phan T, Bladin C, Gerraty R, Varigos J,
INTERSTROKE Australia Importance of
conventional and emerging risk factors for
stroke. NHMRC ID: APP1010759
McCrory P, Morris M, Bladin C, Clark R,
Williams G, Oliver J. Physical fitness and
activity in stroke. NHMRC ID: APP1010077
Research training
PhD
(MS clinical nurse consultant), Felicity Pearson
and KJ Lazarus (research coordinators),
Anne Pieris (research coordinator and
administration) and Esmee Groebbe
(international medical student). To achieve
MS research goals, collaborative partners
include Monash University, University of
Melbourne, Florey Institute of Neurosciences
and Cogstate Pty Ltd.
Major achievements
• Bray J, Deakin University
BMedSci Research
• Daly S, Monash University
• Multiple Sclerosis
The Eastern Health Multiple Sclerosis (MS)
service provides clinical and research services
to people with MS. Research activities
include both pharmaceutical clinical trials
and investigator initiated research. The staff
include MS specialist neurologist A/Prof
Helmut Butzkueven (Head of service), Dr Mark
Marriott, Dr Olga Skibina and Dr Anneke van
der Walt (MS Fellow), as well as Jodi Haartsen
In multiple sclerosis (MS), progressive axonal
loss occurs from disease onset and is thought
to be the main pathological determinant of
permanent neurological disability.
The Eastern Health MS service has
concentrated its research on detecting a
component of nerve cells and axons of the
central nervous system, phosphorylated
neurofilament- H (pNF-H). Damage to
axons releases pNF-H, and as previously
detected this protein in serum as a marker of
axonal injury in a mouse model of neuroinflammatory disease. The service is now
investigating whether serum pNF-H levels can
be used to measure axonal injury in MS.
Thus far the service has measured serum
•A/Prof Helmut Butzkueven
Director, MS Service, Eastern Health Neurology
Focusing on Multiple Sclerosis
A/Prof Butzkueven is Director of the MS service at Box Hill
Hospital. He is an academic A/Prof in the Department of Medicine,
University of Melbourne and a Senior Research Fellow at the
Florey Institute, Melbourne. His basic science research interest
is the characterisation of molecular and cellular CNS responses
to autoimmune injury in animal models of MS. He leads a
number of human studies, particularly focusing on large-scale
MS epidemiology, development of new biomarkers for axonal
degeneration in MS and understanding the effects of MS risk genes.
Since 2005, he has been chief investigator of the international
MSBasis study (MS incident cohort study (50 MS centres,
22 countries, 2610 patients) and since 2004, the Chairman of
the MSBase Foundation (www.msbase.org) that provides a
seminal contribution to this global online MS cohort study with
more than 14,660 patients enrolled (54 centres, 27 countries). He
is currently supervising a research team of 12 people including
research nurses, research assistants, graduate students, a research
officer and clinical fellows.
Eastern Health Research Report 2009-10 37
medicine Neurosciences
pNF-H levels in 65 MS patients and 136
healthy controls, and have found that 13 per
cent (9/65) of RR-MS patients have clearly
elevated blood levels of this protein. These
results confirm that detection of elevated
serum pNF-H levels in RR-MS patients is
feasible. To validate this serum biomarker, its
relationship has been assessed to clinical and
para-clinical measures of disease severity in
MS, namely disability scores and MRI lesion
activity. Analysis shows that MS patients with
elevated serum pNF-H levels have higher
disease severity scores (P<0.05) and greater
MRI lesion load (p<0.05) than patients who
have undetectable serum pNF-H levels.
These findings confirm that elevated serum
pNF-H levels can be detected in a proportion
of MS patients. Importantly, blood pNF-H
levels are higher in MS patients with more
rapidly progressing disease, suggesting it
could be an indicator of rapidly accumulating
axonal damage and could be used in the
future as a clinical trail tool for assessment of
neuroprotective agents. The Eastern Health
MS service is now conducting additional
patient recruitment for further validation.
Research projects in progress
MS Base. Butzkueven H. An international
registry dedicated to evaluating outcomes
data in multiple sclerosis (MS). Eastern Health
is contributing 450 patients to this registry of
more than 15,000 patients globally.
Assessment of MS T-cell gene expression.
Skibina O. Profiling in peripheral blood
leucocytes as a predictor of multiple
sclerosis and its severity after a first
demyelinating event.
TRANSFORMS. Fingolimod (FTY720) Protocol
CFTY720D2302. Butzkueven H. A 12-month,
double-blind, randomised, multicentre, activecontrolled, parallel-group study comparing
the efficacy and safety of 0.5 mg and 1.25 mg
fingolimod (FTY720) administered orally once
daily versus interferon βB-1a.
MusiQoL Responsiveness Study. Butzkueven
H, Skibina O, Marriott M. A multicentre,
multi-regional observational study to test
the responsiveness of the validated MusiQoL
(Multiple Sclerosis International Quality of
Life questionnaire) instrument to EDSS status
changes in any form of multiple sclerosis (MS)
in subjects with or without treatment.
Tysabri Observational Project (TOP).
38 Eastern Health Research Report 2009-10
Butzkueven H. This research program is
aiming to learn more about the safety and the
long-term benefits of TYSABRI® when used in
standard clinical practice.
to explore tolerability and safety and health
outcomes of FTY720 in patients with relapsing
forms of MS.
BEGIN. Marriott M. Betaferon treatment and
exercise data gathering in early MS Protocol
310721. Physical activity is correlated with
clinical symptoms and signs prospectively.
The interaction between physical activity and
other potential influencing factors like fatigue,
depression and wellbeing will be examined.
In addition, observational data on Betaferon®
adherence, safety and tolerability is collected.
Research projects completed
Risk Genes. Butzkueven H. Understanding risk
genes in MS. This study aims to investigate
group of genes (risk genes) that are believed
to increase the risk of MS and how they might
influence immune cells in people with MS,
and people with a first demyelinating event,
compared to healthy volunteers.
Axonal Biomarkers. Butzkueven H. Testing
biomarkers of axonal injury in MS. This
research project is aiming to develop a blood
test that can measure and monitor brain
(neuron) damage (neuro-degeneration) in the
blood of people with MS.
NAB Butzkueven H. Identification of genes
predictive of clinical response to interferon
beta. The study established an extended
database of neutralising antibody status
in Australian MS patients taking IFNβ and
demonstrated reduced bioactivity of this
therapy neutralising antibody-positive
patients (McKay et al, 2006). The study
validated TRAIL as a marker of biological
response to IFNβ ex vivo, and demonstrated
TRAIL upregulation in T and B cell models
in response to IFNβ. In addition BAFF was
identified as a novel biological response
marker of IFNβ (Gandhi et al 2008). The study
demonstrated that haplotypes of the multiple
sclerosis susceptibility gene, IL7Rα, vary in
response to interferon beta (Hoe et al, 2009).
CogniMS Butzkueven H. Observational study
to assess cognition in patients with early MS.
Outcome not yet available.
Future research direction
Assessing Cognitve Function in MS.
Skibina O. Optimal measurement of cognition
in MS. This research project is aiming to
better understand how MS affects cognitive
functions and how we can best measure any
cognitive changes.
Improving clinical symptomatic management
of MS, collaborative medical and nursing
research.
INFORMS FTY720D2306. Butzkueven H.
A double-blind, randomised, multicenter,
placebo- controlled, parallel-group study
comparing the efficacy and safety of
0.5mg FY720 administered orally once daily
versus placebo in patients with primary
progressive MS.
Publications
ReNew. Skibina O, Haartsen J. Post marketing
surveillance study to evaluate the tolerability
of Rebif® New Formulation in patients with
relapsing MS in an Australian clinical setting.
ATAMS. Marriott M. A four-arm randomised,
double-blind, placebo-controlled,
multicentre phase II study to evaluate the
safety, tolerability and efficacy as assessed
by frequent MRI measures of three doses
of atacicept monotherapy in subjects with
relapsing multiple sclerosis (RMS) over a
36-week treatment course.
Health Outcomes. Fingolimod (FTY720)
Protocol CFTY720D2316. Marriott M. A
four-month, open-label, multicenter study
Ongoing collaborative scientific research with
Florey Institute and University of Melbourne into
risk gene analysis and axonal loss biomarkers.
Published
Bahlo M, Booth D, Broadley S, Brown M,
Browning B, Browning S, Butzkueven H,
Carroll W, Clarke G, Cox M, Csurhes P,
Danoy P, Drysdale K, Field J, Foote S, Greer J,
Griffiths L, Guru P, Hadler J, Heard R,
Hoban E, Jensen C, Johnson L, Kermode A,
Kilpatrick T, Lechner-Scott J, Marriott M,
Mason D, McCallum R, Merriman M,
Mierriman M, Moscato P, Pender M, Perreau V,
Perrera D, Pryce K, Rubio J, Scott R,
Stankovich J, Stewart G, Tajouri L, Taylor B,
Willoughby E, Wilkins E, Wiley J. Genomewide scan identifies novel multiple sclerosis
susceptibility loci on chromosomes 12 and
20. The Australia and New Zealand Multiple
Sclerosis Genetics Consortium (ANZgene):
Nature Genetics 2009;41:824-828.
Neurosciences medicine
Stankovich J, Butzkueven H, Marriott M,
Chapman C, Tubridy N, Tait B, Varney M,
Taylor B, Foote J, The ANZgene Consortium,
Kilpatrick T, Rubio J. HLA-DRB1 associations
with disease susceptibility and clinical course
in Australians with multiple sclerosis. Tissue
Antigens.2009;74:17-21.
Perera D, Stankovich J, Butzkueven H,
Taylor B, Foote S, Kilpatrick T, Rubio J. Fine
mapping of MS susceptibility genes provides
evidence of allelic heterogeneity at the
IL2RA locus. Journal of Neuroimmunology
2009;211:105-109.
Van der Walt A, Stankovich J, Bahlo M,
Taylor B.V, Van der Mei IAF, Foote S,
Kilpatrick T, Rubio J, Butzkueven H. The
Apolipoprotein genotype does not influence
MS severity, cognition or brain atrophy.
Neurology 2009;73:1018-1025.
Jensen C, Stankovich J, Van der Walt A,
Bahlo M, Taylor B, IAF Van der Mei IAF,
Foote S, Kilpatrick T, Johnson L, Wilkins E,
Field J, Danoy P, Brown M. Multiple sclerosis
susceptibility-associated SNPs do not
influence disease severity measures in a
cohort of Australian MS patients. ANZGENE,
Rubio JP, Butzkueven H. PLoS ON5(4):e10003.
doi:10.1371/journal.pone.0010003 27/2/2010.
Van der Walt A, Butzkueven H, Kolbe S,
Marriott M, Alexandrou E, Gresle M,
Egan G, Kilpatrick T. Neuroprotection in
Multiple Sclerosis: a therapeutic challenge
for the next decade. Pharmacology and
Therapeutics 2010 Feb1 epub.
Bahlo M, Stankovich J, Danoy P, Hickey P,
Taylor BV, Browning S, ANZgene (including
Butzkueven H), Brown M, Rubio J. Salivaderived DNA performs well in large-scale,
high-density SNP microarray studies. Cancer,
Epidemiology, Prevention and Biomarkers
Accepted 6/1/2010.
Jensen C, Stankovich J. Butzkueven H,
Oldfield B, Rubio J. Common variation
in the MOG gene influences transcript
splicing in humans. Accepted in Journal of
Neuroimmunology 28 July 2010.
Outcomes from research
collaboration
Cohen J, Barkhof F, Comi G, Hartung HP,
Khatri BO, Montalban X, Pelletier J, Capra R,
Gallo P, Izquierdo G, Tiel-Wilck K, de Vera A,
Jin J, Stites T, Wu S, Aradhye S, Kappos L.
Oral fingolimod or intramuscular interferon
for relapsing multiple sclerosis TRANSFORMS
Study Group (including H Butzkueven).
New Engl J Med. 2010;362:402-415.
Gandhi K, McKay F, Cox M, Riveros C,
Armstrong N, Heard R, Vucic S, Williams D
Stankovich J, Brown M, Danoy P, Stewart G,
Broadley S, Moscato P, Lechner-Scott J,
Scott R, Booth D. The multiple sclerosis whole
blood mRNA transcriptome and genetic
associations indicate dysregulation of specific
T cell pathways in pathogenesis ANZgene
Multiple Sclerosis Genetics Consortium
(including H Butzkueven). Human Molecular
Genetics, advanced online publication
27 February 2010.
Presentations
International
Butzkueven H. Glial responses in
inflammatory CNS injury: good and bad.
Invited seminar, Neuropathology Department,
University of Muenster, Germany,
October 2009.
Butzkueven H. A genome-wide association
study identifies new susceptibility loci for
multiple sclerosis. Invited neuroscience
seminar, University of Bochum, Germany,
October 2009.
Butzkueven H. MS Base: Powering Australian
and international longitudinal databasing in
Multiple Sclerosis. Invited Speaker, PACTRIMS
2009, November, Hong Kong, November
2009.
Van der Walt A. The influence of the HLADR2 on Multiple Sclerosis severity, oral
presentation, ANZAN, Christchurch, New
Zealand 2009.
National
Butzkueven H. Recent risk gene discoveries in
Multiple Sclerosis. Invited speaker, Neurology
Grand Round, Royal North Shore Hospital,
Sydney, November 2009.
Butzkueven H. The role of innate immune
system in autoimmune neurological disease.
Invited presentation, 1st Neuroimmunology
Society of Australia meeting, Brisbane,
May 2010.
Butzkueven H. Novel and emerging
immunomodulatory therapies in MS.
Invited oral presentation, Autoimmunity
and Neurology Symposium, The Westmead
Hospital Research Week, Sydney, 2010.
Butzkueven H. Recent risk gene discoveries in
Multiple Sclerosis. Invited speaker, Neurology
Grand Round, Royal North Shore Hospital,
Sydney November 2010.
Local
Butzkueven H. New disease-modifying
drugs for MS. Invited presentation, ANZAN
Neurology Registrar Teaching Course,
Melbourne, March 2009.
Butzkueven H. Using animal models in
neuroscience research. CNS Seminar Series,
Melbourne, May 2009.
Butzkueven H. Glial responses in
inflammatory CNS injury: good and bad,
Anatomy and Cell Biology Seminar Series,
University of Melbourne, Melbourne,
May 2009.
Butzkueven H. New drugs for MS-are we
there yet? Invited speaker, Medical Grand
Round, The Royal Melbourne Hospital,
Melbourne, March 2009.
Butzkueven H. The MS Base Registry. Invited
presentation, Registries Special Interest Group,
The Alfred Hospital, Melbourne, June 2010.
Butzkueven H. Validation of a novel serum
marker of neurodegeneration in MS patients.
Oral presentation, Melbourne Health Research
Symposium, Melbourne, June 2010.
Grants
NHMRC project grant ID628856, Career
development award, Butzkueven H. $94,250/
year 2010-2013.
NHMRC Project Grant ID 6287992, Validating
novel serum markers of neurodegeneration
in Multiple Sclerosis patients 2010-2012,
Butzkueven H, Taylor B, Shaw C. 2010:
$180,000; 2011: $180,000, 2012: $137,000.
Merck Serono 2009-2010, Testing cognition in
MS Eastern Health MS Service $15,000
Sanofi-Aventis Fellowship 2010 in MS van
der Walt A, $16,500.
Research training
PhD
• Dr van der Walt A, Melbourne University,
F/T
Eastern Health Research Report 2009-10 39
medicine Respiratory and sleep
> Respiratory and sleep
The Department of Respiratory and Sleep
Medicine was established in September 2008
and has research interests in a wide range of
clinical respiratory conditions. Clinical trials
are being conducted in asthma, chronic
obstructive pulmonary disease (COPD) and
sleep apnoea. There are also research interests
in complementary and alternative medicine
(CAM) for respiratory disease, spirometry
practice and functional lung imaging. The
unit is led by A/Prof Frank Thien, with clinical
trial investigator Dr Paul Fogarty and staffed
by clinical trial coordinators Irina Shinkarsky
and Sue Dal Sasso. They will be joined in 2010
by Dr Alan Young who has been appointed
director of sleep services with specific
research interests in sleep medicine and
non-invasive ventilation. Advanced trainees
are also strongly encouraged to do a clinical
research project during their clinical training
at Eastern Health.
Major achievement
A major achievement in the last 12 months
has been the awarding of two three-year
NHMRC project grants for 2010-2012 listed
below. In addition to our pharmacological
clinical trials, these investigator initiated
NHMRC funded studies will add considerably
to our knowledge of underlying mechanisms
of asthma and management of COPD. The
unit will continue to grow and build up its
research portfolio.
(T2DM). Subjects are randomised to either
CPAP treatment or no PAP treatment as well
as to lifestyle counselling and followed for
six months.
asthma control. One paper has already
been published with other manuscripts in
preparation for submission and publication.
Clipper study. This is a clinical trial of a oncedaily inhaled steroid/long-acting beta-agonist
combination in COPD looking at reducing
exacerbation rates.
Future research direction
Tiotropium study. This clinical trial looks at a
new delivery system of the long-acting
anti-cholinergic agent tiotropium in COPD.
A clinical trial on acupuncture for hay fever.
This NHMRC-funded Project Grant (555412
Xue C, Thien F, Story DF) is a randomised
controlled trial looking at the effect of
acupuncture on seasonal allergic rhinitis. This
commenced in 2009 and will be completed
over 2010 and 2011.
The effect of a standardised ginseng
extract in patients with moderate COPD.
A randomised, double-blind trial, newly
funded NHMRC project which has just
commenced, and will continue until 2012.
It will study the effects of oral ginseng in
subjects with moderate COPD in addition to
standard care.
Ventilation heterogeneity and airway
remodelling in asthma. This is a study using
hyperpolarised helium magnetic resonance
lung imaging to characterise ventilation
heterogeneity in asthma. This commenced in
mid 2010.
Research projects in progress
The Sleep Apnoea cardioVascular Endpoints
(SAVE) study. This is an international
multicentre open parallel-group, prospective
randomised controlled trial to determine the
effectiveness of treatment with continuous
positive airway pressure (CPAP) in addition to
standard care in reducing cardiovascular (CV)
morbidity and mortality in patients.
GLYC OSA. This is a multicentre, international,
randomised, controlled, prospective study of
the effect of nasal CPAP on glycaemic control
in patients with type 2 diabetes mellitus
40 Eastern Health Research Report 2009-10
The research interests identified above
remain the main activity of the unit.
The research direction will continue to
be in translational clinical research with
pharmacological studies; outcomes of
interventions in sleep medicine; and clinical
applications of functional lung imaging.
Publications
Published
Abramson MJ, Schattner RL, Sulaiman ND,
Birch KE, Simpson PP, Del Colle EA, Aroni RA,
Wolfe R, Thien F. Do spirometry and regular
follow-up improve health outcomes in
general practice patients with asthma or
COPD? A cluster randomised controlled trial.
Med J Aust. 2010;193:104-9.
Zhang CS, Yang AW, Zhang AL, Fu WB,
Thien F, Lewith G, Xue CC. Ear-acupressure
for allergic rhinitis: a systematic review. Clin
Otolaryngol. 2010;35:6-12.
Lenon GB, Xue CC, Story DF, Thien FC,
Li CG. Inhibition of release of inflammatory
mediators in rat peritoneal mast cells and
murine macrophages by a Chinese herbal
medicine formula (RCM-102). Phytother Res.
2009;23:1270-5.
Research projects completed
INTRUST. This study of a once-daily, longacting beta-agonist bronchodilator in patients
with chronic obstructive pulmonary disease
(COPD) was completed in mid 2010. Data is
currently being analysed.
SPIRO-GP. This is a study of the role of
spirometry in general practice completed
last year. The results showed that regular
spirometry in general practice did not
improve quality of life for patients with
obstructive lung disease but improved
Abstracts
Published
Del Colle E, Green J, Adikari A, Schattner R,
Simpson P, Wolfe R, Sulaiman N, Abramson M,
Thien F. Regular spirometry with medical
review is not associated with improvement in
lung function in general practice. Respirology
2010:15 (Suppl. 1):A9.
Ong CW, Coughlin P, Leach D, Thien F.
Implementation of a clinical prediction tool
Respiratory and sleep medicine
for pulmonary embolism diagnosis in a
teaching hospital. Respirology. 2010;15
(Suppl.1):A29.
Aiyappan V, Munawar A, Thien F. A study on
junior doctor awareness on the indications
for diagnostic thoracentesis and familiarity
with the procedure. Respirology. 2010;15
(Suppl.1):A66.
Moldovan C, Aiyappan V, Ibrahim M. Unusual
etiology of PET positive solitary lung nodule
in a patient with previous malignancy.
Respirology. 2010;15 (Suppl.1):A81.
Outcomes of research
collaboration
Calverley PM, Rabe KF, Goehring UM,
Kristiansen S, Fabbri LM, Martinez FJ. M2-124
and M2-125 study groups. Roflumilast in
symptomatic chronic obstructive pulmonary
disease: two randomised clinical trials.
Lancet 2009;374:685-94.
Cazzoletti L, Marcon A, Corsico A, Janson C,
Jarvis D, Pin I, Accordini S, Bugiani M,
Cerveri I, Gislason D, Gulsvik A, de Marco R.
Therapy and Health Economics Group of the
European Community Respiratory Health
Survey. Asthma severity according to Global
Initiative for Asthma and its determinants: an
international study. Int Arch Allergy Immunol
2010;151(1):70-9.
Presentations
and New Zealand Annual Scientific Meeting.
Brisbane, March 2010.
International
Thien F. Obstructive lung diseases, Royal
Thien F, Oei SM, Schattner R, Del Colle E,
Lucas K, Aroni R, Sulaiman N, Abramson MJ.
The effect of spirometry on asthma control
In general practice patients: a randomised
controlled trial. World Allergy Congress.
Buenos Aires, Argentina, December 2009.
Australasian College of Physicians Basic
National
Box Hill. Melbourne, January 2010.
Del Colle E, Green J, Adikari A, Schattner R,
Simpson P, Wolfe R, Sulaiman N,
Abramson M, Thien F. Regular spirometry
with medical review is not associated with
improvement in lung function in general
practice. Thoracic Society of Australia and
New Zealand Annual Scientific Meeting.
Brisbane, March 2010.
Thien F. What is asthma? Asthma Educators
Ong CW, Coughlin P, Leach D, Thien F.
Implementation of a clinical prediction tool
for pulmonary embolism diagnosis in a
teaching hospital. Thoracic Society of Australia
and New Zealand Annual Scientific Meeting.
Brisbane, March 2010.
Aiyappan V, Munawar A, Thien F. A study on
junior doctor awareness on the indications for
diagnostic thoracentesis and familiarity with
the procedure. Thoracic Society of Australia
Physicians lecture. Melbourne, April 2010.
Local
Thien F. Lung function in acute care medicine.
Eastern Health Acute Care Medicine Course,
Course, Lung Health Promotion Centre, Alfred
Hospital. Melbourne, March 2010.
Thien F. World Allergy Congress 2009 review.
Allergy Breakfast Meeting, Box Hill Hospital.
Melbourne, May 2010.
Grants
NHMRC Project Grants
606944 Ventilation heterogeneity and airway
remodelling in asthma. Thien F, Thompson B,
Robinson P, Harris B, Cowin G. $504,750. 616609 The effect of a standardised ginseng
extract in patients with moderate COPD: a
randomised, double-blind trial. Xue C, Thien F,
Wornsnop C, Zhang A. $560,375.
Eastern Health Research Report 2009-10 41
medicine Renal
> Renal
Part of Eastern Health
Integrated Renal Service
The research profile of the Department of
Renal Medicine is still developing. In its first
two years of operation, it has established a
research director Prof Lawrance McMahon,
research Fellow Dr Sanjeev Baweja,
coordinator Annette Kent and research
assistant Amy Clements. In addition, as is
evidenced in details below, the physicians
within the department are involved in
ongoing clinical research.
The main focus currently is on clinical trials,
both investigator- and industry-driven. As
outlined below, there is a keen interest in
improving the quality of life and exercise
capacity of dialysis patients. In addition,
the unit is involved in numerous industryrelated studies from phase I to phase IV trials.
Collaboration with other departments within
Eastern Health and with renal services from
other hospitals is an additional component
and area of research. The unit will continue its
steady growth in renal research, particularly
in a collaborative fashion, and to establish
a focus of expertise and interest in the next
several years.
Major achievement
Cooper B, Branley P, Bulfone L, Collins
J, Craig J, Fraenkel M, Harris A, Johnson
A, Kesselhut J, Li JJ et al. A randomised,
controlled trial of early versus late initiation of
dialysis (IDEAL Study). New England Journal of
Medicine. 27 June 2010. A multicentre study
performed over four years to ascertain the
potential benefits of commencing dialysis at
a higher eGFR (11-13 mL/min) versus lower
eGFR (5-7 mL/min). Despite adequate power,
there was little or no difference.
Research projects in progress
Investigator initiated studies
Effect of combined strength training and
psychological intervention on quality of life
in prevalent haemodialysis patients. This is
42 Eastern Health Research Report 2009-10
an eight month study which examines the
relative benefits of exercise and psychological
support (sequentially) in long-term dialysis
patients. If indicative of benefit, it will be
extended to better ascertain its benefits.
Industry-sponsored trials
• A multicentre, randomised, double-blind
study comparing de novo once monthly
and once every two weeks darbepoetin
alfa dosing for the correction of anaemia
in subjects with chronic kidney disease not
receiving dialysis.
• An open-label, multicentre, randomised,
three-arm study to investigate the
comparative efficacy and safety of
intravenous ferric carboxymaltose
(Ferinject(R) high- and low- dosage
regimens) versus oral iron for the treatment
of iron deficiency anaemia in subjects
with non-dialysis-dependent chronic
kidney disease.
• A phase IIa, randomised, single-blind,
placebo-controlled, parallel-group study
to evaluate the safety pharmacokinetics
and efficacy of 28-day repeat oral doses of
GSK1278863A in anaemic pre-dialysis and
haemodialysis dependent patients.
• A double-blind, randomised, placebocontrolled, two-period crossover study
to assess the safety and tolerability of
single ascending doses of kai-4169 in
hemodialysis subjects with secondary
hyperparathyroidism.
Future research direction
The unit has a long track record of completing
clinical and laboratory-based studies involving
dialysis and pre-dialysis patients with anaemia
and/or exercise intolerance and will continue
to focus on developing research interests and
directions. Additional areas of interest will
likely be to ascertain cardiovascular risk factors
in pre-dialysis, dialysis and transplant patients.
Obstetric medicine issues will also be an
attractive area to explore in conjunction and
collaboration with the obstetric service.
Publications
Published
Lee D, Levin A, Roger S, McMahon LP.
Longitudinal analysis of performance of
estimated glomerular filtration rate as renal
function declines in chronic kidney disease.
Nephrol Dial Transplant 2009. 24:109-116.
Peterson A, Leikis M, McMahon L, Kent A,
McKenna M. Impaired extrarenal potassium
regulation and exercise performance are
improved with endurance training in patients
on haemodialysis. Nephrology Dialysis
Transplantation 2009. 24:2882-2888.
Lowe S, Brown M, Dekker G, Gatt S,
McLintock C, McMahon L, Mangos G,
Moore M, Muller P, Paech Walters M. The
management of hypertensive disorders of
pregnancy. Consensus statement. Society
of Obstetric Medicine of Australia and New
Zealand, The Australian & New Zealand
Journal of Obstetrics & Gynaecology 2009.
49(3):242-246.
McMahon L. The management of chronic
hypertension in pregnancy. Modern Medicine
of South Africa November/December:
2009. 16-22.
McMahon L. Iron deficiency in pregnancy.
Obstetric Medicine 2010, 3:17-24.
McMahon L, Kent A, Keer P, Healy H,
Irish A, Cooper B, Kark A, Roger S.
Intravenous iron sucrose versus oral iron
for the anaemia of chronic kidney disease:
a randomised controlled trial. Nephrology
Dialysis Transplantation, NDT Advance Access
(published 10 November 2009)
In press
Rottembourg J, Bridges I, Pronal W, Feriani M,
McMahon L, De Meester J, Farouk M,
Molemans B. An observational study of
the effectiveness and safety of darbepoetin
alfa administered once every two weeks for
12 months in dialysis patients. Clinical
Nephrology.
Renal medicine
Feriani M, De Meester J, McMahon L,
Rottembourg J, Pronai W, Bridges I, Pronai W,
Farouk M. Extended dosing of darbepoetin
alfa in peritoneal dialysis patients. Peritoneal
Dialysis International.
Abstracts
Published
Feriani M, Pronai W, McMahon L,
De Meester J, Bridges I, Farouk M,
Rottembourg J on behalf of the ALTERNATE
Study Group. Darbepoetin alfa administered
once every two weeks for 12 months in
peritoneal dialysis patients. WCN Meeting,
Milan, Italy. May 2009.
McMahon L, Feriani M, Pronai W,
De Meester J, Bridges I, Farouk M,
Rottembourg J on behalf of the ALTERNATE
Study Group. Darbepoetin alfa administered
once every two weeks for 12 months in
haemodialysis patients. WCN Meeting, Milan,
Italy. May 2009.
Feriani M, De Meester J, McMahon L,
Rottembourg J, Bridges I, Farouk M and
Pronai W on behalf of the ALTERNATE
Study Group. Maintenance of haemoglobin
concentration on a darbepoetin alfa Q2W
dosing schedule in peritoneal dialysis patients:
results from ALTERNATE, a large observational
study in Europe and Australia. 9th European
Peritoneal Dialysis Meeting (EUROPD 2009),
Strasbourg, France. September 2009.
Cooper B, Branley P, Bulfone L, Collins J,
Craig J, Fraenkel M, Harris A, Johnson D,
Kesselhut J, Li JJ, Luxton G, Pilmore A,
Tiller D, Harris C, Pollock C. A randomised,
controlled trial of early versus late initiation of
dialysis (IDEAL) study). NEJM June 27, 2010.
De Meester J, Pronai W, Bridges I, McMahon
L, Rottembourg J, Farouk M, Feriani M on
behalf of the ALTERNATE Study Group.
Challenges of anaemia management in
hemodialysis (HD) patients: maintenance
of haemoglobin (Hb) concentrations with
darbepoetin alfa (DA) every two weeks (Q2W)
ASN Meeting, Philadelphia, USA. October 2009.
ANZSN-Amgen Quality Assurance Grant
Kan K, An exploratory study to compare the
effectiveness of CKD clinic coordinated by
nurse practitioner versus usual care with
nephrologists in the comprehensive care of
stable stage 3-4 CDK patients in the Eastern
Health, $11,000.
De Meester J, Bridges I, Farouk M, Feriani
M, Molemans B, Pronai W, Rottembourg J,
McMahon L on behalf of the ALTERNATE
Study Group. Darbepoetin alfa once every two
weeks in a cohort of haemodialysis patients,
with or without comorbidities, from the
ALTERNATE Study. ERA-EDTA Congress, Munich,
Germany, June 2010.
Grants
Roche Projects McMahon L, PHOENIX Study.
Comparison between two target epoetins,
examining echocardiographic changes and
variations in BNP, $10,000.
Amgen McMahon L. Effect of combined
strength training and psychological
intervention on quality of life in prevalent
haemodialysis patients, $90,000.
Eastern Health Research Report 2009-10 43
medicine Cardiology
> Cardiology
The Eastern Health Department of Cardiology,
provides services from Angliss, Box Hill and
Maroondah hospitals. The department
provides an inpatient and outpatient clinical
service that is supported by three noninvasive echocardiography laboratories at
each site and a cardiac catheter laboratory
at Box Hill Hospital. The unit also has links
with subacute care that includes cardiac
rehabilitation and a HARP-supported heart
failure program.
The department has been conducting
research for over 20 years. A wide variety
of clinical research is pursued that includes
investigation into novel pharmacological
agents, therapeutic devices for patients
who have coronary heart disease, rhythm
disturbances and heart failure. The unit enjoys
collaborative links with departments within
Eastern Health and with other academic
institutions (nationally and internationally)
and the unit fosters a philosophy of
encouragement to staff at all levels such
as medical students, nurses, cardiac
technologists, residents, registrars
and cardiologists to participate in various
research projects.
Major achievement
Shipping Infarcts for Primary Angioplasty in
Eastern Melbourne: The SHIPEM Registry
This prospective registry examines the
safety and efficacy of transferring acute
heart attack patients from nearby hospitals
without on site angioplasty services to Box
Hill Hospital for emergency angioplasty on a
24-hour basis. The six-year registry data was
published in June 2010 in the Medical Journal
of Australia (MJA 2010;192:702-707) alongside
editorials on the same theme raising issues
regarding appropriateness of the CSANZ/
NHF Australian Guidelines in treating acute
coronary syndromes. The study reported on
over 800 patients undergoing emergency
angioplasty and stenting for acute heart
attacks. The study demonstrated that in the
“real world”, it was not dangerous and it is
44 Eastern Health Research Report 2009-10
practical to transfer patients having acute
heart attacks from nearby hospitals without
cardiac catheterisation laboratory to a centre
that has this facility. This information gleaned
from the study provides evidence in support
to the establishment of a coordinated strategy
with Ambulance Victoria to provide urgent
transfer capability.
Research projects in progress
Angioplasty database. A prospective,
consecutive database of all patients
undergoing angioplasty. Clinical outcomes
are presented at departmental, Eastern
Health grand rounds and at national and
international meetings.
Cardiac complications of clozapine (CCC).
A bench-to-bedside study investigating the
mechanisms, incidence, clinical features
and potential therapeutic interventions for
cardiac injury in people taking clozapine for
schizophrenia. This study is a collaboration
between Eastern Health (Cardiology and
Mental Health) and Monash University.
Comparison of outcomes following
fibrinolysis versus transfer for emergency
angioplasty in non-angioplasty capable
centres. This is a retrospective study
comparing the outcomes in patients who
have been transferred from Angliss and
Maroondah hospitals to Box Hill Hospital for
emergency angioplasty for a heart attack with
those patients who did not get transferred
but received an alternative clot dissolving
intravenous medication.
iPad at the cardiology bedside: a pilot
study. As healthcare moves toward use
of electronic medical records, the ability
to seamlessly access these records at the
bedside is becoming pivotal to patient care.
The present system includes use of desktop
computer or a battery-charged laptop on a
trolley (COW – computer on wheels) which
is wheeled from one patient’s bedside to
another during ward rounds. A two-week trial
was performed to assess the potential impact
of the iPad to replace the COW as a point of
care computer. After the two-week trial, the
iPad was found to be a very useful device by
cardiology clinicians. They were able to access
medical records more efficiently. The iPad was
light and easy to carry and work on during
the patient consultation. Images could be
demonstrated to the staff and patient and
their relatives for education purposes. This
trial focused on the basic capabilities of the
iPad and did not explore the wide range of
medical applications that are available online
such as journal databases, risk calculators
and medication guides. There was a positive
response to the use of the iPad but further
refinement in making it HealthSMART
compatible and education of clinicians to fully
integrate this technology into the healthcare
setting is required.
Prognostic validation of treadmill stress
echocardiography in an unselected
Australian population. This is a retrospective
analysis of a consecutive group of patients
referred to Box Hill Hospital for stress echo.
The aim is to evaluate the prognostic value
of stress echocardiography in a real-world
context in Australia, at a public hospital with
an open access referral system. Preliminary
data suggests that stress echocardiography
is a good test to exclude significant coronary
heart disease in the group of patients
presenting for this test.
Local collaborative
research in progress
Melbourne Interventional Group (MIG).
This is a collaborative registry involving
12 public and private hospitals in Victoria
that commenced collecting data in 2005.
The unit contributes information from all
patients undergoing angioplasty. To date the
registry comprises of over 13,000 angioplasty
procedures. There is a 12 month follow up
on 10,000 patients and three-year followup on over 1,000 patients making this the
largest angioplasty registry in Australia. The
MIG has published over 15 manuscripts in
peer review journals and over 100 abstracts
for presentation at national and international
scientific meetings.
Cardiology medicine
Trial of interventions in neurocardiogenic
syncope. This is a collaborative study
between Eastern Health cardiology and
Deakin University that examines the role
of behaviour modification in patients with
neurocardiogenic syncope as defined by a
positive tilt-table test.
International
Collaborative research
Novel cardiac risk factors and biomarkers in
heart disease. This is an ongoing collaborative
research project with the National Heart and
Lung Institute, Imperial College, London
and School of Public Health & Preventive
Medicine, Monash University, Melbourne
examining various risk factors, biomarkers and
non-invasive arterial measurements to predict
risk of coronary heart disease.
dal-OUTCOMES. This is a phase III, doubleblind, randomised placebo-controlled study
to evaluate the effects of dalcedrapid (an oral
agent that raises HDL cholesterol levels) on
cardiovascular risk in stable coronary
heart disease.
PROTECT. This randomised open-labeled
controlled trial comparing Endeavour versus
Cypher drug-eluting stents. The aim of the
study is to compare long-term clinical events
in particular late stent blood clot formation
(thrombosis).
PROTECTION MI. This randomised, placebocontrolled study evaluates the effect of
KAI-9803 to reduce infarct size in patients
presenting with a heart attack undergoing
emergency angioplasty.
RELY ABLE. This randomised, long-term
trial compares the efficacy and safety of
dabigatran etexilate (a novel anti-clotting
agent) with warfarin for the prevention of
stroke and other embolism in patients with
non-valvular atrial fibrillation.
TAXUS ATLAS. A multicentre, single-arm
study of the TAXUS Liberte-SR stent for
the treatment of patients with coronary
artery lesions.
SOLID. A clinical outcomes study of
Darapladib versus placebo in subjects
following acute coronary syndrome
to compare the incidence of Major
Cardiovascular Events (MACE). The purpose
of this study is to test a potential new drug
to promote plaque stabilisation following an
acute cardiac event.
Research projects completed
RE-LY. This international study was conducted
by Boehringer Ingelheim. The study randomly
assigned 18,113 patients who had atrial
fibrillation and a risk of stroke to receive either
fixed doses of dabigatran - 110mg or 150mg
twice daily or warfarin. The median duration
of the follow-up was two years. The primary
outcome was stroke or systemic embolism
(a moving blood clot). The conclusion of the
study was that patients given dabigatran
110mg dose were associated with similar
rates of stroke and systematic embolism as
those taking warfarin but with lower major
bleeding events. The dabigatran 150mg dose
when compared to warfarin showed lower
rates of stroke and systemic embolism but
similar rates of major bleeding. The net clinical
benefit was similar between the two doses of
dabigatran owing to the lower risk of stroke
with the 150mg dose and the lower risk of
bleeding with the 100mg dose. This drug has
recently become available for post-operative
prevention of DVT.
Reactive hypoglycaemia in hypotensive
syncope. McGregor E, Beale J, Snell A, Roberts
L, Hamer AW. The aim of this study was to
determine if venous blood glucose levels are
significantly lowered by acute hypotension
associated with neurocardiogenic syncope
or presyncope. Venous blood samples
were monitored of 50 patients at a variety
of time points throughout their tilt table
test. No systematic evidence was found
for hypoglycaemia playing a clinical role in
neurocardiogenic hypotensive syncope.
Future research direction
•
•
•
•
•
•
•
•
Interventional cardiology
Echocardiography
Rhythm disturbance and pacing
Heart failure
Simulation education
Lipids and other risk factors
Plaque stabilisation
Carotid stenting
Publications
Published
Butler MJ, Eccleston D, Clark DJ, Ajani AE,
Andrianopoulos N, Brennan A, New G,
Black A, Szto G, Reid CM, Yan BP, Shaw JA,
Dart AM, Duffy SJ on behalf of the
Melbourne Interventional Group
Investigators. The effect of intended duration
of clopidogrel use on early and late mortality
and major adverse cardiac events in patients
with drug-eluting stents. Am Heart J 2009;
157:899-907.
Lim HS, Farouque O, Andrianopoulos N,
Yan, Ch P. Lim CS, Brennan AL, Reid CM,
Freeman M, Charter K, Black A, New G,
Ajani, AE, Duffy SJ, Clark DJ on behalf of the
Melbourne Interventional Group. Survival
of elderly patients undergoing percutaneous
coronary intervention for acute myocardial
infarction complicated by cardiogenic shock.
J Am Coll Cardiol Intv, 2009;2:146-152.
Coller JM, Parente P, Esmore D, New G,
Cooke JC, Murugasu A. Large left
ventricular metastasis causing left ventricular
outflow tract obstruction and haemolysis.
European Journal of Echocardiography 2009
10(3):456-458.
New G Left versus right carotid artery
stenting: Is it important? Catheterisation and
cardiac interventions. Catheter Cardiovasc
Interv. 2009 Jul 1;74(1):9-10.
Bladin C, Chambers B, Crimmins D, Denton M,
Davis S, Donnan G, Frayne J, LawrenceBrown M, CLevi, Muller D, New G, Phatouros
C, Scroop R, Harrington T. Guidelines for
patient selection and performing of carotid
stenting: The Carotid Stenting Guidelines
Committee: An Inter-Collegiate Committee
of the RACP (AAN, CSANZ), RACS (ANZSVS)
and RANZCR. Journal of Medical Imaging and
Radiation Oncology; 53 (2009) 538-545.
Kotecha D, Flather M, McGrady M, Pepper J,
New G, Krum H, Eccleston D. Contemporary
predictors of coronary artery disease in
patients referred for angiography. Eur J
Cardiovasc Prev Rehabil. 2010 Jun;17(3):280-8.
Teh AW, New G, Cooke J. A single centre
report on the characteristics of Tako-tsubo
syndrome. Heart Lung Circ. 2010;19:63–70.
Moore M, Roberts L, Liew HB, Briganti EM,
New G. Transferring patients for primary
angioplasty in Eastern Melbourne (the SHIPEM
Registry): Are we meeting the guidelines? MJA
2010;192:702-707.
Bladin C, Chambers B, New G, Denton M,
Lawrence-Brown M. Guidelines for patient
selection and performance of carotid stenting:
The Carotid Stenting Guidelines Committee:
an inter-collegiate committee of the RACP
(AAN, CSANZ), RACS (ANZSVS) and RANZCR.
ANZ J Surg 80 (2010)398–405.
Eastern Health Research Report 2009-10 45
medicine Cardiology
Abstracts
Published
Andrianopoulos N, Yip T, Sebastian M,
New G, Clark D, Ajan A, Duffy S, Brennan A,
Reid, Gender C. Differences in symptomto-balloon time and outcomes in patients
with ST-Elevation myocardial infarction
(Stemi) undergoing primary percutaneous
coronary intervention (PCI): Insights from the
Melbourne Intervention Group (MIG) registry.
Abstract accepted for presentation at the
National Heart Foundation Annual Scientific
Meeting, 2009.
Chan W, Ajani AE, Clark DJ, Andrianopoulos N,
Brennan AL, Reid CM, New G, Kistler M,
Dart AM, Duffy SJ. Impact of peri-procedural
atrial fibrillation (AF) on short-term clinical
outcomes following percutaneous coronary
intervention (PCI). Heart, Lung and Circulation
2009: 18S:S1-S286.
Ching SL, Roberts L, Cheah MS, Purba RK,
Naidu P, Martin C, Cooke J, Fernando D,
Cheong YM, New G. Achieving aggressive
LDL targets in secondary prevention: are we
meeting the LDL guidelines? Heart, Lung and
Circulation 2009;18S:S1-S286.
Mok M, Black A, Ajani AE, Duffy SJ,
Adrianopoulos N, Brennan AL, Reid CM,
New G, Dyson L, Yip T. Primary Percutaneous
Coronary Intervention (PPCI) in St-Elevation
Myocardial Infarction (STEMI): Use of PeriProcedural Glycoprotein IIB/IIIA Inhibitors
(GPIIB/IIIA) in patients already pre-treated with
clopidogrel. Heart, Lung and Circulation 2009;
18S:S1-S286.
Mok M, Black AJ, Clark D, Ajani AE, Duffy SJ,
Black JA, New G, Reid CM, Adrianopoulos N,
Yip T. Procedural Glycoprotein IIB/IIIA Inhibitor
(GPIIB/IIIA) Use In patients With St-Elevation
Myocardial Infarction (STEMI) who undergo
Primary Percutaneous Coronary Intervention
(PPCI) without clopidogrel pretreatment.
Heart, Lung and Circulation 2009; 18S:S1-S286.
Roberts L, Moore MJ, Ching SL, Sapontis J,
Childs W, Beale J, Murray A, McCormack M,
New G. The Shipem Registry: Shipping
46 Eastern Health Research Report 2009-10
Infarcts for Primary Angioplasty In Eastern
Melbourne: Are we meeting the NHF/CSANA
guidelines? Heart, Lung and Circulation 2009;
18S-S1-S286.
Ching SL, Sapontis J, Moore MJ, Childs WY,
Beale J, Roberts L, Rowe M, Goods C,
Prominos G, New G. Thirty-day and one-year
MACE follow-up of elective and non-ST
elevation ACS. Heart, Lung and Circulation
2009; 18S:S1-S286.
Kotecha D, New G, Flather M, Pepper J,
Eccleston D, Krum H. Is five-minute heart
rate variability superior to ECG for identifying
patients with coronary artery disease? Heart,
Lung and Circulation 2009; 18S:S1-S286.
Lim HS, Farougue O, Lim CCS,
Andrianopoulos A, Brennan AL, Moore M,
New G, Ajani AE, Duffy SJ, Clark DJ. Hospital
survival in patients with out-of-hospital
cardiac arrest undergoing percutaneous
coronary intervention. Heart, Lung and
Circulation 2009; 18S:S1-S286.
Sapontis J, Ching SL, Moore MJ, Childs W,
Roberts L, Brennan A, Adrianopoulos N,
Reid C, Black A, New G. Gender differences in
percutaneous coronary intervention (PCI) in
the Drug Eluting Stent (DES) ERA: Melbourne
Interventional Group (MIG) Registry. Heart,
Lung and Circulation 2009; 18S:S1-S286.
Ching S, Roberts L, Cheah MS, Purba RK,
Naidu P, Martin C, Cooke JC, New G. Are we
achieving aggressive LDL targets in secondary
prevention? An Australian experience. The
Canadian Journal of Cardiology October 2009
abstract;25:Supplement B.
Presentations
International
Ching SL. Are we achieving aggressive
LDL targets in secondary prevention?
An Australian experience. Canadian Cardiac
Society, Edmonton, Canada, September 2009.
Roberts L. Shipping Infarcts for Primary
Angioplasty in Eastern Melbourne: SHIPEM
REGISTRY: Is it possible to achieve guideline
door-to-door balloon times? American Heart
Association Scientific Conference. Orlando,
USA, November 2009.
New G. Asymptomatic Carotid Stenosis: Are
there predictors beyond stenosis severity?
American College of Cardiology Annual
Scientific Meeting. Atlanta, Georgia, USA,
March 2010.
National
Ching SL. Thirty-day and one-year MACE
follow up of elective and non ST elevation
ACS, Cardiac Society of Australia and New
Zealand Annual Conference. August,
Sydney 2009.
Sapontis J. Gender differences in
Percutaneous Coronary Intervention (PCI) in
the Drug Eluting Stent (DES) era: Melbourne
Interventional Group (MIG) Registry. Cardiac
Society of Australia and New Zealand Annual
Conference. August, Sydney 2009.
Roberts L. The SHIPEM REGISTRY: Shipping
Infarcts for Primary Angioplasty in Eastern
Melbourne. Are we meeting the CSANZ/NHF
Guidelines? Cardiac Society of Australia and
New Zealand Annual Conference. August,
Sydney 2009.
Lim HS. Hospital survival in patients with
out-of-hospital cardiac arrest undergoing
percutaneous coronary intervention, Cardiac
Society of Australia and New Zealand Annual
Conference. Sydney, August 2009.
Local
New G. Is Carotid Stenting Dead?
Interventional Cardiology Fellows Course,
April 2009.
New G. What should I do when I finish my
training? Interventional Cardiology Fellows
Course, April 2010.
New G. Cardiology in Acute Care Medicine,
ACM, Melbourne, January 2010.
Research training
PhD
• Hamilton L, Deakin University, P/T GERIATRIC medicine
> Geriatric
The overall aim of research in geriatric
medicine is to address clinically and socially
important issues and to link with the clinical
and teaching activities of the unit. Some of
the research has an internal health services
research focus within Eastern Health, other
components have a broader focus. The longterm view is for individual projects to
link into programs, which will over time
provide a comprehensive view of the
health of older people in the Eastern Health
catchment area and will provide evidence
about the effectiveness and efficiency of
health care interventions.
Work continues on financial management
by older people. This research, sponsored
by State Trustees Inc, aims to provide the
understanding necessary to implement and
evaluate programs that protect elders from
financial abuse.
There are a number of initiatives in the
area of driving safety. Research has now
commenced for the Australian Research
Council-funded, OzCanDrive study which
will ultimately provide the information
needed to determine which older people
can safely continue to drive and which
should be stopped before they harm
themselves or others. This complements
ongoing research regarding on-road testing
of older drivers with dementia.
Other research endeavours have addressed
common clinical syndromes in older people,
including skin wounds, falls, medication (ab)
use and pain.
It is intended that these streams of research
will continue. There is to be expansion of
research into education in parallel with some
of the teaching activities of the unit. There
is also a new research program into
community-based aspects of aged care.
The geriatric medicine research team includes
Professor Peteris Darzins (Director), Angela
Berndt (occupational therapy), Gregory
Duncan (pharmacist, epidemiologist and
educator), Dr Richard Kane, (consultant
geriatrician) and A/Professor Samual Scherer,
Dr Jo Warner and Kei Owada. The unit has
research interests in dementia, wound
management, optimal prescribing in older
people, prevention of functional decline
and elder abuse.
Major achievement
While the unit has achieved a number
of commendable outcomes in the last
12 months, of great significance to our
community is our aging population and
therefore financial elder abuse (and the
prevention there of ). Dr Jo Wainer and
Professor Peteris Darzins are co-investigators
undertaking a translational research program
on financial elder abuse titled “Protecting
Elders’ Assets Study” with Kei Owada research
assistant. The three-year program is financed
by State Trustees and is now in its second year.
The purpose of the research program is to
provide the evidence base on which to build
policies and programs to reduce financial
elder abuse and support older people in
managing and protecting their assets.
It is consistent with the State Government
Office of Senior Victorians elder abuse
prevention program.
Over the last year the team has identified
the location, type and source of data held
about financial elder abuse in Victoria.
The study showed the data is disparate,
un-reported for the most part, and gathered
for clinical rather than data analysis
purposes. This showed there is an urgent
need to establish consistent definitions
and a reportable minimum data set from
state-based, non-government and clinical
services in relation to financial elder abuse.
This is a basic first step prior to designing and
evaluating protective interventions for this
growing and devastating problem.
Research projects in progress
Dementia and driving – person /
environment / occupation analysis. Berndt
A. This study is an analysis of the on-road
assessment driving performance of 117
drivers with dementia. Data was collected
prospectively via a standardised occupational
therapy on-road assessment protocol.
The purpose of the study is to describe
the parameters of driving performance in
dementia and to address issues of reliability
and validity of on-road assessment processes,
including route design, sensitivity and
specificity and outcome recommendations.
The OzCanDrive study – An international
Australian and Canadian study of older
drivers at Eastern Health. Darzins P. Eastern
Health in partnership with the Monash
University Accident Research Centre is
undertaking a $1.2m study of older drivers.
The study aims to distinguish between safe
older drivers, who can continue to enjoy the
privilege of driving, and potentially unsafe
older drivers. The research is based at the
Peter James Centre. The study will follow 200
older drivers for five years. Participants take
part in simple, office-based tests and have
tracking devices fitted to their cars to collect
real-world driving data.
Improving quality of life of people
with dementia living in residential care
facilities: a randomised trial of educational
interventions (DIRECT Study). Scherer S
et al. This study is seeking to validate the
hypothesis that providing education on
dementia (of a kind that is actually desired
by the recipients [as shown in a preliminary
study]) to GPs and staff of nursing homes
will improve the quality of life of life of the
residents in their care who have dementia.
Understanding financial mismanagement
among older Greek, Italian, Vietnamese and
rural Victorians. Wainer J, Darzins P, Owada K.
Family based financial management practices
are likely to be culturally and geographically
specific and to vary considerably with
context. The purpose of this study is to gain
insight into financial management practices
of older (65+) non-English speaking and
rural Victorians, and to identify awareness of
financial elder abuse among these population
sub-groups.
Eastern Health Research Report 2009-10 47
medicine GERIATRIC
Research projects completed
The Victorian community wound study.
Duncan G. This study has been completed,
and is now being published as the DPH thesis.
Pressure ulcer incidence in general medical
inpatients. Kane R, Baulch J, Connolly L,
McCabe K, Darzins P, Mansfield D. This study
prospectively measured the incidence of
pressure ulceration in 100 at-risk general
medical inpatients admitted to hospital
over a five month period. A 19.0 per cent
prevalence of pressure ulceration on
admission and a 7.4 per cent incidence of
new pressure ulceration were documented.
Patients with prevalent ulcers were younger
(P=0.01) and more likely to be male (P=0.02).
There was a trend towards longer lengths of
stay in the patients who developed pressure
ulcers in hospital (P=0.07). Data of this kind
provides an important reference by which
to measure new strategies that may
improve outcomes.
Association between psychotropic
medication use and falls on a dementia
and delirium-specific hospital ward.
Kane R, Lemke R. A retrospective case-control
case file audit compared 60 consecutive
patients who fell during admission to a
dementia and delirium-specific hospital
ward to a sample of 60 well-matched
patients who did not. The non-fallers were
predominantly female (P=0.023) with shorter
lengths of stay (P=0.013) and higher baseline
level of function (P=0.005). There was no
significant difference between the groups in
benzodiazepine or antipsychotic use, even
if newly added or used in combination.
The lack of association between
psychotropic medication use and falls in
this audit is of interest but further prospective
studies are needed to strengthen this
observation.
Implementation of sustainable
evidence-based practice for the assessment
and management of pain in residential
aged care facilities. Gibson SJ, Barber B,
Christianson L, Goucke CR, Toye C,
48 Eastern Health Research Report 2009-10
Abbey J, Nay R, Scherer SC. 365 residents at
five residential aged care facilities (RACF) in
three States were assessed for current pain
and levels of depression, anxiety, agitation,
functional disability and quality of life. More than 50 per cent were suffering from
pain, 30-40 per cent had depression and
40 per cent had significant pain-related
interference with everyday activities;
sleep, social function and quality of life. An
education and training program sought to
equip all staff with knowledge and resources
skills to provide best practice pain assessment
and management. Before and after
compliance with published 27-component
evidence-based pain guidelines was
evaluated. All RACFs demonstrated major
improvements in compliance. Compliance
improved from a range of 6-12 components
met at baseline to 21-24 at conclusion of
the project. and are being encouraged to support them
selves when no longer in paid work, there
is increasing vulnerability to the loss of the
financial assets that are the basis for a
healthy older age. There may also be an
increased interest in depriving older people
of their wealth because they have more
money than previous older generations.
One driving research interest for this unit is
in identifying evidence which can support
programs to reduce the incidence of
mismanagement of the financial assets of
older people. The next steps are to consult
with clinical and other disciplines, such as
law and finance, to develop and pilot-test
interventions which may improve awareness
of the problem and prevent it or reduce the
harm when it occurs.
Financial abuse of elders: a review of the
evidence. Protecting Elders’ Assets Study.
Monash University, Melbourne. Lowndes
G, Darzins P, Wainer J, Owada K, Mihalicic
T. A review of the international, Australian
and Victorian evidence of the extent of
financial elder abuse and its consequences
and identified some protective factors and
vulnerabilities to abuse among older people
and perpetrators.
Published
Prevalence of financial elder abuse in
Victoria. Protecting Elders Assets Study.
Monash University, Melbourne. Wainder J,
Darzines P, Owada K. This examined the
available data on financial elder abuse in
Victoria, what the data reveals about who
is being affected and the characteristics of
family members and other trusted people
who misuse the assets of older people.
Two reports above have been published and
are available on the website of State Trustees
www.statetrustees.com.au.
Identified research interests
and future directions
As more people become older, live longer
Publications
Ogrin R, Darzins P, Khalil, Z. The use of
sensory nerve stimulation and compression
bandaging to improve sensory nerve function
and healing of chronic venous leg ulcers.
Current Aging Science. 2009, Vol 2, No1, 72-80.
Duncan G, Darzins P, Brooks M. Chronic
Wound Pain: A Literature Review. Wound
Practice and Research. 2009, Vol 17, No 3
153–156.
Darzins P. Viewpoint. Can this patient go
home? Assessment of decision-making
capacity. Australian Occupational Therapy
Journal (2010) 57, 65–67.
Darzins P, Bedard M. Chapter Dementia
and Driving. In Older Road Users. Myths
and Realties, A Guide for Medical and Legal
Professionals edited by Odell M. Lawyers and
Judges Publishing Company Inc. July 2009.
ISBN 10: 978-1-933264-70-7.
Darzins P, Block A. Supervisors’ guide final
year, Monash University MBBS, 2009. Monash
University.
Duncan GJ, White P (Book Chapter) A Faculty
Approach to Implementing Advanced,
GERIATRIC medicine
E-learning Dependent, Formative and
Summative Assessment Practices in E-Learning
Technologies and Evidence-Based Assessment
Approaches. C Spratt, P Lajbcygier (eds)
Information Science Reference, Hershey
New York, 2009.
Rutter PM, Duncan GJ. Can professionalism
be measured: Evidence from the pharmacy
literature. Pharmacy Practice(Internet) 2010
Jan-Mar;8(1):18-28.
Duncan GJ, Brooks M. Chronic wound pain: a
literature review. Wound Practice and Research
2009 17;3: 37-42.
Scherer SC. Sleep disturbance in a residential
care setting. Geriatric Medicine in General
Practice. 1. 30-31, 2009.
Gibson SJ, Scherer SC, Nay R, Katz B. Book
Chapter: Persistent Pain in the Older Person.
In - Nay R & Garratt S. Older People: Issues
and Innovations in Care. 3rd Edition. Elsevier
Australia 2009.
Beer C, Horner B, Almeida O, Scherer S,
Lautenschlager N, Bretland N, Flett P,
Schaper F, Flicker L. Current experiences
and educational preferences of general
practitioners and staff caring for people
with dementia living in residential
facilities. BMC Geriatrics. 2009, 9:36
doi:10.1186/1471-2318-9-36. http://www.
biomedcentral.com/1471-2318/9/36
Feng L, Scherer SC, Tan BY, Chan G, Fong
NP, Ng TP. Co-morbid cognitive impairment
and depression is a significant predictor of
poor outcomes in hip fracture rehabilitation.
International Psychogeriatrics. 2010 Mar;
22(2):246-53.
Beer CD Horner B, Almeida OP, Scherer
S, Lautenschlager NT, Bretland N, Flett
P, Schaper L, Flicker L. Study protocol in
residential care: education intervention
trial (DIRECT); protocol for a randomised
controlled trial. Trials 2010, 11:63. http://www.
trialsjournal.com/content/11/1/63
In Press
Darzins P, Bedard M. Older driver issues.
Geriatric Medicine in General Practice. 2010
March, Vol4,p21-22.
Abstracts
Published
Kane R, Baulch J, Connolly L, McCabe
K, Darzins P, Mansfield D Pressure ulcer
incidence in general medical inpatients.
Internal Medicine Journal 2010;40(Suppl 1):113.
Kane R, Lemke R Association Between
Psychotropic Medication Use and Falls on
a Dementia and Delirium-Specific Hospital
Ward. Australasian Journal on Ageing
2010;29(Suppl 1):2.
Bosboom P, Jones G, Banz K, Almeida OP,
Flicker L, Launtenschlager NT, Horner B,
Scherer S, Beer C. Perspectives of quality of
life among people with dementia living in
the community and care facilities. (Published
Abstract). Australasian Journal on Ageing: 29.
Supplement 1, May 2010, 10–11.
Kane R, Baulch J, Connolly L, McCabe
K, Darzins P, Mansfield D. Pressure ulcer
incidence in general medical inpatients.
Internal Medicine Journal 2010; 40(Suppl 1):113.
Kane R, Lemke R Association between
psychotropic medication use and falls on a
dementia and delirium-specific hospital
ward. Australasian Journal on Ageing
2010;29(Suppl 1):2.
Presentations
International
Bédard M, Weaver B, Darzins P, Porter MM.
Prediction of driving abilities: Statistical
associations can be misleading. International
Congress of the International Traffic Medicine
Association. The Hague, April 2009.
Bédard M, Weaver B, Darzins P, Porter MM.
Choosing a test to predict driving abilities: Do
not rely on statistical associations. Canadian
Multidisciplinary Road Safety Conference.
Saskatoon, June 2009.
Kiegaldie D, Darzins P, Workman B, Cross W,
French J, Flanagan B, White G, Carodozo S.
Learning about Interprofessional clinical
practice in a simulated ward environment.
Association of Standardised Patient Educators,
Annual Scientific Meeting. Las Vegas,
June 2009.
Duncan GJ. The use of technology in
education. International Pharmacy Federation,
Annual Congress. Istanbul, Turkey.
September 2009.
Duncan GJ. Flexible learning in pharmacy.
International Pharmacy Federation, Annual
Congress. Istanbul, Turkey. September 2009.
Duncan GJ. Education in public health.
International Pharmacy Federation, Annual
Congress. Istanbul, Turkey, September 2009.
Leung A, Mack C, Fong C. Morbidity and
methotrexate use in rheumatoid arthritis
patients admitted to a public hospital
Australian Rheumatology Association and
New Zealand Society of Rheumatology
Combined Meeting. Auckland, May 2009.
Kane R Pressure ulcer incidence in general
medical inpatients. World Congress of Internal
Medicine, Melbourne, March 2010.
Kane R Association between psychotropic
medication use and falls on a dementia and
delirium-specific hospital ward. The Australian
& New Zealand Society for Geriatric Medicine
Annual Scientific Meeting, Queensland,
May 2010.
Scherer SC. Forging an integrative roadmap
for the care of older people. Insights from the
Alfred Health – Royal Freemasons Transition
Care Project, Melbourne, Australia. Singapore
Geriatric Medical Society. Biennial Scientific
Conference November, Singapore 2009.
Darzins P. Personal care participation
restriction. Swiss Paraplegic Research
Institute. Nottwil, Switzerland,
September, 2009.
Eastern Health Research Report 2009-10 49
medicine GERIATRIC
National
Local
Kane R, Baulch J, Connolly L, McCabe K,
Darzins P, Mansfield D. Pressure ulceration
incidence In general medical inpatients.
World Congress of Internal Medicine.
Melbourne, March 2010.
Berndt A. Cognitive Disorders Diagnosis
and Management Services (CDAMS) Eastern
Health Region, Melbourne Victoria Education
Day – drivers with dementia. May 2010.
Darzins P, Kiegaldie D, Maddock B, White G,
Duncan G. Inter-professional learning – the
new big thing in education. Australian and
New Zealand Society for Geriatric Medicine
Annual Scientific Meeting. Freemantle,
September 2009.
Berndt A, May E, Darzins P. Dementia and
driving – on road assessments. National
Dementia Research Forum. Sydney,
Septmber 2009.
Berndt A, May E, Darzins P On-road
assessment of people with dementia – How
to achieve the Goldilocks point. Presented
at 3rd National Dementia Research Forum.
Sydney, September 2009.
Darzins P. Assessment of capacity. Workshop
at the Australian Guardianship and
Administration Council, National Conference.
Brisbane, March 2009.
Wainer J, Darzins P, Owada K. Protecting
elders’ assets. International Federation on
Ageing 10th Global Conference. Melbourne,
May 2010.
Berndt A. Dementia and mobility is core
business. Invited presenter, 1st combined
OT Country Forum & State Conference.
Clare Valley, October 2009.
Berndt A, May E, Darzins P. Mapping the
dementia and driving assessment route.
Presented at Alzheimer’s Australia Conference.
Adelaide, June 2009.
Bosboom P, Jones G, Banz K, Almeida OP,
Flicker L, Launtenschlager MT, Horner B,
Scherer S, Beer C. Perspectives of quality
of life among people with dementia living in
the community and care facilities. Australian
and New Zealand Society for Geriatric
Medicine. Annual Scientific Meeting.
Coolum, May 2010.
50 Eastern Health Research Report 2009-10
Darzins P. Capacity: Distinction between
dementia, mental illness, and acquired brain
injury. Law Institute of Victoria. Elder Law
Conference. Melbourne, February 2009.
Darzins P. Assessment of decision-making
capacity. Law Institute of Victoria, Elder Law
and Ethics Conference. Melbourne, May 2009.
Darzins P. Dementia and quality of life
workshop. Alzheimer’s Australia National
Conference. Adelaide, June 2009.
Darzins P. Assessment of decision-making
capacity. Seniors Rights Victoria, World
Elder Abuse Awareness Day presentation.
Melbourne, June 2009.
Darzins P. Hypothetical panel member.
Seniors Rights Victoria, World Elder Abuse
Awareness Day presentation. Melbourne,
June 2009.
Darzins P. Delirium. Presentation to general
practitioners together with Dr Michael Murray.
Highwood Court. Melbourne, July 2009.
Darzins P. Legal Practitioners Liability
Committee Risk Management Seminars.
Melbourne, July and August 2009.
Darzins P. From ethics proposal to publication.
Victorian Geriatricians Peer Review Meeting.
Stoneleigh, August 2009.
Darzins P. Assessment of decision-making
capacity. Australian Association of Social
Workers, Aged Services Special Interest Group,
Melbourne, February 2010.
Darzins P. Hypothetical panel member.
Medicine and Law Conference of the Law
Institute of Victoria and the Australian Medical
Association. Melbourne, February 2010.
Darzins P. Aged Care - the Future. Eastern
Ranges General Practice Association Seminar.
Melbourne, February 2010.
Darzins P. Inter-Professional Learning. Training
seminar. Melbourne, February 2010.
Darzins P. Capacity assessment. Eastern
Health Allied Health Continuing Professional
Education. Melbourne, February 2010.
Darzins P. Medicine through the ICF Lens.
Plenary presentation at the World Congress of
Internal Medicine. March, Melbourne 2010.
Darzins P. Presentation to the Victorian
Parliament, Law Reform Committee Review
into the Powers of Attorney, Parliament
House, Melbourne, March 2010.
Darzins P. Assessment of decision-making
capacity - Advance Care Planning for
incompetent clients, Inaugural International
Advance Care Planning Conference.
Melbourne, April 2010.
Gibson S, Farrell M, Nay R, Scherer S.
Pain in persons with dementia. (Invited
Symposium) International Federation on
Ageing 10th Global Conference.
Melbourne, May 2010.
Scherer SC. National Ageing Research
Institute – Royal Melbourne Hospital Research
Seminar 2009. Sabbatical Report: The Best of
the East and the Best of the West. Melbourne,
August 2009.
Wainer J, Darzins P, Owada K. Protecting
Elders’ Assets. International Federation on
Ageing 10th Global Conference.
Melbourne, May 2010.
Awards
Berndt A, May E, Darzins P. Dementia
Collaborative Research Centres, First prize
poster presentations, National Dementia
Research Forum. Sydney 2009.
Grants
Australian Research Council Linkage grant
scheme. Five-year study to investigate older
driver safe mobility. Partners include VicRoads,
Victoria Police, the Transport Accident
Commission, Road Safety Trust New Zealand
GERIATRIC medicine
and Eastern Health. Charlton J, Langford J,
Koppel S, Odell M, Darzins P Di Stefano M,
Macdonald W, Marshall S. $1.8 million
NHMRC Project Grant Improving quality
of life of people with dementia living in
residential care facilities: a randomised trial of
educational interventions. (DIRECT Study). A/
Prof Samuel C Scherer.
Research Training
• Duncan G, Doctor of Public Health,
Monash University, P/T
• Berndt A, Doctor of Philosophy, University
of South Australia, P/T
• Burgess, S, Doctor of Philosophy, Monash
University, P/T
Eastern Health Research Report 2009-10 51
medicine Intensive Care
> Intensive care
Research activities in intensive care medicine
continues to expand with participation in
multicentre trials run by the Australian and
New Zealand Intensive Care Society (ANZICS)
Clinical Trials Group, home grown research
projects and leads Australian recruitment
for a number of the pharmaceutical
clinical trials.
The research program has been led
predominantly by A/Prof David Ernest and
three experienced research coordinators
Suzanne Eliott, Jaspreet Sidhu, Inga Mercer
and co-investigators Dr Ann Whitfield,
Anthony Cross, Dr Sam Radford,
Dr Daryl Jones and A/Prof Ramesh Nagappan.
However others within and outside of Box
Hill Hospital Intensive Care Unit (ICU) who
have contributed significantly to the research
program are Dr Ashwin Subramaniam, Renata
Mistarz, Marg Kirby, Ian Monk, Michelle
McPhee and Sam Brean.
Amongst the new pharmacotherapies aimed
at improving survival in patients with severe
sepsis; hospital acquired pneumonia; there
were also studies run by the ANZICS CTG
looking at early parenteral nutrition in the
critically ill patient population; comparison of
heparin and fragmin for DVT prophylaxis in
the critically ill patient; and beyond this, home
grown research looked at impacts of soluble
medications mixed with enteral feeds; and
comparison of energy requirements using
predictive equations in critically ill patients.
Of significance during the 2009 winter season
pandemic, Eastern Health’s ICUs participated
in the important enquiry into the impact and
risk factors associated with H1N1 (INFINITE
study) prompting publications in the British
Medical Journal and New England Journal
of Medicine.
Medicine Journal, Vol 40, Suppl 1, Mar 2010,
P 370) Highly recommended poster.
Research projects in progress
ANZICS Clinical Trials Group
Prophylaxis for thromboembolism in critical
care (PROTECT). Critically ill patients have an
increased risk of deep vein thrombosis (DVT)
due to their acute illness, procedures such as
central venous catheterisation and immobility.
To evaluate the effect of low molecular
weight heparin vs unfractionated heparine
on the primary outcome of proximal leg DVT
diagnosed by compression ultrasound, and
the secondary outcomes of PE, bleeding, HIT
and objectively confirmed venous thrombosis
at any site.
Early parenteral nutrition versus standard
care in the critically ill (EarlyPN). A recently
published review of small clinical studies
that compare early parenteral (intra-venous)
nutrition to standard care suggests that
receiving early parenteral (intra-venous)
nutrition might reduce patient chances
of dying during this hospital admission by
half (54 per cent reduction). However, these
clinical studies also suggest that parenteral
(intra-venous) nutrition may lead to a 38 per
cent increase in infections that may need
treatment with antibiotics. The optimal timing
for starting parenteral (intravenous) nutrition
is unclear and intensive care specialists in
Australia are unsure if their patients would
benefit from early (within 24 hours of
admission) parenteral (intravenous) nutrition.
The purpose of the trial is to determine
whether early parenteral (intra-venous)
nutrition when compared to standard care
improves survival, measured 60 days after
commencement of treatment.
Major achievement
Poster presentation at the World Congress
of Internal Medicine by ICU Senior Registrar
Dr Ashwin Subramaniam titled: Dapsoneassociated methaemoglobinaemia in patients
with a haematologic malignancy (Internal
52 Eastern Health Research Report 2009-10
Pharmaceutical Industry
Comparison of eritoran tetrasodium and
placebo in patients with severe sepsis
(ACCESS) – EISAI. Severe sepsis is the second
most frequent cause of death in intensive-
care patients, surpassed only by cardiovascular
events. Development of multiple-organ
dysfunction in the setting of sepsis results in
death in 30 per cent to 70 per cent of patients,
and is especially high in those with multiple
hospital-acquired infections. The primary
objective of this study is to demonstrate that
eritoran tetrasodium treatment of subjects
with severe sepsis results in a reduction in
28-day all-cause mortality.
The secondary objectives are to confirm
eritoran’s safety profile and to demonstrate
long-term benefit of eritoran treatment
(reduction in 12-month mortality). In addition,
the population pharmacokinetic (PK) profile
of eritoran will be evaluated.
Comparison of safety and efficacy of two
doses of tigecycline versus imipenem/
cilastin in hospital acquired pneumonia
(Protocol 3074K6-2000-WW) – Wyeth. The
main purpose of this study is to compare the
safety and effectiveness of two dose levels of
tigecycline with those of another antibiotic
called imipenem/cilastatin for treating
hospital acquired pneumonia.
Efficacy and safety of drotrecogin-alfa
in septic shock (PROWESS-SHOCK). A
multicenter, randomised, double-blind,
parallel, placebo‑controlled, phase III study of
Drotrecogin alfa (activated) in patients with
septic shock. Planned enrollment in the study
is approximately 1500 patients. Patients will be
randomly assigned to either the drotrecogin
alfa (activated) or placebo treatment group
in a 1:1 ratio. The aim of the study is to
demonstrate that treatment with drotrecogin
alfa (activated) 24 mcg/kg/h administered as
an intravenous infusion for 96 hours reduces
28‑day all-cause mortality in adult patients
with septic shock compared with placebo.
Safety and efficacy of ART 123 in patients
with sepsis and DIC (ART 123) – ARTISAN.
A multicentre, randomized, parallelgroup, double-blind, placebo-controlled
study of a soluble recombinant human
thrombomodulin in patients with sepsis
and DIC. The drug is a soluble recombinant
Intensive Care medicine
human thrombomodulin. Its activity in
thrombin binding and protein C activation
have been thoroughly evaluated in a series of
in vitro and animal studies. Briefly, it inhibits
tissue factor activated thrombin formation
and improves laboratory parameters of DIC
in several animal models. In addition, it has
been shown to inhibit the activity of HMGB1
and complement. The primary efficacy
objective is to evaluate the activity of the drug
in reducing mortality in patients with sepsis
and disseminated intravascular coagulation.
Safety and efficacy of doripenem compared
to imipenem in the treatment of ventilator
associated pneumonia (DORI-10). A
prospective, randomised, double-blind,
double-dummy, multicenter study to
assess the safety and efficacy of doripenem
compared with imipenem-cilastatin in
the treatment of subjects with ventilatorassociated pneumonia.
National Audits
Audit of severe acute pancreatitis feeding
practices (ASAP). To prospectively investigate
current nutritional practices of patients with
severe acute pancreatitis in Australasia. Firstly
describe the clinical and epidemiological
features of severe acute pancreatitis and
describe current nutritional management
in Australasia of patients with severe acute
pancreatitis. Measure patient outcomes,
including all-cause in-hospital mortality,
duration of mechanical ventilation, duration
of intensive care (ICU) stay and duration
of hospital stay. Benchmark Australasian
nutritional management practices against
local and international guidelines. Assess
the feasibility of a multicentre, randomised,
controlled trial to investigate nasogastric
feeding vs. nasojejunal feeding in patients
with severe acute pancreatitis.
Haemostasis study. Department of
Epidemiology and Preventative medicine
was given a grant to establish a registry of
patients receiving rVIIa throughout Australia
and New Zealand. The purpose of this
registry was to gain information on safety,
efficacy, appropriateness of use and dosages
of recombinant activated factor VII (rFVIIa,
NovoSeven). This registry may not provide
data as convincing as that of a clinical trial,
however does provide valuable observational
data regarding efficacy, adverse events,
effective dosage and cost-effectiveness.
INFINITE study. Establishment of a real-time
registry and the collection of clinical health
information in patients with influenza A
and H1N1 admitted to the intensive care
unit. The results of this study prompted a
publication in the BMJ titled Critical illness due
to the 2009 A/H1N1 influenza in pregnant
and postpartum women: population based
cohort study as well as in the NEJM article
titled -Critical Care Services and 2009 H1N1
Influenza in Australia and New Zealand.
Box Hill Hospital Projects
Mapping ICU liaison nurse services in
Australia. The intensive care unit liaison nurse
is a senior member of the multidisciplinary
teams assisting in the management of
patients with complex care needs across
the hospital and in particular facilitating a
smooth transition of patients admitted to and
discharged from ICU.
Evaluation of delirium and its recognition
in critically ill patients in Australian ICUs.
Delirium is an acute reversible condition
associated with severe illness and increased
morbidity and mortality. Detection of delirium
in most ICUs is dependent on simple bedside
observation. This was shown to be unreliable
in a small study performed within Box Hill ICU.
•Dr Ashwin Subramaniam
Intensive Care Unit, Registrar, Box Hill Hospital
Focusing on nutrition in critically ill patients
Dr Ashwin Subramaniam is currently pursuing CICM (ICU) training
after completing the FRACP and is developing a keen interest
in research since conducting ischaemia reperfusion injury
experiments on rat and rabbit hearts at the University of Chicago.
Ashwin completed his Master of Medicine degree (University
of Melbourne) and thesis project in nutrition, comparing high
carbohydrate feeds to high fat feeds in patients with weaning
failure. This provided an impetus to research further in the area of
nutrition of the critically ill patients. He is currently using the results
of his nutrition study to validate findings by comparing it with the
gold standard method. If the results are favourable, he will extend
his work and design a multicentre study.
Ashwin has successfully had his work published on two occasions
this year and has presented posters at two international
conferences. Ashwin’s research interests further extend to
involvement in designing surveys on the topical areas of critical
care practice like managing sepsis, vancomycin use in ICU and
understanding pleural pathophysiology.
Eastern Health Research Report 2009-10 53
medicine Intensive Care
A process is underway of extending this pilot
into a multi centre trial to determine how
widespread this issue is.
for the registrants of Acute Care Medicine
course in January 2010, with questions
covering the different aspects of sepsis.
Predicting energy requirement in critically
ill septic patients – Schofield and Harris
Benedict Nomograms Vs Weir Equation.
Critically ill ventilated septic patients had
their energy requirement predicted by the
Schofield [1] or the Harris Benedict methods
[2], which are age-based, weight-determined,
gender-specific equation that incorporates
stress and/or activity factor. These were
compared with the Weir equation which
estimates energy requirements using
estimates of CO2 production (VCO2) and O2
consumption (VO2) (Energy expenditure =
[(VO2 x 3.941) + (VCO2 x 1.11)] x 1440 cal/
day). The energy expenditure was calculated
from (a) end-tidal CO2 derived CO2 production
(VCO2) (Evita, Drager) and (b) VO2 deduced
assuming a respiratory quotient of 0.8381
(VO2 = VCO2 / RQ).
Retrospective audit – hospital outcome
of bariatric patients undergoing weight
reduction surgery at Box Hill Hospital
2002 to 2008. Weight reduction surgery is
increasingly used in the management of
morbidly obese patients. Little has been
published regarding the short-term outcome
of these patients. The audit will look at the
demographics of the patient population
(age, gender, BMI, co-morbidities), the type
of surgery performed, the complications that
occurred and the patient outcomes in terms
of hospital length of stay and survival. The
findings of the audit will be presented to
Box Hill Hospital clinical staff (ICU,
anaesthetics, surgical meetings) as part of the
quality improvement programs in each area.
Comparison of energy requirements using
various predictive equations in critically
ill septic patients. Many ICUs employ
nomograms to predict energy requirement.
As metabolic carts are unfeasible in
many ICUs, the Weir equation may be a
useful alternative. Many add stress and/
or activity factors to the nomograms. The
unit compared the Weir equation with five
commonly used predictive nomograms.
Data collection is now complete and under
analysis with an intention to publish the
results in critical care and nutrition journals
respectively.
Appropriate use of vancomycin in critical
care – a survey. Even though vancomycin
is a commonly used antibiotic in critically
ill patients, the pharmacology of this agent
is not well appreciated. The unit designed
a questionnaire for the registrants of
ANZICS Intensive Care Medicine course
in July 2009, with questions covering the
pharmacodynamic and pharmacokinetic
properties, administration errors and adverse
effects. Data analysis will be submitted for
publication in critical care journals.
Surviving sepsis – a clinical survey. Sepsis is a
serious medical condition that is characterised
by a whole-body inflammatory state and the
presence of a known or suspected infection. It
is usually treated in the intensive care unit and
is associated with a high morbidity and
mortality. The unit designed a questionnaire
54 Eastern Health Research Report 2009-10
Advanced care planning and
end-of-life care: should we include
organ and tissue donation?
Respecting Patient Choices (RPC) is a
widely accepted program designed to help
communicate patient wishes regarding endof-life care. Currently the RPC advance care
plan provides no documentation of wishes
in regards to organ and tissue donation. This
study was conducted to measure clinicians’
attitudes to incorporating information about
donation into existing advance care plans.
Advanced care planning promotes
mutual trust, confidence and respect. As a
recommendation we seek to include organ
and tissue donation into our advanced care
plans with the ultimate aim of optimising and
normalising organ and tissue donation as part
of end-of-life care.
At all times we seek to encourage appropriate
end-of-life discussion and care.
Research projects completed
Dapsone-associated methaemoglobinaemia
in patients with a haematologic
malignancy. Subramaniam A, Nagappan R,
Corallo C. Dapsone is commonly used agent for
prophylaxis of Pneumocystis jiroveci pneumonia
in leukaemic patients. Even though dapsoneassociated methaemoglobinaemia is a
well-documented adverse effect, research
has found a higher incidence than what is
previously reported. Methaemoglobinaemia
also occurred earlier than what was reported
earlier. The unit also noticed potential
interactions with agents commonly used with
the contemporary chemotherapeutic agents.
The primary aim in publishing this article
was to create awareness of this potentially
dangerous complication that causes significant
morbidity, even mortality. Leukaemic patients
are particularly susceptible due to their
underlying anaemia, immunosuppression
and potential drug interactions, particularly
corticosteroids, a common adjunct to the
chemotherapeutic regimens.
Future research direction
ICU research currently leads recruitment in
Australasia of patients with sepsis into the
sepsis studies. With the commencement of
new sepsis study and ICU involvement with
the ANZICS CTG, the unit hopes to continue
the growth pattern and encourage more
in-house research and develop a more
enquiring mindset within the unit as well as
better supporting senior registrars in their
research projects.
The unit’s senior registrar has a desire to
continue his enquiry into nutrition in critically
ill patients, nursing interest include the
extended effects of liaison nurse services, the
organ and tissue donation team continues to
work with palliative care and neurosciences
as well as in the ICU to develop a range of
awareness building tools and further establish
the best methods for the youth demographic
– to be a joint project with Deakin University.
Publications
Published
Subramaniam A, Cooke J, Ernest D.
‘Inverted’ tako-tsubo cardiomyopathy due to
exogenous catecholamines – A case report.
Crit Care Resusc. 2010 Jun ;12(2):104-8.
Duke G, Buist M, Pilcher D, Scheinkestel C,
Santamaria J, Gutteridge G, Cranswick P,
Ernest D, French C, Botha J. Interventions
to circumvent intensive care access block: a
retrospective 2-year study across metropolitan
Melbourne. Med J Aust 2009;190:375-378.
Whitfield A, Coote S, Ernest D. Therapeutic
hypothermia in out-of-hospital arrest:
one hospital’s experience. Crit Care and
Resuscitation. 2009;11:97-100.
Pilcher D, Hoffman T, Thomas C, Ernest D,
Hart G. Risk-adjusted continuous outcome
Intensive Care medicine
monitoring with an EWMA chart: could it have
detected excess mortality among intensive
care patients at Bundaberg Base Hospital?
Crit Care and Resuscitation. 2010;12:36-42.
NICE-SUGAR Study Investigators, Finfer S,
Chittock D, Su S et al. Intensive versus
conventional glucose control in critically ill
patients. N Engl J Med. 2009;360:1283-97.
Whitfield A, Mistarz R, Eliott S, Ernest D.
Detecting delirium in Australian ICUs. ANZICS/
ACCCN ASM, Perth 2009.
The ANZIC Influenza Investigators, Webb S,
Pettila V, Seppelt , et al. Critical Care Services
and 2009 H1N1 Influenza in Australia and
New Zealand. N Engl J Med. 2009;361;1925-34.
Kirby M, McPhee M, Monk I, Whitfield A.
Soluble medications mixed with enteral feeds
may block a nasogastric tube. ANZICS/ACCCN
ASM Perth 2009.
Corallo C, Whitfield A, Wu A. Anticholinergic
syndrome following an unintentional
overdose of scopolamine. Therapeutics and
Clinical Risk Management 2009.
Coutsevelis J, Corallo C, Dooley M, Foo J,
Whitfield A. Implementation of a pharmacistinitiated pharmaceutical handover for
oncology and haematology patients being
transferred to critical care units. Support Care
Cancer DOI 10.1007/s00520-009-0713-4.
Principal Investigator in multicentre
trials with results published
Chen J, Bellomo R, Flabouris A et al. The
relationship between early emergency team
calls and serious adverse events. Crit Care Med
2009;37:148-53.
Riker R, Shehabi Y, Bokesch P et al.
Dexmedetomidine vs midazolam for sedation
of critically ill patients: a randomized trial.
JAMA 2009;301:489-99.
Chen J, Hillman K, Bellomo R et al. The
impact of introducing medical emergency
team system on the documentations of vital
signs. Resuscitation 2009;(1):35-43.
The ANZIC Influenza Investigators, Webb S,
Pettila V, Seppelt I et al. Critical illness due
to 2009 A/H1N1 influenza in pregnant and
postpartum women: population based
cohort. BMJ 2010;340:c1279.
In press
Subramaniam A, Nagappan R. Corallo C.
Dapsone-associated methaemoglobinaemia
in Patients with a haematologic malignancy
– AIC
in patients with a haematologic malignancy.
September supplement issue of the ESICM/
ESPNIC.
Subramaniam A, McPhee, M., Nagappan, R.
Predicting energy requirement in critically ill
septic patients – Schofield and Harris Benedict
Nomograms Vs Weir Equation. September
supplement issue of the ESICM/ESPNIC.
Presentations
International
European Society of Intensive Care
Medicine. Dapsone-associated
methaemoglobinaemia in patients with a
haematologic malignancy. Accepted for
presentation. Barcelona, Spain, October 2010.
Local
Endacott R, Eliott S, Chaboyer W. The scope
and impact of intensive care liaison and
outreach services: an integrative review and
meta-synthesis (2009) JCN
World Congress of Internal Medicine
Melbourne. Dapsone-associated
Methaemoglobinaemia in Patients with a
Haematologic Malignancy. Melbourne
March 2010.
Abstracts
Radford S, Sidhu J, Brean S. Advanced care
planning and end-of-life care: Should we
include organ and tissue donation? Inaugural
International Advanced Care Planning
Conference. Melbourne, April 2010
Published
Subramaniam A, Nagappan R, Corallo C.
Dapsone-associated methaemoglobinaemia
in patients with a haematologic malignancy
Internal Medicine Journal, Vol 40, Suppl 1, Mar
2010, P 370.
Research training
Masters
In press
Eliott S, Griffith University, P/T
Subramaniam A, Nagappan R., Corallo C.
Dapsone-associated methaemoglobinaemia
Eastern Health Research Report 2009-10 55
medicine Palliative Care
> Palliative care
Incorporating Respecting
Patient Choices – Advance Care
Planning Program
The palliative care service spans the whole of
Eastern Health with outpatient, consultation
and inpatient services. Clinicians in all of
these services are involved in clinical research
including audits of clinical practice. The
palliative care research committee meets
monthly and staff complete most of their
research work in their own time. Multiple
presentations have been made at state and
national conferences. Links exist with Deakin
University, the Eastern Health neurology
department, the Eastern Health transplant
team and other palliative care units across
Australia.
The Respecting Patient Choices Program is
focused upon facilitating patients within the
acute and sub-acute hospital system and in
the community to complete advance care
planning (ACP) in relation to future healthcare
decision-making. Respecting Patient Choices
is affiliated with Austin Health, the lead
agency for this national program. Research is
generally retrospective auditing, measuring
the presence of ACP documents, clinicians
compliance with an individual’s wishes and
evidence of the Medical Enduring Power
of Attorney (MEPOA) or person responsible
being part of the decision-making process
when required.
Major achievement
Introduction of the Liverpool Care Pathway
(LCP) for dying patients improved the care
of dying patients and their families in an
acute stroke unit. Fullerton S, Chapman M,
Bradford K, Ryan C, Bladin C. The LCP is an
internationally recognised pathway for the
best practice care of the dying. The pathway
was piloted on dying patients in the stroke
unit at Box Hill Hospital. Physical care of
25 stroke patients improved on the LCP
compared to 25 patients dying not on the LCP.
Inappropriate interventions and medications
were ceased more often. Communication and
56 Eastern Health Research Report 2009-10
spiritual care were improved on the LCP. Staff
knowledge and confidence in caring for dying
patients and their families was improved after
the intervention and the pathway has been
proven popular with staff.
Research projects in progress
Corneal donation – A collaboration
between palliative care and the transplant
team. Fullerton S, Lucas K, Radford S. This
project aims to explore experience and beliefs
about corneal donation before and after an
education program. We aim to improve staff
knowledge and confidence in issues around
corneal and tissue donation and to improve
corneal donation rates.
Developing an evidence-based approach to
the management of cancer-related fatigue
- A resource for occupational therapists
working in oncology and palliative pare in
inpatient and community settings. Mortell
M, Allen J, Kashyap J. This project aims to
establish an evidence base for occupational
therapists to provide best practice in
managing cancer related fatigue in oncology
and palliative patients across inpatient and
outpatient settings.
Key issues of multidisciplinary team
members caring for patients with
depression/anxiety in palliative care.
Braithwaite M, Moran J, Wilson J, Thompson A,
Taylor N, Hudson P. Based on the qualitative
findings from phase II of this study, a survey
has been developed and is being distributed
to five sites across Victoria. It aims to explore
multidisciplinary team members’ experiences,
increased burden, key issues and barriers in
optimal care for depressed and/or anxious
patients in palliative care.
Occupational therapists use of therapeutic
relaxation as an intervention for oncology
and palliative care patients. George P, Innes
M, Brookshaw K. This project aims to develop
an evidence-based therapeutic relaxation
package for occupational therapists to use
across the oncology and palliative care
continuum. This resource aims occupational
therapists to enhance the provision of
comprehensive supportive care with
oncology and palliative care patients.
Opioid-induced constipation – clinical
experience with methylnaltrexone. Moran
J, Douglas C, Broadbent A. Methylnaltrexone
is a quarternary opioid antagonist which
has recently been added to the PBS for the
treatment of opioid induced constipation. This
is a collaboration between several Australian
palliative care units to assess the effectiveness
of this medication in a non-research setting.
Outcomes of patients in a palliative care
unit (PCU) who have been assessed by
ACAS (aged care assessment service) for
residential care. Sung CB, Fullerton F, Darzins P.
The purpose of this study is to examine the
demographics, diagnosis and outcome of 100
patients who underwent an ACAS assessment
in the palliative care unit. The aim to determine
which types of patients are more likely to die
before successful residential care placement.
Preadmission clinic: a window of
opportunity. Power S, Moran J. The Victorian
Medical Treatment Act was introduced
in 1988, yet few people have taken the
opportunity to appoint a Medical Enduring
Power of Attorney (MEPOA). The project’s
objective was to ascertain if patients
scheduled for elective admission would
choose to appoint a MEPOA when given
instructional paperwork at the preadmission
clinic visit. Outcomes of the study indicated
that 7.7per cent of 703 inclusions, or one in
13 patients chose to appoint a MEPOA. The
results suggest that preadmission clinic is an
appropriate time to introduce the benefits
and tools for patients to appoint a MEPOA.
Returning dying nursing home patients from
Eastern Health emergency departments
(ED) back to nursing homes for end of life
care (EOLC). Wilkinson J, Marriott J, Fullerton
S, Street M, Livingston P.. The number of
nursing home residents presenting to the ED
is increasing. Many have end-stage illnesses
and receive futile interventions. The aim of this
study is to assess the extent of the problem
Palliative Care medicine
then develop a care pathway to facilitate the
return of patients to nursing for EOLC.
Research projects completed
A place for the arts in palliative care –
establishing a need for an art program.
Yong C, Freston J, Kashyap J. The purpose
of the research was to conduct a needs
assessment for an art program in a
palliative care ward at Wantirna Health.
Researchers conducted:
• Interviews with patients, allied health and
nursing staff at Wantirna Health
• Site visits to comparable palliative
care units
• A literature review which exposed a variety
of positive beneficial functions
Patient interviews revealed time-use patterns
whilst in hospital with the majority of patients
expressing an interest in participating in an
art program. Staff interviews and the literature
highlighted the challenges and benefits of
sustaining an accessible arts program.
“Do we have to call the coroner?” Caring
for patients dying from mesothelioma.
Fullerton F. The Wantirna palliative care unit
has one death a month due to mesothelioma,
which must be reported to the coroner in
Victoria. A pathway was designed to assist
staff in managing reporting requirements
for these deaths. A document was designed
after consultation with the Coroner’s Office.
An audit of completed pathway in the first 12
mesothelioma patients who were admitted
to the unit was carried out. The pathway was
successful in its aims of reducing stress and
uncertainly for staff and families dealing with
the stressful situation of a reportable death
and improving information given to the family
about the process.
“Do what you can, with what you have,
where you are (Roosevelt)”. Maximising
physical function and emotional
wellbeing through interdisciplinary
practice. Horne-Thompson A, Bramley R. The
purpose of the project was to determine the
effectiveness of an interdisciplinary music
and exercise group on patients’ function
and emotional wellbeing. An eight-week
music and exercise group was conducted
on a palliative care unit. Pre- and post-group
measures were taken. Emotional wellbeing
improved as a result of group participation.
Physical function was either maintained or
improved. Participation in an interdisciplinary
music and exercise group was beneficial to
patients with terminal disease.
Further research is required with a larger
sample size and also to determine
long-term effects.
Improving patient pathways between
palliative services in the Melbourne’s
Eastern Metropolitan Region (EMR):
identifying current gaps. Wilkinson J,
Jacques V, Draper K. This project assessed the
current palliative care services in the EMR.
A number of issues related to the different
services were identified:
• Standardisation of admission criteria and
processes to services
• No central source of information for
stakeholders – a central website was
suggested to address this
• Poor information transfer between
organisations with inability to track patients
between services
Possible solutions to improve the transition
between services include:
• A central access point and common
electronic record for all palliative
care patients
• A patient handheld record
• A central database for Eastern Health
Palliative patients
•Dr Juli Moran
Director of Palliative Care Service, Eastern Health
Focusing in clinical research palliative care
Palliative care is a relative newcomer to the field of research with
many practices still unproven by research. The palliative care
research committee was established soon after the opening of
the palliative care unit in 2008 at Wantirna Health with activity
undertaken around clinical commitments. Dr Juli Moran’s research
interests include the management of end-stage illnesses such as
cardiac failure and dementia. She has presented multiple projects
at national conferences based on reviewing care practices including
the management of end-stage peripheral vascular disease, the
drainage of severe peripheral oedema and the management of
patients admitted to acute hospitals with end-stage heart failure.
Juli’s current research projects take a multidisciplinary study
approach involving the palliative care team and extend to
investigating the needs of relatives of patients with end-stage brain
tumours. In addition, she is working on developing a care pathway
for heart failure patients admitted to acute hospitals and an
ongoing audit of the use of a new medication for constipation.
Eastern Health Research Report 2009-10 57
medicine Palliative Care
Key issues of multidisciplinary team
members caring for patients with
depression/anxiety in palliative care.
Braithwaite M, Moran J, Wilson J,
Thompson A, Taylor N, Hudson P.
Focus groups across three palliative care
sites (N=25) explored multidisciplinary team
members’ experiences and barriers to optimal
care for depressed and/or anxious patients.
Themes included:
• Teams provide a positive environment that
is hard to maintain if working alone
• Treatment challenges; a slower approach
to goal setting than the system allows.
Depressed patients utilise the most time.
Anxious and depressed patients increase
stress and leave staff feeling helpless and
unappreciated
• Need to improve access to specialist
mental health
• Mechanisms for supporting staff These themes have been important
determinants towards understanding staff
experiences and in improving staff satisfaction
and patient care.
Potential benefits of clinical psychology
in an established palliative care consult
service. Braithwaite M, Moran J,
Sivakumaran H. Clinical psychology
(ClinPsych) is acknowledged as adding value
to patient care. In 2008, a clinical psychologist
was appointed to the Palliative Care Consult
Service (PCCS). Our objective was to evaluate
the benefits of the ClinPsych. A survey was
distributed following 12 months of service.
Staff valued the ClinPsych’s involvement
highly, with 100 per cent of staff reporting it
as “mostly useful” or “very useful” for patients.
Most staff reported ClinPsych’s involvement
was mostly or very useful to family and the
team. In conclusion, a psychologist dedicated
to supporting patients and families is a
valuable addition to palliative care services.
Future research direction
over the coming months to assess the role
of advance care planning in patients with
chronic renal failure.
Publications
Published
Marriott J, Moran J. Palliative Care for the
older person. The Australian and New Zealand
Society for Geriatric Medicine 2009.
Ryan J. A Creative Style of Pastoral Care.
Australian Journal of Pastoral Care and Health
2009,3:2,41-45.
In press
Horne-Thompson A, Bolger K. An
investigation comparing the effectiveness
of a live music therapy session and recorded
music in reducing anxiety for patients with
amyotrophic lateral sclerosis/motor neurone
disease. Australian Journal of Music Therapy.
Presentations
International
Fullerton S. Introduction of the Liverpool
Care Pathway for dying patients improved the
care of dying patients and their families in an
acute stroke unit. Annual Scientific Meeting of
the Royal Australasian College of Physicians,
Auckland, New Zealand, 2009
National
Moran J, Fullerton S, Jacques V. Assessing
unmet palliative care needs across a suburban
hospital network. Australia and New Zealand
Society of Palliative Medicine, September 2010.
Fullerton S, Radford S, Lucas K, Moran J.
Educating palliative care clinicians in corneal
donation: a donatelife clinical partnership.
Australia and New Zealand Society of Palliative
Medicine, September 2010.
Winter N, Bhagat S, Fullerton S, Moran J.
Factors that predispose to terminal restlessness.
Australia and New Zealand Society of Palliative
Medicine, September 2010.
Current interests include multidisciplinary
approaches to palliative conditions, such as
delirium and brain tumours. Work is underway
around the assessment of patients from
nursing homes in the emergency department
with a view to assisting these patients to
return to their homes to die, rather than being
admitted. There is a strong interest in the role of
palliative care in conditions other than cancer.
Braithwaite M, Moran J, Sivakumaran H.
Potential benefits of clinical psychology in
an established palliative care consult service.
Poster session presented at 8th Asia Pacific
Hospice Palliative Care Conference. Perth,
September 2009.
The Respecting Patient Choices program
will be working closely with Renal Services
Fullerton S. Liverpool care pathway.
Poster session presented at 8th Asia Pacific
58 Eastern Health Research Report 2009-10
Hospice Palliative Care Conference, Perth
September 2009.
Horne-Thompson A, Bramley R. “Do what
you can, with what you have, where you are”
(Roosevelt). Maximising physical function and
emotional wellbeing through interdisciplinary
practice. Poster session presented at 8th Asia
Pacific Hospice Palliative Care Conference.
Perth, September 2009.
Jacques V. Palliative care transition from
acute to subacute, sometimes too late and
sometimes just not quite right. Poster session
presented at 8th Asia Pacific Hospice Palliative
Care Conference. Perth, September 2009.
O’Neill S. “Walk right in; sit right down…”
the development of a community-based
outpatient palliative care service. Poster session
presented at 8th Asia Pacific Hospice Palliative
Care Conference. Perth, September 2009.
Wilkinson J, Jacques V, Draper K. Improving
patient pathways between Palliative Services
in the Melbourne’s Eastern Metropolitan
Region (EMR): identifying current gaps.
Poster session presented at 8th Asia Pacific
Hospice Palliative Care Conference.
Perth, September 2009.
Power S, Moran J. Preadmission clinic:
A window of opportunity? Inaugural
International advance care planning
Conference. Melbourne, April 2010.
Power S, Moran J. Five years on; clinician’s
awareness of Advance Care Planning.
Inaugural International Advance Care
Planning Conference. Melbourne, April 2010.
Local
Allen J, Mortell M, Kashyap J. Developing
an evidence-based approach to the
management of cancer-related fatigue
– A resource for occupational therapists
working in oncology and palliative care in
inpatient and community settings (posters).
OT AUSTRALIA Victoria State Conference.
Melbourne, November 2010.
George P, Innes M, Brookshaw K.
Occupational therapists use of therapeutic
relaxation as an intervention for oncology
and palliative care patients (oral presentation).
OT AUSTRALIA Victoria State Conference.
Melbourne, November 2010.
Yong C, Freston J, Kashyap J. A Place for the
arts in palliative care – establishing a need
for an art program (posters). OT AUSTRALIA
Victoria State Conference. Melbourne,
November 2010.
Obstetrics and gynaecology medicine
> Obstetrics and gynaecology
The Women’s and Children’s Program provides
clinical services in paediatrics, maternity and
gynaecology. Within a busy clinical program
there is increasing interest in collaborative and
independent research particularly in areas of
maternity care models and education.
Research projects in progress
PROMPT pilot project. Barnett M,
Shoushtarian M, Patterson D, Wallace E,
Watkins V, Chew J. The PROMPT (Practical
Obstetric Multi-professional Training) is a multi
professional training package for midwives,
obstetricians and anaesthetists in obstetric
emergencies. This project is to introduce the
program and evaluate its effectiveness in an
Australian setting including its influence on
perinatal outcomes and staff satisfaction.
Maternal health and wellbeing during
pregnancy. Skouteris H, McCabe M, Milgrom
J, Kent B, Cook V. To pilot test an intervention
designed to prevent excessive gestational
weight gain and post-partum weight
retention in primigravid pregnant women.
Collaborative maternity care pathways.
Watkins V, Kent B. This study is to assess
the effectiveness of the implementation
and uptake of collaborative maternity care
pathways for pregnant women in improving
measurable maternity outcomes and
improving satisfaction for both women and
maternity clinicians and reducing clinical risk.
The effect of customised growth charts
on neonatal mortality and morbidity.
Fitzgerald N. The benefit of growth charts in
identifying intra-uterine growth restricted
babies is limited in a heterogeneous society.
This study is using charts which are particular
to specific patient groups aiming to improve
our ability to identify these at risk babies.
Eastern Health Research Report 2009-10 59
medicine surgery
> Surgery
Surgical research at Eastern Health has been
growing in the past few years. There is now
a (post FRACS) research fellow post as part of
Surgical Unit B at Box Hill Hospital and there
are currently two fellows enrolled for Masters
of Surgery, Dr Salena Ward and Dr Lachlan
Dandie. Dr Ward is examining the status of
pancreatic exocrine function after upper
gastrointestinal resection using the C13 mixed
chain triglyceride breath test. Dr Lachlan
Dandie is examining the use of video analysis
of laparoscopic cholecystectomy, with the dual
aims of establishing criteria of competency
for this procedure, and then examining
the introduction of the new single-incision
technique for cholecystectomy.
In addition, the Eastern Health Surgical
Research Group established by Professor
Michael Grigg, Eastern Health Director of
Surgery, provides support and advice to
residents and registrars who are seeking to
carry out a research project during clinical
work. This group now has more than 20
members and several projects are ongoing.
As in previous years, the group was well
represented at the recent RACS Victorian
meeting (the AGSFM).
already existing into one cohesive patient
management plan, with the aim of improving
patient outcomes and shortening patient
length of stay, whilst reducing patient
morbidity.
Post-operative pancreatic exocrine
insufficiency study. Ward S, Cade R, Mackay
S, Hassen AS, Banting S, Gibson P. This project
is designed to assess pancreatic exocrine
function following upper GI surgery. It utilises
a new, noninvasive test (C13) breath test to
measure fat digestion. Control groups as well
as patients undergoing a range of upper GI
operations are being studied. If pancreatic
insufficiency is document, it is being treated
with enzyme supplements.
Publications
Published
Epari K, Cade R. Oesophagectomy for
tumours and dysplasia of the oesophagus and
gastro-oesophageal junction. Aust N Z J Surg
2009; 79:251-7.
Presentations
International
Hepatobiliary/Upper GI
surgical unit
Research projects in progress
Video assessment of surgical skills during
laparoscopic cholecystectomy. Dandie L,
Hassen S, Mackay S, Gibson P. This project
aims to develop an objective rating scale to
allow video assessment of surgeons/trainees
performing laparoscopic cholecystectomy
with application to training and certification
of surgeons of the future.
Enhanced Recovery after Surgery (ERAS).
Myles P, Beilby D, Cade R, Steel M. The
Enhanced Recovery after Abdominal Surgery
(ERAS) project is a Victorian Department of
Health-funded quality improvement project.
It seeks to bring together various patient
management strategies and techniques
60 Eastern Health Research Report 2009-10
Ward S, Cade R, Mackay S, Hassen S,
Banting S, Gibson P. Pancreatic exocrine
function post oesophagectomy, gastrectomy
and pancreatico-duodenectomy. 42nd
European Pancreatic Club. June, Stockholm,
Sweden 2010.
National
Cade R. Laparoscopic myotomy is the
treatment of choice for achalasia. AGW/
ANZGOSA, Sydney 2009.
Ward S, Cade R, Mackay S, Hassen S,
Banting S, Gibson P. Pancreatic exocrine
function post oesophagectomy, gastrectomy
& whipples procedure, interim results. Surgical
Research Society Annual Meeting. Adelaide,
October 2009.
Cade R. Oesophagectomy for end-stage
achalasia. ASC, RACS. Perth, November 2010.
Cade R. How I do it: semi-mechanical
oesophago-gastric anastomosis. ASC, RACS.
Perth, May 2010.
Mackay S. S.I.L.S. RACS New Zealand Assoc of
General Surgeons Annual Scientific Meeting.
New Zealand, March 2010.
Mackay S. Academic Surgery. RACS New
Zealand Assoc of General Surgeons Annual
Scientific Meeting. New Zealand, March 2010.
Mackay S. US in inguinal hernia. Australasian
Sonographers Assoc Annual Meeting.
Melbourne, May 2010.
Local
Cade R. Oesophagectomy for end-stage
achalasia. M.U.G.S, Melbourne 2009.
Hassen AS. Laparoscopic approach to
GIST tumours of the stomach. M.UG.S,
Melbourne 2009.
Hassen AS. Antireflux surgery. Victorian State
Committee meeting, RACS, 2009.
Hassen AS. Surgical decision-making in
complex GI problems. Victorian trainees
weekend, RACS, 2010.
Mackay S. S.I.L.S. RACS Victorian State
Committee Annual Meeting, 2009.
Grants
AstraZeneca Upper GI Research Grant
Cade R, Ward S, Gibson P. Pancreatic
Insufficiency following major upper GI surgery
– a novel method of measuring a hitherto
understudied problem. $11,000.
Solvay Pharmaceuticals, Pancreatic Exocrine
Insufficiency Travel Scholarship 2009
Ward S. Post-operative pancreatic exocrine
insufficiency study. $1100.
Research Training
Enrolled for M.S Masters
• Ward S, Monash University, 2009
• Dandie L, Monash University, 2010
rheumatology medicine
> Rheumatology
Rheumatology is one of the smallest medical
specialties within Eastern Health. There are
two consultants and a registrar (inaugural
2009) geared mainly toward service
delivery. The unit actively collaborates with
other specialties including dermatology,
gastroenterology, geriatrics, orthopaedics
and internal medicine within Eastern Health
by participating in multicentre studies and
having work published. Research activity is
primarily clinically and service delivery/audit
orientated and the unit has commenced
collaborating with larger external
rheumatology hospital departments.
Major achievement
Dr Albert Leung (past registrar) won best
advanced trainee poster award at the 2010
World Congress of Internal Medicine for his
prospective audit of the ortho-geriatric
service at Box Hill Hospital comparing
the service to before a medical consult
service and after and also with Maroondah
Hospital which did not have a service at that
time. He demonstrated that with regular
rheumatology/medical registrar ward rounds
by the pre-existing team at Box Hill Hospital
and consultant supervision, there were less
medical complications and improved care
and length of stay for patients presenting with
hip fractures at both their acute and subacute
inpatient stay.
Research projects in progress
An Australian cross-sectional
epidemiological study to evaluate the
prevalence of undiagnosed psoriatic
arthritis in psoriasis patients in dermatology
practice focusing on disease severity,
disease burden and quality of life. Fong C.
A multicentre study with dermatologists in
Australia including Drs John Su and Chris
Mack and rheumatologists at St Vincent’s
Hospital and Royal Melbourne Hospital.
Back pain audit. Development and audit of
back pain management at Eastern Health in
collaboration with physiotherapy, emergency
and internal medicine.
Future research direction
The unit is developing a research interest in
psoriatic arthritis and has strong clinical ties
with dermatology. Rheumatology is working
to attract the necessary research grants.
The unit is also collaborating with Alfred
Health – Monash University into MRI findings
of hip osteoarthritis. Furthermore, with the
establishment of a bone density at Eastern
Health, osteoporosis and bone diseases
is another area in which the unit is keen
support research activity. In collaboration
with orthopaedics the unit is also interested
in looking into global management of
musculoskeletal management and research
in light of Deakin University combining
rheumatology and orthopaedic teaching.
Publications
Published
Leung A, Sung C, Kothari G, Mack C,
Fong C. Utilisation of plasma exchange in
the treatment of digital infarcts. Wegener’s
Granulomatosis International Journal of
Rheumatic Diseases 2010 Vol 9999:1756-1841.
Pang J, Yu H, Pearson K, Lynch P, Fong C.
Comparison of the MMSE and RUDAS
cognitive screening tools in an elderly
inpatient population in everyday
clinical use Internal Medicine Journal 2009,
Vol 39,(6):411-414.
Buchbinder R, Osborne R, Ebeling P, Ward
J, Mitchell P, Wriedt C, Graves S, Phil D,
Staples M, Murphy B. A Randomised trial
of vertebroplasty for painful osteoporotic
vertebral fractures N Engl J Med 2009;
361:557-568.
Presentations
International
Leung A, Mack C, Fong C. Morbidity and
methotrexate use in rheumatoid arthritis
patients admitted to a public hospital.
Australian Rheumatology Association and
New Zealand Society of Rheumatology
Combined Meeting, Auckland, New Zealand,
May 2009.
National
Ting C, Leng A, Darzins P, Fong C. Prospective
audit on delirium in a subacute orthogeriatric
population: assessing risk factors and
outcome. World Congress Internal Medicine.
Melbourne, March 2010.
Leung A, Franklyn K, Ting C, Gudjuhar A,
Mack C, Fong C. Utility of an ortho-geriatric
service: hip fracture patient outcomes across
three metropolitan hospitals. World Congress
Internal Medicine. March, Melbourne 2010.
Franklyn K, Fong C. Osteoporosis: missed
opportunities for treatment in hip fracture
patients’. International Bone & Mineral
Research Society Meeting. Sydney,
February 2009.
Awards
Dr Albert Leung (Rheumatology Registrar)
World Congress Internal Medicine Royal
Australian College of Physicians “Best
Advanced Trainee Poster Award” at the World
Congress Internal Medicine 2010.
Research training
Franklyn K Master Public Health 2009
Eastern Health Research Report 2009-10 61
62 Eastern Health Research Report 2009-10
Nursing and
Midwifery
Quality
evidence-based
healthcare
Highlights
$500,000 in grants received to pursue
patient-centred research
Staff present research activities at
international, national and local conferences
Focusing on collaborative research to
achieve evidence-based outcomes
Eastern Health Research Report 2009-10 63
Nursing and midwifery
> Nursing and Midwifery
In the quest to deliver high quality evidencebased and knowledge-driven healthcare,
nurses and midwives are constantly
challenged to discover new and improved
ways of delivering care. Furthermore, nurses
and midwives have a professional obligation
to the community to provide care that is
reviewed, researched and validated. Nursing
and midwifery research advances knowledge
around professional practice, evaluates
existing practice and services and provides
evidence that will inform education, practice,
research and management.
The nursing and midwifery research unit at
Eastern Health is an established partnership
with Deakin University and provides research
support and advice to Eastern Health.
The unit consists of three jointly appointed
positions:
• Prof Bridie Kent – Chair of Nursing Eastern
Health
• Dr Trish Livingston (Senior Research Fellow)
• Dr Maryann Street (Research Fellow)
Research assistants support the work of the
unit and are employed through grant funding.
The Nursing and Midwifery Research
Unit has three core programs of activity:
• Service delivery – models of care
• Inter-professional communication &
clinical decision-making
• Quality and risk management
In addition to providing consultancy services
within Eastern Health, in 2009 both Bridie
Kent and Trish Livingston were members
of Eastern Health’s Research & Ethics
committee, reviewing research and quality
improvement projects.
The partnership with Deakin University
has continued to flourish with a number
of successful grant applications and new
collaborations established, including one
with the Joanna Briggs Institute through the
formation of a new international collaborating
centre at Deakin University.
64 Eastern Health Research Report 2009-10
Major achievement
Nurses & Midwives ‘CONNECT’: Improving
patient outcomes through teamwork.
Stevens J, Kent B, Patterson D, Blencowe P,
Street M. The aim of the project was to
introduce a sustainable approach to personcentred care whilst ensuring enhanced
communication and clinical support
processes for staff, especially for the graduate
nurses. The project had two key objectives:
• improve the quality, safety and experience
of patient care
• create a positive workplace culture for all
staff, based on support, appreciation and
empowerment, using small teams with
identified team leaders
Using a mixed method, action learning
approach, the nursing staff reviewed
the model of care, developed process
tools including bedside handover, care
conferencing and patient comfort/safety
rounds and participated in ongoing
evaluation of the intervention.
Empowered team members worked together
with vitality and enthusiasm, spent more time
in direct patient care, with increased time in
the patient room. This resulted in significant
reductions in falls and pressure ulcers, plus
positive changes to staff perception of
teamwork and safety, morale and the
climate of care.
Implementing alternative approaches to care
provision at the point of delivery, through
empowerment and active engagement
of staff and management, leads to
improvements in patient safety, quality of care
provision and vitality of nurses. The project
will be extended across all in-patient units in
Eastern Health throughout 2010.
Research projects in progress
Service delivery – models of care
Models of care to improve the management
of patients who require the use of specials
across Eastern Health. Riddell K, Livingston
P, Kent B. The aim of the research study is to
evaluate a new evidence-based model of
care for older people in acute care settings
who have an increased need for additional
vigilance, since delirium and dementia
commonly occur, with sufferers exhibiting
paranoia and hallucinations. The study will
provide recommendations and guidelines
that enhance patient safety, progress patient
management, optimise cost efficiency and
improve nursing satisfaction.
Survey of urology nurses, oncologists and
urologists regarding knowledge, attitudes
and practices associated with physical
activity among survivors of prostate cancer.
Spellman C (Eastern Health Honours student),
Livingston P. The aim of this study was to
examine the role of medical and nursing
clinicians in the promotion of physical activity
among cancer survivors.
A retrospective review of breast cancer
chemotherapy dose intensity and use of
growth factor support at Eastern Health.
Bae S, Yeung Y, Ng S, Craike M, Livingston P,
Chirgwin J. This study aims to review current
practice in breast cancer management
(schedules used and dose intensity) and
growth factor (GCSF) support and to produce
local guidelines for best standard of care for
breast cancer patients across Eastern Health.
Stand Together and Care Kent B, McIntosh M,
Williamson P, Hams K. This pilot project within
the mental health unit at Upton House,
aims to maximise the therapeutic benefit
of graduate nurses, post graduate students
and preceptors’ involvement in collaborative
person-centred activity that helps improve
self-control of senses, known as sensory
modulation.
Pre-admission tour for paediatric patients
undergoing day surgery. Niki Jewell N,
Angliss Hospital Day Surgery Unit (DSU), Kent
B. A quality improvement project to develop
and implement a pre-admission tour for
paediatric patients, involving screening of a
specialised DVD showing the progression of a
paediatric patient through the peri-operative
Nursing and midwifery
area, as well as interactive information
boards and specialised paediatric and parent
information booklets. Awarded NBV June
Allen Practice Enhancement grant for the
development of the DVD.
Evidence-based, best-practice
implementation project on maintenance,
documentation and removal of intercostals
catheters (ICC) on a surgical ward. Henry E,
Wittkopp C, Kent B. This audit of practice is
being undertaken to determine the extent to
which practices differ from evidence based
recommended ones. A range of practice
updating activities will then be put in place
in the ward, followed by a further audit of
practice. Awarded JBI Clinical Fellowship.
Enrolled nurse extended scope of practice
in renal nursing. Wilson C, Colvin J, Kent B,
Street M. This quality improvement project
has been funded by Department of Health
(DoH) as part of the Enhanced Scope of
Practice (ESOP) for Enrolled Nurse. The primary
aim of this quality project is to redesign the
model of care in maintenance dialysis to
include the enrolled nurse using the learnings
from previous ESOP projects. This will support
the expansion of renal services in Eastern
Health, address the projected workforce
challenges and provide career development
opportunities for enrolled nurses.
Inter-professional communication &
clinical decision-making
Safety-related attitudes of operating room
staff across Eastern Heath: a multidisciplinary
survey. Sommerville J, Kent B, Riley R.
The aim of this study is to measure the safety
attitudes of multidisciplinary healthcare
professionals (surgeons, anaesthetists, nurses
and technicians) in three operating room
departments across Eastern Health.
Victorian nurse practitioner project: service
plan framework. Wintle M, Newsome P,
Livingston P. The aim of this study was to
develop an organisational wide framework
to support the expanded scope of practice
of Nurse Practitioners (NPs) across Eastern
Health. Manuscript under review.
An audit of nursing home residents
presenting to Eastern Health emergency
departments: Streamlining patients back to
nursing home for end of life care. Wilkinson J,
Livingston P, Street M, Marriott J, Fullerton S.
The overall aim of this study is to formulate
a care pathway to assist in the process of
returning patients to nursing homes for
end of life care. The first stage is to identify
current issues and gaps in relation to aged
•Vanessa Watkins
Clinical Midwife Consultant, Eastern Health
Focusing on collaborative maternity care
pathways for pregnant women
Before commencing at Eastern Health in 2003 and working in Box
Hill Women’s and Children’s Services and Practice Development
Unit, Vanessa worked as both a registered nurse and midwife in
the UK prior to migrating to Australia in 2002. In her current role
as Clinical Midwife Consultant, Vanessa has strived to improve
interdisciplinary clinical practice, utilising clinical audit and
educational frameworks.
Over the past two years, Vanessa has worked in partnership with
the Eastern Health midwives and practice development unit to
introduce water birth as a birthing option for pregnant women at
Birralee Maternity Service, Box Hill Hospital. She works to support
clinical knowledge of birth through water by auditing both the
use of, and clinical outcomes following, water immersion for
labour and birth.
Vanessa drives clinical practice quality improvement initiatives for
the identification and management of severe events in pregnancy,
using the WHO ‘Maternal Near Miss’ identification criteria to assess
the quality of maternity care delivered within Eastern Health, and
by chairing an interdisciplinary working party to audit severe
post partum haemorrhage. In addition, she works with national
maternity projects including the Australasian Maternity Outcomes
Surveillance System (AMOSS) to study rare severe conditions in
pregnancy to improve the safety and quality of maternity care in
Australasia. She is also a project officer for the National Evidence
Based Antenatal Care Guidelines project.
Most recently, she has been instrumental in spearheading the
development of a major Eastern Health Women’s and Children’s
Health project to develop expected pathways of care for pregnant
women - an innovation that aims to promote seamless collaborative
maternity care across Eastern Health where the woman is the
central point. The pilot study is in progress and Vanessa has been
accepted by Deakin University as a PhD candidate to fully evaluate
the pathways project.
Eastern Health Research Report 2009-10 65
Nursing and midwifery
care residents presenting to EDs who may
require end of life care, rather than acute
care management.
Eastern Health emergency department (ED)
presentations by nursing home patients:
what are the clinical and cost implications?
Street M, Livingston T, Marriott J. The aim of
this study was to describe ED presentations
for older people living in residential care and
identify their triage assessment, length of
stay (LOS) in ED, hospital admission and
related costs.
Nurses and Midwives CONNECT:
Transforming Care at the Bedside. Kent B,
Stevens J, Patterson D, Street M. The aim of
this project was to introduce a sustainable
approach to person-centred care whilst
ensuring enhanced communication and
clinical support processes for staff, especially
for the graduate nurses.
Transforming Care at Peter James Centre.
Black A, Kent B, McKenna A. The aim of
the project was to introduce a sustainable
approach to person-centred care whilst
ensuring enhanced communication and
clinical support processes for staff.
development pathway to ensure they are
able to deliver the care and service associated
with this specialist role. The project identified
the key clinical indicators used to evaluate,
professionally support and develop the role of
the clinical nurse specialist.
Post-anaesthetic discharge scoring criteria:
A comprehensive systematic review.
Phillips N, Street M, Kent M. This project is a
systematic review which will identify the best
available evidence regarding the essential
components of an effective scoring system,
to assess patients following anaesthesia and
surgery. The draft tool of discharge measures
will be evaluated in a subsequent large scale
consensus study and then a clinical trial to
determine impact and usability.
Early recognition of the deteriorating
patient. Peel L. This was an audit of inpatient
notes which found that, during a three-week
period, Medical Emergency Team (MET) calls
were not made for 24 patients who fulfilled
the MET criteria. Furthermore, only a small
number of patients had complete sets of
observations documented and documentation
of respiratory rate ranged from 3.4-55per cent.
Thus improvements can be made to practice
involving acutely ill patients.
Clinical nurse specialist – role development.
Normand F, Stockton-Gugele M. This pilot
study aimed to create a toolkit to validate
the core competencies of the clinical nurse
specialist role and provide a professional
Midwifery research:
Introduction of a multidisciplinary clinical
handover quality improvement project.
Angliss Hospital Maternity Department:
•Julie van der Klift
Registered Nurse, Intensive Care, Maroondah Hospital, Postgraduate Student
Focusing on heart failure
In 2006, Julie began to transition from a career in educational
management to nursing by commencing full-time nursing study
at Deakin University. In the course of her training, evidencebased practice was emphasised as the means to improve patient
care and clinical outcomes. Having worked in innovation and
development within the educational sector, basing change upon
research evidence was of particular interest to Julie and has led
her to undertake a combined graduate year and honours research
program in 2009.
Julie’s honours research project evaluated a number of mortality
risk prediction tools amongst 100 local heart failure patients. Plans
are underway to continue the second phase of this project which
will use the findings to develop a palliative care referral pathway for
nursing and medical staff with an aim to increase the low palliative
care referral rate and improve access to services.
66 Eastern Health Research Report 2009-10
Julie’s career choice to transition to nursing has focused on making
a tangible difference in someone’s life every day with a specific
interest assisting patients and families during episodes of acute
illness by providing quality nursing care, education and support.
Julie is completing postgraduate training in intensive care and
in the future, plans to undertake further research in order to
contribute to ongoing evidence-based practice development and
implementation.
Julie has received a number of awards for her academic
achievements and contribution to nursing research including the
Alfred Deakin Medal 2008, Box Hill Hospital Nursing Excellence 2009
and the Deakin Marjory Walkowski Award 2010.
Nursing and midwifery
Stevens G, Hally B. Handover to and
between the various professionals (midwifery,
medical and allied health) who provide care
to the maternity patients at Angliss Hospital
is an undefined process and there is an
ability to improve the transfer in information
and in doing so, clarify responsibility and
accountability. The aim of the project is to
standardise handover processes to ensure
consistency in patient care information
exchanges.
Maternal health and wellbeing during
pregnancy. Skouteris H, McCabe M, Kent B,
Milgrom J, Cook V. Associate investigator
Patterson D. Pregnancy is a time of significant
physiological and physical change for
women; it is also a time where interventions
to address overweight/obesity in women are
likely to be successful. The goal of this pilot
study is to test an intervention designed to
prevent excessive gestational weight gain and
postpartum weight retention in primigravid
pregnant women.
Research projects completed
Predicting short-term heart failure mortality
to inform development of an in-patient
palliative care referral pathway.
Van der Klift J, Livingston P. This study
evaluated which heart failure mortalityrisk prediction tool was the most clinically
appropriate to detect mortality risk among
Eastern Health heart failure patients. Ms Van
der Klift, a Deakin University Honours student
in 2009, received the 2010 Deakin University
School of Nursing prize with a 90 per cent
thesis result [manuscript submitted to
European Journal of Heart Failure; May 2010].
ED presentation during adjuvant
chemotherapy. This study investigated
the prevalence of ED presentations among
patients undergoing adjuvant chemotherapy
as day oncology patients. Eastern Health
nurse clinicians involved in data collection:
Debra Berry (MH); Vivian Mak (Eastern Health
Honours Student) (two manuscripts in
press; 2010.)
Survey of advanced breast cancer
multi-disciplinary team meetings. Gray C,
Livingston P, Chirgwin J. The aim of this study
was to determine the contribution of the
Advanced Breast Cancer multidisciplinary
team meetings to patient care and clinical
outcomes. (Manuscript under review, 2010).
Five-year survival of women with breast
cancer across Eastern Health. Hunter S
(Eastern Health Honours student), Livingston
P, Chirgwin J. This study investigated the fiveyear survival rates of breast cancer patients at
Maroondah Hospital.
Role of emergency departments in
screening for obese and overweight
children. Considine J, Craike M, Smit, Stergiou
H, Waddell D, Hauser S. This study investigated
screening for obese children who present to
emergency departments.
Do stroke symptoms present as expected?
Bray J (Deakin University PhD student),
Bladin C, Gilligan A, O’Connell B,
Livingston P. A cross-sectional study of
Eastern Health stroke patients and witnesses
to the acute stroke event. This study aims
to examine how closely the experience
of stroke patients in relation to prior
expectations.
Clinical handover survey at Box Hill Hospital.
A survey of a single day’s handover practices
at change of shift over three consecutive shifts
was conducted across 22 Box Hill Hospital
wards in order to uncover the issues identified
by nursing staff involved in clinical handovers.
The survey was themed around perceived
barriers and enablers to effective handover.
Manuscript submitted for publication.
It is intended that a core component of the
work of the nursing & midwifery research
unit will be to related to the Eastern
Health operations and improvement plan,
particularly the goals of a great place to learn
and work and a great patient experience.
Responding to Medical Emergencies:
System Characteristics Under Examination
(RESCUE). Livingston P, Street M. The aim of
this multi-site study was to determine the
prevalence and outcomes of patients at risk
of a medical emergency and relate this to the
actual rate of MET activation.
Furthermore, since Deakin University’s School
of Nursing and Midwifery now hosts a Joanna
Briggs Collaborating Centre (The Deakin
Centre for Quality and Risk Management in
Health), the nursing and midwifery research
centre will be contributing to the joint
ventures between this and Eastern Health.
Future research direction
Publications
Published
Kent B, Hutchinson AM, Fineout-Overholt E.
Getting evidence into practice–
understanding knowledge translation to
achieve practice change. Worldviews Evid
Based Nurs. 2009; 6:183-5.
Kent B, Hutchinson AM, Fineout-Overholt E,
Williamson KM. Strategies for translating
knowledge into practice. Worldviews Evid
Based Nurs. 2009;6:246-9.
Fineout-Overholt E, Williamson KM, Kent B,
Hutchinson AM. Teaching EBP: strategies for
achieving sustainable organisational change
toward evidence-based practice. Worldviews
Evid Based Nurs; 2010;7:51-3.
Williamson KM, Fineout-Overholt E, Kent B,
Hutchinson AM. Teaching EBP: Integrating
technology into academic curricula to
facilitate evidence-based decision-making.
Worldviews Evid Based Nurs. 2010.
Richardson K, MacLeod R, Kent B.
Ever decreasing circles: terminal illness,
empowerment and decision-making. Journal
of Primary Health Care. 2010;2:130-135.
Livingston PM, White V, Hayman J,
Maunsell E, Dunn S, Hill D. The psychological
impact of a specialist referral and telephone
intervention on male cancer patients.
Psychooncology; 2010;19:617-25.
Dobbinson S, White V, Wakefield M,
Jamsen K, White VM, Livingston PM,
English D, Simpson J. Purpose-built shade in
secondary schools for adolescent skin cancer
prevention: cluster randomised controlled
trial. British Medical Journal; 2009;338;
doi:10.1136/bmj.b95online.
Craike M, Livingston PM, Botti M.
Determinants of physical activity for prostate
cancer patients and survivors: an area in need
of further research and an opportunity for
health services. ANZJPH; 2009;33:193.
Considine J, Livingston PM, Bucknall T,
Botti M. Chemotherapy-related complications
and its impact on emergency departments.
Journal Clinical Nursing 2009;18(18):2649-2655.
King S, Livingston PM, Turner L, Byrne K,
Sidwell J, et al. What information is provided
along the treatment pathway for CRC
patients? Euro J Cancer Care; 2009; online
doi:10.1111/j.1365-2354.2009.01080.
Eastern Health Research Report 2009-10 67
Nursing and midwifery
In press
Bray JE, O’Connell B, Gilligan A,
Livingston PM, Bladin C. Is FAST Stroke
Smart? Does the content and language
used in awareness campaigns describe the
experience of stroke symptoms? Internatonal
Journal of Stroke; (March 2010).
Craike M, Livingston PM, Considine J.
Emergency department presentations of
patients from culturally and linguistically
diverse backgrounds (CALDB) receiving
chemotherapy in day oncology settings.
Australasian Emergency Nursing Journal.
(July 2010).
Craike M, Livingston PM, Botti M. An
exploratory study of the factors that influence
physical activity for prostate cancer survivors.
Supportive Care in Cancer (May 2010).
Livingston PM, Craike M, White VM,
Jefford M, Hordern A, Botti M, Lethborg C,
Oldroyd J. A nurse-assisted screening and
referral program for depression among
survivors of cancer: a feasibility study. Medical
Journal Australia; supplement on Cancer &
Depression (April 2010).
Livingston PM, Craike M, Considine J.
Presentation to emergency departments due
to chemotherapy-induced complications:
opportunities for improving service delivery.
British Cancer Journal (August 2010).
Abstracts
Published
Livingston PM, Craike M, White V,
Hordern A, Jefford M, Botti M, Lethborg C;
Oldroyd J.A. A nurse-assisted screening
and referral program for distress among
survivors of cancer: a pilot study. AsiaPacific Journal of Clinical Oncology; Brisbane;
November 2009.
Outcomes from
collaborative research
Hotu C, Bagg W, Collins J, Harwood L,
Whalley G, Doughty R, Gamble G, Braatvedt
G on behalf of the DEFEND investigators.
A community-based model of care improves
blood pressure control and delays progression
of proteinuria, left ventricular hypertrophy
and diastolic dysfunction in Māori and Pacific
patients with type 2 diabetes and chronic
kidney disease: a randomised controlled trial.
68 Eastern Health Research Report 2009-10
Nephrol Dial Transplant. 2010. doi: 10.1093/
ndt/gfq168.
Presentations
International
Bray J, Cui J, O’Connell B, Gilligan A,
Livingston P, Bladin C. Do acute stroke
symptoms present as expected by patients
and bystanders? European Stroke Conference,
Switzerland, May 2010.
Bucknall T, Jones D, Barrett J, Bellomo R,
Ruseckaite R, Dunning T, Livingston P,
O’Connell B, Currey J, Considine J.
Responding to medical emergencies:
System Characteristics Under Examination
(RESCUE). Pittsburgh Rapid Response System
Conference; Pittsburgh; USA. April 2010.
Bray J, O’Connell B, Gilligan A, Livingston P,
Bladin C. Do mass media campaigns capture
and describe the experience of stroke
symptoms? XVIII. European Stroke Conference
Stockholm, Sweden, May 2009.
National
Livingston PM, Craike M, White V, Hordern A,
Jefford M, Botti M, Lethborg C, Oldroyd JA.
A nurse-assisted screening and referral
program for distress among survivors of
cancer: a feasibility study. Cancer Nurses
Society of Australia. Perth, July 2010.
Bray J, Cui J, O’Connell B, Gilligan A,
Livingston P, Bladin C. An examination of
factors related to patients’ delay in presenting
to hospital for stroke symptoms. Stroke
Society of Australasia conference.
Melbourne, September 2010.
Livingston PM, Craike M, Considine J,
Botti M, OConnell B. Presentation
to emergency departments due to
chemotherapy-induced complications:
opportunities for improving service delivery.
International Conference for Emergency
Nursing. Queensland, October 2009.
Livingston PM, Craike M, White V, Hordern A,
Jefford M, Botti M, Lethborg C, Oldroyd J.
A nurse-assisted screening and referral
program for distress among survivors of
cancer: a pilot study. Victorian Integrated
Cancer Services Supportive Care conference.
Melbourne, October 2009.
Livingston PM, Craike M, Considine J, Botti
M, OConnell B. Presentation to emergency
departments due to chemotherapy-induced
complications: opportunities for improving
service delivery. Victorian Integrated Cancer
Services Supportive Care conference.
Melbourne, October 2009.
Bray J, O’Connell B, Gilligan A, Livingston P,
Bladin C. Exploring key decision-making
processes leading to presentation to hospital
for stroke symptoms. Stroke Society of
Australasia conference. Cairns, September
2009.
Bray J, O’Connell B, Gilligan A, Livingston P,
Bladin C. Illness perceptions of the acute
stroke event. Stroke Society of Australasia
conference. Cairns, September 2009.
Riddell K, Kent B, Livingston P, Newsome P.
Constant observation (specialling): an
economic and clinical practice challenge.
Royal College of Nursing, Australia.
Queensland, September 2009.
Craike M, Livingston P, Botti M. An
exploratory study of the factors that influence
physical activity for prostate cancer survivors.
Deakin University Faculty of Health, Medicine,
Nursing and Behavioural Sciences Research
Conference. Melbourne, August 2009.
Riddell K, Kent B, Livingston P, Newsome P.
Constant observation (specialling): an
economic and clinical practice challenge.
Nursing and Midwifery Council. Queensland,
July 2009.
Local
O’Connell B, Livingston PM, Ockerby C.
Symptom management of patients
undergoing chemotherapy in day oncology.
Southern Health Research Week; Melbourne,
April 2009.
Grants
Australian Government Organ and Tissue
Authority Raising awareness of organ and
tissue donation among tertiary education
students: doing it their way. Kent B, Radford S,
Sidhu J, Brean S, $28,930.
Australian Research Council The
effectiveness of a referral and physical activity
program to increase physical activity among
survivors of prostate cancer. Livingston PM,
Salmon J, Courneya K, Gaskin C, Botti M,
Broadbent S, Kent, $382,000.
Australian Research Council Translation of
evidence into pain management practices
Nursing and midwifery
in acute care environments, Botti M, Kent
B, Bucknall T, Johnstone M, Duke M, Considine J, Watts R, Redley B, de Steiger R,
$146,380
Research training
Higher Degree Research Students
Phd
Masters
• Riddell K, Deakin University, P/T
Honours
•
•
•
•
•
Cull E, Deakin Univeristy
Sommerville J, Deakin University
van der Klift J, Deakin University
Spellman C, Deakin University
Hunter S, Deakin University
• Watkins V, Deakin University, P/T
• Bray J, Deakin University, P/T
Eastern Health Research Report 2009-10 69
70 Eastern Health Research Report 2009-10
Allied Health
Collaborative
evidence-based
research
Highlights
Research outcomes recognised and adopted
in practice by like service providers
Staff achieve peer recognition and
commendation in multiple forums
Multi-disciplinary collaborative research
funded by nationally competitive grants
Eastern Health Research Report 2009-10 71
allied health
> Allied Health
The allied health clinical research office at
Eastern Health was established in November
2006 as a joint initiative between Eastern
Health and La Trobe University. Many of the
research activities receive direction through
the Allied Health Research Committee, a
committee with representatives from allied
health disciplines and our research active
clinicians. The committee aims to strengthen
the evidence base of allied health practice
through undertaking, mentoring and
facilitating collaborative and multi-disciplinary
clinical research projects across Eastern Health.
The key research themes in allied health are:
• Community reintegration after healthrelated events
• Expanded and/or non-traditional roles for
allied health
• Systems for delivery of allied health services
As well as conducting research, the Allied
Health Clinical Research Office has important
roles in research promotion and research
training. Research training opportunities in
allied health include the allied health research
training program (Stepping into research, a
program to introduce clinicians to research by
completing a systematic review) and
allied health research scholarships. In
2009/2010, Dr Maxine Braithwaite and
Tash Brusco were recipients of allied health
research scholarships.
Major achievement
The mother and baby exercise program
was developed at the Angliss Hospital
physiotherapy department to fulfil the need
to create a healthy, safe environment for the
200-plus new mothers to exercise with their
babies at the Hhospital. The effectiveness
of physiotherapy-based group exercise
combined with allied health education on
new mothers’ wellbeing and risk of postnatal
depression had never been investigated
before. Emily Norman, a physiotherapist
working in women’s health, evaluated the
effectiveness of this popular program. Emily
conducted a randomised, controlled trial
72 Eastern Health Research Report 2009-10
as part of her Masters of Physiotherapy
(Research) at University of Melbourne. The
findings of the trial have been presented
at conferences such as the Australian
Physiotherapy Association Conference 2007
in Cairns where Emily won the Women’s
Health Inaugural Research Prize and was later
published in Physical Therapy in 2010.
As a result of this research, a package of the
program has been developed. This enables
physiotherapists to implement the evidencebased program in their own clinical setting.
After having the mother and baby research
published, the findings attracted national and
international press coverage.
Research projects in progress
An evaluation of the responsiveness of the
health status and quality of life outcome
measures in the routine care of clients at the
Angliss Hospital Community Rehabilitation
Service. Barker L, Parks C, Baldwin C, Grant M,
Robinson D, Harding K. (Multidisciplinary,
Angliss).
Dementia and driving – personenvironment - occupation analysis. Berndt A,
Darzins P, May E (Occupational therapy).
Do SMS reminders reduce ‘did not attend’
(DNA) rates in physiotherapy outpatient
clinics? Benjamin D, Taylor N, Pagram A,
Bottrell J. (Physiotherapy, Maroondah
and Angliss).
Key issues of multidisciplinary team
members caring for patients with
depression/anxiety in an inpatient palliative
care setting. Braithwaite M, Moran J.
(Multidisciplinary, Wantirna Health).
Evaluation of the De Morton mobility index
in transitional care. Brusco T, De Morton N,
Taylor N. (Physiotherapy, multisite).
Sustainability of improvement in clinical
outcome of the interdisciplinary Angliss and
Yarra Ranges pain management program.
Chu E. (Occupational therapy, Angliss and
Yarra Ranges).
Do live musical cues improve mood,
exercise adherence and exercise output for
older adults in slow stream rehabilitation
attending a group exercise program?
Clark I, Taylor N, Roche E, Au I.
(Multidisciplinary, Wantirna Health).
Can patients meet walking requirements to
walk in the community after hip fracture?
Dennett A, Mulrain K, Taylor N. (Physiotherapy,
Peter James Centre).
Evaluation of the De Morton mobility
index in patients with hip fracture.
De Morton N, Taylor N, Harding K, Harrison G.
(Physiotherapy, Peter James Centre).
Evaluation of the De Morton mobility index
in patients with Parkinson’s disease.
De Morton N, Johnston M, Taylor N, Harding K.
(Physiotherapy, Wantirna Health).
Eastern Health policy management of
women who have extensive perineal
trauma during delivery. Flett M, Frawley H.
(Multidisciplinary, Angliss).
What are the most effective interventions
to address decreased problem solving
and planning abilities in clients over 65
years old? Green C, Harris K, Louden K,
Parker D, Starkey J, Stokes D, Terrington N.
(Occupational therapy).
Triage of clients for community
rehabilitation services: How does
triage category impact on the patient
experience? Harding K, Taylor N, Leggat S.
(Multidisciplinary, Peter James Centre and
Wantirna Health).
Explaining variations in the management
of patients with chronic obstructive
pulmonary disease. Holland A, Taylor N,
Thien F. (Multidisciplinary, Angliss).
Health coaching for recovery of low
back pain. Iles R, Taylor N, Davidson M.
(Physiotherapy, Angliss).
Qualitative study of recovery expectation
of people with low back pain. Iles R, Taylor N,
Davidson M. (Physiotherapy, Angliss).
allied health
Nutritional content and patient/resident
satisfaction with texture modified diets at
Angliss Hospital and Edward Street Nursing
Home. Jardine A, Flett M, Butterly M, Ibrahim M,
Middleton J. (Dietetics) Determining
acceptability and nutritional adequacy of
texture modified diets served at Angliss
Hospital and Edward Street Nursing Home.
Impact of food choice, energy intake and
regurgitation symptoms on weight loss and
compliance with population-based dietary
guidelines in post bariatric surgery patients.
McGrice M, Boltong A, Frydenberg H.
(Dietetics) Investigating the nutritional intake
and dietary quality of patients post bariatric
surgery.
Exercise and psychosocial support for
patients with chronic kidney disease.
Mc Mahon LP, Wilby A, Taylor N, Wiggins K,
Kent A. (Multidisciplinary, multisite).
The impact of a leisure activity area on
patients; physical activity and leisure
participation levels in an inpatient
rehabilitation unit. Rice K, Kennedy G.
(Multidisciplinary, Peter James Centre).
A phase I trial of early exercise in the
management of inpatients with chronic
obstructive pulmonary disease. Tang C,
Blackstock F, Taylor N, Clarence M.
(Physiotherapy, Maroondah).
Do additional allied health services for
rehabilitation patients reduce length of stay
without compromising patient outcomes?
Taylor N, Brusco N, Shields N, Watts J, Sullivan N,
Teo K, Kennedy G, Peiris C, Radia-George C,
Lockwood K, Farley A. (Multidisciplinary,
Peter James Centre and Angliss).
Research projects completed
Improving the overall quality of life for
patients attending Box Hill Hospital
Oncology Day Centre. Allen J. Matanas M,
Houeix C. The overall objective of the
project was to investigate and complete
the four components of a comprehensive
needs assessment. The project managers
completed a normative-needs assessment
which identified occupational performance
issues commonly presented in oncology
patients. Through a comparative needs
assessment, the project managers completed
a benchmark table, making a comparison of
the service delivery of each day oncology unit
within metropolitan Melbourne.
Mapping the evidence-practice gap for
nutritional management of malnutrition
across the continuum of care at Eastern
Health. Berryman M, Jamieson R. The purpose
was to conduct an audit of current malnutrition
screening tools used across the continuum
of care within Box Hill Hospital, Peter James
Centre and Wantirna Health in order to
compare practice with newly published,
evidence-based guidelines. Wards/programs
not using evidence-based malnutrition
screening tools were identified so that work
can commence to address routine malnutrition
screening and improve clinical care.
Investigating the provision and acceptability
of culturally appropriate meals for inpatients
of Eastern Health facilities. Boltong A,
Wilton A, Kyriopoulos A, Colaci L, Jardine L,
Berlandier M, Jardine A, Truby H. The purpose
was to investigate meal provision and
food experiences among culturally and
linguistically diverse (CALD) patient groups
during admission at Eastern Health. Sites
varied in the extent and nature of culturallyappropriate meal offerings available to
patients. Where traditional food items are
offered, they are commonly not deemed
authentic by patients from CALD groups. A
suite of recommendations for improvement
of menus and patient-centred information
have been developed as an outcome of this
work. Implementation of recommendations
will require cooperation from dietitians, nursing
staff, food service staff and contractors.
Evaluation of the efficacy of the
interdisciplinary Angliss and Yarra Ranges
pain management program. Chu E,
Yeomanson A, Yencken S. Thirty-one out of
35 clients completed the interdisciplinary
allied health chronic pain management
program which is structured in line with
the International Association for the Study
of Pain between January and June 2009.
All participated in group exercise/function
training, relaxation practice and education
on pain management. Individual sessions
from clinical psychologist, physiotherapist or
occupational therapist were also provided.
Results indicate significant reduction in
patient’s pain severity at time of assessment
(pre versus post), increased sense of control,
reduced beliefs that pain indicates damage
and activity can cause harm, less reliance on
medication, reduced anxiety and depression
and improved goal attainment.
Food: a tool for developing cultural
competency during clinical placement.
Corken M, Boltong A, Dart J. The purpose was
to provide a unique learning opportunity
in the placement education setting which
focused on developing cultural awareness
and cultural competencies for student
dietitians. Students were required to discuss
traditional food preparation with Chinese
patients, source ingredients from local Asian
markets and prepare and consume traditional
Chinese rice congee. Nutritional analysis
and therapeutic applications were used as
discussion points and activities were filmed
for future reference. Qualitative evaluation was
documented from students and dietitians.
Both students and supervisors described
the students as better prepared for working
with this patient group and deemed that the
experiences extended learning beyond that
attained in the academic setting.
“Do what you can, with what you have,
where you are” (Roosevelt). Maximising
physical function and emotional wellbeing
through interdisciplinary practice. HorneThompson A, Bramley R. The purpose of the
project was to determine the effectiveness
of an interdisciplinary music and exercise
group on patients’ function and emotional
wellbeing. An eight-week music and exercise
group was conducted on a palliative care unit.
Pre- and post-group measures were taken.
Emotional wellbeing improved as a result of
group participation. Physical function was
either maintained or improved. Participation
in an interdisciplinary music and exercise
group was beneficial to patients with terminal
disease. Further research is required with a
larger sample size and to determine longterm effects.
Improving food service to midwifery patients.
Jardine A. The purpose was to improve
food service to ensure provision of a quality,
nutritionally-adequate food service to patients
in the midwifery ward. Observations of food
quality and size of servings from regular food
temperature and plating accuracy surveys were
made together with observation of meals and
snacks sent to patients in the midwifery ward.
Of particular nutrition concern were patients
who were vegetarian. Following discussion
with the charge nurse, ISS Food Services and
the ward dietitian, a number of changes were
made to food service.
Exploring perceptions of falls and fall
prevention among patients admitted
to a sub-acute geriatric evaluation and
management ward. Lim J, Lovell R, Chu E.
In this qualitative project, participants in this
Eastern Health Research Report 2009-10 73
allied health
study were generally aware of falls being an
issue or were concerned about falls. There were
several suggested causes of falls: behaviours,
medical conditions, environmental factors and
uncontrollable circumstances. Most suggested
strategies to prevent falls were related to the
individual behaviour.
An exercise and education program
improves wellbeing of new mothers: a
randomised controlled trial. Norman E,
Sherburn M, Osborne R, Galea M. Evaluation
of the program demonstrated a significant
improvement in wellbeing scores and
depressive symptoms of the women in the
exercise group compared with the women
in the education-only group over the
study period. More specifically, there was a
significant positive effect on wellbeing scores
and depressive symptoms at the end of the
program, and this effect was maintained
four weeks after completion. The number
of women identified as at risk for postnatal
depression pre-intervention was reduced by
50 per cent by the end of the program.
Do predictive equations accurately estimate
energy requirements in critically ill obese
patients: a systematic review. McPhee M,
Barrett J. The purpose of the project was
to determine the most accurate predictive
equation for estimating energy requirements
in critically ill obese patients; which body
weight (i.e. actual, adjusted, ideal) should be
applied; which stress factor should be applied.
This review concluded that no prediction
equations could be recommended when
estimating energy requirements in the
critically ill obese. An improved understanding
of medical statistics was gained throughout
the process of this systematic review.
Appropriate provision of the low bacterial
diet on an Eastern Health oncology ward.
Murphy A, Boltong A. The purpose was to
identify current use of the low bacterial (LB)
diet on ward 3 west at Box Hill Hospital. The
LB diet was inconsistently and inappropriately
provided over the audit period which
increased risk of food borne illness in some
patients and unnecessarily restricted food
choice in others. An Eastern Health policy,
Nutritional Management of Patients with
Neutropenia, has been drafted. Patient
education material regarding a LB diet has
been revised.
Neutropenic diets, were do we stand as a
Nation? Murphy A, Boltong A. The purpose was
to review existing national standards relating
to nutritional management of neutropenia in
74 Eastern Health Research Report 2009-10
order to inform a local policy for neutropenic
patients and create a baseline to progress the
work of a newly established neutropenic diet
working party in Australia. The outcome of
this project was identification of inconsistent
guidelines regarding nutritional management
of neutropenic patients. Further research is
required to develop evidence-based, bestpractice guidelines from which consistent
and practical national and local policy should
be developed.
Investigating meal time interruptions at
Eastern Health. Oppenheimer W, Boltong A,
Zhang HX, Wilton A. The purpose was to
undertake observational audits across five
Eastern Health sites to determine which
modifiable factors occurring during meal
times in Eastern Health facilities affect food
consumption by patients and to examine
meal time conditions at Eastern Health
facilities that may affect meal enjoyment and
patient satisfaction. The results of audits across
the five sites were combined in this project
to determine relationships between relevant
data variables. Overall food consumption at
Eastern Health was 62 per cent. The range
of consumption across all sites was 52-74
per cent. The largest proportion of meal
consumption was at Wantirna Health and the
least food eaten was at Box Hill Hospital (52
per cent).
Predicting energy requirement in critically
ill septic patients – Schofield and Harris
Benedict Nomograms versus Weir Equation.
Subramaniam A, McPhee M, Nagappan R.
The purpose was to compare the energy
requirements as calculated with the various
predictive equations with Weir equation
in critically ill patients with SIRS, Serious
Sepsis and Septic Shock. While routine direct
calorimetry with metabolic carts is unfeasible
in many Intensive Care Units (ICUs), Weir
equation may be a useful alternative.
Equipment use post total hip joint
replacement. Young S, Young N, Thomason A,
Smith K, Jones A, Chu E, Stephen K.
A systematic review of equipment used post
hip replacement. Guidelines were developed
to facilitate effective use of equipment post
hip replacement. Patient histories were
audited to assess current practice. Results
indicated occupational therapists do not
always document clinical reasoning
processes involved with equipment
prescription thus making it difficult to
assess if all factors were being considered to
facilitate effective equipment use.
Publications
Published
Barker L, Ziino C. Community rehabilitation:
home versus centre, guidelines for choosing
the optimal treatment location. International
Journal of Rehabilitation Research.2010;
33(2):115-123.
Clark A, Franklin J, Pratt I, McGrice M.
Overweight and obesity: use of portion
control in management. Aust Family Physician
2010; 39(6):404-411.
Harding KE, Taylor NF. Highly satisfied
or eager to please? Assessing satisfaction
amongst allied health outpatients.
International Journal of Therapy and
Rehabilitation 2010; 17(7):353-359.
Harding K, Taylor N, Shaw-Stuart L. Triaging
patients for allied health services: a systematic
review of the literature. British Journal of
Occupational Therapy 2009; 72(4):153-162.
Iles R, Davidson M, Taylor N, O’Halloran P.
Systematic review of the ability of recovery
expectations to predict outcomes in nonchronic non-specific low back pain. Journal of
Occupational Rehabilitation 2009; 19(1):25-40.
Irvine C, Taylor NF. Progressive resistance
exercise improves glycaemic control in people
with type 2 diabetes mellitus: a systematic
review with meta-analysis. Australian Journal of
Physiotherapy 2009; 55:237-246.
Johnston M, Chu E. Does attendance at a
multidisciplinary outpatient rehabilitation
program for people with Parkinson’s disease
produce quantitative short term or long
term improvements? A systematic review.
NeuroRehabilitation 2010; 26(4):375-83.
McAloney K, Stagnitti K. Pretend play and
social play: the concurrent validity of the
child-initiated pretend play assessment.
International Journal of Play Therapy 2009;
18(2):99-113.
Mirkhil S, Kent P. The diagnostic accuracy
of brief screening questionnaires for
psychological risk factors of poor outcome
from an episode of pain: a systematic review.
Clinical Journal of Pain 2009; 25(4):340-348.
Norman E, Sherburn M, Osborne RH,
Galea M. An exercise and education program
Improves wellbeing of new mothers: a
randomised controlled trial. Physical Therapy
2010; 90(3): 348-355.
O’Connor DW, Gardner BK, Eppinstall B,
Tofler D. Cognition in elderly patients
allied health
receiving unilateral and bilateral
electroconvulsive therapy: a prospective,
naturalistic comparison. Journal of Affective
Disorders 2010; 124(3):235-240.
satisfaction with cook-chill foodservice
systems: a preliminary study using a validated
questionnaire. Journal of Foodservice 2009;
20: 81-89.
O’Connor DW, Ames D, Gardner B, King M.
Psychosocial treatments of psychological
symptoms in dementia: a systematic review
of reports meeting quality standards.
International Psychogeriatrics 2009;
21(2):241-251.
Porter J, Raja R, Cant R, Aroni R. Exploring
issues influencing the use of the malnutrition
universal screening tool by nurses in two
Australian hospitals. Journal of Human
Nutrition and Dietetics 2009; 22(3):203-209.
O’Connor DW, Ames D, Gardner B, King M.
Psychosocial treatments of behavior
symptoms in dementia: a systematic review
of reports meeting quality standards.
International Psychogeriatrics, 2009; 21(2):
225-240.
Plitas A, Tucker A, Kritikos A, Walters I,
Bardenhagen F. Comparative study of the
cognitive performance of Greek Australian
and Greek national elderly: implications
for neuropsychological practice. Australian
Psychologist 2009; 44:27-39.
Porter J, Cant R. Exploring hospital patients’
Stephens D, Taylor NF, Leggat SG. Research
experience and research interests of allied
health professionals. Journal of Allied Health
2009; 38(4): 107E-111E.
Tang CY, Taylor NF, Blackstock FC. Chest
physiotherapy for patients admitted to
hospital with an acute exacerbation of chronic
obstructive pulmonary disease (COPD): a
systematic review. Physiotherapy 2010; 96:1-13.
Taylor NF, Barelli C, Harding KE. Community
ambulation before and after hip fracture:
a qualitative analysis. Disability and
Rehabilitation 2010; 32(15): 1281-1290.
Taylor NF, Harding K, Dowling J, Harrison G.
Discharge planning for patients receiving
rehabilitation after hip fracture: a qualitative
analysis of physiotherapists’ perceptions.
Disability and Rehabilitation 2010;
32(6):492-499.
In Press
Arnold M, Taylor NF. Does exercise reduce
cancer-related fatigue in hospitalised
oncology patients? A systematic review.
Onkologie.
Harding KE, Taylor NF, Leggat SG, Wise VL.
Prioritising patients for community
rehabilitation services: do clinicians agree on
triage decisions? Clinical Rehabilitation.
Harding KE, Stephens D, Taylor NF, Chu E,
Wilby A. Development and evaluation of an
allied health research training scheme. Journal
of Allied Health.
Horne-Thompson A, Bolger K. An
investigation comparing the effectiveness
•Helena Frawley
PhD Allied Health Research Lead, Eastern Health
PhD candidate, La Trobe University
Focusing on Women’s health physiotherapy,
especially pelvic floor dysfunction
Dr Helena Frawley completed her PhD in 2008 on pelvic floor
muscle measurements and the role of pelvic floor physiotherapy
in gynaecological surgery. Helena’s current research activity at the
University of Melbourne includes a position as chief investigator
and national project manager of the Australian arm of an
international NH&MRC funded research project, investigating
physiotherapy treatment for women with pelvic organ prolapsed.
programs at the University of Melbourne and is currently cosupervising two physiotherapy clinical doctorate students. Helena
has 13 publications (peer-reviewed) in the area of pelvic floor
physiotherapy and has had research selected for presentation at
the leading international conferences in her field and she has won
two Best Scientific Paper Awards for her work at national scientific
meetings.
In her role as allied health research lead at Angliss Hospital,
Helena is mentoring a project conducted by a dietician, on the
multi-disciplinary postpartum management of women who
have extensive perineal tears. Helena is also the mentor for
a physiotherapist conducting a systematic literature review
as part of the Eastern Health Allied Health Research Training
Scheme. Helena teaches on the Masters and Doctoral coursework
Helena is looking forward to ongoing research activity broadly
within the field of women’s health physiotherapy and higher
degree research student supervision. Within allied health, Helena
hopes to continue to foster collaboration in research activities
between the allied health disciplines, and between women’s health
physiotherapy and the obstetric/midwifery and gynaecology
disciplines at Eastern Health.
Eastern Health Research Report 2009-10 75
allied health
of a live music therapy session and recorded
music in reducing anxiety for patients with
amyotrophic lateral sclerosis/motor neurone
disease. Australian Journal of Music Therapy.
Abstracts
Published
Arblaster K, Uric K, McCluskey A.
Organisational changes leading to use
of assertive community treatment and
supported employment improve outcomes
for people with severe mental illness.
Australian Occupational Therapy Journal 2009;
56(5):362-364.
students. Australian Occupational Therapy
Journal 2009; 56(4): 293-294.
Urlic K, Wallen M. The assisting hand
assessment is a reliable and valid measure
of assessing hand function for children
with hemiplegic cerebral palsy and
obstetric brachial plexus palsy. Australian
Occupational Therapy Journal 2009; 56(4):
295-296.
Berndt A, May E, Darzins P. On-road
assessment of people with dementia – How to
achieve the Goldilocks point. Presented at 3rd
National Dementia Research Forum, Sydney,
September 2009.
Berndt A, May E, Darzins P. Mapping the
dementia and driving assessment route.
Presented at Alzheimer’s Australia Conference
Adelaide, June 2009.
Urlic K, Hoffmann T. Patient-based
educational interventions for cancer pain
management reduce pain intensity and
improve attitudes and knowledge towards
cancer pain. Australian Occupational Therapy
Journal 2010; 57(2):146-147.
Berlandier M, Urlic K. Can dietetic intervention
in adult chemotherapy patients prevent
or reduce malnutrition or other nutritionrelated disorders associated with cancer?
Dietitians’ Association of Australia 27th National
Conference, Darwin, May 2009.
Berlandier M, Urlic K. Can dietietic
intervention in adult chemotherapy patients
prevent or reduce malnutrition or other
nutrition-related disorders associated with
cancer? A systematic review. Nutrition and
Dietetics 2009; 66 (Suppl. 1) A35.
Wilton A, Halloran H. What do people
with newly diagnosed type 2 diabetes
want to know? Improving the journey with
consumer-centred information. Nutrition
and Dietetics, 2010; 67(Suppl 1):51.
Berryman M, Jamieson R. Mapping the
evidence-practice gap for nutritional
management of malnutrition across the
continuum of care at Eastern Health. Nutrition
& Dietetics 2010;67:s1.
Presentations
Berryman M, Jamieson R. Mapping the
evidence-practice gap for nutritional
management of malnutrition across the
continuum of care at Eastern Health. An audit
of current malnutrition screening tools used
within Central East and a comparison of the
results against new evidence-based practice
guidelines. 28th National Dietitians Association
of Australia (DAA) Conference, Melbourne, May
2010.
Boltong A, Keast RJ. Investigating the
impact of chemotherapy on taste function:
A systematic review. Nutrition and Dietetics,
2010;67(Suppl 1)51.
Brennan E, Porter J, Berlandier M.
Assessment through functional domains: new
territory for dietitians. Nutrition & Dietetics,
2009;66(S1):A35.
Corken M, Boltong A, Dart J. Food: a tool
for developing cultural competency during
clinical placement. Nutrition and Dietetics,
2010; 67(Suppl 1)51.
Flett M, Brusco N. Can exclusive breastfeeding
in the first four months of life protect against
adolescent obesity? A systematic review.
Nutrition and Dietetics, 2010; 67(Suppl 1):36.
McPhee M, Barrett J. Do predictive equations
accurately estimate energy requirements in
critically ill obese patients: a systematic review.
Nutrition & Dietetics 2010;67:s1
Murphy A, Boltong A. Neutropenic diets,
where do we stand as a nation? Nutrition and
Dietetics, 2010;67 (Suppl 1): 51.
Urlic K, Low R. Students with mild disabilities
demonstrate lower quality of schoolwork
performance as measured by the School
AMPS compared to typically developing
76 Eastern Health Research Report 2009-10
International
Clark I. Musical Instrument playing to
address upper limb exercises for older adults
in a rehabilitation unit: a collaborative music
and occupational therapy project. 24th
International Institute of Neurologic Music
Therapy, London, May 2009.
Horne-Thompson A, Bramley R. “Do
what you can, with what you have, where
you are” (Roosevelt). Maximising physical
function and emotional wellbeing through
interdisciplinary practice. Poster session
presented at 8th Asia Pacific Hospice
Palliative Care Conference, September 2009.
National
Arthur V, Rosen K, Barelli C, Dallimore S,
Tucker S. Inappropriate footwear during
rehabilitation may be putting patients at
risk, (Poster), 23rd Australasian Podiatry
Conference, Gold Coast, May 2009.
Baldwyn C. Introducing an interprofessional
model of practice into a falls clinic service
in Melbourne. All Together Better Health
Conference. International Interprofessional
Conference, Sydney, April 2010.
Barker L. Making it work – Interprofessional
Management and Professional Leadership
All Together Better Health Conference.
International Interprofessional Conference,
Sydney, April 2010.
Boltong A. Investigating the impact
of chemotherapy on taste function. A
systematic review investigating the impact of
chemotherapy on the five basic tastes – sweet,
salt, sour, bitter and umami. 28th National
Dietitians Association of Australia (DAA)
Conference, Melbourne, May 2010.
Boltong A, Voevodin, M. Clinical outcome
measures: filing a gap in the clinical governance
framework for allied health, Electronic poster
presentation at 8th National Allied Health
Conference, Canberra, October 2009.
Brusco N, Taylor N. Survey on the provision of
allied health services outside of business hours.
8th National Allied Health Conference, Canberra,
October 2009.
Brusco N, Butler M. Development of allied
health assistant competencies and training
package, 8th National Allied Health Conference,
Canberra, October 2009.
Clark I. Instrument playing to facilitate the
relearning of functional upper limb movements
in older adults. 36th National Conference of
Australian Music Therapy Association: With
Music in Mind, Melbourne, September 2010.
Clark I. What do we know about singing
interventions and psychosocial outcomes for
people in therapeutic programs? 36th National
Conference of Australian Music Therapy
allied health
Association: With Music in Mind, Melbourne,
September 2010.
Corken M, Boltong A, Dart J. Food: a
tool for developing cultural competency
during clinical placement. Results of a pilot
project used to engage dietetics students in
developing skills around food and culture,
and raise cultural awareness. 28th National
Dietitians Association of Australia (DAA)
Conference, Melbourne, May 2010.
Corkhill C, Tucker S. Establishment of
footwear bank in a rehabilitation hospital
(Poster). 23rd Australasian Podiatry
Conference, Gold Coast, May 2009.
Flett M, Brusco N. Can exclusive breastfeeding
in the first four months of life protect against
adolescent obesity? A systematic review. 28th
National Dietitians Association of Australia
(DAA) Conference, Melbourne, May 2010.
Gray J, Barker L. Cardiac Rehabilitation:
Collaboration and partnerships, All Together
Better Health Conference. International
Interprofessional Conference, April 2010.
Harding K, Taylor N, Leggat S. Do triage
systems improve patient flow? A systematic
review of the literature. Health Services
and Policy Research Conference, Brisbane,
November 2009.
Kostopoulos T, Brusco T, Barker L, Harding
K. Development of key recommendations
for the recruitment and retention of allied
health, 8th National Allied Health Conference,
Canberra, October 2009.
Harding K, Taylor NF, Leggatt S. Agreement
between clinicians using an allied health
triage protocol for prioritisation of community
rehabilitation services. 8th National Allied
Health Conference, Canberra, October 2009.
Lockwood K, Deeker S, Ghaly R. View
from a hill: a new look at providing a rapid
assessment medical unit response at Box
Hill Hospital. 4th Healthcare Without Walls
Conference, Sydney, October 2009.
Jardine A. Improving food service to
midwifery patients. Implemented changes
and patient evaluations as a result of a review
of food service provision to midwifery patients
at Angliss Hospital 28th National Dietitians
Association of Australia (DAA) Conference,
Melbourne, May 2010.
McGrice M, O’Shea T. Diet pills: an update
for APDs working in weight management.
Dietitians Association of Australia Conference,
Melbourne, May 2010.
Kaminski M, Frescos N, Tucker S. Prevalence
of risk factors for foot ulceration in
patients with end stage renal disease on
haemodialysis. 8th National Australian Wound
Management Association Conference, Perth,
March 2010.
McGrice M. Dietary management of serum
lipids – what can be achieved? General
Practice Conference and Exhibition, Sydney,
November 2009.
McGrice M. Motivating patients to change.
Practice Nurse Conference and Exhibition,
Sydney, November 2009.
McGrice M. Bariatric surgery – a dietitian’s
•Katherine Harding
Allied Health Research Officer, Clinical Consultant, Continence
and Women’s Health Physiotherapy, Eastern Health
(Senior Lecturer and Researcher, the University of Melbourne)
Focusing on triage and prioritisation
systems for allied health services
Since graduating as an occupational therapist with Honours from
La Trobe University in 1994, Katherine has had a diverse and
somewhat untraditional career path. After spending some time in
mainstream clinical practice, mainly in the acute sector, she spent
three years with Australian Volunteers International developing
a rehabilitation service in a small Pacific nation, the Republic of
the Marshall Islands. Keen to ensure that the service would be
successful and sustainable, during this period she completed a
Masters of Public Health. On returning to Australia, she joined
Eastern Health as an assessment officer with the Aged Care
Assessment Service. She continued to develop an interest in health
services research and took up a position with the Eastern Health
Allied Health Clinical Research Office in 2007.
In early 2009, Katherine enrolled as a PhD student with La Trobe
University. Her research is focusing on the methods used to triage
patients for allied health services and ways to improve efficiency
of access to the healthcare system for patients requiring these
services. Her work has so far led to two publications and two
presentations at national conferences. Katherine continues to work
as a part-time research officer for the Allied Health Clinical Research
Office, which aims to promote research and provide support for
clinicians interested in conducting research within their clinical roles
at Eastern Health.
Eastern Health Research Report 2009-10 77
allied health
perspective. Dietitians Association of Australia
Conference, Darwin, May 2009.
McPhee M, Barrett J. Do predictive equations
accurately estimate energy requirements
in critically ill obese patients? A systematic
review. A systematic review of reliability
studies to determine the most accurate
predictive equation and body weight to be
applied to energy calculations in critically
ill obese patients. 28th National Dietitians
Association of Australia (DAA) Conference,
Melbourne, May 2010.
Moore H, Boltong A. Don’t fall for weight: a
systematic review of weight status and falls.
This systematic review found that referrals
for nutritional management to decrease falls
risk should not be based on weight status
alone. Malnutrition screening should be
incorporated into falls clinics. 28th National
Dietitians Association of Australia (DAA)
Conference, Melbourne, May 2010.
Murphy A, Boltong A. Neutropenic diets –
where do we stand as a nation? A review of
existing recommendations for the nutritional
management of neutropenia and a call for
national consistency in practice through the
development and endorsement of evidencebased practice guidelines. 28th National
Dietitians Association of Australia (DAA)
Conference, Melbourne, May 2010.
Oppenheimer W, Zhang HX, Boltong A,
Wilton A, Appelton J. Addressing mealtime
interruptions – transforming bedside care. An
observational study of the components of
the meal-time environment and the extent to
which each component influences food intake.
28th National Dietitians Association of Australia
(DAA) Conference, Melbourne, May 2010.
Proud E, Harding K, Rosen K, Kennedy
G, Taylor N. Length of stay and functional
outcomes of stroke rehabilitation. Australian
Physiotherapy Association Conference
Sydney, October 2009.
Raymond M, Bramley RE, Jeffs K, Winter A,
Holland. A high-intensity progressive
resistance strength training in older people: a
systematic review of randomised controlled
trials. Australian Physiotherapy Association
Conference, Sydney, October 2009.
Roddy L, Taylor N, Tang C, Norman E,
Pagram A, Hearn K. Primary contact
physiotherapy in the emergency department
results in reduced length of stay; a controlled
trial. Australian Physiotherapy Association
Conference Week: Musculoskeletal
78 Eastern Health Research Report 2009-10
Physiotherapy, Sydney, October 2009.
Stephens D, Taylor NF, Leggatt S. Research
interest and research experience of allied
health clinicians. 2009. 8th National Allied
Health Conference, Canberra, October 2009.
Taylor NF, Dodd KJ. Therapeutic exercise.
Plenary session: Australian Physiotherapy
Association Conference Week, Sydney,
October 2009.
Taylor NF, Harding K, Stephens D, Chu E,
Wilby A. Stepping into research: development
and evaluation of an allied health research
training scheme. 8th National Allied Health
Conference, Canberra, October 2009.
Taylor NF, Tang C, Norman E, Roddy L,
Hearn K, Pagram A. An expanded role for
physiotherapy in the emergency department
can reduce patient length of stay. 8th National
Allied Health Conference, Canberra,
October 2009.
Thompson A. Keeping music in the minds
of decision-makers: growing music therapy
programs in a competitive marketplace,
36th National Conference of Australian Music
Therapy Association: With Music in Mind,
Melbourne, September 2010.
Tucker S, Firth J, Yates K. The unmet need
for inpatient podiatry. The 23rd Australasian
Podiatry Conference, Gold Coast, May 2009.
Tucker S, Firth J, Butcher G, Perry E. The
high-risk foot clinician in Australia (Invited).
23rd Australasian Podiatry Conference, Gold
Coast, May 2009.
Way A. Shower Song: Case study of NMT in
the rehabilitation of a basal ganglia stroke.
36th National Conference of Australian Music
Therapy Association: With Music in Mind,
Melbourne, September 2010.
Way A. Songwriting in Music Therapy
7th Biennial Conference Palliative Care –
Extending the Reach, November 2010.
Wilton A, Halloran H. What do people
with newly-diagnosed type 2 diabetes
want to know? Improving the journey with
consumer-centred information. A description
of the consumer consultation and evaluation
process that resulted in the selection of
education resources to make up a type 2
diabetes client information pack to be given
at type 2 diabetes diagnosis. 28th National
Dietitians Association of Australia (DAA)
Conference, Melbourne, May 2010.
Yeomanson A, Barker L. Encouraging
interdisciplinary practice within a specialist
pain management team. All Together
Better Health Conference International
Interprofessional Conference, April 2010.
Yeomanson A, Barker L. Commencement
of a chronic pain client support group as
a partnership between Knox Community
Health Service and Eastern Health. All Together
Better Health Conference. International
Interprofessional Conference, April 2010.
Local
Matanas M, Houeix C. Improving the Overall
Quality of life for patients attending Box
Hill Hospital Oncology Day Centre. Poster
Showcase. Monash University, Peninsula
Campus, Frankston, June 2010.
Tucker S. The Long Road to Podiatry
Prescribing (Invited) Australian Podiatry
Association (Victoria) State Conference,
Melbourne, March 2010.
Awards
Imogen Clark (Music therapy). Bursary
awarded on the basis of abstract titled
“Musical Instrument playing to address
upper limb exercises for older adults in a
rehabilitation unit: A collaborative music and
occupational therapy project”, to attend the
24th International Institute of Neurologic Music
Therapy, London, May 2009.
Michelle Kaminski (Podiatry), The “Aaxis New
Investigator Award” for the best new scientific
presentation for her presentation “The
prevalence of risk factors for foot ulceration in
patients with end stage renal disease“ at the
Australian Wound Management Association
Conference in Perth, March 2010.
Grants
NHMRC Partnership Project Grant
Do additional allied health services for
rehabilitation reduce length of stay without
compromising patient outcomes? Taylor N,
Brusco N, Watts J, Shields N, Sullivan N, $233,079.
Department of Health Allied Health transdisciplinary screening and intervention in an
emergency department outside of regular
business hours for nutritional, cognitive,
communication, swallowing and psychosocial
presentations, Goding M, Wilton A, $20,000.
Department of Health An investigation
of trans-disciplinary models of care for
psychosocial presentations to an emergency
department outside of regular business hours.
allied health
Wilby A, $20,000.
• Brusco N, La Trobe University, P/T Department of Health An investigation of the
efficacy of flexible models of service delivery
for cardiac rehabilitation patients outside of
regular business hours across the Allied Health
team. Wilby A, Higgins R, $18,100.
• Harding K, La Trobe UniversityF/T Research training
PhD
• Boltong A, University of Melbourne, F/T • Iles R, La Trobe University, P/T
• Peiris C, La Trobe University, F/T
• Mulrain K, University of Queensland P/T
Masters
• Tang C, La Trobe University, P/T • Radia-George C, La Trobe University, P/T Honours
• Dennett A, La Trobe University
• Kaminski M, La Trobe University
• Shaw K, La Trobe University
Eastern Health Research Report 2009-10 79
allied health Mental health
> Mental Health
Research activity across the mental health
program incorporates Turning Point Alcohol
and Drug Centre, Allied Health, Child Youth
Family Mental Health Service, Mental Health
Nursing, Spectrum Personality Disorder
Service for Victoria and Aged Persons
Mental Health. The main aim of research by
these services has been to improve service
delivery directly by feeding back findings
to the current service system and treatment
models and indirectly by improving
team cohesion and job satisfaction across
the workforce.
Major achievements
With an evolving and coordinated effort
focusing on mental health research, a number
of major achievments and outcomes are
evident over the past 12 months. These
include: the establishment of a strong clinical
psychology training and research partnership,
between a tertiary mental health service and
applied research, driven by Deakin University;
the Child Youth Family Mental Health Service
(formally Child and Adolescent Mental Health
Service [CAMHS]) contribution to routine
outcomes measurement captured in an
invited book chapter in the recently
published Outcome Measurement in Mental
Health. Trauer T Ed, Cambridge University
Press, Cambridge, 2010; the Aged Person
Mental Health services received a ARC
Research Grant for the evaluation of a training
program for staff to recognise depression
among aged people living in residential and
community care.
Projects in progress
Prevention and Recovery Care (PARC). A
pilot program aimed at avoiding or reducing
the length of psychiatric hospital admissions.
The aim of the current study is to evaluate the
relationships between a PARC admission and
consumer mental health as well as number of
acute inpatient days.
Child Youth Family Mental Health Service
(formally Child and Adolescent Mental
80 Eastern Health Research Report 2009-10
Health Service [CAMHS]. In conjunction with
the Marika Ferguson of Avenues Education,
this research program is comparing the
characteristics and outcomes for those young
people in the service who are receiving
educational input from Avenues with
those without Avenues support. Avenues
is a Department of Education and Early
Childhood Development school that works
with the child mental health services of both
The Alfred and Eastern Health.
Stand together and care collaborative
project. The aim of this project, coordinated
by the nursing and occupational therapy
team, is to maximise the therapeutic benefit
of graduate nurses, post graduate students
and preceptors’ involvement in collaborative
person-centred activity that helps improve
self-control of senses, known as sensory
modulation. Stage 1 of the pilot project is
complete and stage 2 has commenced with
graduates teaching their preceptors.
Spectrum service-wide evaluation. Rao S,
Hendricks K. This project aims to evaluate the
impact of spectrum therapeutic interventions
on clients’ psychiatric symptoms, quality of life,
self-harm behaviour and hopelessness.
The use of video monitoring for inpatients
in an acute aged mental health unit –
enhancing clinical care. Sivakumaran H,
Thirunavukarasu G.
Enhancing clinicians’ involvement with
patients’ families in an aged person’s mental
health service. Hudgson C, Rycroft P, Giri, S.
Randomised control trial of an
individualised biopsychosocial treatment
approach for behavioural and psychological
symptoms of dementia in residential aged
care. Davidson T, McCabe M, Bird M,
Hudgson C.
A qualitative analysis of a culture change
process in aged residential care. Hudgson C,
Buchanan G, Knight T.
An experience in reducing seclusions and
restraints in an aged mental health inpatient
Unit. Sivakumaran H, George K, Pfukwa K.
ECT in the elderly population with MONARC.
Multicentre trial.
Projects completed
Examining the relationship between
admission to a sub-acute mental health
service and hospital admissions. Mildred
H, Gedge R, Petrenko J. Data was examined
for a consecutive cohort of Prevention and
Recovery Care (PARC) clients over a 2.5 year
period (182 people). Results demonstrated
that consumer mental health significantly
improved across the time of their admission
to a PARC Service (a maximum of four weeks).
Inpatient days and crisis team contact were
both significantly lower in the 12 months
post-PARC compared to the 12 months prior
to PARC.
Predicting self-injury in borderline
personality disorder (BPD). Hulbert
C, Thomas R. This project investigated
the degree to which various indices of
experiential avoidance predicted frequency
and lethality of self-injurious behaviour (SIB)
in a female BPD sample. It was found that
motivations related to relief from negative
emotions positively predicted frequency
of non-suicidal, but not suicidal, SIB. On the
other hand, reliance on avoidant coping
strategies predicted lethality of SIB, while selfblaming coping and motivations related to a
desire to influence others predicted frequency
of non-suicidal SIB.
Psychotropic drug use in the management
of borderline personality disorder. Rao S,
Thomas R, Neski J. Polypharmacotherapy in
the treatment of symptoms of borderline
personality disorder has been cautioned for its
medical risks and psychiatric complications.
This project was a naturalistic study that
found that patients who underwent an
intensive residential psychotherapy program
appeared to utilise fewer psychotropics and
have reduced polypharmacy. This reduction
was sustained one year after the patient was
discharged from the Spectrum program.
Mental health allied health
Evaluation of a 12-session Acceptance and
Committment Therapy (ACT) group for
people with borderline personality disorder.
Morton J, Gopold M, Snowden S. Wise
Choices groups were conducted at
Spectrum as an intervention to assist with
increasing participants’ capacity to tolerate
distressing emotions and decrease reliance
on harmful avoidance strategies such as
self-injury and suicidal behaviours. This study
found that the Wise Choices groups resulted
in significant improvements in psychiatric
symptoms, fewer BPD behaviours, as well
as a greater acceptance of emotional states.
In summary, findings suggested that Wise
Choices Groups are a valuable and costeffective addition to public-sector treatment
for people with BPD.
Trial of a new tool for the assessment of
behavioural and psychological symptoms
of dementia in psycho-geriatric
nursing homes.
Future research direction
Mental Health services will continue build
upon research activity that translates directly
to client and patient treatment and care.
A number of key focus areas for the future
include investigating whether there is a
difference on key measures in recovery
related a client attending PARC to prevent
an admission (step up) and those who are
discharged early from the acute unit (step
down); measuring the effectiveness of a
teaching program in sensory modulation and
its effect on positive consumer outcomes; and
for Spectrum, investigating mentalisation-
based therapy with mounting evidence
supporting its effectiveness as a treatment for
borderline personality disorder. Spectrum is
currently considering a research proposal for a
cross-site project examining an MBT-informed
approach to case-management.
Publications
Published
Beatson J, Sao S, Watson C. Borderline
personality disorder: towards effective
treatment. Melbourne: Australian Postgraduate
Medicine, 2010.
Cooke K. Self at zero: bringing spontaneity
to the treatment of borderline personality
disorder. Australian & New Zealand
Psychodrama Association Journal.
2009:18:81-89.
•Dr Helen Mildred
Senior Clinical Academic and Director EH/Deakin University Psychology Clinic
Focused on child and adolescent mental health problems including non-suicidal
self injury and mental health evaluation and service development
Dr Helen Mildred has been working in public mental health for
over 18 years, predominantly within child and adolescent mental
health. She has demonstrated a strong commitment to improving
mental health outcomes, particularly for vulnerable young people,
and undertaken research in a wide range of areas. Her Honours
research was in the area of language development of people
who are bilingual, and her Masters research was on risk factors for
eating disorders in Greek and Anglo-Australian adolescent girls. Her
Doctoral research explored suicidality and self-harm behaviour of
homeless young men and women. Since 1997, when a partnership
was established between Deakin University School of Psychology
and Eastern Health Mental Health Program, Helen has focused on
improving research activity and outputs of both organisations,
as well as providing clinical training opportunities for provisional
psychologists undertaking postgraduate clinical psychology
training at Deakin. We are pleased that Eastern Health has reaped
the benefits of this program by employing many psychology
graduates who we have directly trained.
Helen has occupied the collaborative appointment since its inception,
and over that time has directly supervised five Honours and six
Masters and Doctoral theses and linked other Deakin Academics
with clinical staff at Eastern to produce 10 other research projects.
She has been successful in attaining research grants to investigate
aspects of our mental health service delivery both within the child
and adolescent and the adult areas of practice. Helen as well as
her colleagues and students have presented this work at many
local, national and international conferences. She has produced
six refereed journal articles and co-authored two book chapters on
children of parents with a mental illness and clinical assessment
respectively. In recent years the partnership has extended to the
establishment of two additional collaborative positions, one in
aged and one in adult mental health to which Helen has provided
mentoring. These three positions have assisted in extended research,
clinical training and the establishment of the EH/Deakin University
Psychology training clinic which has been operating for three years
and is now currently becoming embedded in the new Child, Youth
and Family Mental Health Service here at Eastern Health.
Eastern Health Research Report 2009-10 81
allied health Mental health
George K. Psychiatric admission in
dementia care – Cultural and social factors
may determine outcome. Asian Journal of
Psychiatry, 2010. 3,73-75.
George K. (2010). Vanuatu: happiest nation
on earth, mental health and the church. The
Royal Australian and New Zealand College of
Psychiatrists, 2010. 18(1), 63-75.
Payman V, Ryburn B. (2010). Religiousness
and recovery from inpatient geriatric
depression: Findings from the PEJAMA Study.
The Royal Australian and New Zealand College
of Psychiatrists, 2010. 44, 561-568
Davison TE, McCabe MP, Mellor D,
Karantzas G, George K. Knowledge of late-life
depression: An empirical investigation of aged
care staff. Aging & Mental Health, 2009.
13, 577-586.
Davison TE, McCabe MP, Mellor D. An
examination of the gold standard diagnosis
of major depression in research with aged
care residents. American Journal of Geriatric
Psychiatry, 2009. 17, 359-367.
McCabe M, Davison T, Mellor D, George K.
Barriers to care for depressed older people:
Perceptions of aged care among medical
professionals. International Journal of Aging
and Human Development, 2009. 68(1), 53-64.
In press
Bridges B, Welsh P. When avoidance and
resistance is used as exclusion criteria by
services. New paradigm: The Australian Journal
on Psychosocial Rehabilitation. 2010
Hulbert C, Thomas R. Predicting self-injury
in BPD: an investigation of the experiential
avoidance model. Journal of Personality
Disorder. 2010
Trett R, Dick D, Cooke K. Major mental
illnesses: borderline personality disorder. In
K. Edward, I. Munro, A. Robins & A. Welch,
(Ed’s). Nursing in Mental Health: Dimensions of
Praxis. 2010
82 Eastern Health Research Report 2009-10
Abstracts
Mental Health Nursing and Occupational
Therapy. The 11th Victorian Collaborative
Psychiatric Nursing Conference Abstract
Booklet and the International Journal
of Mental Health Nursing ACMHN 36th
International Conference Abstract Booklet.
Hobart, Tasmania 2010 [to be published].
Outcomes from research
collaboration
Digre E, Reece J, Johnson A, Thomas R.
Treatment response in subtypes of borderline
personality disorder. Personality and Mental
Health 2009: 3:57-67.
Nesci J, Smith D, Altieri T. Subgroups of
borderline personality disorder: identification
and clinical utility. VDM Verlag, 2009.
Presentations
International
Cooke K. Empathic attunement and play:
social atom repair with people who have
a diagnosis of borderline personality
disorder. Australian and New Zealand
Psychodrama Association, Annual General
Meeting Dunedin, New Zealand,
January 2009.
Cooke K. Empathic attunement and play:
social atom repair with people who have
a diagnosis of borderline personality
disorder. Australian and New Zealand
Psychodrama Association, Annual General
Meeting. Dunedin, New Zealand,
January 2009.
Nedeljkovic R, Rao S. The significance of
understanding interpersonal dynamics in
assessment and management of personality
disorder. The Royal Australian and New
Zealand College of Psychiatrists Annual
Congress, Adelaide 2009 (Poster presentation).
Local
Bridges B, Welsh P. When avoidance and
resistance is used as exclusion criteria by
services, VICSERV International Mental Health
Conference, Melbourne, April 2010.
Williamson P. Stand Together and Care
collaborative project: implementing sensory
modulation in an acute adult mental health.
OT Australia, State Conference, Melbourne,
November 2010.
Grants
ARC Evaluation of a training program for staff
to recognise depression among aged people
living in residential and community care,
McCabe MP, Mellor D, Davison TE, George K,
Karantzas G. $255,000.
Department of Health & Ageing McCabe MP,
Mellor D, Davison T, George K, and Storer S.
Intervention for depression among palliative
care patients and their families: Training
program for care staff, $474,322.
NHMRC (Category 1) McCabe MP, Bird M,
Davison T, Mellor D, and George K. Evaluation
of an instrument for management of
behavioural and psychological symptoms of
dementia.
Research training
National
McIntosh, M, Hams, K. “Stand Together and
Care”, Enhancing the therapeutic environment
through graduate nurses engagement and
implementation of sensory modulation.
Eastern Health, Practice Development Team,
ACMHN 36th International Conference, Hobart,
Tasmania August/September 2010.
Neski J, Doctor of Psychology, Royal
Meblourne Institute of Technology (RMIT)
Lange F, Master of Clinical Psychology,
Swinburne University
Becker A, Doctor of Counselling Psychology,
La Trobe University
pharmacy
> Pharmacy
Pharmacy at Eastern Health has two major
branches of research activity. Clinical trial
units based at both Box Hill and Maroondah
hospitals undertaking medication related
research are supported by pharmacy services.
This support includes membership on the
Human Research Ethics Committee (HREC
see pg 7), dispensing of trial medications,
protocol review, assistance in randomisation
and maintenance of blinding. A significant
number of clinical trials require aseptic
preparation in specialised facilities. At the
time of writing, pharmacy was involved
in over 140 clinical trials across a range
of clinical specialties including oncology,
haematology, neurology, gastroenterology,
respiratory, endocrinology, surgery and
intensive care medicine. Approximately
12 per cent of clinical trials are investigator
driven, the remainder being sponsored by the
pharmaceutical industry.
Pharmacy research activity further extends
to practice-based applications. Traditionally,
these have been small studies examining
various aspects of pharmacy practice. This
focus on ensuring practices introduced
into the provision of pharmaceutical care is
effective and evidence-based.
Research projects in progress
‘Are you being served?’ Hospital pharmacists
ask community pharmacists. O’Brien T,
Zamani M, Cording A. This study aims to
optimise the relationship and communication
between hospital and community
pharmacists and to determine whether
community pharmacists needs are being met
by hospital pharmacy service. Community
pharmacies were contacted by phone to
arrange a face-to-face meeting and consisted
of an informal overview of the hospital’s
clinical pharmacy services, pertinent to the
community pharmacy. The community
pharmacists completed a feedback form to
rate services being provided, outlined their
specific needs and commented further on
any other issues.
Doctors’ attitude towards, and knowledge
of, antibiotics prescribing at Box Hill
Hospital. Georgy M, Lim K, Chally R,
Zaidi T. The project is measuring doctors’
attitude towards, and knowledge of,
antibiotic prescribing before and after the
implementation of a web-based antibiotic
approval program. The investigators are
particularly interested in the educational
impact of the antibiotic decision support
system at Box Hill Hospital.
A quantitative and qualitative analysis
of pharmacists’ interventions before and
after the implementation of a web-based
antibiotic stewardship program. Zaidi T,
Georgy M, Jones N. Antibiotics are one of the
most commonly-used medication categories
in hospitals. Pharmacists often spend time
to ensure the rational use of antibiotics.
This project is measuring the impact of a
web-based antibiotic stewardship program
on the number and nature of pharmacists’
interventions related to antibiotics at
Box Hill Hospital.
Patients’ age and eGFR were found to be the
best predictors of therapeutic vancomycin
concentration (Adjusted R2= 0.929) after
eliminating all the other study variables in a
stepwise backward linear regression model.
The impact of a unit-based clinical
pharmacy service on medication
prescribing errors. Chandler K, Shen S,
Cording A. Changing the model of care being
utilised to allow the clinical pharmacists
to work more closely with medical staff in
the treating unit, in contrast to providing a
traditional ward-based clinical service, has
demonstrated improvements in patient safety.
This is evident through improvements in the
quality of prescribing and enabling the clinical
pharmacist to intervene at the point the
prescriber writes a medication order rather
than detecting the error after it has already
occurred and medication may have already
been administered to the patient.
Research projects completed
The impact of a unit-based clinical
pharmacy service on discharge efficiency
and waiting times. Chandler K, Shen S,
Cording A. Linking the clinical pharmacist
to the treating unit in contrast to working
independently and providing a ward-based
service appears to have little impact on the
number of prescriptions written in advance
and time taken to write patient discharge
prescriptions. Consequently there appears to
be little or no improvements in the efficiency
of the discharge process or in the time taken
for the patient to receive their discharge
medications and associated counselling.
Does one dose fit all? Determinants of
therapeutic vancomycin concentrations
in adult patients. Zaidi T, Chia M, Dang N.
The first 24 hours are critical in the treatment
of resistant gram positive infections. This
study aims to measure the average time
required to achieve therapeutic vancomycin
concentration in patients treated with this
antibiotic. The average time required to reach
therapeutic vancomycin concentration was
61.8 hrs. Four patients were unable to reach
therapeutic levels while only six patients were
able to reach therapeutic levels within 24 hrs.
Mentoropoly: a training resource for
both mentors and students. Chandler K,
Ku M, Jelbart V, Ransom J. Traditionally,
didactic teaching is often utilised when first
orientating students to new departments for
clinical placements. Students are told what
to do and are expected to do it. In order to
bridge the gap between the expectations
of the clinical mentor and the relative
inexperience of the student, a new innovative
board game was designed to quickly
orientate students to common clinical and
professional scenarios.
The impact of distractions on the safety and
completeness of medication administration.
Price G, Lau Y, Van de Vreede M. To determine
the nature and scope of nurses’ perception
of factors that impact on the safe and
complete medication administration. To
assess if a suite of targeted medication-related
changes can reduce the effect of the major
distractions identified.
Eastern Health Research Report 2009-10 83
pharmacy
Stop the Clot! Using warfarin week to raise
awareness for nursing staff. Shen S,
Chandler K, Cording A. A warfarin week
initiative was successfully implemented to
raise awareness amongst nursing staff of the
importance of appropriate administration of
warfarin and other commonly administered
anticoagulants via the promotion of a warfarin
education week.
Presentations
National
Zaidi T, Marriott J, Nation R. Barriers and
facilitators to the doctors’ adoption of an
antibiotic decision support system. Society
of Hospital Pharmacists of Australia 35th
Annual Conference. Perth, Western Australia,
November 2009.
Chandler K, Ku M, Jelbart V, Ransom J.
Mentoropoly: A Training Resource for Both
Mentors and Students. Society of Hospital
Pharmacists of Australia 35th Annual
Conference. Perth, Western Australia,
November 2009.
Cording A, Lau D, Boyd W, Middleton M,
Phulwani K, Van de Vreede M. Development
of an integrated medicines management
structure across a large, multicentre, public
health service. Society of Hospital Pharmacists
of Australia 35th Annual Conference. Perth,
Western Australia, November 2009.
Cording A. Utilising web-based technologies
in pharmacy practice for gains in efficiency,
education and communication. Society
of Hospital Pharmacists of Australia 35th
Annual Conference, Perth, Western Asutralia,
November 2009.
Molenaar M, Van de Vreede M. Managing
medication risks in the development of a
statewide electronic clinical system. Society
of Hospital Pharmacists of Australia 35th
Annual Conference. Perth, Western Australia,
November 2009.
Van de Vreede M, VicTAG QUM group. A
state QUM group: a bottom-up approach
to improving safety statewide. Society
of Hospital Pharmacists of Australia 35th
Annual Conference Perth, Western Australia,
November 2009.
Van de Vreede MA. High risk drugs: how
commonly are they used? Society of
Hospital Pharmacists of Australia 35th
Annual Conference. Perth, Western Australia,
November 2009.
Currey J, Van De Vreede, M, Yu K, Allen, J,
Dooley M, Nation R. Nurse Interventions in
the medication process to prevent patient.
National Medicines Symposium. Melbourne,
May 2010.
•Paula Lee
Senior Clinical Trials Pharmacist, Eastern Health
Focused on supporting clinicians and participants involved in clinical drug trials
Paula has been working in Eastern Health since 2002. During this
time she has been heavily involved in ward-based clinical pharmacy
and clinical trials services. She completed her Graduate Diploma in
Clinical Research in 2008 and is currently enrolled in a Diploma in
Management program. Paula has been part of the Eastern Health
Human Research and Ethics Committee (HREC) since 2006 and
is a member of the Society of Hospital Pharmacy Committee of
Specialty Practice (Investigational Drugs).
In her role as the clinical trials pharmacist, Paula has seen the
clinical trials pharmacy services evolve from purely a supply role
to a clinical support role, which includes providing advice to
investigators, sponsors and study teams regarding data collection,
protocol design and randomisation. Over the last few years, the
84 Eastern Health Research Report 2009-10
number of studies involving pharmacy at Eastern Health has
flourished from 60 studies to a current status of approximately 120
active studies. The number of pharmacy staff involved in clinical
trials has also doubled from five to nine in order to accommodate
for the growing pharmacy involvement.
Paula sees a very bright future for Eastern Health Pharmacy in
the area of clinical trials. Her upcoming focus in pharmacy will
be to provide greater support to participants of clinical trials in the
form of direct counselling and printed medication information.
Paula will also strive to increase pharmacy staff training and
involvement in research and provide a greater consultative role for
pharmacy researchers.
health promotion unit
> Health Promotion Unit
Eastern Health’s health promotion unit
endeavours to improve the health and
wellbeing of the community. The unit
provides integrated health promotion
programs that enable people to strengthen
their coping abilities and achieve positive
physical, mental and social wellbeing.
knowledge and trust to further empower
and connect them with others. The project
was an evidence-based mental health,
health promotion intervention aimed at
strengthening the capacity of vulnerable
pregnant women to cope with transition
to parenthood.
Staff of the unit include qualified health
promotion/public health practitioners who
have conducted research as part of a Master
of Public Health at La Trobe University. Other
research is also performed in accordance with
health promotion best-practice guidelines.
Questionnaires and interviews were
conducted as part of the program evaluation.
The questionnaires reported a decline in the
risk of depression and identified feelings of
increased support amongst participants.
The interviews further revealed the positive
attributes of the program. This project
presents a unique public health approach
using a preventative based perinatal program
to reduce depression in mothers-to-be by
strengthening mothers’ confidence and
resilience in coping.
The development of health promotion
programs requires significant evaluation and
research from inception to completion. The
unit has a strategic focus of ensuring all new
programs are evaluated through the life of
their program. Evidence on emerging health
issues, social determinants and risk factors
is used to guide program development.
Program evaluation measures ensure goals,
objectives are effective in supporting
improved health outcomes.
The unit currently has three health promotion
priority areas including mental health and
wellbeing, reducing tobacco-related harm and
improving access to nutritious food.
Research projects in progress
Ready Set Baby. Stevenson K, Russ J.
Continued program implementation and
evaluation with at-risk pregnant women.
The program is delivered in partnership with
Connections, a community welfare agency
and the finalisation of a licensing agreement
with Connections is underway with future
partnerships also being pursued.
Major achievement
In 2009 a Ready Set Baby pilot project
was developed to improve the health and
wellbeing of at-risk pregnant women through
participating in an enhanced ante-natal
program facilitated by highly experienced
midwives and social workers.
The project included the delivery of 10
two-hour birth and parenting sessions for
socially disadvantaged pregnant women
requiring additional guidance and support,
with greater emphasis being made on the
transition to parenting, family of origin and
mother/baby attachment.
A significant component of the program
relates to women being active health
consumers where they can develop skills,
Research projects completed
Ready Set Baby (RSB) 2009 pilot project.
Stevenson K, Russ J, Fitcher L, Kunek P. This
project was unique in supporting pregnant
women who are less likely to access
mainstream maternity services because of
their personal circumstances. This project
links social inclusion and mental health and
wellbeing where the protective effects of
“belonging to a social network” have been
considered. This approach has particular
relevance for at-risk populations where
interventions should seek to improve quality
rather than the quantity of relationships. The
personal style of the program assisted in
developing the participant’s decision-making
and information seeking skills and
the additional support for participants at
risk of depression and social isolation were
valuable outcomes.
Identified research interests
and future direction
Expansion of the Ready Set Baby program
throughout the Eastern Metropolitan
Region has been identified. Increasing
program delivery and increasing community
partnerships will extend the program reach.
Future directions include applying new
research methods in partnership with other
agencies to investigate ongoing community
supports required to improve the health
outcomes of at risk population groups. Areas of
interest include developing linkages to support
the future development of peer support
groups, community kitchens, community
gardens and supported playgroups.
Other identified research interests include
consideration of parent/child attachment
during the perinatal period, reducing
ante-natal depression and accessing barriers
to breastfeeding.
Presentations
National
Acceptance to present at 3rd Biennial
Conference ‘Breathing New Life into Maternity
Care’, Northern Territory, July 2009.
Local
La Trobe University Presentation Evening, a
showcase of Masters of Public Health Action
Learning Research projects. Guests included
representatives from public and private
hospitals, Department of Health as well as
community/welfare/health organisations.
October 2009.
Eastern Health Research Report 2009-10 85
86 Eastern Health Research Report 2009-10
Turning Point
Alcohol and
Drug Centre
Practical
and applied
research
Highlights
Appointment of Prof Dan Lubman, Director,
Turning Point Alcohol and Drug Centre
and Prof of Addiction Studies and Services,
Monash University
Multiple projects receive national and
international recognition for their outcomes
Staff contribute to over 100 peer-reviewed
publications and community reports
Eastern Health Research Report 2009-10 87
Turning Point Alcohol and Drug Centre
> Turning Point Alcohol and Drug Centre
Turning Point is an internationally respected
specialist alcohol and drug organisation that
integrates treatment and support services
with research, education and training. Turning
Point’s research team (consisting of 30 staff )
conducts practical and applied research
leading to policy and service development.
Areas of research and development include:
• Health services research which informs
policy and service development, enabling
a better understanding of the needs of
service users
• Clinical and forensic research which focuses
on integrating medical, psychological and
social aspects of drug use and treatment,
and includes intervention research
• Cognitive and neurobiological research
which focuses on examining the impact
of drug use on brain development, brain
function and clinical outcomes
• Population health and school-based
research which seeks to improve the
community’s literacy regarding alcohol and
drug use and subsequent help-seeking
• Epidemiology and surveillance which
investigates patterns of drug use and the
associated outcomes in the community
• Alcohol policy research which monitors
drinking trends and alcohol-related harm
someone else’s drinking, ranging from minor
annoyance to physical violence or death.
The research draws on and analyses a wide
variety of existing and newly-developed data,
including a national survey of more than 2600
Australians aged 18 or older conducted in
2008. The study reports for the first time on
the previously largely hidden financial costs
of alcohol abuse on others, including family
members of drinkers, friends, workmates and
strangers.
Major achievement
The Range and Magnitude of Alcohol’s
Harm to Others. Laslett A-M, Catalano P,
Chikritzhs T, Dale C, Doran C, Ferris J,
Jainullabudeen T, Livingston M, Matthews S,
Mugavin J, Room R, Schlotterlein M,
Wilkinson C. Fitzroy, Victoria: AER Centre for
Alcohol Policy Research, Turning Point Alcohol
and Drug Centre, Eastern Health. 2010.
The range and magnitude of
alcohol’s harm to others
The alcohol’s harm to others project
conducted within the AER Centre for
Alcohol Policy Research at Turning Point was
commissioned by Alcohol Education and
Rehabilitation Foundation (AERF) and is a
collaborative study with the National Drug
and Alcohol Research Centre, Sydney and the
National Drug Research Institute, Perth. The
project aims to assess the harm caused not
to drinkers but because of the heavy drinking
of others.
According to the study, almost threequarters of all adults in Australia were
negatively affected over a one-year period by
88 Eastern Health Research Report 2009-10
These new costings estimate that alcohol’s
harm to others equates to an estimated $14
billion per annum across Australia. Previous
estimates have focused mainly on the drinkers
themselves and the direct costs to society.
The study concludes that costs to Australia of
alcohol abuse could be double the previous
estimates if the additional impact that heavy
drinkers have on others around them is taken
into account, particularly in areas such as outof-pocket expenses, lost time, foregone wages
and productivity.
The study represents a sustained,
comprehensive effort to quantify alcohol’s
harms to others.
The full study is available on the AER website,
www.aerf.com.au.
Research projects in progress
Studies of the effects of alcohol outlet
density. Livingston M, Room R. This project
examines the ways in which recent changes
to the availability of alcohol in Victoria have
affected rates of alcohol consumption and
related harm. The study has thus far found
some substantial associations between
alcohol outlet density and violence in
Melbourne, with results published in a series
of journal articles. The project will continue,
looking at how alcohol outlet density relates
to drinking patterns and to rates of
chronic disease.
The range and magnitude of alcohol’s harm
to others. Laslett A, Livingston M, Mugavin J,
Ferris J, Schlotterlein M, Room R, Matthews S,
Wilkinson C. The range and magnitude of
alcohol’s harm to others project, considers
the adverse effects of drinking in Australia on
people other than the drinker. Includes the
effects of drinking on the health of others,
on injuries and damage from assaults
and from traffic crashes, on family life and
functioning, and on the welfare of others.
Methods for costing the effects in dollars
are also employed. The first stage of the
project has been completed, with the launch
of the project report at The Press Club in
Canberra. The second stage of the project
is ongoing, with further analysis of alcohol’s
secondary harms to be undertaken across a
range of new areas.
Drinking patterns, gender and social
roles in alcohol problems in Victoria, in
an international comparative context
(GENACIS Gender Alcohol and Culture: An
International Study). Room R, Matthews S.
The goal of this project is to develop a better
understanding of the patterning of alcohol
consumption and of the relation of these
patterns to problems in social relations,
particularly in couples and the family,
by establishing an Australian arm of the
GENACIS - GENder, Alcohol and Culture: An
International Study.
GENACIS Gender Alcohol and Culture:
An International Study. Room R, Ferris J.
Investigates gender and cultural differences
in drinking behaviour and its adverse effects;
how drinking and its effects are modified by
socio-economic conditions, social status and
social roles and drinking contexts; and how
drinking is linked to social pressure to control
drinking, intimate relationships and intimate
partner violence.
Turning Point Alcohol and Drug Centre
Alcohol control, consumption and
consequences: time series analyses of
the Australian experience. Livingston M,
Wilkinson C, Room R. This study collates
and analyses historical data on alcohol
consumption and mortality in Australia, from
1907 to 2005. This is the first study in Australia
to systematically examine the relationships
between population level alcohol
consumption and mortality from specific
causes such as liver disease, injuries and
heart disease, with significant implications for
epidemiology and health policy.
Ecstasy survey: community attitudes and
social marketing. Pennay A. The aim of
this project is to gain an understanding of
the knowledge, attitudes and behaviours
of ecstasy users in relation to both ecstasy
and other illicit drugs over time. The project
involves recruiting a panel of 400 current
ecstasy users to complete three online
surveys over a period of 12 months.
Evaluating the impact of local law 8 in
Yarra. Pennay A, Kenny P, Berends L. Effective
1 January 2010, a local Law was passed in
the City of Yarra enforcing the prohibition of
public drinking. This project seeks to evaluate
the impacts of this law on a range of different
groups including police, residents, traders
and other members of the community
who visit the area to drink. Data collection
methods include observation, interviews
and focus groups.
The provision of methodological support
for the development of volatile substance
use guidelines. MacLean S, Cameron J. This
project provides methodological support
to inform the development of volatile
substance use (VSU) guidelines. The project
involves development of a search protocol
and conducting a systematic literature
search for evidence relating to treatment and
response to VSU. In-depth review and rating
of evidence will culminate in the provision of
comprehensive evidence tables to inform the
clinical guideline development.
Greater western area health service opioid
treatment review. Kenny P, Berends L,
Mugavin J, Strickland H. The Health Services
Research program is undertaking a review
of the opioid treatment programs (OTP)
provided by the Greater Western Area Health
Service (GWAHS) in regional NSW. The review
will focus on mapping OTP service delivery,
including interventions currently provided,
waiting lists and program relationships with
other GWAHS and external services. Findings
will be used to identify areas for improvement.
Queensland magistrates early referral into
treatment (QMERIT): Evaluation. Berends L,
Kenny P, Mugavin J, Eleftheriadis D.
A comprehensive evaluation of the QMERIT
pilot program on behalf of Queensland
Health. QMERIT is a pre-sentence diversion
program which targets offenders at an
early stage in the criminal justice process.
Individuals charged with drug-related
offences are encouraged to undergo
treatment for their illicit drug use problems
while they are on bail.
Improved services grant. Pennay A,
Cameron J, Reichert T, Connolly K, Simpson A.
This project aims to improve services for
clients by increasing the capacity of Turning
Point Clinical Services to treat mental health
problems as core business along with drug
dependence. This is a collaborative project
across all areas of Turning Point, including
clinical research, clinical services, education
and training and HealthLink.
Reducing risky drinking in culturally and
linguistically diverse communities. Pennay A,
Connolly K, Nielsen S, Pahoki S. This study aims
to examine the misuse of over the counter
codeine (OTC) containing analgesics in order
to get a better understanding of how people
develop dependence to OTC codeine and
consequently inform the development of
interventions for misuse, dependence and
other related harms from these products.
Youth Cohort Study: Young people’s
pathways through Alcohol and Other Drugs
(AOD) treatment services. Nielsen S, Harney
A, Pahoki S, Reed M, Lubman D. The aim of this
study is to find out more about the treatment
experiences and pathways for young people
who are in contact with a range of treatment
services, and to follow how these experiences
may change over time. This study involves
recruitment of 150 young people using AOD
treatment services (aged 16-21 years), for a
series of interviews over 18 months to two
years. Participants will be primarily recruited
from Melbourne as well as the Barwon South
West region.
Victorian Pharmacotherapy Review (with
the Drug Policy Modelling Program, UNSW).
Berends L, Kenny P, Strickland H. Working
with the Drug Policy Modelling Program at
the University of NSW, to develop a detailed
and evidence-based options paper for the
Victorian Pharmacotherapy Maintenance
Program to ensure pharmacotherapy services
in the state remain responsive to current and
future demand while improving accessibility
for clients and reducing service gaps.
Research to inform a standards framework
for substitution therapy service provision
in yunnan province, China. Berends L. This
project is about the development of a quality
improvement framework for methadone
maintenance therapy service provision in
Yunnan Province. Turning Point staff from
the Health Services Research and Evaluation
Program and the Epidemiology and
Surveillance Program are working with staff at
the Yunnan Institute for Drug Abuse (YIDA) to
complete the project.
Evaluation of primary health services (PHS)
for injecting drug users. Hunter B, Kenny
P, Mugavin J, Eleftheriadis D. The aim of this
project is to evaluate Victoria’s PHS and their
ancillary services to assess their effectiveness
in meeting the overarching objective of PHS,
since the 2006 evaluation; and to identify
ways of sustaining and improving the PHS
service delivery model into the future.
Specialist methamphetamine clinics:
evaluation. Lee N, Devaney M, Reed M.
Turning Point, in collaboration with
Access Health, has been awarded a
grant through the Proceeds of Crime Act
(POCA) to establish and evaluate specialist
services for methamphetamine users. The
clinics will provide specialist services for
methamphetamine and other stimulant
users including best-practice psychological
and medical treatment for dependence, brief
interventions, assessment and referral and
information and harm reduction advice.
North and West Metropolitan Region
alcohol and other drug plan. Hunter B,
Roberts B, Kenny P, Eleftheriadis D, Mugavin J.
The Health Services Research Program has
been employed to provide North and West
Metropolitan Region (N&WMR) with an
evidence base to inform the development of
the N&WMR alcohol and other drug plan.
Alcohol maltreatment through the
windows of child protection and a
national survey. Laslett A. This project will
describe and measure the adverse effects
of drinking on children in two separate
studies. The first study will focus on children
in the Victorian Child Protection system and
examine alcohol involvement in 19 years of
Eastern Health Research Report 2009-10 89
Turning Point Alcohol and Drug Centre
Victorian Department of Human Services
Child Protection data. The second study
will assess via a national survey the number
of households where children have been
affected by someone else’s drinking using
questions that stem from key definitions
of types of child maltreatment used in the
Victorian child protection system. Child
maltreatment includes exposure to physical,
emotional and sexual abuse, as well as
neglect and domestic violence.
The earlier identification of drug harms
project (EIDHP). Cogger S, Haines A, Lloyd B.
The EIDHP is a bi-monthly information
collection system that aims to identify
changing and/or emerging drug use patterns
and behaviours among Victorian AOD service
clients with the intention of preventing and
reducing drug-related harms among Victorian
illicit drug users.
The range and magnitude of alcohol’s harm
to others II. Laslett A, Wilkinson C, Mugavin J,
Ferris J, Room R. This project aims to further
describe and measure the adverse effects of
drinking in Australia on people other than
the drinker.
Ambo project: alcohol and drug-related
ambulance attendances. Lloyd B, McElwee P,
Haines A. The purpose of the project is to
maintain a mechanism for the surveillance of
illicit and licit drug-related events attended
by ambulance. The surveillance of drugrelated events utilises information derived
from Patient Care Records. Data is routinely
collected by Ambulance Victoria paramedics
in the course of their normal duties. The
project database contains de-identified
information on drug class involvement,
demographic and other characteristics of
events attended by ambulance.
Mapping of alcohol and drug-related events
attended by ambulance. McElwee P, Lloyd B.
This project will contribute to responses to
the Blueprint for Alcohol and Other Drug
Treatment Services 2009-2013 and also
Restoring the Balance: the Victorian Alcohol
Action Plan through enhancing the evidence
relating to changing patterns of harm and
opportunities to assess the effectiveness of
prevention and intervention strategies.
Examination of alcohol cirrhosis trends
over time. Lloyd B, Barratt M. This study aims
to analyse and report on trends in alcoholic
liver cirrhosis mortality and morbidity over
a 10-year period in Victoria. Specific trends
90 Eastern Health Research Report 2009-10
across demographic groups (e.g, sex, age
group and area of patient residence) will also
be examined.
Victorian alcohol statistics series.
Matthews S, Barratt M, Lloyd B. The Victorian
Alcohol Statistics Handbook series is
designed to provide information on alcohol
consumption and related harms in the
Victorian community at statewide, regional
(Victorian Department of Health regions)
and local area (Local Government Area LGA)
levels.
Victorian drug statistics handbook. Cogger S,
Barratt M, Lloyd B. The Victorian Drug Statistics
Handbook series is an annual, ongoing
project funded by the Victorian Department
of Health that describes the major patterns of
drug use and associated harms experienced
in Victoria. The series has been produced
annually since 1999.
Drug and alcohol-related ambulance
and hospital data linkage project Lloyd B,
McElwee P, Matthews S. This project addresses
gaps in knowledge regarding the prevalence
and course of harmful alcohol and other drug
(AOD) use outcomes by linking de-identified
records from Turning Point’s drug-related
ambulance attendance dataset with
de-identified records in the Victorian
Emergency Minimum Dataset (VEMD) and the
Victorian Admitted Episodes Dataset (VAED).
Drinking cultures and social occasions:
Alcohol harms in the context of major
public holidays, sporting and cultural
events. Lloyd B, Matthews S, Livingston M.
This project will explore the nature and extent
of alcohol-related harms in the context of
social events such as sporting events and
public holidays. Through examination of
hospital, police and ambulance data, periods
of increased alcohol-related harm will be
mapped against social events to identify
occasions associated with highest risks
of harm.
Problem gambling in Victoria: Identifying
local area community and gaming industry
risk and protective factors. Matthews S,
Livingston M, Barratt M. This project seeks
to determine local government area-level
characteristics that are associated with
problem gambling as assessed through call
volume to Gambler’s Help and the prevalence
of agency-based treatment services.
Estimating the mortality of drug treatment
clients in Victoria: A feasibility study.
Barratt M, Lloyd B. The aim of this retrospective
cohort study is to produce more reliable
estimates of drug-related mortality in Australia
that are comparable to international studies.
Arthur Robinson Research to Practice
Fellowship. Cameron J, Murray J. Allens
Arthur Robinson (AAR) has chosen to provide
Turning Point Alcohol & Drug Centre with
financial support for a Research to Practice
Fellow. The focus of the AAR Research
to Practice Fellowship is on increasing
knowledge, translating knowledge to practice
and building on evidence based-research and
ultimately improving client outcomes in the
Alcohol and other Drug (AOD) sector.
Dual diagnosis and comprehensive care
Reichert T, Cameron J, Pennay A, Hall K.
This project aims to improve services for
AOD clients who present to treatment with
a co-occurring substance use disorder (SUD)
and symptoms of Borderline Personality
Disorder (BPD). This is a collaborative project
between Turning Point Clinical Research and
Clinical Services.
Defining the hidden population of
pharmaceutical users. Nielsen S, Cameron
J, Pahoki S. This study defines the population
of pharmaceutical opioid analgesics (POA)
dependent people seen at GP services and
identify resources for GPs in management
of this patient group (including discussion
around potential tools and referral pathways
with GPs and addiction medicine specialists).
Current responses to POA dependence will
be explored and opportunities for greater
linkages between addiction and primary care
services identified.
Understanding the role of benzodiazepine
use in crime. Nielsen S, Pennay A, Harney
A. This project examines the role of
benzodiazepine use and its contribution
to crime. This research will aim to better
understand if benzodiazepines contribute
to a disproportionate amount of crime. The
project will include primary data collection
from attendees at diversion programs through
the Magistrates and Dandenong Drug Court
and AOD service users that have had recent
involvement with the criminal justice system.
Translating research into practice: psycheck
dissemination. Lee N, Cameron J, Harney A,
Roeg A. Among alcohol and drug treatment
clients, mental health symptoms are common.
Although psychosis has a large impact on
Turning Point Alcohol and Drug Centre
services, by far the majority of clients have
symptoms of one of the high prevalence
disorders: depression or anxiety. This project
continues work in the development and
trialling of PsyCheck, which has resulted in
the validation of the PsyCheck screening tool
and the initial development of the PsyCheck
resource package.
Mapping Australian public opinion on
alcohol policies in the new millennium.
Livingston M, Wilkinson C, Room R. This
project seeks to measure and locate, socially
and geographically, support and opposition
for various alcohol control policies. Specifically,
exploring the support in terms of the degree
to which attitudes towards different kinds of
alcohol policy initiatives cohere or diverge.
Variations in support for particular policies by
demographic groups and among those with
different drinking patterns will be explored.
Research projects completed
Alcohol and other drug treatment needs
and service system responses for older
people (>65 years). Hunter B, Berends L,
Strickland H, Roberts B, Eleftheriadis D. A
project for the Victorian Department of Health
which explored the alcohol and other drug
treatment needs and potential service system
responses for people aged over 65 years.
Over the counter codeine dependence.
Nielsen S, Cameron J, Pahoki S. This study
examined the misuse of over the counter
codeine (OTC) containing analgesics in order
to get a better understanding of how people
develop dependence to OTC codeine and
consequently inform the development of
interventions for misuse, dependence and
other related harms from these products.
Building an evidence base from the Alcohol
Education and Rehabilitation Foundation
Limited (AER) funded projects. MacLean S,
Berends L, Hunter B, Mugavin J, Roberts B,
Room R. Since 2001 the Alcohol Education
and Rehabilitation Foundation Ltd (AER)
has funded a wealth of projects intended
to reduce the burden of harm arising out of
alcohol-misuse and/or inhalant misuse in
Australia. A consolidation of the knowledge
obtained through this work has been
completed and disseminated to a wide range
of audiences.
Australian Leadership Award – Fellowship,
Berends L. HIV transmission rates are on the
rise in China and methadone maintenance
therapy is essential to tackle this pandemic
and provide effective care for opioid users.
Methadone maintenance therapy in China
has expanded rapidly in the past decade and
more than 800 clinics will be in place by the
end of 2009.
•Prof Dan Lubman
Director, Turning Point Alcohol and Drug Centre and Prof of Addiction Studies and Services, Monash University
Focusing on problematic substance use and addiction
Prof Dan Lubman has worked across mental health and drug
treatment settings in both the UK and Australia and was appointed
as Director of Turning point Alcohol and Drug Centre and Professor
of Addiction Studies, Monash University in April 2010.
He embarked on a career in psychiatry in 1994, and in 1996 was
awarded a prestigious MRC Training Fellowship, which allowed
him to investigate neurobiological mechanisms underlying opiate
addiction. Dan was appointed as the Nauma Licht Research Fellow
at the Mental Health Research Institute in 2002 and Senior Lecturer
in 2003 at the University of Melbourne (and subsequently as A/Prof
from 2007), where he led a clinical research team at Orygen Youth
Health focused on investigating the relationship between drug
use and mental health issues in young people, as well as the most
effective treatment approaches for this population.
His research is collaborative and includes work in the fields of
neuropsychology, psychophysiology, neuroimaging and the basic
sciences, as well as epidemiology and clinical treatment studies. He
has been a chief investigator on multiple large research projects
investigating problematic substance use and addiction, including
studies within primary care, drug treatment and mental health
settings. Since 2003, this work has attracted over $6 million in
national and international research funding, as well as over $3
million in clinical treatment and training grants. In recognition of
his work, he was awarded the Organon Young Psychiatrist Award by
the RANZCP in 2006.
Dan has published over 120 peer-reviewed scientific papers
and book chapters in a wide range of international, high-impact
journals, and is currently Chair of the RANZCP Section of Addiction
Psychiatry and an advisory board member of the National
Cannabis Prevention and Information Centre and the National
Drug Research Institute.
Eastern Health Research Report 2009-10 91
Turning Point Alcohol and Drug Centre
Barwon Youth, Youth Access Program:
Evaluation. Kenny P, Berends L. The Youth
Access Program aims to provide coordinated
pathways and supported referrals for young
people in need of Alcohol and other Drug
(AOD) treatment. The program offers a
specialist youth outreach service to young
people aged 12 to 21 years who are located in
the Barwon South-West Region of Victoria.
Hume Region Alcohol Screening and Brief
Intervention Project: evaluation. Berends L,
Roberts B, Mugavin J. The Screening and Brief
Intervention (SBI) pilot project was developed
as a consequence of research into rates of
alcohol consumption and alcohol-related
harms in the Hume region of Victoria. The
project operated across two regional hospitals
and Turning Point undertook an evaluation
that focused on project implementation,
findings and workforce development. The
evaluation highlights our capacity to work
across different areas of health and support
project effectiveness through collaborative
work practices.
Mirabel Project. Berends L, Mugavin J. The
Mirabel Foundation assists children who
have been orphaned or abandoned due to
parental illicit drug use. The main focus of
this project is the sustainability of the Mirabel
Foundation’s NSW program. The project
involves conducting a survey with program
staff and key stakeholders and it will make
recommendations to guide the sustainability
of the service model.
Windana Alcohol and Drug Day Program:
evaluation. Berends L, Kenny P, Eleftheriadis
D. Windana has a new day program that is
designed for adults seeking to address their
Alcohol and other Drug (AOD) problems in
a non-residential, therapeutic environment.
Turning Point is working with Windana staff
to establish indicators for baseline and followup measurement, to identify whether the
program is effective.
Statewide Review of Places of Safety,
Tasmania. Hunter B, Kenny P, Eleftheriadis D,
Berends L. This statewide review of places of
safety involves the review of current practice
against protocols and legislation, and the
comparison of models of practice (and
protocols) across the six identified sites of
service provision.
Double-blinded, placebo-controlled
trial of Modafinil for methamphetamine
withdrawal Lee N. The use of
92 Eastern Health Research Report 2009-10
methamphetamine is widespread with
an estimated 72,000 dependent users.
Medication plays an important role in
treatment but despite this, there are very
few clinical studies investigating various
medications for methamphetamine
withdrawal. Previous studies in the
United States have shown that modafinil
(Modavigil®) has potential for treating cocaine
dependence. This project is a randomised,
placebo-controlled design comparing the
effects of modafinil and a placebo pill on
withdrawal symptoms and neurocognitive
measures. Patients stay for up to 10 days on a
fixed schedule of medication.
Treatment Access Project (TAP). Hunter B,
Mugavin J, Kenny P. This project will provide
descriptors of existing intake systems in the
Victorian Alcohol and other Drug (AOD)
service sector. The objectives of this project
are to:
• identify and describe existing models of
treatment intake in the Victorian AOD
sector
• document good practice and the context
within which it occurs
• identify enablers and barriers in AOD intake
models
• identify opportunities to improve access to
the Victorian AOD sector through models
of intake.
The project incorporates a literature review,
key informant interviews and validated case
examples.
Defining alcohol and other drug treatment
and workforce. Berends L, Connolly K,
Pennay A, Mugavin J, Cogger S, Strickland H,
Kenny P, Roberts B. This important project
will provide direction for Victoria on
proportional investment for specialist AOD
treatment according to the evidence along
with suggestions regarding workforce
requirements.This project is led by HSRE and
involves staff from other programs in research
as well as education and training.
A pilot study to examine the effectiveness
of clinical case management for alcohol and
drug clients. Cameron J, Johns L, Strickland H,
Lee N. The aim of this pilot study is to conduct
a randomised, controlled trial to assess the
efficacy of a clinical case management (CM)
model for improving mental health, alcohol
and other drug (AOD) use and quality of life
outcomes in an AOD setting.
Evaluation of a best practice integrated
intervention for regular methamphetamine
users with comorbid depression. Lee N,
Pennay A, Harney A. This study trials a new
integrated psychological intervention for
the management of depression among
amphetamine users. To date, very little
research has been conducted within the
population of people with depression and
co-occurring amphetamine use problems,
whose complex presentation makes it difficult
for treatment providers to deliver effective
interventions. Although rates of depression
and amphetamine use is on the increase in
our community, it is still not clear how to best
to manage this group.
Pharmaceutical misuse amongst drug
treatment clients. Nielsen S, Pahoki S,
Strickland H. This project investigated
the role of pharmaceutical drug use and
misuse in clients presenting for treatment
at alcohol and drug treatment agencies.
It also examined the nature and extent of
diversion and misuse of pharmaceutical drugs
and any associated health harm within this
group. The results will be used to inform the
development of a national intentional misuse
of pharmaceuticals prevention strategy,
screening tools for identifying problematic
pharmaceutical use in clients presenting to
treatment and appropriate treatment for
managing pharmaceutical misuse within
treatment settings.
Translation of research into practice –
training clinicians to review the evidence.
Cameron J, Lee N. The initial component
of the Practice Research Network (PRN),
supported by the Alcohol Education and
Rehabilitation Foundation (AERF), was
officially completed in November 2008 with
the final training sessions held in Fitzroy. As
a result of the success of the project, Turning
Point has made an ongoing commitment to
building on and strengthening the network.
The AAR Research to Practice fellowship
project will provide an opportunity to
evaluate the translation of research to
practice model using a demonstration project
and involve close collaboration between
researchers and clinicians.
Psychostimulant withdrawal: natural history
and options for intervention Lee N,
Pennay A, Kenny P, Harney A. This
comprehensive study aimed to understand
the natural history of psychostimulant use,
dependence and withdrawal, focusing on
pathways to dependence and experiences
of treatment; to develop withdrawal
Turning Point Alcohol and Drug Centre
protocol/s for the various psychostimulants
and to examine the role and efficacy of,
and to develop guidelines for psychosocial
interventions for psychostimulant users
in withdrawal. The study used a mixed
methodology of literature review, client and
key informant interviews and case studies. In
addition it examined the feasibility of using
modafinil during withdrawal as an aid for
withdrawal and entry into further treatment.
Increasing access to methamphetamine
prevention and intervention using the
Internet: Development and evaluation of
a novel website. Lee N, Jenner L, Noble R.
Methamphetamine users are often reluctant
to enter treatment and when they do
seek help it is often in response to serious
consequences such as psychosis, physical
ill health, social and/or legal problems. This
project focused on the need to develop
services for stimulant users that are targeted,
responsive, appropriate and aim to increase a
user’s self awareness.
Data collection system analysis. Lloyd B,
Livingston M. This project aimed to assess
the state of data collection systems in
Victoria across the alcohol and other
drugs sector and to recommend ways to
address any gaps in the current systems.
Analysis has been undertaken in order
to develop recommendations regarding
the use and development of data
systems to provide a basis from which
the effectiveness of drug and alcohol
prevention strategies may be assessed.
In order to develop recommendations
regarding the measurement of policy and
strategy effectiveness in terms of drug and
alcohol prevention measures, a number of
approaches were required. These approaches
included examination of existing policies,
gathering information relating to current
data systems available that may measure
outcomes of interest, and identification of
gaps and opportunities for the expansion or
development of new measures.
Alcohol and interpersonal violence in
Victoria: trends over time. Lloyd B, Barratt M.
This research provided a profile of alcohol
use and interpersonal violence in Victoria. The
project was commissioned by VicHealth to
inform a larger research project. The project
draws on available data to examine alcohol
and interpersonal violence. The aims of the
project were to provide a profile of trends
in alcohol-related violence in Victoria and
explore differences in patterns of alcohol and
interpersonal violence in terms of gender, age,
geographic location, temporal and seasonal
variations.
Australian Treatment Outcome Study
(ATOS): Heroin. The Australian Treatment
Outcome Study (ATOS): Heroin is a large-scale
prospective study of a cohort of heroindependent individuals seeking treatment
for problems associated with the use of
heroin. The study was based primarily on
the methodology adopted by the National
Treatment Outcome Research Study in the
UK and Drug Abuse Treatment Outcome
Study in the USA. In Australia, the study was
conducted across Victoria, New South Wales
and South Australia. This report describes the
Victorian heroin cohort.
Publications
Published
Ferris JA. Missing Data: A Gentle Introduction.
Drug and Alcohol Review. 2009;28(1):90-1.
Livingston M. Multilevel analysis for
applied research – It’s just regression! (book
review). Drug and Alcohol Review. [Review/
Commentary]. 2009;28:91-2.
Nielsen S, Barratt MJ. Prescription drug
misuse: is technology friend or foe? Drug and
Alcohol Review. 2009 Jan;28(1):81-6.
Rehm J, Room R. Monitoring of alcohol use
and attributable harm from an international
perspective. Contemporary Drug Problems.
2009;36(3-4):575-87.
Room R, Livingston M. Does it matter where
the drinking is, when the object is getting
drunk? Addiction. [Review/Commentary].
2009;104:110-1.
Room R, Österberg E, Ramstedt M, J R.
Explaining change and stasis in alcohol
consumption. Addiction Research and Theory.
2009;17(6):562-76.
Room R, Rehm J, Ramstedt M, Österberg E.
Policy changes and effects on individual
consumption: complexities of measurement
and of influences. Addiction Research and
Theory. 2009;17(6):588-90.
Swan A, Tyssen E. Enhancing treatment
access: Evaluation of an Australian web-based
alcohol and drug counselling initiative. Drug
and Alcohol Review. 2009;28:48-53.
Pitts MK, Ferris JA, Smith AM, Shelley JM,
Richters J. Prevalence and correlates of
three types of pelvic pain in a nationally
representative sample of Australian women
(letter). Med J Aust. [Letter]. 2009 Jan
5;190(1):48.
Parry C, Rehm J, Poznyak V, Room R. Alcohol
and infectious diseases: an overlooked causal
linkage? Addiction. 2009 Mar;104(3):331-2.
Berends L. Community psychology.
Challenges, controversies and emerging
consensus, Jim Orford [book review]. Drug &
Alcohol Review. 2009;28(2):212-3.
Livingston M. Effects of alcohol consumption
in spousal relationships on health-related
quality of life and life satisfaction. Journal
of Studies on Alcohol and Drugs. [Original
research]. 2009;70(3):383-90.
Livingston M, Room R. Variations by age and
sex in alcohol-related problematic behaviour
per drinking volume and heavier drinking
occasion. Drug and Alcohol Dependence.
[Original research]. 2009;101(1):169-75.
Wilkinson C, Room R, Livingston M. Mapping
Australian public opinion on alcohol policies
in the new millennium. Drug and Alcohol
Review. [Original research]. 2009;28(3):263-74.
Rehm J, Room R. A case study in how harmful
alcohol consumption can be. Lancet. 2009 Jun
27;373(9682):2176-7.
Berends L. The emergence of a specialist role
in rural alcohol and drug service delivery:
Lessons from a review in rural Victoria,
Australia. Drugs: education, prevention and
policy. 2009:Early Online.
Ferris JA, Pitts MK, Richters J, Simpson JM,
Shelley JM, Smith AM. National prevalence of
urogenital pain and prostatitis-like symptoms
in Australian men using the National Institutes
of Health Chronic Prostatitis Symptoms Index.
BJU Int. 2010 Jun 22;105(2):373-9.
Nielsen S, Lloyd B. Benzodiazepines: misuse,
treatment and surveillance. Of Substance.
2009;7(3):12-3.
Room R. Book review: The politics of
alcohol: A history of the drink question in
England. Drug and Alcohol Review. 2010 May
2010;29:346-7.
Wilkinson C, Room R. Information and
warnings on alcohol containers: experience
internationally and evidence on effects. Drug
and Alcohol Review. 2009;28(4):426–35.
Eastern Health Research Report 2009-10 93
Turning Point Alcohol and Drug Centre
Clemens SL, Grant BM, Matthews SL.
A review of the impacts of health and health
behaviours on women’s alcohol use. American
Journal of Health Behaviors. 2009;33(4).
Smith AM, Ferris JA, Simpson JM, Shelley J,
Pitts MK, Richters J. Cannabis use and sexual
health. J Sex Med. 2009 Aug 17;Epub Date
2009 Aug 22.
Ferris J, Richters J, Pitts M, Shelley J,
Simpson J, Ryall R, et al. Circumcision in
Australia: further evidence on its effects
on sexual health and wellbeing. Australian
and New Zealand Journal of Public Health.
2010;34(2):160-4.
Reissner V, Baune B, Kokkevi A, Schifano F,
Room R, Palm J, et al. Burnout, coping and
job satisfaction in service staff treating opioid
addicts - from Athens to Zurich. Stress and
Health. 2010;26(2):149-59.
Rehm J, Room R. Why do we need
international regulations for alcohol
control? Nordic Studies on Alcohol & Drugs.
2009;26(4):447-50.
Smith A, Lyons A, Ferris J, Richters J, Pitts M,
Shelley J. Are sexual problems more common
in men who have had a vasectomy? A
population-based study of Australian men.
J Sex Med. 2009 Oct 29;Epub Date 2009 Oct 29.
Lee NK, Cameron J. Differences in self and
independent ratings on an organisational
dual diagnosis capacity measure DDCAT
versus Self Measures. Drug and Alcohol Review.
2009;28(6):682-4.
Room R, Rehm J. Commentary on Hickman
et al. (2009): The place of risk in drug policies.
Addiction. 2009;104(11):1862-3.
Pennay A. Translation of addictions science
into practice. Drug and Alcohol Review.
[Review]. 2009 November;28(6):692.
Pennay A, Lee NK. Barriers to
methamphetamine withdrawal treatment
in Australia: Findings from a survey of AOD
service providers. Drug and Alcohol Review.
2009;28(6):636-40.
Pennay A, Lee NK. A systematic review of
treatment options for methamphetamine
withdrawal. Drug and Alcohol Review.
2009;28(S1):A78.
Reichert T, Cameron J, Pennay A. Who
should respond to personality disorders? A
stepped care approach to managing complex
behaviours in AOD settings. Drug and Alcohol
Review. 2009;28(S1):A53.
94 Eastern Health Research Report 2009-10
Room R, Rehm J. The place of risk in drug
policies. Addiction. 2009;104(11):1862-3.
Rehm J, Samokhvalov AV, Neumann MG,
Room R, Parry C, Lönnroth K, et al. The
association between alcohol use, alcohol use
disorders and tuberculosis (TB): A systematic
review. BMC Public Health. 2009;9:450.
Berends L. Embracing the visual: Using
timelines to enhance in-depth interviews
on substance abuse and treatment. The
Qualitative Report. 2010.
Bloomfield K, Wicki M, Gustafsson N-K,
Mäkelä P, Room R. Changes in alcohol-related
problems after alcohol policy changes in
Denmark, Finland, and Sweden. Journal of
Studies on Alcohol & Drugs. 2010;71(1):32-40.
Roberts B. Tracking the story of dual
diagnosis. New Paradigm Psychiatric
Disability Services of Victoria (VICSERV) inc.
2010;Summer:31-2.
Room R, Livingston M. Who drinks how
much less with which price policy? A rich
feast for policy discussion. Addiction. [Review/
Commentary]. 2010;105(3):394-5.
review and meta-analysis of how acute
alcohol consumption and injury or collision
risk increase together. Drug and Alcohol
Dependence. 2010;110(1-2):108-16.
Room R, Ferris J, Laslett A-M, Livingston M,
Mugavin J, Wilkinson C. The drinker’s effect
on the social environment: A conceptual
framework for studying alcohol’s harm to
others. International Journal of Environmental
Research and Public Health. 2010;7(4):1855-71.
Babor T, Caetano R, Casswell S, Edwards G,
Giesbrecht N, Graham K, et al. Alcohol:
No ordinary commodity – a summary of
the second edition. Addiction. [Review/
Commentary]. 2010;105(5):769-79.
Jenner L. Online Guidance and Counselling
Skills: A Practical Resource for Trainees and
Practitioners: Book review. Drug and Alcohol
Review. 2010;29(3):345-6.
Rehm J, Baliunas D, Borges GLG, Graham K,
Irving H, Kehoe T, et al. The relation between
different dimensions of alcohol consumption
and burden of disease: an overview. Addiction.
2010;105(5):817-43.
Samokhvalov AV, Popova S, Room R,
Ramonas M, Rehm J. Disability associated
with alcohol abuse and dependence.
Alcoholism Clinical and Experimental Research.
2010;34(11):1-8.
Hides L, Carroll S, Catania L, Cotton SM,
Baker A, Scaffidi A, Lubman DI. Integrated
cognitive behaviour therapy (CBT) for cooccurring depression and substance misuse
in young people: A pilot study. Journal of
Affective Disorders. 2010;121:169-174.
Smith A, Lyons A, Ferris J, Richters J, Pitts M,
Shelley J. Are sexual problems more common
in women who have had a tubal ligation? A
population-based study of Australian women.
BJOG. 2010 Jan 14;Epub Date 2010 Jan 16.
Scott RM, Hides L, Allen JS, Burke R,
Lubman DI. Depressive and anxiety
symptomatology in ecstasy users: The relative
impact of genes, trauma, life stress and drug
use. Psychopharmacology. 2010;20:25-36.
Lee N, Jenner L. Development of PsyCheck
Screening tool: An instrument for detecting
common mental health conditions among
substance use treatment clients. Mental
Health and Substance Use: Dual Diagnosis.
2010;3(1):56-65.
Lubman DI, Berk M. Pharmacotherapy for
co-occurring alcohol and drug disorders in
schizophrenia and bipolar disorder: Where
is the evidence? Acta Neuropsychiatrica.
2010;22:95-97.
Lee NK, Pohlman S, Baker A, Ferris J, KayLambkin F. It’s the thought that counts:
craving metacognitions and their role in
abstinence from methamphetamine use.
J Subst Abuse Treat. 2010 Apr;38(3):245-50.
Jenner L. Book review: Online guidance and
counselling skills: a practical resource for
trainees and practitioners. Drug and Alcohol
Review. 2010;29(3):345 - 6.
Taylor B, Irving HM, Kanteres F, Room R,
Borges G, Cherpitel C, et al. The more
you drink, the harder you fall: a systematic
Baker A, Hides L, Lubman DI. Treatment of
cannabis use among people with psychotic
and depressive disorders: A systematic review.
Journal of Clinical Psychiatry. 2010;71:247-254.
Lorenzetti V, Lubman DI, Velakoulis D,
Yücel M. Pituitary gland volume among
heroin users stabilised on substitution
pharmacotherapy. Drug and Alcohol
Dependence. 2010; 110:164-166.
Lubman DI, King J, Castle DJ. Treating
comorbid substance use disorders in
schizophrenia. International Journal of
Psychiatry. 2010;22:191-201.
Turning Point Alcohol and Drug Centre
Lorenzetti V, Lubman DI, Whittle S,
Solowij N, Yücel M. Structural MRI findings in
long-term cannabis users: What do we know?
Substance Use and Misuse. 2010;45:1787-1808.
Dale C, Livingston M. The burden of alcohol
drinking on co-workers in the Australian
workplace. Medical Journal of Australia.
[Original research]. In press.
use across Victorian Local Government Areas
1999/00–2006/07. Volume 1. Melbourne:
Turning Point Alcohol and Drug Centre;
In press.
Takagi MJ, Yücel M, Lubman DI. The dark side
of sniffing: Paint colour affects intoxication
experiences among adolescent inhalant users.
Drug and Alcohol Review. 2010;29:452-455.
Dietze P, Livingston M. The relationship
between alcohol supply source and young
people’s risky drinking and alcohol related
problem behaviours in Victoria, Australia.
Australian and New Zealand Journal of Public
Health. [Original research]. In press.
Matthews S, Barratt MJ, Lloyd B. Victorian
Alcohol Statistics Series: Alcohol-related
harms and use across Victorian Local
Government Areas 1999/00–2006/07. Volume
2. Melbourne: Turning Point Alcohol and Drug
Centre; In press.
Dietze P, Room R, Jolley D, Matthews S,
Chikritzhs T. The adverse consequences of
alcohol consumption in a sample of Australian
adults. Journal of Substance Use. In press.
Matthews S, Barratt MJ, Strickland H.
Victorian Alcohol Statistics Series: Wholly
alcohol attributable hospitalisations across
Victorian Local Government Areas 2003–04
to 2007–08. Volume 12. Melbourne: Turning
Point Alcohol and Drug Centre; In press.
Reavley NJ, Cvetkovski S, Jorm AF,
Lubman DI. Helpseeking for substance use,
anxiety and affective disorders among young
people: results from the 2007 Australian
National Survey of Mental Health and Wellbeing.
Australian & New Zealand Journal of Psychiatry.
2010;44:729-735.
Cheetham A, Allen NB, Yücel M,
Lubman DI. The role of affective dysregulation
in drug addiction. Clinical Psychology Review.
2010;30:621-634.
Cameron J, Lee NK, Harney A. Changes
in attitude to, and confidence in, working
with comorbidity after training in screening
and brief intervention. Mental Health and
Substance Use: Dual Diagnosis. 2010 June
2010;3(2):124.
Babor T, Caulkins J, Edwards G, Fischer B,
Foxcroft D, Humphreys K, et al. Drug Policy
and the Public Good: Summary of the Book.
Addiction. 2010;105:1137-45.
Room R. The long reaction against
the wowser: The prehistory of alcohol
deregulation in Australia. Health Sociology
Review. 2010;19(2):151-63.
In press
Barratt MJ, Matthews S, Livingston M.
Problem Gambling in Victoria: Identifying local
area community and gaming industry risk and
protective factors. Melbourne: Department of
Justice; In press.
Cogger S. The Victorian Drug Statistics
Handbook: Patterns of drug use and related
harm in Victoria for the period July 2008
to June 2009 (Report No. 12). Melbourne:
Victorian Government Department of Health;
In press.
Cogger S, Barratt MJ, Lloyd B. The Victorian
Drug Statistics Handbook: Patterns of drug
use and related harm in Victoria for the
period July 2007 to June 2008 (Report No.
11). Melbourne: Victorian Government
Department of Health; In press.
Hölscher F, Reissner V, Di Furia L, Room R,
Schifano F, Stohler R, et al. Differences
between men and women in the course of
opiate dependence: is there a telescoping
effect? European Archives of Psychiatry and
Clinical Neuroscience. In press.
Jenner L. Ups and Downs: Physical and
mental health consequences of ATS use. In:
Rawson R, Lee NK, editors. Amphetamine
Type Stimulants: Challenges and responses: IP
Communications; In press.
Laslett A-M, Catalano P, Chikritzhs T, Dale C,
Doran C, Ferris J, et al. The range and
magnitude of alcohol’s harm to others.
Fitzroy, Victoria: AER Centre for Alcohol Policy
Research, Turning Point Alcohol and Drug
Centre, Eastern Health; In press.
Lee NK, Jenner L, Baker A, Ritter A, Hides L,
Norman J, et al. Screening and intervention
for mental health problems in alcohol and
other drug settings: Can training change
practitioner behaviour? Drugs: Education,
Prevention & Policy: In press.
Livingston M, Matthews S, Barratt M,
Lloyd B, Room R. Diverging trends in alcohol
consumption and alcohol-related harm in
Victoria. Australian and New Zealand Journal of
Public Health. [Original research]. In press.
Livingston M, Matthews S, Barratt MJ,
Lloyd B, Room R. Diverging trends in alcohol
consumption and alcohol-related harm in
Victoria. Australian and New Zealand Journal of
Public Health. In press.
Livingston M, Wilkinson C, Laslett AM.
The impact of heavy drinkers on health and
wellbeing. Journal of Studies on Alcohol and
Drugs. [Original research]. In press.
Matthews S, Barratt MJ, Lloyd B. Victorian
Alcohol Statistics Alcohol-related harms and
Matthews S, Barratt MJ, Strickland H.
Victorian Alcohol Statistics Series: Volume
2 Data Tables 1999–2000 to 2007–08.
Melbourne: Turning Point Alcohol and Drug
Centre; In press.
Pennay A, Lee NK. Putting the call out for
more research: The poor evidence base for
treating methamphetamine withdrawal. Drug
and Alcohol Review. In press.
Pennay A, Moore D. Exploring the micropolitics of normalisation: Narratives of
pleasure, self-control and desire in a sample of
young Australian ‘party drug’ users. Addiction
Research and Theory. In press.
Rehm J, Giesbrecht N, Gliksman L, Graham K,
Le AD, Mann RE, et al. Substance abuse
research in a modern health care centre: The
case of the Centre for Addiction and Mental
Health. Addiction. In press.
Room R. The political response to alcohol
and drug advice in Australia: Comparing the
response to two expert reports. Contemporary
Drug Problems. In press.
Room R. A blast from the past – Temperance
as the source of all our troubles. Addiction
Research and Theory. In press.
Room R. “Contemporary Drug Problems” then
and now – an editor’s envoi. Contemporary
Drug Problems. In press.
McCann TV, Lubman DI, Clark E. First-time
primary caregivers’ experiences of caring for
young adults with first-episode psychosis.
Schizophrenia Bulletin. In press.
Feil J, Sheppard D, Fitzgerald PB, Yücel M,
Lubman DI, Bradshaw JL. Addiction,
compulsive drug seeking, and the role of
frontostriatal mechanisms in regulating
Eastern Health Research Report 2009-10 95
Turning Point Alcohol and Drug Centre
inhibitory control. Neuroscience and
Biobehavioural Reviews. In press.
Edge;1–4 November 2009; Darwin. Drug and
Alcohol Review; 2009. p. A78.
Brown A, Lubman DI, Paxton S. Sexual
risk behaviour among young adults with
first-episode psychosis. Early Intervention in
Psychiatry. In press.
Wilkinson C, Olsson C, Phillips L. The
relationship between DSM-IV personality and
alcohol use disorders in emerging adulthood:
results from the Victorian adolescent health
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personal cost of someone else’s drinking:
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Ferris JA, Berends L. So what exactly did
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Ferris JA, Pennay A. Post treatment outcomes
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Hester R, Lee N, Pennay A, Ferris JA.
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Lee N, Pennay A, Hester R, Ferris JA,
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withdrawal. Australasian Professional Society
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of other people’s drinking on health and
wellbeing. Australasian Professional Society
on Alcohol and Other Drugs, Living on the
Edge; 1–4 November 2009; Darwin. Drug and
Alcohol Review; 2009. p. A78.
Ferris J, Pennay A, Lee NK, Hester R. Post
treatment outcomes at one month after
modafinil for methamphetamine withdrawal.
Australasian Professional Society on Alcohol
and Other Drugs, Living on the Edge; 1–4
November 2009; Darwin. Drug and Alcohol
Review; 2009. p. A78.
Service impact and what the neighbours
think! Australasian Professional Society on
Alcohol and Other Drugs, Living on the
Edge; 1–4 November 2009; Darwin. Drug and
Alcohol Review; 2009. p. A67.
Nielsen S, Cameron J. Over the counter pain
relievers … hidden harms? Results of a web
based survey Australasian Professional Society
on Alcohol and Other Drugs, Living on the
Edge; 1–4 November 2009; Darwin. Drug and
Alcohol Review; 2009. p. A67.
Jenner L. Online self-help for
Methamphetamines users: development
and evaluation of an Australian website.
Australasian Professional Society on Alcohol
and Other Drugs, Living on the Edge; 1–4
November 2009; Darwin. Drug and Alcohol
Review; 2009. p. A67.
Matthews S, Ferris J, Dietze P, Room R,
Chikritzhs T. Who abstains from drinking
and why (poster)? Australasian Professional
Society on Alcohol and Other Drugs, Living on
the Edge; 1–4 November 2009; Darwin. Drug
and Alcohol Review; 2009. p. A67.
Hester R, Lee NK, Pennay A, Ferris J.
Neurocognitive changes as a result of
modafinil during withdrawal. Australasian
Professional Society on Alcohol and Other
Drugs, Living on the Edge; 1–4 November
2009; Darwin. Drug and Alcohol Review; 2009.
p. A78.
Cogger S, Lloyd B, Johnston J. The earlier
identification of drug harms project (EIDHP):
Research mediating between policy and
practice (poster). Australasian Professional
Society on Alcohol and Other Drugs, Living on
the Edge; 1–4 November 2009; Darwin. Drug
and Alcohol Review; 2009. p. A67.
Lee NK, Pennay A, Hester R, Ferris J,
Dunlop A. Double-blind placebo-controlled
pilot trial of modafinil for methamphetamine
withdrawal. Australasian Professional Society
on Alcohol and Other Drugs, Living on the
Edge; 1–4 November 2009; Darwin. Drug and
Alcohol Review; 2009. p. A78.
Lloyd B, McElwee P. Pharmaceutical
analgesics and acute harms: Characteristics of
ambulance attendances for analgesic-related
presentations. Australasian Professional
Society on Alcohol and Other Drugs, Living on
the Edge; 1–4 November 2009; Darwin. Drug
and Alcohol Review; 2009. p. A67.
Pennay A, Lee NK. A systematic review of
treatment options for methamphetamine
withdrawal. Australasian Professional Society
on Alcohol and Other Drugs, Living on the
Edge; 1–4 November 2009; Darwin. Drug and
Alcohol Review; 2009. p. A78.
Lloyd B, McElwee P. Patterns of acute
drug and alcohol related harm: Trends in
ambulance attendances 1998/9-2008/9
(poster). Australasian Professional Society
on Alcohol and Other Drugs, Living on the
Edge; 1–4 November 2009; Darwin. Drug and
Alcohol Review; 2009. p. A67.
Reichert T, Cameron J, Pennay A,
Strickland H, Lee NK, Connolly K. Who should
respond to personality disorders? A stepped
care to managing complex behaviours in AOD
settings. Australasian Professional Society
on Alcohol and Other Drugs, Living on the
Edge; 1–4 November 2009; Darwin. Drug and
Alcohol Review; 2009. p. A67.
Reed M, Devaney M, Harney A, J. C, Lee N.
Access Point Stimulant Treatment Centres:
Cogger S, Lloyd B, Johnston J. The Earlier
Identification of Drug Harms Project Research
mediating between practice and policy
(poster). Australasian Professional Society
on Alcohol and Other Drugs, Living on the
Edge; 1–4 November 2009; Darwin. Drug and
Alcohol Review; 2009. p. A67.
Kenny P, Berends L, Swan A. The Victorian
Alcohol and Other Drug (AOD) Withdrawal
Turning Point Alcohol and Drug Centre
Practice Guidelines: A conceptual approach
to AOD withdrawal care. Australasian
Professional Society on Alcohol and Other
Drugs, Living on the Edge; 1–4 November
2009; Darwin. Drug and Alcohol Review; 2009.
p. A67.
Kenny P, Edwards K, Berends L. The
Windana Day Program (WDP) Evaluation:
A collaborative approach to evaluating an
innovative AOD service model. Australasian
Professional Society on Alcohol and Other
Drugs, Living on the Edge; 1–4 November
2009; Darwin. Drug and Alcohol Review; 2009.
p. A67.
Hunter B, MacLean S, Berends L. Using realist
synthesis to build an evidence-base from
Alcohol Education and Rehabilitation (AER)
Foundation funded projects. Australasian
Professional Society on Alcohol and Other
Drugs, Living on the Edge; 1–4 November
2009; Darwin. Drug and Alcohol Review; 2009.
p. A67.
Berends L, Kenny P, Sciacchitano L, Mugavin
J, Eleftheriadis D, Swan A. Effectiveness of
the Queensland Magistrate’s Early Referral Into
Treatment (QMERIT) program. Australasian
Professional Society on Alcohol and Other
Drugs, Living on the Edge; 1–4 November
2009; Darwin. Drug and Alcohol Review; 2009.
p. A67.
Ferris J, Berends L, Laslett AM. The personal
cost of someone else’s drinking! Data from
the range and magnitude of alcohol’s harm to
others study. Australasian Professional Society
on Alcohol and Other Drugs, Living on the
Edge; 1–4 November 2009; Darwin. Drug and
Alcohol Review; 2009. p. A78.
Books
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Reports
Livingston M, Lloyd B. The Victorian Alcohol
Action Plan: an indicator framework.
Melbourne, Victoria: Turning Point Alcohol
and Drug Centre; 2009.
Livingston M, Lloyd B. The Victorian Alcohol
Action Plan: an indicator framework report for
Victorian Department of Human Services and
the VDAPC. Melbourne: Turning Point Alcohol
and Drug Centre; 2009.
Lloyd B. Alcohol and interpersonal violence in
Victoria: trends over time. Melbourne: Turning
Point Alcohol and Drug Centre; 2009.
Lloyd B, Livingston M. Measures of drug
and alcohol prevention, use and harm:
Data collection system analysis. Melbourne,
Australia: Turning Point Alcohol and Drug
Centre; 2009.
Lloyd B, Livingston M. Data collection
systems analysis component 1: Compendium
of policies and data systems report for
Victorian Department of Human Services and
the VDAPC. Melbourne: Turning Point Alcohol
and Drug Centre; 2009.
Matthews S. Bargoongagat case coordination
panel evaluation. Melbourne: Turning Point
Alcohol and Drug Centre; 2009.
Matthews S. Gambling and local government
area (LGA) indicators. Report 7 (March).
Report for Victorian Department of Justice.
Melbourne: Turning Point Alcohol and Drug
Centre; 2009.
Eastern Health Research Report 2009-10 97
Turning Point Alcohol and Drug Centre
Cogger S, Kinner S. Queensland trends in
illicit drug markets 2008: findings from the
illicit drug reporting system (IDRS).
Australian Drug Trends Series No. 27. Sydney:
NDARC; 2009.
Berends L, Kenny P, Sciacchitano L, Buykx P,
Mugavin J, Eleftheriadis D, et al. The
Queensland Magistrate’s Early Referral Into
Treatment (QMERIT) pilot program evaluation.
Interim report to Alcohol, Tobacco and Other
Drugs Branch, Queensland Health. Fitzroy,
Victoria: Turning Point Alcohol and Drug
Centre; 2009.
Cogger S. The earlier identification of drug
harms project (EIDHP). Bi-monthly report no.
3. February-March 2009. Melbourne: Turning
Point Alcohol and Drug Centre; 2009.
Devaney M. Alcohol and other drug unmet
service demand project: Review of service
opportunities: St John of God Health Care;
2009 May.
Kenny P, Berends L. The Windana day
program: Interim report. Fitzroy, Victoria:
Turning Point Alcohol and Drug Centre; 2009.
Kenny P, Swan A, Berends L, Jenner L,
Hunter B, Mugavin J. Alcohol and other drug
withdrawal: Practice guidelines. Melbourne:
Turning Point Alcohol and Drug Centre; 2009.
Cogger S. The earlier identification of drug
harms project (EIDHP). Bi-monthly report no.
4. April-May 2009. Melbourne: Turning Point
Alcohol and Drug Centre; 2009. Report No.: 4.
Devaney M. Rapid situation assessment of
amphetamine type stimulants treatment
and training in Cambodia, China, Lao PDR,
Myanmar, Thailand and Vietnam: United
Nations Office on Drugs and Crime; 2009
June.
Hunter B, Berends L, Roberts B,
Sciacchitano L, Mugavin J, Swan A.
Treatment and access in the Victorian AOD
sector. Fitzroy, Victoria: Turning Point Alcohol
and Drug Centre; 2009.
Jenner L, Lee NK. Report on the development
of a National Alcohol Policy for Vanuatu; 2009.
Kenny P, Swan A, Berends L, Jenner L,
Hunter B, Mugavin J. Alcohol and other
drug withdrawal: practice guidelines 2009.
Fitzroy, Victoria: Turning Point Alcohol and
Drug Centre; 2009.
Lee NK, Nielsen S, Ferris J, Pennay A,
Devaney M, Reed M. Australian Treatment
98 Eastern Health Research Report 2009-10
Outcomes Study: Amphetamines. Melbourne:
Turning Point Alcohol and Drug Centre; 2009.
Cogger S, Barratt MJ, Matthews S, Lloyd B,
Strickland H. The Victorian Drug Statistics
Handbook: Patterns of drug use and related
harm in Victoria for the period July 2006
to June 2007 (Report No. 10). Melbourne:
Victorian Government Department of Human
Services.; 2009.
Jenner L. How to write for a general audience:
a guide for academics who want to share
their knowledge and have fun doing it; 2009.
Report No: 1465-3362 Contract No:4.
Matthews S. Drug use in the City of
Whittlesea: a local profile. Melbourne: Turning
Point Alcohol and Drug Centre; 2009.
Matthews S. Drug Use in the City of Bayside:
a local profile: Turning Point Alcohol and Drug
Centre; 2009.
Matthews S, Barratt MJ. Drug use in the
south west primary care partnership: a local
profile 2006–07. Melbourne: Turning Point
Alcohol and Drug Centre; 2009.
Matthews S, Cameron J, Barratt MJ,
Strickland H. Drug use in the City of
Maribyrnong: a local profile. Melbourne:
Turning Point Alcohol and Drug Centre; 2009.
Cameron J, Strickland H, Devaney M, Lee N,
Wright I, Karametos C. A pilot study to
examine the effectiveness of clinical case
management for alcohol and drug clients.
Report to Australian Rotary Health Research
Fund. Melbourne: Turning Point Alcohol and
Drug Centre; 2009.
Cogger S. The earlier identification of drug
harms project (EIDHP). Bi-monthly report no.
5. June-July 2009. Melbourne: Turning Point
Alcohol and Drug Centre; 2009.
Wilkinson C, Laslett, A-M, Ferris J,
Livingston M, Mugavin J, Room R. The range
and magnitude of alcohol’s harm to others:
study design, data collection procedures and
measurement. Fitzroy: AER Centre for Alcohol
Policy Research, Turning Point Alcohol & Drug
Centre; 2009.
Reichert T, Cameron J, Pennay A,
Strickland H, Lee NK. Effective screening and
interventions for clients with substance use
disorder and borderline personality disorder: A
review of the literature and recommendations
for treatment. Fitzroy, Victoria: Turning Point
Alcohol and Drug Centre; 2009.
Berends L, Mugavin J, Roberts B. Hume
region alcohol screening and brief
intervention project: evaluation. Fitzroy,
Victoria: Turning Point Alcohol and Drug
Centre; 2010.
Cogger S. The earlier identification of drug
harms project (EIDHP). Bi-monthly report
no. 6. August-September 2009. Melbourne:
Turning Point Alcohol and Drug Centre; 2009.
Mugavin J, Berends L. Mirabel Project.
Fitzroy, Victoria: Turning Point Alcohol and
Drug Centre; 2009.
Harney A, Lee N. Evaluation of a bestpractice, integrated intervention for regular
methamphetamine users with comorbid
depression. Fitzroy, Victoria: Turning Point
Alcohol and Drug Centre; 2009.
Kenny P, Berends L, Eleftheriadis D. Windana
Alcohol and Drug Day Program: Evaluation.
Fitzroy, Victoria: Turning Point Alcohol and
Drug Centre; 2009.
Cogger S. The earlier identification of drug
harms project (EIDHP). Bi-monthly report
no. 7. October-November 2009. Melbourne:
Turning Point Alcohol and Drug Centre; 2009.
Hunter B, Kenny P, Eleftheriadis D, Berends L.
Statewide review of places of safety, Tasmania.
Fitzroy, Victoria: Turning Point Alcohol and
Drug Centre; 2009.
Jenner L, Devaney M, Lee N. Case
management in alcohol and drug treatment
settings. Melbourne, Victoria: Turning Point
Alcohol and Drug Centre; 2010.
Berends L. Australian Leadership Award –
Fellowship. Fitzroy, Victoria: Turning Point
Alcohol and Drug Centre; 2009.
Cogger S. The earlier identification of drug
harms project (EIDHP). Bi-monthly report
no. 8. December-January 2010. Melbourne:
Turning Point Alcohol and Drug Centre; 2010.
Berends L, Connolly K, Pennay A, Mugavin J,
Cogger S, Strickland H, et al. Defining alcohol
and other drug treatment and workforce.
Fitzroy, Victoria: Turning Point Alcohol and
Drug Centre; 2010.
Cogger S, Lloyd B. The earlier identification of
drug harms project (EIDHP). Bi-monthly report
no. 9. February-March 2010. Melbourne:
Turning Point Alcohol and Drug Centre; 2010.
MacLean S, Berends L, Hunter B, Mugavin J,
Roberts B. Project implementation in the
Turning Point Alcohol and Drug Centre
alcohol and other drug field: Enablers, barriers
and sustainability. Fitzroy, Victoria: Turning
Point Alcohol and Drug Centre; 2010.
Cogger S, Lloyd B. The earlier identification of
drug harms project (EIDHP). Bi-monthly report
no. 10. April-May 2010. Melbourne: Turning
Point Alcohol and Drug Centre; 2010.
Jenner L. An evaluation of a national
web-based drug counselling service,
CounsellingOnline; 2010.
Jenner L. An evaluation of an internet site for
the Australian National University counsellor’s
measure JustAskUs. Canberra, Australia,
Ageing AGDoHa; 2010.
Jenner L, Lee NK. An evaluation of a self-help
website for methamphetamine users, meth.
org.au; 2010.
Nielsen S, Cameron J, Pahokis S. Over the
counter codeine dependence. Melbourne:
Turning Point Alcohol and Drug Centre; 2010.
Presentations
International
Berends L, Hunter B. It seemed like a good
idea at the time: Experiences in centralised
intake for alcohol and drug treatment across
three jurisdictions. Models, implications and
meanings of alcohol and drug treatment
systems. Kettil Bruun Society Thematic
Meeting; Stockholm, Sweden, June 2009.
Berends L, Smith BM, Hayter J. Standardising
quality in methadone maintenance treatment:
The development of a standards framework
for clinics in Yunnan province, China.
International Harm Reduction Conference;
Bangkok, Thailand, April 2009.
Devaney M. Research capacity building
workshop: Utilising research evidence. Pacific
Drug and Alcohol Research Meeting; Fiji, July
2009.
Laslett A. The effect of alcohol and other
factors in substantiated child maltreatment
and sequential stages of the child protection
process. Kettil Bruun Society Alcohol
Epidemiology Symposium; Copenhagen,
Denmark, June 2009.
Livingston M. How domestic violence rates
change with changes in outlet density,
Kettil Bruun Society Alcohol Epidemiology
Symposium; Copenhagen, Denmark,
June 2009.
Mugavin J, Livingston M. Alcohol-related
violence: An Australian contextualisation.
Kettil Bruun Society Alcohol Epidemiology
Symposium; Copenhagen, Denmark,
June 2009.
Room R. The idea of a treatment system in
the context of handling alcohol and drug
problems. Models, implications and meanings
of alcohol & drug treatment systems.
Stockholm, Sweden, October 2009.
Mugavin J, Livingston M. Alcohol and
other drugs and violence: An Australian
contextualisation. Kettil Bruun Society
Alcohol Epidemiology Symposium; 2009,
Copenhagen, Denmark 2009.
Room R. Should they be in the same house?
Relations between mental health and alcohol/
drug services. 52nd ICAA Conference on
Depenedencies. Estoril, Portugal,
October 2009.
Room R. Cannabis policy: moving beyond
stalemate. Drug Policy Symposium;
Wellington, New Zealand, February 2009.
Wilkinson C. Alcohol-related harm in the
public domain. Kettil Bruun Society Alcohol
Epidemiology Symposium. Copenhagen,
Denmark, June 2009.
Room R. Measuring alcohol’s harm to others:
first steps with Australian data. Royal Society
of Edinburgh conference on “Alcohol, our
favourite drug”. Edinburgh, Scotland,
February 2009.
Room R. Drugs, alcohol and tobacco policy
research or psychoactive substance research?
From separate worlds to a common frame.
International Society for the Study of Drug
Policy. Vienna, Austria, March 2009.
Room R. Cannabis policy: moving beyond
stalemate. Commission on Narcotic Drugs.
Vienna, Austria, March 2009.
Room R. What are the research needs and
priorities for alcohol policymaking: a view
from Melbourne. Kettil Bruun Society Alcohol
Epidemiology Symposium. Copenhagen,
Denmark, June 2009.
Berends L, Roberts B. Providing appropriate
care for hospital patients with alcohol
problems. Kettil Bruun Society Alcohol
Epidemiology Symposium. Lausanne,
Switzerland, June 2010.
Dietze P, Ferris J, Room R. Who suggests
drinking less? Demographic and national
differences in informal social controls
on drinking. Kettil Bruun Society Alcohol
Epidemiology Symposium. Lausanne,
Switzerland, June 2010.
Ferris J. Social network of heavy drinkers: How
many drinkers do you need to know before
one is a problem for you? Kettil Bruun Society
Alcohol Epidemiology Symposium. Lausanne,
Switzerland, June 2010.
Room R. Addiction and personal responsibility
as solutions to the contradictions of neoliberal
capitalism. Alcohol tobacco & obesity:
Interrogating the New Public Health’s “axis of
evil”. Vancouver, Canada, July 2009.
Jenner L. Online self-help for
methamphetamines users: development and
evaluation of an Australian website. College
on Problems of Drug Dependence Annual
Meeting; June 2010.
Room R. Alcohol & public health in the
international arena: preparing for the WHO
Global Strategy, and looking toward a
Framework Convention. International Seminar
on Alcohol Retail Monopolies. Seattle, USA,
August 2009.
Laslett A-M, Dietze P, Ferris J, Room R.
Measuring alcohol-related child maltreatment
in Australian families using survey and
system data. Kettil Bruun Society Alcohol
Epidemiology Symposium. Lausanne,
Switzerland, June 2010.
Room R. Alcohol problems and social
development: a longer-term view. Global
Expert Meeting on Alcohol, Health &
Social Development. Stockholm, Sweden,
September 2009.
Livingston M. “Polarisation” – how can
diverging trends in alcohol consumption
and harm be explained? Kettil Bruun Society
Alcohol Epidemiology Symposium. Lausanne,
Switzerland, June 2010.
Room R. Does it matter if the main drink
is spirits? Alcohol policy evidence base.
Stockholm, Sweden, October 2009.
Lloyd B, Matthews S, Livingston M. Drinking
cultures and social occasions: Alcohol harms
in the context of major public holidays,
sporting and cultural events. Kettil Bruun
Society Alcohol Epidemiology Symposium.
Lausanne, Switzerland, May/June 2010.
Room R. Nordic tax study: making sense of it
all. Alcohol policy evidence base. Stockholm,
Sweden, October 2009.
Eastern Health Research Report 2009-10 99
Turning Point Alcohol and Drug Centre
Matthews S, Dietze P, Room R, Jolley D,
Chikritzhs T. Attitudes to drinking among
abstainers, frequent and heavy episodic
drinkers: Findings from the Australian
GENACIS study. Kettil Bruun Society Alcohol
Epidemiology Symposium. Lausanne,
Switzerland, June 2010.
Mugavin J. Service use because of others’
drinking. Kettil Bruun Society Alcohol
Epidemiology Symposium. Lausanne,
Switzerland, May/June 2010.
Nielsen S, Cameron J, Lee NK. Is there a
new population of opioid users in Australia?
A web-based survey on non-prescription
codeine use. NIDA International Forum;
Scottsale, Arizona, USA, June 2010.
Room R. The debate about legalisation of
marijuana. Mexican Council for International
Relations. Mexico City, Mexico, February 2010.
Room R. Cannabis policy: moving beyond
stalemate. Collective for a Comprehensive
Policy Towards Drugs conference. Mexico City,
Mexico, February 2010.
Room R. Advising the population about
drinking and risk: the Australian experience.
Alcohol Research Conference; 2010; Skarpö,
Sweden 2010.
Room R. Drug policy and control at the
international level. NIDA International Forum.
Scottsdale, Arizona, USA, June 2010.
Room R. Softening prohibition and regulating
markets: two ways forward? College on
Problems of Drug Dependence Annual
Meeting. Scottsdale, Arizona, USA, June 2010.
Room R, Greenfield T, Bond J, Ferris J,
Holmila M. Patterns of informal pressure
to drink less or more: A cross-national
comparison. Kettil Bruun Society Alcohol
Epidemiology Symposium. Lausanne,
Switzerland, June 2010.
Room R, Reuter P. Cannabis policy: moving
beyond stalemate. Inter-American Dialogue;
2010 Washington, USA, February 2010.
public amenity problems. Kettil Bruun Society
Alcohol Epidemiology Symposium. Lausanne,
Switzerland, June 2010.
National
Livingston M. Alcohol availability and alcoholrelated problems – A Victorian case study
Alcohol, Tobacco and other Drugs Council of
Tasmania’s Alcohol Symposium. Hobart,
June 2009.
Room R, Laslett A-M, Ferris J, Livingston M,
Mugavin J, Wilkinson C. When others drink
too much: Adverse effects of drinking in the
family, among friends, at work and in the
community. Thinking drinking 3: Action for
change. Brisbane, August 2009.
Livingston M. Alcohol outlet density and
alcohol-related problems: The view from
Victoria Thinking drinking 3: Action for
change. Brisbane, August 2009.
Berends L, Kenny P, Sciacchitano L,
Mugavin J, Eleftheriadis D, Swan A.
Effectiveness of the Queensland Magistrate’s
Early Referral Into Treatment (QMERIT)
program. Australasian Professional Society on
Alcohol and Other Drugs, Living on the Edge;
November, Darwin. Drug and Alcohol Review;
2009, p.A67.
Ferris J, Berends L, Laslett AM. The personal
cost of someone else’s drinking. Data from
the range and magnitude of alcohol’s harm to
others study. Australasian Professional Society
on Alcohol and Other Drugs, Living on the
Edge; November, Darwin. Drug and Alcohol
Review; 2009, p.A78.
Ferris J, Pennay A, Lee NK, Hester R. Post
treatment outcomes at one month after
modafinil for methamphetamine withdrawal.
Australasian Professional Society on Alcohol
and Other Drugs, Living on the Edge;
November, Darwin. Drug and Alcohol Review;
2009, p.A78.
Lubman DI. Managing affective symptoms
among injecting drug users. Improving
Outcomes in the Treatment of Opiate
Dependence. Berlin, Germany. May 2010.
Ferris JA, Berends L. So what exactly did
they do? Reported behaviour of the person
whose drinking had the most negative
effect. Australasian Professional Society on
Alcohol and Other Drugs, Living on the Edge;
November, Darwin. Drug and Alcohol Review;
2009, p.A78.
Wilkinson C, Livingston M. “...if I’d known
what it was like on Fridays and Saturdays, I’d
never have moved here.” Distances to alcohol
outlets and experiences of alcohol-related
Ferris JA, Berends L, Laslett A-M. The
personal cost of someone else’s drinking:
Data from the Range and Magnitude of
Alcohol’s Harm to Others Study. Australasian
100 Eastern Health Research Report 2009-10
Professional Society on Alcohol and Other
Drugs, Living on the Edge; November, Darwin.
Drug and Alcohol Review; 2009. p.A78.
Ferris JA, Pennay A. Post treatment outcomes
at one month after modafinil for withdrawal.
Australasian Professional Society on Alcohol
and Other Drugs, Living on the Edge;
November, Darwin. Drug and Alcohol Review;
2009, p.A67.
Hester R, Lee N, Pennay A, Ferris JA.
Neurocognitive changes as a result of
modafinil during withdrawal. Australasian
Professional Society on Alcohol and Other
Drugs, Living on the Edge; November, Darwin.
Drug and Alcohol Review; 2009, p.A78.
Hester R, Lee NK, Pennay A, Ferris J.
Neurocognitive changes as a result of
modafinil during withdrawal. Australasian
Professional Society on Alcohol and Other
Drugs, Living on the Edge; November, Darwin.
Drug and Alcohol Review; 2009, p.A78.
Hunter B, MacLean S, Berends L. Using realist
synthesis to build an evidence-base from
Alcohol Education and Rehabilitation (AER)
Foundation funded projects. Australasian
Professional Society on Alcohol and Other
Drugs, Living on the Edge; November, Darwin.
Drug and Alcohol Review; 2009,p.A67.
Jenner L. Online self-help for
methamphetamines users: Development
and evaluation of an Australian website.
Australasian Professional Society on Alcohol
and Other Drugs, Living on the Edge;
November, Darwin. Drug and Alcohol Review;
2009, p.A67.
Kenny P, Berends L, Swan A. The Victorian
Alcohol and Other Drug (AOD) Withdrawal
Practice Guidelines: A conceptual approach
to AOD withdrawal care. Australasian
Professional Society on Alcohol and Other
Drugs, Living on the Edge; November, Darwin.
Drug and Alcohol Review; 2009, p.A67.
Kenny P, Edwards K, Berends L. The
Windana Day Program (WDP) Evaluation:
A collaborative approach to evaluating an
innovative AOD service model. Australasian
Professional Society on Alcohol and Other
Drugs, Living on the Edge November, Darwin.
Drug and Alcohol Review; 2009, p.A67.
Lee N, Pennay A, Hester R, Ferris JA,
Dunlop A. Double-blind placebo-controlled
pilot trial of modafinil for methamphetamine
withdrawal. Australasian Professional Society
on Alcohol and Other Drugs, Living on the
Turning Point Alcohol and Drug Centre
Edge November, Darwin. Drug and Alcohol
Review; 2009, p.A78.
Lee NK, Pennay A, Hester R, Ferris J,
Dunlop A. Double-blind, placebo-controlled
pilot trial of modafinil for methamphetamine
withdrawal. Australasian Professional Society
on Alcohol and Other Drugs, Living on the
Edge; November, Darwin. Drug and Alcohol
Review; 2009, p.A78.
Livingston M, Wilkinson C. The impact
of other people’s drinking on health and
wellbeing. Australasian Professional Society on
Alcohol and Other Drugs, Living on the Edge;
November, Darwin. Drug and Alcohol Review;
2009, p.A78.
Matthews S, Ferris J, Dietze P, Room R,
Chikritzhs T. Who abstains from drinking and
why (poster)? Australasian Professional Society
on Alcohol and Other Drugs, Living on the
Edge; November, Darwin. Drug and Alcohol
Review; 2009,p.A67.
Nielsen S, Cameron J. Over the counter pain
relievers … hidden harms? Results of a webbased survey Australasian Professional Society
on Alcohol and Other Drugs, Living on the
Edge; November, Darwin. Drug and Alcohol
Review; 2009,p.A67.
Pennay A, Lee NK. A systematic review of
treatment options for methamphetamine
withdrawal. Australasian Professional Society
on Alcohol and Other Drugs, Living on the
Edge; November, Darwin. Drug and Alcohol
Review; 2009,p.A78.
Reed M, Devaney M, Harney A, J. C, Lee N.
Access Point Stimulant Treatment Centres:
Service impact and what the neighbours
think! Australasian Professional Society on
Alcohol and Other Drugs, Living on the Edge;
November, Darwin. Drug and Alcohol Review;
2009, p.A67.
Reichert T, Cameron J, Pennay A,
Strickland H, Lee NK, Connolly K. Who should
respond to personality disorders? A stepped
care to managing complex behaviours in AOD
settings. Australasian Professional Society on
Alcohol and Other Drugs, Living on the Edge;
November, Darwin. Drug and Alcohol Review;
2009.p.A67.
Wilkinson C, Olsson C, Phillips L. The
relationship between DSM-IV personality and
alcohol use disorders in emerging adulthood:
results from the Victorian adolescent
health cohort study (est 1992). Australasian
Professional Society on Alcohol and Other
Drugs, Living on the Edge; November, Darwin.
Drug and Alcohol Review; 2009,p.A67.
Cogger S, Lloyd B, Johnston J. The Earlier
Identification of Drug Harms Project Research
mediating between practice and policy
(poster). Australasian Professional Society on
Alcohol and Other Drugs, Living on the Edge;
November, Darwin. Drug and Alcohol Review;
2009, p.A67.
Lloyd B, McElwee P. Pharmaceutical
analgesics and acute harms: Characteristics of
ambulance attendances for analgesic-related
presentations. Australasian Professional
Society on Alcohol and Other Drugs, Living
on the Edge; November, Darwin. Drug and
Alcohol Review; 2009,p. A67.
Lloyd B, McElwee P. Patterns of acute
drug and alcohol related harm: Trends in
ambulance attendances 1998/9-2008/9
(poster). Australasian Professional Society on
Alcohol and Other Drugs, Living on the Edge
November, Darwin. Drug and Alcohol Review;
2009, p.A67.
Cogger S, Lloyd B, Johnston J. The Earlier
Identification of Drug Harms Project (EIDHP):
Research mediating between policy and
practice (poster). Australasian Professional
Society on Alcohol and Other Drugs, Living
on the Edge; November, Darwin. Drug and
Alcohol Review; 2009.p.A67.
Lubman DI. Cannabis and mental health –
what is the link? Challenges of Co-morbidity
Forum. Hobart, April 2010.
Local
Jenner L. Going it alone at meth.
org.au: Delivering practical advice to
methamphetamine users. Turning Point
Alcohol and Drug Centre Symposium.
Melbourne, August 2009.
Lloyd B, Nielsen S. The changing face
of opioid dependence: New research in
pharmaceutical misuse. Turning Point Alcohol
and Drug Centre Symposium. Melbourne,
August 2009.
Matthews S. Alcohol harms in 18-24 year olds:
An eight-year profile. Turning Point Alcohol
and Drug Centre Symposium. Melbourne,
August 2009.
Devaney M, Schmich L. Building research
capacity: the Pacific Drug and Alcohol
Research Network Turning Point Alcohol and
Drug Centre Symposium. Melbourne,
August 2009.
Livingston M. The liberalisation of Victorian
alcohol policy: Implications for alcohol-related
harm. Turning Point Alcohol and Drug Centre
Symposium. Melbourne, August 2009.
Livingston M. Planning for health: Utilising
alcohol research evidence. Turning Point
Alcohol and Drug Centre Symposium.
Melbourne, August 2009.
Livingston M. Alcohol outlet density and
alcohol-related problems: The view from
Victoria. Australian Drug Strategy Conference.
Melbourne, March 2010.
Ferris J. Alcohol-related violence from the
known drinker: A focus on social location
using cluster analysis. Kettil Bruun Society
Thematic Meeting on Alcohol and Violence.
Melbourne, March 2010.
Laslett A-M. A comparison of alcohol’s
involvement in different forms of child abuse
and neglect. Kettil Bruun Society Thematic
Meeting on Alcohol and Violence 2010;
Melbourne, March 2010.
Livingston M. Alcohol outlet density and
harm: comparing the impacts on violence and
chronic harms Kettil Bruun Society Thematic
Meeting on Alcohol and Violence. Melbourne,
March 2010.
Lloyd B, Barratt MJ. Alcohol and Violence:
The Victorian Picture. Kettil Bruun Society
Thematic Meeting on Alcohol and Violence.
Melbourne, March 2010.
Room R. Alcohol and violence: the work of
a conference. Kettil Bruun Society Thematic
Meeting on Alcohol and Violence. Melbourne,
March 2010.
Roberts B. An exploration of dual diagnosis
policy. Address to sustaining the momentum:
embedding dual diagnosis practice in
organisations A conference for Improved
Services Initiative and Victorian Dual Diagnosis
Initiative consultants; Lorne, June 2010.
Grants
Department of Health (Vic) Alcohol Cirrhosis,
Lloyd B, $49,000.
Victoria Police Data provision to VicPol –
Drug Harms index, Lloyd B, Matthews S,
Livingston M, $98,000.
Department of Health Risky Drinking
Strategy (CALD), Pennay A, Nielsen S, $30,000.
Eastern Health Research Report 2009-10 101
Turning Point Alcohol and Drug Centre
Research Training
Allens Arthur Robinson Allens Arthur
Robinson Research Fellowship, Cameron J,
$105,000.
National Health & Medical Research Council
/ Department of Health (Vic) Contribution to
the NWMR AOD Plan, Hunter B, $54,000.
PhD
Department of Health (Vic) (FaSA) Youth
Cohort study (YOCO), Lee N, $155,880.
European Commission Study on the
development of an EU framework for
minimum quality standards and benchmarks
in drug demand education (with University of
Zurich), Berends L, $20,000.
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Proceeds of Crime Specialist
methamphetamine clinics implementation
and evaluation (Access Point), Lee N,
Devaney M, $250,000.
Department of Health & Ageing Online
Treatment Services Jenner L, Lee N, $233,200.
Department of Health (Vic) (FaSA) Over The
Counter Codeine study, Nielsen S, $44,000.
Helen MacPherson-Smith Monitoring harm
caused by pharmaceutical misuse, Nielsen S,
$25,000.
Alcohol Education & Rehabilitation
Foundation Ltd Alcohol Policy Research,
Room R, Livingston M, $200,000.
Alcohol Education & Rehabilitation
Foundation Ltd The range and magnitude
of alcohol’s harm to others, Room R, Laslett
AM, Livingston M, Wilkinson C, Mugavin J,
Matthews S, $236,000.
National Health & Medical Research
Council Alcohol control, consumption and
consequences: time series analyses of the
Australian experience, Livingston M,
Room R, $296,000.
Alcohol Education & Rehabilitation
Foundation Ltd Conference on alcohol and
violence, Wilkinson C, Room R, $20,000.
VicHealth The growth of alcohol outlets in
Victoria 1991-2007, Livingston M, $45,000.
102 Eastern Health Research Report 2009-10
Queensland Health QMerit, Berends L,
$285,877.
Alcohol Education & Rehabilitation
Foundation Ltd Building an evidence-base
from the AER funded projects, Berends L,
$219,700.
Barwon Youth Evaluation of Youth Access
Program, Kenny P, Berends L, $15,000.
Department of Health (Vic) Defining Alcohol
and Other Drug Treatment, Berends L [with
Connolly K, Ritter A] $145,000
National Health & Medical Research Council
Inhalant guidelines, MacLean S, Cameron J,
Lee N, $63,000.
Australian Football League AFL binge
drinking, Hunter B, $30,000.
Department of Health (Vic) (FASA) AOD
treatment needs and service system
responses for people aged over 65, Hunter B,
$89,800.
Australian Football League Players
Association AFL Agents & Alcohol, Hunter B,
$14,000.
City of Yarra Yarra LL8, Pennay A, $150,000.
Department of Health (Vic)
Pharmacotherapy Review, Berends L,
$50,000.
Livingston M. University of Melbourne, F/T
Laslett AM. University of Melbourne, F/T
Matthews S. University of Melbourne, P/T
Rodda S. University of Melbourne, P/T
Barratt M. Curtin University of Technology,
P/T
• Simpson A. La Trobe University, P/T
• Roberts B. Monash University, F/T
• Clarke C. University of Melbourne, P/T
Masters
• Schotterlein M. La Trobe University, F/T
• Kenny P. University of Melbourne, F/T
• McElwee P. Deakin University, PT
Honours students
• Wilkinson C. University of Melbourne P/T
• Harney A. La Trobe University, P/T
Research Fellows
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Petroulias D. P/T
Siegmann L.
Jenner L.
Matthews S. F/T
Cogger S. F/T
Pennay A. F/T
Harney A. P/T
Roberts B. P/T
Dale C. Visiting Fellow, PhD, London School
of Hygiene and Tropical Medicine
Senior Research Fellows
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Berends L. F/T
Lloyd B. F/T
Hunter B. F/T
Nielsen S. F/T
Devaney M. F/T
> Contact us
Eastern Health
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ph 03 9764 6111
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