Eastern Health Research Report 2009вЂ“2010 Eastern Health Research Report 2009-10 1 Contents 3 10 62 70 Chief Executive and Board ChairвЂ™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 ChairвЂ™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 HealthвЂ™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 HealthвЂ™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 HealthвЂ™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 AustraliaвЂ™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 HealthвЂ™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.В 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 вЂўProf 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 supportвЂ™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 HealthвЂ™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 librariesвЂ™ co-operative network, as well as Eastern HealthвЂ™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 вЂўAdrienne 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 HealthвЂ™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 вЂў Medical Student Programs вЂў Research вЂў Eastern Clinical Research Unit (ECRU) вЂў 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 вЂ�learning in contextвЂ™. 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 womenвЂ™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 studentsвЂ™ relevant clinical skills, studentsвЂ™ assessments of their own performance and participantsвЂ™ perceptions about the program. and evaluation of a novel aid for medical studentsвЂ™ 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 studentsвЂ™ and junior doctorsвЂ™ 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 вЂ�learning in contextвЂ™ 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 studentsвЂ™ 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 DuttonвЂ™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 вЂў 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 divisionвЂ™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 вЂ�non-coeliac gluten intoleranceвЂ™ 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 CrohnвЂ™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 CrohnвЂ™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 вЂ“ 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 вЂ�intoleranceвЂ™ 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 вЂ“ 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 CrohnвЂ™s disease. Van Langenberg D, Russell A, Gibson P. Fatigue is a very common symptom of CrohnвЂ™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 CrohnвЂ™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 вЂ“ 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 IsosourceВ® 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 вЂ�non-coeliac gluten-intoleranceвЂ™ 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 вЂ�normalвЂ™ 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 вЂ“ 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 CrohnвЂ™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 CrohnвЂ™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 CrohnвЂ™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 nursesвЂ™ 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 вЂ“ 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. ChildrenвЂ™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 вЂ“ 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 вЂ“ oral or parenteral? Raising Expectations Symposium. Sydney, March 2010. Gibson PR. (1) New concepts in coeliac disease. (2) Food choice вЂ“ 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 вЂ“ 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. вЂўDr 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 вЂ�Demystifying fatigue in CrohnвЂ™s diseaseвЂ™, given that fatigue is a common, debilitating yet under-recognised symptom in patients with CrohnвЂ™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 CrohnвЂ™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 вЂ“ 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 CrohnвЂ™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: вЂў Halmos E, Eastern Health Clinical School,Postgraduate scholarship вЂў Biesiekierski J, Faculty of Medicine, Nursing and Health Sciences, Postgraduate scholarship вЂў Van Langenberg D, NHMRC, Postgraduate scholarship вЂў Newnham E, Gastroenterological Society of Australia, Postgraduate scholarship Research training PhD вЂў 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 CrohnвЂ™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 CrohnвЂ™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 вЂў 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. вЂў Van Langenberg D, Monash University, F/T Major Achievement вЂў 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) вЂў James SL, Monash University, P/T вЂў Mond M, Monash University, F/T Masters вЂў Ward S, Monash University, P/T вЂў Dandie L, Monash University, P/T вЂў Mills J, Monash University, F/T Honours students вЂў Yao CK, Monash University, 2009 вЂў TanВ HL, Monash University, 2009 вЂў Power V, Monash University, 2009-2010 вЂў Iacovou M, Monash University, 2010 вЂў Ku C, 2010, Monash University, 2010 вЂў 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 unitвЂ™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 HuntingtonвЂ™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. PPARОі 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, BoГ«lle 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, DГјring 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, OвЂ™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. PPARОі 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 вЂў Chandran C, Monash University, F/T вЂў 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 вЂњEinsteinвЂќ. 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 вЂњEinstein ExtensionвЂќ, the results of which were presented at the 2009 meeting of the American Society of Haematology (see abstracts). Onyx VTE orthopaedic surgery prevention study (150вЂ“CLвЂ“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) вЂњRemedyвЂќ extended prevention of VTE recurrence (1160.47) Recover 2вЂќ 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-HodgkinвЂ™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): вЂњMagellanвЂќ VTE medical prevention study (BAY59/7939/11289) Vantage vorinostat and bortizimab treatment of multiple myeloma вЂ“ blinded (MK 0683 088) Vantage vorinostat and bortizimab treatment of multiple myeloma вЂ“ 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. вЂўBrenda 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. BrendaвЂ™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 вЂ“ 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, Г–hlschlegel 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, ThГјlimann 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, ThГјrlimann B, Price K, Holmberg S, Crivellari D, Coates A, Goldhirsch A. Adjuvant!В© 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, NordenskjГ¶ld B, GutiГ©rez 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, ThГјrlimann 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. ThГјrlimann 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 вЂ“ 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, ThГјrlimann 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, ThГјrlimann B, Mouridsen H, Campone M, Forbes J, Paridaens RJ, Colleoni M, Pienkowski T, Nogaret J-M, LГЎng 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, ThГјrlimann 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, ThГјrlimann 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, ThГјrlimann 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, ThГјrlimann 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, ThГјrlimann 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 TrialistsвЂ™ 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, DellвЂ™Orto P, Mastropasqua M, Rasmussen B, MacGrogan G, Braye S, Orosz Z, Giobbie-Hurder A, Neven P, Knox F, Oehlschlegel C, ThГјrlimann 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, ThГјrlimann 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, ThГјrlimann 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, ThГјrlimann 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, RochГ© 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, RochГ© H, Pinter T, Eiermann W, Kennedy MJ, Priou F, Provencher L, Adrover E, Pienkowski T, HouГ© 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 physicianвЂ™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 unitвЂ™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-weeksвЂ™ 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 mealвЂ‘time insulin as part for the remaining meals with insulin detemir plus mealвЂ‘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, parallelвЂ‘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 typeВ 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, parallelвЂ‘group, multicenter study to determine the efficacy and safety of study drug as compared with sitagliptin in subjects with typeВ 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 HenryвЂ™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 вЂ“ 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 вЂњAaxis New Investigator Award for the best new scientific presentationвЂќ at the AWMA Conference, March 2010. Grants Victorian Cancer Agency The genetic pathology of thyroid tumours, Gilfillan C. $197,000 Research training PhD вЂў 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 CrohnвЂ™s disease and inflammatory bowel disease Gibson P. There are several clinical trials ongoing for patients with poorly controlled CrohnвЂ™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 CrohnвЂ™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 CrohnвЂ™s Colitis 2009;3:196-9. In press Krieger-GrГјbel 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. GrГјbel 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 AlzheimerвЂ™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 вЂ“ 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 вЂ“ 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 вЂ“ a randomised controlled trial. DIAS3 Desmoteplase in acute stroke (Lundbeck). Eastern Health Research Report 2009-10 33 medicine Neurosciences Dementia trials LZAN H8A-MC вЂ“LZAN Solanezumab LY2062430 Effect of passive immunisation on the progress of AlzheimerвЂ™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 вЂњA graphic reanalysis of the NINDS TrialвЂќ. 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) вЂ“ 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 вЂ“ 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, OвЂ™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 вЂ“ 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, OвЂ™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, OвЂ™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, OвЂ™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, OвЂ™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 вЂ“ 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, OвЂ™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 вЂ“ the dextran in carotid endarterectomy (dice) trial. Cerebrovascular Diseases 2010, Supplement 2;29; p32. Bray J, OвЂ™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 PГ©rez 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, OвЂ™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 FoundationвЂ™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, OвЂ™Connell B, Gilligan A, Livingston P, Bladin C. An examination of factors related to patientsвЂ™ 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, OвЂ™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, OвЂ™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, OвЂ™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, OвЂ™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, OвЂ™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, вЂњBest Emergency Prehospital PaperвЂќ; 2009 Stroke Society of Australasia, вЂњNew Investigator AwardвЂќ; 2009 Stroke Society of Australasia Nursing Scientific Award Grants Project GrantВ 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).В 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 вЂ“ 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 вЂ“ 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 вЂ�Enhancing Stroke CareвЂ™. Are acute stroke patients assessed by ambulance transported to specialist stroke centres? 2010, $10,652. Current Submission вЂ“ 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 вЂў Bray J, Deakin University BMedSci Research вЂў Daly S, Monash University вЂў 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 вЂўA/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 ОІB-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 TYSABRIВ® 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 BetaferonВ® 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 IFNОІ 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 IFNОІ ex vivo, and demonstrated TRAIL upregulation in T and B cell models in response to IFNОІ. In addition BAFF was identified as a novel biological response marker of IFNОІ (Gandhi et al 2008). The study demonstrated that haplotypes of the multiple sclerosis susceptibility gene, IL7RО±, 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 RebifВ® 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 вЂў 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.В 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 вЂў 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. вЂў 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. вЂў 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. вЂў 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 вЂњreal worldвЂќ, 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 вЂ“ computer on wheels) which is wheeled from one patientвЂ™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 Liberteп››-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 вЂў вЂў вЂў вЂў вЂў вЂў вЂў вЂў 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;19:63вЂ“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)398вЂ“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 вЂў 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 вЂњProtecting EldersвЂ™ Assets StudyвЂќ 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 вЂ“ 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 вЂ“ 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.В 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.В 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.В 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 EldersвЂ™ 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 153вЂ“156. Darzins P. Viewpoint. Can this patient go home? Assessment of decision-making capacity. Australian Occupational Therapy Journal (2010) 57, 65вЂ“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. SupervisorsвЂ™ 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, 10вЂ“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 BГ©dard 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. BГ©dard 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 вЂ“ 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 вЂ“ drivers with dementia. May 2010. Darzins P, Kiegaldie D, Maddock B, White G, Duncan G. Inter-professional learning вЂ“ 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 вЂ“ on road assessments. National Dementia Research Forum. Sydney, Septmber 2009. Berndt A, May E, Darzins P On-road assessment of people with dementia вЂ“ 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 eldersвЂ™ 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 AlzheimerвЂ™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. AlzheimerвЂ™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 вЂ“ 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 EldersвЂ™ 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 вЂў Duncan G, Doctor of Public Health, Monash University, P/T вЂў Berndt A, Doctor of Philosophy, University of South Australia, P/T вЂў 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 HealthвЂ™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,В 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) вЂ“ 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 eritoranвЂ™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) вЂ“ 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, placeboвЂ‘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 28вЂ‘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) вЂ“ 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. вЂўDr 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. AshwinвЂ™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 вЂ“ 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 вЂ“ 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 вЂ“ 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 вЂ“ a clinical survey. SepsisВ is a seriousВ medicalВ condition that is characterised by a whole-bodyВ inflammatoryВ state and the presence of a known or suspectedВ infection. It is usually treated in theВ intensive care unitВ 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 cliniciansвЂ™ 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 unitвЂ™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 вЂ“ to be a joint project with Deakin University. Publications Published Subramaniam A, Cooke J, Ernest D. вЂ�InvertedвЂ™ tako-tsubo cardiomyopathy due to exogenous catecholamines вЂ“ A case report. CritВ CareВ 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 hospitalвЂ™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 вЂ“ 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 вЂ“ 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,В 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 вЂ“ 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 individualвЂ™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 вЂ“ 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 membersвЂ™ 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 вЂ“ 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 projectвЂ™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 вЂ“ 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: вЂў Interviews with patients, allied health and nursing staff at Wantirna Health вЂў Site visits to comparable palliative care units вЂў 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. вЂњDo we have to call the coroner?вЂќ 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 CoronerвЂ™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. вЂњDo what you can, with what you have, where you are (Roosevelt)вЂќ. 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 patientsвЂ™ 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 MelbourneвЂ™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: вЂў Standardisation of admission criteria and processes to services вЂў No central source of information for stakeholders вЂ“ a central website was suggested to address this вЂў Poor information transfer between organisations with inability to track patients between services Possible solutions to improve the transition between services include: вЂў A central access point and common electronic record for all palliative care patients вЂў A patient handheld record вЂў A central database for Eastern Health Palliative patients вЂўDr 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 MoranвЂ™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. JuliвЂ™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 membersвЂ™ experiences and barriers to optimal care for depressed and/or anxious patients. Themes included: вЂў Teams provide a positive environment that is hard to maintain if working alone вЂў 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 вЂў Need to improve access to specialist mental health вЂў 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 ClinPsychвЂ™s involvement highly, with 100 per cent of staff reporting it as вЂњmostly usefulвЂќ or вЂњvery usefulвЂќ for patients. Most staff reported ClinPsychвЂ™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. вЂњDo what you can, with what you have, where you areвЂќ (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. OвЂ™Neill S. вЂњWalk right in; sit right downвЂ¦вЂќ 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 MelbourneвЂ™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; clinicianвЂ™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 вЂ“ 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 вЂ“ establishing a need for an art program (posters). OT AUSTRALIA Victoria State Conference. Melbourne, November 2010. Obstetrics and gynaecology medicine > Obstetrics and gynaecology The WomenвЂ™s and ChildrenвЂ™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 вЂ“ 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 вЂў Ward S, Monash University, 2009 вЂў 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 VincentвЂ™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 вЂ“ 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. WegenerвЂ™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, VolВ 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 patientsвЂ™. International Bone & Mineral Research Society Meeting. Sydney, February 2009. Awards Dr Albert Leung (Rheumatology Registrar) World Congress Internal Medicine Royal Australian College of Physicians вЂњBest Advanced Trainee Poster AwardвЂќ 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: вЂў Prof Bridie Kent вЂ“ Chair of Nursing Eastern Health вЂў Dr Trish Livingston (Senior Research Fellow) вЂў 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: вЂў Service delivery вЂ“ models of care вЂў Inter-professional communication & clinical decision-making вЂў 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 HealthвЂ™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 вЂ�CONNECTвЂ™: 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: вЂў improve the quality, safety and experience of patient care вЂў 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 вЂ“ 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 preceptorsвЂ™ 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 вЂўVanessa 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 WomenвЂ™s and ChildrenвЂ™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 вЂ�Maternal Near MissвЂ™ 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 WomenвЂ™s and ChildrenвЂ™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 вЂ“ 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: вЂўJulie 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. JulieвЂ™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 JulieвЂ™s career choice to transition to nursing has focused on making a tangible difference in someoneвЂ™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,В Craike M,В Smit,В 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, OвЂ™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 dayвЂ™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 UniversityвЂ™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 practiceвЂ“ 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, OвЂ™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 MДЃori 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, OвЂ™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, OвЂ™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, OвЂ™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, OвЂ™Connell B, Gilligan A, Livingston P, Bladin C. An examination of factors related to patientsвЂ™ 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, OвЂ™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, OвЂ™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 OвЂ™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,В Kent B,В Bucknall T,В Johnstone M,В Duke M,В Considine J,В Watts R,В Redley B,В de Steiger R, $146,380 Research training Higher Degree Research Students Phd Masters вЂў Riddell K, Deakin University, P/T Honours вЂў вЂў вЂў вЂў вЂў Cull E, Deakin Univeristy Sommerville J, Deakin University van der Klift J, Deakin University Spellman C, Deakin University Hunter S, Deakin University вЂў Watkins V, Deakin University, P/T вЂў 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: вЂў Community reintegration after healthrelated events вЂў Expanded and/or non-traditional roles for allied health вЂў 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 mothersвЂ™ wellbeing and risk of postnatal depression had never been investigated before. Emily Norman, a physiotherapist working in womenвЂ™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 WomenвЂ™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 вЂ“ personenvironment - occupation analysis. Berndt A, Darzins P, May E (Occupational therapy). Do SMS reminders reduce вЂ�did not attendвЂ™ (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 ParkinsonвЂ™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 patientвЂ™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. вЂњDo what you can, with what you have, where you areвЂќ (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 patientsвЂ™ 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 вЂ“ 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, OвЂ™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 ParkinsonвЂ™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. OвЂ™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. OвЂ™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;В 22(3):203-209. OвЂ™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,В Tucker A,В Kritikos A,В 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 patientsвЂ™ 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 physiotherapistsвЂ™ 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 вЂўHelena Frawley PhD Allied Health Research Lead, Eastern Health PhD candidate, La Trobe University Focusing on WomenвЂ™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. HelenaвЂ™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 womenвЂ™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 womenвЂ™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):В 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 вЂ“ 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 AlzheimerвЂ™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? DietitiansвЂ™ 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. вЂњDo what you can, with what you have, where you areвЂќ (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 вЂ“ 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 вЂ“ 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, OвЂ™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 вЂ“ 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 вЂ“ a dietitianвЂ™s вЂўKatherine Harding Allied Health Research Officer, Clinical Consultant, Continence and WomenвЂ™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. DonвЂ™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 вЂ“ 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 вЂ“ transforming bedside care. An observational studyВ of theВ 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 вЂ“ 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 вЂњMusical Instrument playing to address upper limb exercises for older adults in a rehabilitation unit: A collaborative music and occupational therapy projectвЂќ, to attend the 24th International Institute of Neurologic Music Therapy, London, May 2009. Michelle Kaminski (Podiatry), The вЂњAaxis New Investigator AwardвЂќ for the best new scientific presentation for her presentation вЂњThe prevalence of risk factors for foot ulceration in patients with end stage renal diseaseвЂњ 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. вЂў Brusco N, La Trobe University, P/TВ В В В В В В В 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. вЂў Harding K, La Trobe UniversityF/TВ В В В В В В Research training PhD вЂў Boltong A, University of Melbourne, F/T В В В В В В В В В В В В В В В вЂў Iles R, La Trobe University, P/T вЂў Peiris C, La Trobe University, F/T вЂў Mulrain K, University of Queensland P/T Masters вЂў Tang C, La Trobe University, P/TВ В В В В В В В В В В В В В В В В В В В В В вЂў Radia-George C, La Trobe University, P/TВ В В В Honours вЂў Dennett A, La Trobe University вЂў Kaminski M, La Trobe University вЂў Shaw K,В 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 preceptorsвЂ™ 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 clientsвЂ™ psychiatric symptoms, quality of life, self-harm behaviour and hopelessness. The use of video monitoring for inpatients in an acute aged mental health unit вЂ“ enhancing clinical care. Sivakumaran H, Thirunavukarasu G. Enhancing cliniciansвЂ™ involvement with patientsвЂ™ families in an aged personвЂ™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 participantsвЂ™ 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. вЂўDr 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 вЂ“ 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, (EdвЂ™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.В 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.В 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. вЂњStand Together and CareвЂќ, 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 вЂ�Are you being served?вЂ™ Hospital pharmacists ask community pharmacists. OвЂ™Brien T, Zamani M, Cording A. This study aims to optimise the relationship and communication between hospital and community pharmacists and to determine whether communityВ 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 hospitalвЂ™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. DoctorsвЂ™ attitude towards, and knowledge of, antibiotics prescribing at Box Hill Hospital. Georgy M, Lim K, Chally R, Zaidi T. The project is measuring doctorsвЂ™ 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 pharmacistsвЂ™ 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 pharmacistsвЂ™ interventions related to antibiotics at Box Hill Hospital. PatientsвЂ™ 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 nursesвЂ™ 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 doctorsвЂ™ 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. вЂўPaula 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 HealthвЂ™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 mothersвЂ™ 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 вЂњbelonging to a social networkвЂќ 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 participantвЂ™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 вЂ�Breathing New Life into Maternity CareвЂ™, 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 PointвЂ™s research team (consisting of 30 staff ) conducts practical and applied research leading to policy and service development. Areas of research and development include: вЂў Health services research which informs policy and service development, enabling a better understanding of the needs of service users вЂў Clinical and forensic research which focuses on integrating medical, psychological and social aspects of drug use and treatment, and includes intervention research вЂў Cognitive and neurobiological research which focuses on examining the impact of drug use on brain development, brain function and clinical outcomes вЂў Population health and school-based research which seeks to improve the communityвЂ™s literacy regarding alcohol and drug use and subsequent help-seeking вЂў Epidemiology and surveillance which investigates patterns of drug use and the associated outcomes in the community вЂў Alcohol policy research which monitors drinking trends and alcohol-related harm someone elseвЂ™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 AlcoholвЂ™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 alcoholвЂ™s harm to others The alcoholвЂ™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 alcoholвЂ™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 alcoholвЂ™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 alcoholвЂ™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 alcoholвЂ™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 alcoholвЂ™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 peopleвЂ™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 VictoriaвЂ™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 elseвЂ™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 alcoholвЂ™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 PointвЂ™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 GamblerвЂ™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 вЂ“ 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. вЂўProf 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 FoundationвЂ™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 (ModavigilВ®) 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: вЂў identify and describe existing models of treatment intake in the Victorian AOD sector вЂў document good practice and the context within which it occurs вЂў identify enablers and barriers in AOD intake models вЂў 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 вЂ“ 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 userвЂ™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 вЂ“ ItвЂ™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, Г–sterberg 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, Г–sterberg 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):426вЂ“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 womenвЂ™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 addictsВ -В 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, LГ¶nnroth 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, MГ¤kelГ¤ 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 drinkerвЂ™s effect on the social environment: A conceptual framework for studying alcoholвЂ™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 вЂ“ 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. ItвЂ™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, YГјcel 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, YГјcel 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 1999/00вЂ“2006/07. Volume 1. Melbourne: Turning Point Alcohol and Drug Centre; In press. Takagi MJ, YГјcel 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 peopleвЂ™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 1999/00вЂ“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 2003вЂ“04 to 2007вЂ“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, YГјcel 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. HГ¶lscher 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 alcoholвЂ™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 1999вЂ“2000 to 2007вЂ“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 вЂ�party drugвЂ™ 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 вЂ“ Temperance as the source of all our troubles. Addiction Research and Theory. In press. Room R. вЂњContemporary Drug ProblemsвЂќ then and now вЂ“ an editorвЂ™s envoi. Contemporary Drug Problems. In press. McCann TV, Lubman DI, Clark E. First-time primary caregiversвЂ™ experiences of caring for young adults with first-episode psychosis. Schizophrenia Bulletin. In press. Feil J, Sheppard D, Fitzgerald PB, YГјcel 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;1вЂ“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 cohort study (est 1992). Australasian Professional Society on Alcohol and Other Drugs, Living on the Edge; 1вЂ“4 November 2009; Darwin. Drug and Alcohol Review; 2009. p. A67. Coulson C, Williams LJ, Henry MJ, Berk M, Lubman DI, Brennan S, Nicholson GC, Kotowicz MA, Korn S, Pasco JA. Patterns of alcohol use and associated physical and lifestyle characteristics according to new Australian guidelines. Australian & New Zealand Journal of Psychiatry. In press. Smith A, Lyons A, Ferris J, Richters J, Pitts M, Shelley J, et al. Sexual and relationship satisfaction among heterosexual men and women: The importance of desired frequency of sex. Journal of Sex & Marital Therapy. in press. Abstracts Ferris JA, Berends L, Laslett A-M. The personal cost of someone elseвЂ™s drinking: Data from the Range and Magnitude of AlcoholвЂ™s Harm to Others Study. Australasian Professional Society on Alcohol and Other Drugs, Living on the Edge; 1вЂ“4 November 2009; Darwin. Drug and Alcohol Review; 2009. p. A78. 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; 1вЂ“4 November 2009; 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; 1вЂ“4 November 2009; 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; 1вЂ“4 November 2009; Darwin. Drug and Alcohol Review; 2009. p. A78. 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 96 Eastern Health Research Report 2009-10 Livingston M, Wilkinson C. The impact of other peopleвЂ™s drinking on health and wellbeing. Australasian Professional Society on Alcohol and Other Drugs, Living on the Edge; 1вЂ“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; 1вЂ“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; 1вЂ“4 November 2009; Darwin. Drug and Alcohol Review; 2009. p. A67. Nielsen S, Cameron J. Over the counter pain relievers вЂ¦ hidden harms? Results of a web based survey Australasian Professional Society on Alcohol and Other Drugs, Living on the Edge; 1вЂ“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; 1вЂ“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; 1вЂ“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; 1вЂ“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; 1вЂ“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; 1вЂ“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; 1вЂ“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; 1вЂ“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; 1вЂ“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; 1вЂ“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; 1вЂ“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; 1вЂ“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; 1вЂ“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; 1вЂ“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 MagistrateвЂ™s Early Referral Into Treatment (QMERIT) program. Australasian Professional Society on Alcohol and Other Drugs, Living on the Edge; 1вЂ“4 November 2009; Darwin. Drug and Alcohol Review; 2009. p. A67. Ferris J, Berends L, Laslett AM. The personal cost of someone elseвЂ™s drinking! Data from the range and magnitude of alcoholвЂ™s harm to others study. Australasian Professional Society on Alcohol and Other Drugs, Living on the Edge; 1вЂ“4 November 2009; Darwin. Drug and Alcohol Review; 2009. p. A78. Books Cherpitel CJ, Borges G, Giesbrecht N, Hungerford D, Peden M, Poznyak V, et al, editors. Alcohol and Injuries: emergency department studies in an international perspective. Geneva: Departments of Mental Health and Substance Abuse & of Injuries and Violence Prevention, World Health Organisation, 2009. Babor T, Caulkins J, Edwards G, Fischer B, Foxcroft D, Humphreys K et al. Drug Policy and the Public Good. Oxford: Oxford University Press; 2010. Room R, Fischer B, Hall W, Lenton S, Reuter P. Cannabis Policy: Moving Beyond Stalemate. Oxford; New York: Oxford University Press; 2010. Babor T, Caetano R, Casswell S, Edwards G, Giesbrecht N, Graham K et al. Alcohol: No Ordinary Commodity - Research and Public Policy. 2nd ed. Oxford: Oxford University Press; 2010. Book sections: Giesbrecht N, Cherpitel CJ, Room R. Alcohol policy and public health implications in a global perspective. In: Cherpitel CJ, Borges G, Giesbrecht N, Hungerford D, Peden M, Poznyak V, et al, editors. Alcohol and Injuries: Emergency Department Studies in an International Perspective. Geneva: Departments of Mental Health and Substance Abuse & of Injuries and Violence Prevention, World Health Organisation; 2009. p.293-300. Rehm J, Room R. Aggregate versus. individual data as bases for modelling the impact of alcohol on injury. In: Cherpitel CJ, Borges G, Giesbrecht N, Hungerford D, Peden M, Poznyak V et al, editors. Alcohol and Injuries: Emergency Department Studies in an International Perspective. Geneva: Departments of Mental Health and Substance Abuse & of Injuries and Violence Prevention, World Health Organisation; 2009. p.109-20. Room R. The relation between blood alcohol content and clinically assessed intoxication: Lessons from applying the ICD-10 Y90 and Y91 codes in the emergency room. In: Cherpitel CJ, Borges G, Giesbrecht N, Hungerford D, Peden M, Poznyak V, et al, editors. Alcohol and Injuries: Emergency Department Studies in an International Perspective. Geneva: Departments of Mental Health and Substance Abuse & of Injuries and Violence Prevention, World Health Organisation; 2009. p.149-60. Room R, Cherpitel C. Issues related to emergency department studies: Introduction. In: Cherpitel CJ, Borges G, Giesbrecht N, Hungerford D, Peden M, Poznyak V, et al, editors. Alcohol and Injuries: Emergency Department Studies in an International Perspective. Geneva: Departments of Mental Health and Substance Abuse & of Injuries and Violence Prevention, World Health Organisation; 2009. p.67. Schmidt L, MГ¤kelГ¤ P, Rehm J, Room R. Alcohol: equity and social determinants. In: Blas E, Sivasankara Kurup A, editors. Equity, Social Determinants and Public Health Programmes. Geneva: World Health Organisation; 2010. p.11-29. Room R. The ambiguity of harm reduction: goal or means, and what constitutes harm? In: Rhodes T, Hedrich D, editors. Harm Reduction: Evidence, Impacts and Challenges. Lisbon: European Monitoring Centre for Drugs and Drug Abuse; 2010. p.115-8. Hester R, Lubman DI, YГјcel M. The role of executive control in human drug addiction. In: Behavioral Neuroscience of Drug Addiction. Self DW, Staley JK (eds). Springer; 2010. p.301-318. Hides L, Carroll S, Lubman DI, Baker A. Brief motivational interviewing interventions for depression and anxiety. In: Oxford Guide to Low Intensity CBT Interventions. Bennett-Levy J, Richards D, Farrand P, Christensen H, Griffiths K, Kavanagh K, Klein B, Lau MA, Proudfoot J, Ritterband L, Williams C, White J (eds). Oxford University Press; 2010. p.177-186. 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 MagistrateвЂ™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 2006вЂ“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 alcoholвЂ™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 вЂ“ 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 counsellorвЂ™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 alcoholвЂ™s harm to others: first steps with Australian data. Royal Society of Edinburgh conference on вЂњAlcohol, our favourite drugвЂќ. 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 HealthвЂ™s вЂњaxis of evilвЂќ. 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. вЂњPolarisationвЂќ вЂ“ 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 othersвЂ™ 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; SkarpГ¶, 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 вЂ“ A Victorian case study Alcohol, Tobacco and other Drugs Council of TasmaniaвЂ™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 MagistrateвЂ™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 elseвЂ™s drinking. Data from the range and magnitude of alcoholвЂ™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. вЂњ...if IвЂ™d known what it was like on Fridays and Saturdays, IвЂ™d never have moved here.вЂќ Distances to alcohol outlets and experiences of alcohol-related Ferris JA, Berends L, Laslett A-M. The personal cost of someone elseвЂ™s drinking: Data from the Range and Magnitude of AlcoholвЂ™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 peopleвЂ™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 вЂ¦ 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 вЂ“ 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 alcoholвЂ™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 вЂ“ 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. вЂў вЂў вЂў вЂў вЂў 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 alcoholвЂ™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 вЂў Simpson A. La Trobe University, P/T вЂў Roberts B. Monash University, F/T вЂў Clarke C. University of Melbourne, P/T Masters вЂў Schotterlein M. La Trobe University, F/T вЂў Kenny P. University of Melbourne, F/T вЂў McElwee P. Deakin University, PT Honours students вЂў Wilkinson C. University of Melbourne P/T вЂў Harney A. La Trobe University, P/T Research Fellows вЂў вЂў вЂў вЂў вЂў вЂў вЂў вЂў вЂў 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 вЂў вЂў вЂў вЂў вЂў Berends L. F/T Lloyd B. F/T Hunter B. F/T Nielsen S. F/T Devaney M. 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