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2012Research ReportBroadmeadows Health ServiceBundoora Extended Care CentreCraigieburn Health ServicePanch Health ServiceThe Northern Hospital

Our VisionOutstanding health care forour communityOur MissionTo provide people in Melbourne’snorth with outstanding health care by:• Expanding from a great community basedhealth service to a major university teachinghealth service.• Developing the services and the pathways toservices that our community needs.• Embedding the best teaching and researchpractice in everything we do.• Cultivating a community of staff, patients andfamilies who work together.Our Commitment• Passionate – we care• Dedicated – we are focused• Progressive – we look to improve• Collaborative – we are a teamOur Priorities1. Provide a balanced mixof quality services.2. Fully utilise our resources anddevelop our infrastructure.3. Strengthen organisational capability.4. Attract and develop a highperforming workforce.

contentsappointmentscontentsat Latrobe, Deakin and the University of Melbourne are held by many Northern Health staff and this is one ofResearch Report3 CEO’s Message5 Introduction6 From The Research Committee11 2012 Research Committee Members13 Northern Health Human Research Ethics Committee15 Allied Health Research At Northern Health17 Allied Health Learning and Research Centre24 Clinical Medicine and Aged Care Research28 Clinical Haematology Service31 Oncology Department32 Cardiology Research34 Intensive Care Unit37 Paediatrics39 Orthopaedic Research40 Department of Orthopaedic Surgery43 Northern Clinical Research Centre49 Nursing Research50 Nursing Education54 Deakin University – Northern Health Clinical Partnership60 The University Of Melbourne Department Of Medicine (Nwac)65 The University Of Melbourne, Department Of General Surgery67 The University Of Melbourne, Department Of Psychiatrythe areas that we particularly wish to grow over the next few years.1

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CEO’s MessageNorthern Health is expanding from a community based health service to a major university teaching health service.Along with our academic partners we understand the importance that research and training plays in strengthening ourcapability and influencing patient outcomes.The population of the north is predicted to grow by 64% by 2026, in response to this growth, Northern Health willcontinue to adapt and improve our clinical services to meet the ever-changing needs of our community. We believethat research focused on the community will help prevent ill health, provide better care and build better health systems.As our clinicians work with patients and their families to address immediate health issues, our research aims to raiseawareness and discover outcomes that will benefit the community as a whole.In 2013 we officially opened three Clinical Education Buildings, located at Bundoora Extended Care Centre,Broadmeadows Health Service and Craigieburn Health Service, enabling Northern Health to attract and develop a highperforming workforce by building on innovative integration of researchers, educators and health professionals. Thesefacilities are complimented by our new Teaching, Training and Research Precinct which is currently under constructionand will be completed in 2015.Through initiatives such as these and continued investment into high quality innovative programs we will ensurepatients receive the latest evidence-informed care.chief executive officer’s messageJanet ComptonChief Executive OfficerNorthern Health3

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IntroductionINTRODUCTIONThe Northern Health Strategic Plan 2013-2017 – Outstanding healthcare for our community emphasises the importanceof research and innovation in all that we do at Northern Health. Our vision to provide people in Melbourne’s North withoutstanding health care is predicated on research assisting in the development of new services which are aligned withcommunity needs, expanding to a major university teaching health service and using innovation to improve our productivity.Over the past 12 months we have significantly boosted our profile in research by increased publishing in peer reviewedjournals and grants from government agencies including the National Health and Medical Research Council (NHMRC). Ourlinks with industry are increasing, so too is our community engagement. An increasing number of clinical trials means ourpatients have the opportunity to access medications and devices before the general Australian public and also allows ourclinicians to be at the cutting edge of health innovations. Our small grants scheme which is used to start young researcherson a research trajectory remains very popular and it was pleasing to see so many high quality applications again this year.We appreciate the enormous efforts our clinicians make in engaging in research when the pressures of delivering servicesare so great. This appreciation of the importance of the research and learning agenda will take Northern Health to newheights and we know that requires dedication and sacrifice on the part of our clinicians, for which we are very grateful.Our partnerships with the University of Melbourne and La Trobe University will be strengthened with the building of theTeaching, Training and Research Precinct which will be completed by the end of 2014. This will add significantly to ourresearch and learning by providing state of the art facilities for inter-professional education (a key factor in training the futurehealth workforce), simulation and research space. Sharing this facility is expected to lead to an expansion in collaborativeresearch activities which are crucial in this era of competitive funding. Partnerships with Deakin University and RMIT arealso being expanded and Northern Health researchers continue to take a leadership role in national and international healthpartnerships.Again the Board and Executive acknowledge the efforts of all our researchers and hope you will read this annual researchreport with interest and some feeling of ownership for it – you after all have all made your contribution to it as staffmembers of Northern Health.Gab KovacsWorkforce Organisational DevelopmentResearch and Education Committee5

From the Research CommitteeThe 2012 Northern Health Research Report builds on last year’s report and demonstrates significant growth and consolidationof research activities across Northern Health. It is important that our research activities remain relevant to our mission ofproviding high quality clinical outcomes to our patients and that the research informs our teaching as well.This report provides information on the increasing number of active clinical research groups and activities within the clinicaldepartments across Northern Health. It indicates major achievements, details of specific research projects and benefits thatflow from these efforts.This year we have concentrated on communicating our research activities by creating a web-based portal so that researcherscan link with each other easily and share information on research activities ideas and protocols in a protected portal. Itwill also provide information on research grant opportunities and other research relevant issues. The portal will also allowmembers of the public to get an idea of the research activities that are being pursued and understand how they can make apositive contribution to research by volunteering as participants in trials.The research themes developed in last year’s strategic plan continue to guide our efforts and will be further developed in theyears ahead. They are:Health Research at Northern HealthCHRONICDISEASECENTREFOR AGEINGRESEARCHCENTREFOR CARDIAC& VASCULARRESEARCHDIVERSITYEQUITYCLINICALTRIALSHEALTHSERVICESRESEARCH6In February 2013 we held a strategic planning morning with over 30 clinicians to explore research opportunities acrossNorthern Health. The enthusiasm at the session was terrific and many participants commented that they were unawareof much of the research activity underway – emphasising that we at the research office not only need to be better atcommunicating the research ‘message‘ but that we also have a good base on which to build.annual research report Northern Health 2012

One of the opportunities for research is that of clinical trials and it was good to see the involvement of some of the trialsnurses at the research planning day. We are involved in an increasing number of clinical trials – often funded through thepharmaceutical industry- which provides our patients with earlier access to new treatments and allows our doctors to usecutting edge technologies and medications before they are available to the general public.Our local population is so diverse that it will become increasingly important for these trials and also for investigator-driventrials where the question is something that we at Northern Health need answered. This is an area of significant expansionas we go forward, whether it is looking at new ways of delivering care to the aged using different types of workers, alliedhealth or nursing assistants, or using technologies such as mobile phones and telehealth to improve access to health care.We need to emphasise the importance of patient participation in clinical research as it is beneficial to their care and clinicaloutcomes as well.This year we saw increased NHMRC funding to Northern Health staff in the areas of epilepsy and obesity research. Wewere also successful in obtaining grants in the area of telehealth and in developing new models of care delivery for chronicdisease. The outcomes of these research activities have the potential to significantly improve patient care.An important initiative of Northern Health continues to be the small research grants scheme and we thank the Board forthis. These grants allow early researchers to develop their projects through to publication, supplies subsequent externalfunding and forms a very important part of the Northern Health Quality and Research Week. In 2012 a wide range of clinicaldisciplines were awarded small grants as detailed in the list below.From the Research Committee• Podiatry: Use of compression stockings in the management of neuropathic foot ulcers.• Physiotherapy: Development and evaluation of a training package enabling carers of patients admitted to the TransitionCare Program to assist with the provision of physiotherapy.• Orthopaedic Unit: Outcomes of operated ankle fractures treated with early weight bearing versus six weeks of plastering.A randomised control trial.• Department of Medicine: Emergency presentations of abdominal pain in the geriatric population: Common diagnosesand parameters that predict acuity and outcomes.• Nursing Education: Evaluation of the traditional preceptor ship model in a changed workforce: a localised study.• Nursing: Recognition of clinical deterioration in maternity patients.• Physiotherapy: Diastasis of the rectus abdominis muscles; does it resolve spontaneously postpartum?• Department of Orthotics: Relationships between depression on quality of life and foot ulcer healing rate in type 2diabetic patients with a neuropathic foot ulcer.• Department of Surgery: The utility of breast MRI in high mammographic density patients.Another continuing agenda is the partnerships that we have with our universities.The University of Melbourne and La Trobe University have collaborated in the Teaching, Training and Research Precinct (TTRP)which will be finished at the end of 2014. The TTRP will provide state of the art facilities for teaching and research includingspace to help grow our research capacity as well as providing learning spaces for our students – the health researchers ofthe future. We are also developing research collaborations with RMIT and Deakin University who, as well as using NorthernHealth for student placements, also have campuses and research expertise close by that can help us answer importantclinical questions.An example of such collaboration is a very exciting project currently being developed by researchers from the University ofMelbourne, La Trobe and Deakin which focuses on the use of a Mediterranean diet to reduce weight and thus the impactof obesity on chronic diseases such as diabetes and cardiac disease. This is an exemplar of bringing research expertisefrom a number of institutions to address an important clinical question, developing a protocol for carrying out the researchand then seeking funding for the study. This project will involve many clinical groups – nutritionists, dieticians, biochemists,cardiologists, diabetologists, general practitioners, nurses, allied health practitioners, epidemiologists and more as well asbiostatisticians.7

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From the Research Committee cont’dThe Northern Health community has significant clinical issues particularly relating to chronic disease. The average Australianover the age of 60 will have at least four chronic conditions and there are enormous opportunities for working closely withclinicians and the community to solve some of these important problems.From the Research CommitteeHealth services research offers the opportunity of true translation of results of research into better health outcomes for thecommunity. It is not just about getting a positive result for a research program but ensuring that that results are convertedinto policy and practice and that they have a positive impact on the patient. An important component is how we providebetter supports in the community to reduce hospital admission. The rapidly growing number of aged Australians with chronicdiseases will place unprecedented demands on the health system that requires planning for the future in a very differentway. At Northern Health we have the opportunity to be at the forefront of these new models of care delivery – engaging ourclinicians and the community in providing solutions to these exciting but challenging issues.This year we will be focusing our research week again on the quality and safety agenda. Quality, Safety and Research Weekwill provide a range of educational activities directed at the issue of clinical handover and patient literacy - both importantissues if we are to impact positively on patient outcomes.We look forward to working with all staff of Northern Health in helping to grow the research agenda over the next few yearsand ensure that the research we do is relevant to patient outcomes.Professor Peter BrooksExecutive Director of ResearchDr Anastasia HutchinsonChair, Research Committee9

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2012 Research Committee membersProfessor Peter BrooksDr Anastasia HutchinsonMs Maree CuddihyExecutive Director of ResearchChair; Director, Northern Clinical Research CentreExecutive Director Business Performance PlanningWorkforce2012 Research Committee membersAssociate Professor Julie ConsidineDeputy Chair; Senior Research Fellow,Deakin University – Northern HealthProfessor Judy SavigeProfessor of MedicineAssociate Professor Kwang LimDirector, Clinical Services Medicine andChief Medical OfficerMr Ryan BrownDirector, Corporate CommunicationsMs Robyn SmithDirector, Allied Health Learning and ResearchDr Karen BarclaySurgeon and lecturer in surgery, Universityof MelbourneAssociate Professor Peter BarlisCardiologist Northern Health, Austin Health,University of MelbourneDr Louisa RamuduClinical Nurse Educator (Neonates)Ms Jana GazarekChair of Allied Health Research portfolioMiss Loretta GiummarraNorthern Health Research Coordinator – Minute taker11

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Northern Health Human Research Ethics CommitteeNorthern Health coordinates primary and low risk/quality ethics committees and is responsible for the governance ofstreamlined ethical review process for multi-site clinical trials conducted at Northern Health. Both our Primary and Low RiskCommittees operate in accordance with the National Statement on Ethical Conduct in Human Research 2007.The Primary Committee reviewed a total of 20 acute studies and approved five drug or device trials, and 15 studies beingperformed by investigators wishing to publish their results.Eleven multi-site clinical trials were considered and approved in 2012 where Northern Health monitors research governanceof these trials only.The Low Risk committee has approved a total of 42 low risk and quality projects in 2012.Northern Health Human Research Ethics Committee Primary DivisionDr Barbara Hayes Ms Maree Cuddihy Mr Michael El MoussalliMs Jane Petryszyn Mr Russell Peterson Ms Fiona MiddletonDr William van Gaal Mr Neil Strugnell Ms Kate EveMs Cheryle Williams (Research Governance Officer).Retiring members: The Northern Health Primary HREC would like to thank Associate Professor Phillip Ebrall, Dr Shane White,Dr Graeme Duke and Ms Christine Lamotte for their past dedication and contribution to the committee.Northern Health Human Research Ethics CommitteeNorthern Health Human Research Ethics Committee Low Risk/Quality DivisionDr Anastasia Hutchinson (Chair)Mr Tshepo RasekabaMr Shane GrantDr Erica PennoMs Lori McLeod-MillsAssociate Professor Graeme HawthorneDr Barbara HayesMs Jenny PetersonMs Robyn SmithDr Peter JordanMs Pramila NaiduMs Loretta GiummarraWe continue to be indebted to the members of these committees for their dedicated attention to detail, thoughtfulconsideration of proposals and support of research effort within Northern Health.Ms Maree CuddihyDr Anastasia HutchinsonNorthern Health Human Research Ethics Committees13

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Allied health research at Northern HealthAllied Health is often referred to as ‘the bridge’ between the hospital and the home with allied health practitionersat Northern Health spanning a broad range of disciplines including physiotherapy, speech pathology, audiology,orthoptics, nutrition and dietetics, podiatry and more.Consequently, the Allied Health Learning and Research Program at Northern Health covers a diverse range of topicswith more than 20 projects underway, but each study has a very clear aim: to find ways of improving and enhancingpatient care.With that objective in sight, there are a number of projects that specifically investigate the impact of cultural andlinguistic diversity on health outcomes for which there is often little primary research available. For example, one studyhas conducted focus groups and interviews with pregnant Iraqi women who have gestational diabetes to determinewhat is required for effective, culturally appropriate nutritional education for their condition. Another investigationby physiotherapy students looks at stroke patients and the impact of interpreter use on health outcomes; while athird study examines culturally and linguistically diverse patients with colorectal cancer and the timing of their initialpresentation to the health service for treatment.Allied health research at Northern HealthA major research project investigates the potential of inter-professional learning with medical, nursing and allied healthstudents working as a team to provide ward-based care to older patients with multiple conditions. By promotingperson-centred care and working in an inter-disciplinary team, students have the ability to become more confident intheir individual role while at the same time gaining a greater insight into the roles of other team members. The projecthas received overwhelmingly positive feedback from both students and patients.Providing enhanced care for the increasing number of women giving birth at The Northern Hospital is a focus of acurrent physiotherapy investigation which looks at abdominal muscle strength post-birth in order to provide evidencebasedguidance on when new mothers can safely start exercising after giving birth.Another study led by the podiatry team investigates the relationship between depression, quality of life and the healingof foot ulcers which may have far-reaching implications for the growing number of patients with diabetes and thecomplications that arise from poor circulation such as foot ulcers. Early research findings indicate a link betweendepression and quality of life and the time it takes for a foot ulcer to heal.Podiatry students are also examining new training tools such as simulated foot models which would enable studentsto practice their skills on a model before administering care to a patient.15

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Allied Health Learning and Research CentreAllied health staff at Northern Health work across all campuses and programs of the health service. Allied health itself is abroad group of health practitioners – with each discipline contributing their own unique perspective and skill set to clinicalcare and to the research arena.This year has been one of evolution and change – within the allied health research team and more broadly in the health caresector. Change brings with it opportunity, and we plan to capitalise on the opportunities ahead of us to strengthen researchcollaborations and to refine our research directions and activities.Even with a busy clinical load, many allied health staff are focusing on research questions directly relevant to the care theyprovide to the northern community. More staff are taking up opportunities to apply for small research grants, to undertakehigher degree study and to actively engage in the research process. This is a great result and an important step for eachindividual’s career development. It also contributes to Northern Health being a dynamic and interesting workplace that iscommitted to developing and delivering higher quality services to a growing population.Allied Health Learning and Research CentreKey research areasChronic disease managementCultural diversityNutritionPhysical activity and rehabilitationClinical education/workforce developmentNew models of care/health services researchFalls prevention, safety and risk managementResearchers and staffRobyn SmithProfessor Karen DoddDr Kim MillerApril TuDirector, Allied Health Learning and ResearchProfessor of Allied Health (acting from Jan – Sep)Allied Health Research Fellow (Feb – July)Allied Health Research OfficerJessica AndrianakisCasie BarretteRilda BennettPeter BrackTara BrehenyChris BuckleyElla BuschBianca CappelliSophie CookeSarah DaviesAnne-Marie DawZeina DayoubLauren DwyerRachel EllisLisa ElyJane FeutrillSarah FosterJana GazarekSharon HakkennesAnton HarmsKate HarperFiona HollandJim HoweIngrid IoannidisSarah JeffressRebecca JessupJulie LamRebecca LamontLucette LanyonKatherine LawlerEdmund LeahyKenneth KohSimone MaherShari MaverTalya McDonaldSarah McMillanPasty MillsAshley NgKrystle NgCaroline OstbergCarla PearsonDavid PriceSophie RodierConstance SchneiderClaire SchofieldJenni SmithAnita SpringAndrew SteelNadia SzwedAdele TaylorJonathan WarneRobyn WallaceCraig WhitbourneKathryn WilsonEmiliano Zucchi17

Allied Health Learning and Research Centre cont’d18Major achievements in 2012 and futureresearch goalsAllied Health staff and students focus on issues arising fromthe provision of health care to our community. The areasof research fit well within Northern Health’s research matrixof strategic priority. Our projects reflect the Northern Healthcommunity’s wide range and high level of chronic disease,its cultural diversity and the breadth of the life span.Our research questions are generated through direct clinicalexperience. How will we ensure culturally appropriate carefor a wide range of people with significant health careconditions? How can we build capacity to teach and trainmore health professionals and prepare them more effectivelyfor working in collaborative teams when they join theworkforce? What are the best models of care? How can weimprove our treatment approaches and techniques so thatpeople receive better, more efficient care?Northern Health Allied Health continues to successfullyattract project funding, through the Northern Health smallgrants scheme, Northern Health Foundation and externalfunding agencies. We engage with a wide range ofcollaborators from other health services in multi-site studiesand also with a range of university partners. This year, wehave also engaged in-house with a number of collaborativeprojects that include investigators across allied health,medicine and nursing. Research collaboration amongworking teams is a positive development at Northern Healthand a trend we will continue to foster.In 2012 we have experienced significant change in ourhealth service and in our research team. As we farewelledProfessor Keith Hill, our inaugural Professor of Allied Health(a joint appointment with La Trobe University), ProfessorKaren Dodd continued La Trobe University’s commitmentto collaboration by providing support to Northern HealthAllied Health research during the recruitment process fora new professor. This new role – Professor of Clinical andCommunity Care – will commence by mid 2013. Our goalinto the future is to build on our current research themes andto develop streams of research activity. This will lead intolarger and more significant projects. We will also encouragethe continued trend of allied health staff taking up postgraduateand higher degree study. We are developing aprogram that will foster evidence-informed practice and astronger focus on translational research.Research projects in 2012An analysis of the perceived impact of student pairplacements on occupational therapy supervisorsDavid Priceannual research report Northern Health 2012Audit of renal and low potassium diet codes, indications forclinical management and their implication on malnutritionTalya McDonaldCultural competence and patient-centred careEmiliano ZucchiDevelopment of a culturally appropriate nutrition educationresource for Iraqi women with gestational diabetes mellitusattending the Northern Hospital Gestational Diabetes MellitusClinicNadia SzwedDoes allied health therapy provided by caregivers improvepatient outcomes? A systematic reviewKatherine Lawler, Nick Taylor LTU, Nora Shields LTUDoes exercise following distal radius fracture improveactivity? A multi-centre randomised controlled trialNicholas Taylor LTU, Nora Shields LTU, Karen Dodd LTU,Adele Taylor, Andrea Bruder LTU)Does clinical supervision improve performance of Grade 2allied health clinicians?Kathryn Wilson, Jenni SmithEvaluation of a specific brain training exercise forosteoarthritic knee pain – is it more effective at reducing painthan usual non-surgical care?Anton Harms, Raphael Hau, Lorimer Moseley euRA, TashStanton University of South Australia)Evaluation of the role of a clinical educator (speechpathology) within a Melbourne metropolitan multi-site healthserviceSarah FosterFalls, activity level, and fear of falling in hip fracture patientsreturning home after rehabilitation.April Tu, Keith Hill, Stephen Gill Barwon Health, ChristopherLindner Barwon Health, Kate Lawry, Maivili SelvarajahFalls in older persons: An exploration of factors impacting onthe decision to participate in an exercise program amongstrecent fallersJulie Lam, Pranee Liamputtong LTU, Keith HillHow does cultural and linguistic diversity affect healthoutcomes in stroke patients and what is the impact ofinterpreter use on health outcomes?Sarah Davies, Keith Hill, Karen Dodd [LTU], April Tu

How much is enough? An exploratory study of the alliedhealth intervention received by people admitted to theGeriatric Evaluation & Management UnitRobyn Smith, April TuInterprofessional Practice Placement ProjectRobyn Smith, Sarah McMillan, Peter BrackImproving balance outcomes for patients participating inthe Broadmeadows Health Service strength and balancegroup – a comparison of outcomes associated with adding ahome-based exercise program to a group exercise programfor clients attending community therapy servicesCraig Whitbourne, Sophie Cooke, Carla Pearson, KatharineLawler, Keith HillInsights into nurse knowledge and beliefs surrounding fallsprevention and safety climateAnne Barker Monash University, Keith Hill, Jeanette Kamar,Renata Morello Monash University, Anastasia Hutchinson,April TuLong-term psychosocial stress and quality of life after thediagnosis and treatment of colorectal cancer – the effect ofacculturation, previous experience and major life events in amulticultural tertiary settingFiona Holland, Karen Barclay, Anastasia Hutchinson,Prudence PoonNorthern Health Eye Services – Evaluating orthoptist-ledservices (Department of Health Workforce Innovation GrantProject)Jana Gazarek, Rebecca JessupThe COPD Assessment Test in comparison with the StGeorge Respiratory Questionnaire in an Australian culturallyand linguistically diverse population with chronic obstructivepulmonary diseaseRasekaba Tshepo, Katherine Feely, Florian Zimmerman,Peter Jung, Anastasia Hutchinson, Vicki Lawlor, Elsa Zhang,et alThe effect of acculturation on stage at presentation ofcolorectal cancerFiona Holland, Karen Barclay, Anastasia Hutchinson,Prudence PoonResponding to the needs of children/young people visitingpatients in the Intensive Care UnitIngrid Ioannidis, Kate Eve, Fiona Holland, Mary DeHaan,Keith Bell, Louise Greenstock University of MelbourneStudentsPhDLauren Dwyer (School of Psychological Science, La TrobeUniversity) – ‘Difficulties faced by health professionals in thediagnosis of dementia.’Sharon Hakkennes (School of Physiotherapy, La TrobeUniversity) – ‘Defining rehabilitation admission criteriafollowing moderate to severe stroke – an observationalstudy.’Lucette Lanyon (School of Health Sciences, La TrobeUniversity) – ‘Community aphasia groups: the perspectivesof people with aphasia.’Katherine Lawler (School of Physiotherapy, La TrobeUniversity) – ‘Does Allied Health Therapy provided bycaregivers improve patient outcomes? A systematic review.’Andrew Steel (Department of Psychology– RMIT) –‘Relationships between depression, quality of life and footulcer healing rate in type 2 diabetic patients with neuropathicfoot ulcers.’MastersJessica Andrianakis (School of Health Sciences, Universityof Newcastle) – Master of Health Science (StrokeManagement)Bianca Cappelli (School of Public Health and HumanBiosciences, La Trobe University) – Master of Public HealthSarah Davies (School of Health Sciences, La TrobeUniversity) – Masters by Research, PhysiotherapyRachel Ellis (La Trobe University) – Masters of AppliedScienceLisa Ely (University of Newcastle) – Masters of HealthScience (Stroke Management)Jane Feutrill (School of Health Sciences, Universityof Newcastle) – Master of Health Science (StrokeManagement)Sarah Foster (School of Community Services and SocialSciences, RMIT) – Master of Social SciencesJana Gazarek (School of Public Health and PreventiveMedicine, Monash University) – Master of Health ServiceManagementCaroline Ostberg (School of Public Health and PreventativeMedicine, Monash University) – Master of Public HealthDavid Price (La Trobe Business School, La Trobe University) –Master of Business AdministrationSophie Rodier (Faculty of Medicine and Health Sciences,University of Melbourne) – Master of PhysiotherapyConstance Schneider (Flinders University) – Master ofApplied GerontologyJenni Smith (Graduate School of Business, Deakin University)– Master of Business AdministrationJonathan Warne (School of Surgery, University of WesternAustralia) – Master of Manual TherapyAllied Health Learning and Research Centre19

Allied Health Learning and Research Centre cont’dOtherJimmy Goulis (School of Health Sciences, La TrobeUniversity) – Graduate Certificate in MusculoskeletalPhysiotherapy (coursework)Student completions in 2012Casie Barrette (School of Pharmacy, Monash University) –Graduate Diploma in Wound CareKate Harper (School of Pharmacy, Monash University) –Graduate Diploma in Wound CareKenneth Koh (School of Physiotherapy, La Trobe University)–Graduate Certificate in Musculoskeletal PhysiotherapySimone Maher (Department of Physiotherapy, University ofMelbourne) – Specialist Certificate in Paediatric OrthopaedicPhysiotherapyAshley Ng (School of Exercise and Nutrition Sciences,Deakin University) – Honours Degree: ‘The effect ofnutritional supplementation on the healing of diabetic footulcers.’ Northern Health supervisor – Tara Breheny and TanyaGilliverAdele Taylor (School of Physiotherapy, La Trobe University) –Graduate Certificate in Musculoskeletal PhysiotherapyResearch and project grantsGrants where Northern Health is the sole or lead agencyYear grant received Funding source Project name Investigators and affiliations Amount2010–12 Department of Interprofessional Smith R, McMillan S, Brack P $473,000Health and Ageing practice placements2011-12 Department of Health, Learning together to work Smith R, Baldac S, partnering $121,000Victoria together in Melbourne’s with Darebin Community,north - Interprofessional Health Centre, La TrobeLearningUniversity, Austin Health2012 MND Association NinaBuscombe Award Bennett R $2,000of Victoria(provides funds forattendance at trainingcourses, conferenceswithin Australiaor overseas)2012 Department of Health Orthoptist-led Gazarek J, Jessup R, Dayoub Z, $26,954monitoring clinicWallace R (Cancer CouncilVictoria)2012 Northern Health Small Development and Lawler K, Taylor N (LTU), $4,977Research Grant – evaluation of a training Shields N (LTU)Round 12package enabling carersof patients admittedto the Transition CareProgram to assist with theprovision of physiotherapy2012 Northern Health Diastasis of the rectus Schofield C $4,862Small Research Grant – abdominis muscles; doesRound 13it resolve spontaneouslypostpartum?20annual research report Northern Health 2012

Year grant received Funding source Project name Investigators and affiliations Amount2012 Northern Health Small Relationships between Steel A, Reece J(RMIT), Daw AM $4752.88Research Grant – depression on qualityRound 13of life and foot ulcerhealing rate in type 2diabetic patients witha neuropathic foot ulcer2012 Northern Health Small Use of compression Harper K, Spring A, $4799.65Research Grant – stockings in the Munteanu S(LTU)Round 13management ofneuropathic foot ulcersAllied Health Learning and Research CentreGrants involving Northern Health staff, but external lead agencyYear grant received Funding source Project name Investigators and affiliations Amount2012 Health Workforce Simulation Centres St Vincent’s Health, Northern $1.6 millionAustralia/Department of Excellence Health, Austin Health,of Health Victoria La Trobe University, RMITUnviersity, Mercy Health,St Vincents’ Private, AustralianCatholic University.Research publicationsPeer reviewed journalsAndrews S, Lea E, Haines T, Nitz J, Haralambous B, MooreK, Hill K, Robinson A. 2012, ‘Reducing staff isolation anddeveloping evidence-informed practice in the aged careenvironment through an action research approach to fallsprevention’, Advances in Nursing Science, 35(1):3-13.Clark E, Hill K, Punt D. 2012, ‘Responsiveness of two scalesto evaluate lateropulsion or pusher syndrome recoveryafter stroke,’ Archives of Physical Medicine andRehabilitation 93(1): 149-155.Maver S, Dodd K, Hylton M. 2012, ‘Lower limb reactiontime discriminates between multiple and single fallers,’Physiotherapy Theory and Practice 27(5): 329-366.Price S, Kinsella G, Ong B, Storey E, Mullaly E, Phillip M,Pangnadasa L, Perre D. 2012, ‘Semantic verbal fluencystrategies in amnestic mild cognitive impairment,’Neuropsychology 26(4):490-497.Raspovic A, Landorf K, Gazarek J, Stark M. 2012, ‘Reductionof peak plantar pressure in people with diabetes-relatedperipheral neuropathy: an evaluation of the DH PressureRelief ShoeTM,’ Journal of Foot and Ankle Research5(1): 25.Taylor N, Bottrell J, Lawler K, Deenika B. 2012, ‘Reminderscan reduce non attendance in physiotherapy outpatientclinics: a randomised controlled trial,’ Archives of PhysicalMedicine and Rehabilitation 93: 21-26.OtherMorris M, Ozanne E, Miller K, Santamaria N, Pearce A, SaidC, Adair B. 2012, ‘Smart technologies for older people.A systematic literature review of smart technology thatpromote health and wellbeing of older people living athome,’ Report for the Institute for a Broadband EnabledSociety.In pressLawler K, Taylor N,, Shields, N. ‘Outcomes After Caregiver-Provided Speech and Language or Other Allied HealthTherapy: A Systematic Review,’ Archives of Physicalmedicine and Rehabilitation.Lanyon L, Rose M, Worrall L. ‘The efficacy of outpatientand community-based aphasia group interventions:a systematic review,’ International Journal of SpeechLanguage Pathology.Mulcare H, Kashima Y, Milgrom J, Wheeler G, Wirth A,Bishop M, Schofield P. ‘Avoidant adjustment predictslower information seeking in people with lung cancer,’Psycho-Oncology.21

Allied Health Learning and Research Centre cont’d22Research presentations and abstractsInternationalBeer E. Advancing speech pathologists’ clinical practice: thedevelopment of a speech pathology tracheal suctioningtraining program at Northern Health.New Zealand Speech-Language Therapists’ AssociationNational Conference, New Zealand, May 2012.Busch E. Review of nutritional adequacy of inpatienttherapeutic diet codes: are we providing enough proteinand energy in default menus?International Congress of Dietetics, Australia,September 2012.Jim Howe, Rebecca Lamont, Rilda Bennett, Sarah Jeffress,Pasty Mills, Krystle Ng, Calvary Health Care Bethlehem.You can do it too! The development of a satellite MNDclinic in suburban Melbourne, Australia.MND Conference, Chicago, November 2012.Lam J, Hill K, Liamputtong P. Falls in older persons: factorsimpacting on the decision to participate in an exerciseprogram amongst recent fallers.Biennial Australian and New Zealand Falls PreventionConference, Australia, October 2012.Lanyon L. Perspectives on community aphasia groups: theexperience of people with aphasia.International Aphasia Rehabilitation Conference, Australia,October 2012.McDonald, T. Audit of renal and low potassium diet codes,indications for clinical management and their implicationson malnutrition.International Congress of Dietetics, Australia,September 2012.Price D, Brack P. Challenging traditional supervision modelsto increase occupational therapy student placementcapacity.Australian and New Zealand Association for HealthProfessional Educators Conference, New Zealand, June2012.Smith RA, McMillan S. How do allied health cliniciansprepare for teaching students in the clinical setting?Australia New Zealand Association of Health ProfessionalEducators (ANZAHPE) 2012: Professionalism UnderPressure. Rotorua, New Zealand, July 2012.Smith RA, McMillan, S, Brack, P. Ward based interprofessionalplacements – under pressure learning in teams!Australia New Zealand Association of Health ProfessionalEducators (ANZAHPE) 2012: Professionalism UnderPressure. Rotorua, New Zealand, July 2012.annual research report Northern Health 2012Breheny T, Kennett P, Sunderland Y, Leahy E, Hill K, LimK. PRIME – “The biggest innovation in improvingthe elective surgery journey” – does intensivemultidisciplinary assessment, including nutritionassessment and management, prior to elective surgeryimprove preoperative and postoperative outcomes inelderly patients?International Congress of Dietetics, Australia, September2012.Tu A, Hill K, Gill S, Lindner C, Kate L, Selvarajah M. Falls,activity level, and fear of falling in hip fracture participantsreturning home after rehabilitation: preliminary analysis.Biennial Australian and New Zealand Falls PreventionConference, Australia, October 2012.NationalBuckley C. Supported early discharge for respiratory patientsat Northern Health.The Thoracic Society of Australia & New Zealand,Australia, March 2012.Gazarek J, Butters T, Blenkiron F. Group model of studentsupervision – the way of the future.Australian Podiatry Association Victoria State Conference,Bendigo, April 2012.Gazarek J, Jessup R, Wallace R, Dayoub Z. Orthoptist ledassessments for diabetic retinopathy and cataracts.Australian Disease Management Association Conference,Melbourne, September 2012.Gazarek J, Jessup R, Wallace R, Dayoub Z. Orthoptist ledassessments for diabetic retinopathy and cataracts.Orthoptics Australia 69th Annual Scientific Conference,Melbourne, November 2012.Lanyon L. Community aphasia group: a systematic review.Stroke Conference, Sydney, August 2012.Lanyon L, Rose M, Worrall L. Community aphasia groups:current practices, evidence for their efficacy, andchallenges in implementation in Australia.Speech Pathology Australia National Conference, Hobart,June 2012.Smith, RA, Baldac, S., Brack, P. Invited presentation:La Trobe University Clinical Educators Workshop –Interprofessional Learning. Melbourne, July, 2012.Szwed N. Current practice for dietary managementof obesity.Gastroenterological Nurses College of AustraliaConference, Melbourne, May 2012.

Tinney J, Cyarto E, LoGiudice D, Haralamboujs B, LeeSM, Rayner V, Zucchi E. Supporting stakeholders ininterpreter-mediated CALD cognitive assessments:guidelines and technology.Australian Association of Gerontology Conference,Brisbane, November 2012.Tu A, Hill K, Gill S, Lindner C, Kate L, Selvarajah M. Falls,activity level, and falls efficacy in hip fracture patients.Australian Association of Gerontology Conference,Brisbane, November 2012.Valle R, Gilliver T, Kozica S. Benchmarking clinical practiceguidelines against evidence based practice guidelines forthe dietetic management of patients with pressure ulcers.Australian Wound Management Association Conference,Sydney, March 2012.Zucchi E. Beyond interpreting: the case fir a languageservice discipline in the health context.Culturally and Linguistically Diverse CommunitiesConference, Sydney, April 2012.Zucchi E, Zen S. The impact of the Northern Health TALSeducation program on the organisation’s culturalcompetence.CALD Patient Services in the Acute Setting Conference,Melbourne, August 2012.Zucchi E. A matter of responsibility – Why hospitals shouldgive Language Services equal importance (and equalfunding) within Allied Health Research Centre.Languages and Cultures Annual Symposium, Adelaide,December 3-4, 2012.Zucchi, E., Zen, S. The impact of the Northern HealthTALS Education Program on the organisation’s culturalcompetence.Culturally Responsive Health Services Conference,Melbourne, August 2012Zucchi, E, Going Beyond Interpreter Booking – EvaluatingCommunication Encounters and Overcoming Resistance,panel discussion.Culturally Responsive Health Services Conference,Melbourne, August 2012.Zucchi E. Beyond Interpreting: the Case for a LanguageServices Discipline Health Context.Culturally and Linguistically Diverse CommunitiesConference, Sydney, April 2012.CollaborationsLa Trobe University, RMIT, University of Newcastle, MonashUniversity, University of Melbourne, Flinders University,Deakin University, University of Western Australia,University of South Australia, Barwon Health.Allied Health Learning and Research Centre23

Clinical medicine and aged care researchDr Doug CromptonDr Doug Crompton is a full time Neurologist at Northern Health. Prof Chris Semsarian and Dr Richard Bagnall (both Universityof Sydney) have, together with Dr Crompton, been awarded $600,000 by Northern Health and MRC for their research projectNeuro-cardiac genetic basis of sudden unexpected death in epilepsy (SUDEP). Doug started his career as a basic scientist,working on genes involved in establishing the nervous system of the fruit fly. After completing his undergraduate degree(University of Cambridge) and his PhD (University of Glasgow) he moved to the Newcastle upon Tyne University (UK) to studymedicine. He completed general medical training in hospitals in and around Newcastle, then embarked on specialty training inneurology, beginning in neuroscience centres in north-east England (2002-06) followed by a Clinical Fellowship in Epilepsy atAustin Health, Melbourne with Professors Sam Berkovic and Ingrid Scheffer (2006-09). Doug then returned to the UK as SeniorClinical Lecturer in Neurogenetics at Newcastle University and Honorary Consultant Neurologist at James Cook UniversityHospital, Middlesbrough (2009-12) before returning to Melbourne as full time neurologist at Northern Health in 2013. Doug’sclinical practice is in all areas of neurology, but his research focus is in the genetics of epilepsies, and he continues to workclosely with Professors Berkovic and Scheffer at the University of Melbourne, Austin Health, who are world leaders in this field.SUDEP project outline: Sudden unexpected death in epilepsy (SUDEP) is the most common epilepsy-related cause of deathand accounts for up to 18 per cent of all deaths in people with epilepsy. SUDEP is characterised by a sudden, unexpected,non-traumatic and non-drowning death in a person with epilepsy, where the post-mortem does not reveal a cause of death.This devastating disorder can affect otherwise well young people and the mechanisms are poorly understood, though recentresearch by Professor Semsarian and his team has shown that mutations in genes which encode cardiac ion channel proteinsplay a role. In this project we will attempt to better understand the clinical basis of SUDEP by studying families of people whohave suffered SUDEP, using a combination of structured interviews, examinations and simple cardiac tests to identify andcharacterise both epilepsies and cardiac disorders. In addition we will sequence all coding genes (“whole exomes”) in peoplewho have died of SUDEP and in selected family members. We will then use a variety of genetic data analysis strategies toidentify gene mutations predisposing to SUDEP. Identification of causative genes should give vital insights into how and whySUDEP happens, potentially enabling preventative strategies to be devised in the future.24annual research report Northern Health 2012

Clinical medicine and aged care researchDr Cilla HaywoodDr Cilla Haywood, one of the geriatricians working for Northern Health, is doing a PhD along with Professor Joseph Proiettoand Associate Professor Kwang Lim, who are her supervisors. The team have been successful in obtaining an NHMRC projectgrant of $594,599. Dr Haywood’s project is an intervention study addressing older patients with obesity titled “Obesity in theelderly: impact of weight loss therapy on physiology and function.” This is a randomised controlled trial of 200 patients over65 years of age comparing exercise alone, exercise in combination with a very low energy diet and a very low energy diet onits own.25

26 annual research report Northern Health 2012

Researchers and staffAssociate Professor Kwang LimDr Craig AboltinsDr Niroj ObeyesekereDr Adam HedleyProfessor Judy SavigeDr Yana SunderlandDr David BaritDr Akram MarcusDr Cameron JeremiahDr Spiros FourlanosDr Carol TongDr Steven NgKey research areasDr Thuy LeDr Suresh VaradarajanDr Sam HumeDr Carol ChongDr Sandra BrownDr Yan ChenDr Parvinder ChaalDr Suresh VaradarajanDr N SachithanandanDr Myra YeoDr Fiona LeePublicationsChong CP, van Gaal WJ, Profitis K, Ryan JE, Savige J, Lim WK.2012, ‘Electrocardiograph changes, troponin levels andcardiac complications after orthopaedic surgery,’ Annals,Academy of Medicine, Singapore. In press. Impact factor1.245.Chong CP, Haywood C, Barker A, Lim WK. 2012, ‘Is EmergencyDepartment length of stay associated with inpatientmortality?’ Australasian Journal of Ageing. In press.Impactfactor 0.905.Lau L, Chong C, Lim WK. 2012, ‘Hospital treatment in residentialcare facilities is a viable alternative to hospital admission forselected patients,’ Geriatrics and Gerontology International.In press. Impact factor 2.164.Chong CP, van Gaal W, Ryan J, Profitis K, Savige J, Lim WK.2012, ‘Does cardiology intervention improve mortalityfor post-operative troponin elevations after emergencyorthopaedic-geriatric surgery? A randomised controlledstudy,’ Injury. 43: 1193-98. Impact factor 2.336.Clinical medicine and aged care researchAged careChronic diseaseObesityHealth services evaluationTelehealthChong CP, Lim WK, Velkoska E, van Gaal WJ, Ryan JE, SavigeS, Burrell LM. 2012, ‘Terminal pro-brain natriuretic peptideand angiotension converting enzyme 2 levels and theirassociation with post-operative cardiac complications afteremergency orthopaedic surgery,’ American Journal ofCardiology, 1;109(9):1365-73. Impact factor 3.578.Successful grant applications2013 NHMRC Project Grant - ID 1044334: AssociateProfessor Kwang Lim, Chief InvestigatorTitle: Impact of intentional weight loss inobese elderly subjects $594,599Current students under supervisionDr Kim Jeffs - PhD. Randomised controlled trial of deliriumprevention (recruited in excess of 700 patients.Recruitment complete-thesis submission pendingDr Cilla Haywood- PhD. Randomised controlled trial. Obesityin the elderly. In progressRachel Ellis - Masters. Exercise in heart failureOther research projects in progressAbdominal pain-clinical determinants of poor outcomeSepsis in the elderlyTelemedicine and its application in acute medical treatmentin residential careIRIS Study: Principle investigator Steven NgInsulin resistance intervention after stroke (IRIS) trial.A randomised, double-blinded, placebo-controlled trialtesting to see if pioglitazone will reduce recurrent heartattacks and strokes in patients who are insulin resistantand have already suffered a Transcient ischaemic AttackTIA or strokeRasekaba TM, Lim WK, Hutchinson AF.2012, ‘Impact of a chronicdisease management program for patients with diabeteson hospitalisation and acute care costs,’ Australian HealthReview, 36 (2): 205-12. Impact factor 0.545.Peel TN, Buising KL, Dowsey MM, Aboltins CA, Daffy JR,Stanley PA, Choong PF. 2013, ‘Outcome of debridement andretention in prosthetic joint infections by methicillin-resistantstaphylococci, with special reference to rifampin andfusidic acid combination therapy,’ Antimicrobial Agents andChemotherapy, 57(1):350-5.Mahony AA, Cheng AC, Olsen KL, Aboltins CA, Black JF,Johnson PD, Lindsay Grayson M, Torresi J. 2012, ‘Diagnosingswine flu: the inaccuracy of case definitions during the 2009pandemic, an attempt at refinement, and the implications forfuture planning,’ Influenza and Other Respiratory Viruses.Knox J, Cowan RU, Doyle JS, Ligtermoet MK, Archer JS, BurrowJN, Tong SY, Currie BJ, Mackenzie JS, Smith DW, CattonM, Moran RJ, Aboltins CA, Richards JS. 2012, ‘MurrayValley encephalitis: a review of clinical features, diagnosisand treatment,’ Medical Journal of Australia,196(5):322-6.Review.Teh B, Olsen K, Black J, Cheng AC, Aboltins C, Bull K, JohnsonPD, Grayson ML, Torresi J. 2012, ‘Impact of swine influenzaand quarantine measures on patients and householdsduring the H1N1/09 pandemic,’ Scandinavian Journal ofInfectious Diseases,44(4):289-96.27

Clinical Haematology Service28Researchers and staffDr Lachie HayesDr Nicholas MurphyDr Frank HongDr Swe Myo HtetDr Pru SmithDr Nonni DimoskaMichael CooneyRajani IywanLynda HarrisonAurelia Magatannual research report Northern Health 2012Director Clinical HaematologyServiceHaematologistHaematologistLaboratory Haematology RegistrarSenior Medical RegistrarObstetrics and GynaecologyResidentNurse Practitioner CandidateClinical Trials NurseClinical Trials NurseTransfusion NurseMajor achievements in 2012 and futureresearch goalsThe Clinical Haematology Service at Northern Healthcommenced in 2010 and has grown from a limited consultliaisonservice to include a comprehensive outpatient service,an evolving inpatient service for the treatment of increasinglycomplex malignant and non-malignant haematologicalconditions and an active role in teaching covering nursing,junior medical and community medical staff.Several Australasian Leukaemia and Lymphoma Group(ALLG)and pharmaceutica-sponsored clinical trials havebeen opened in 2012 with more planned to open in 2013.The advent of the regular weekly Myeloma Clinic hascreated an opportunity and a need to establish a structureto undertake relevant local research in coordination with theassigned nurse practitioner candidate.In 2012 the Haematology Service collaborated with theDepartment of Orthopaedic Surgery and researchers fromLaunceston General Hospital and Calvary Private Hospitalto participate in a multi-centre phase IV randomised controltrial looking at the use of novel venous thromboembolicprophylactic agents in patients undergoing hip and kneereplacement surgery.In 2012 the service evolved with the addition of anaccredited Haematology Registrar and the plannedestablishment in 2013 of a research development rolewill support expansion in research via the Myeloma Clinicand opportunity for research into non-malignancy areasof haematology that are prevalent the in Northern growncorridor. These include clotting disorders and iron deficiencyin pregnant and non-pregnant populations.Clinical trials in 2012AMG 162 – Investigators: Lachie Hayes, Frank Hong andNicholas MurphyA randomized, double-blind, multi-centre study ofdenosumab compared With zoledronic acid (Zometa)in the treatment of bone disease in subjects with newlydiagnosed multiple myelomaCLL6 – Investigators: Constantine Tam and CLL Aust.Research Consortium / ALLG)A phase III, randomised trial comparing fludarabine,cyclophosphamide and rituximab with or withoutLenalidomide consolidation in CLLCML10 RESIST – Investigators: Timothy Hughes and ALLGAssessment of sensitivity and therapeutic response tonext-line therapy in chronic myeloid leukaemiaPREVENT – Investigators: Professor A. Khalafallah , BernieEinoder, John Batten, Lachie Hayes and Raphael HauAssessment of bleeding after prophylaxis withendoxaparin or rivaroxaban against throboembolicdisease following hip and knee surgeryResearch projects and clinical auditsThrombotic Thrombocytopenic Purpura Registry(Dr Zoe McQuilten, TORC/ARCBS)Massive Transfusion Registry(Dr Frank Hong, TORC/ARCBS)Revision of Northern Health Anticoagulation Guidelines(Lachie Hayes, Prahlad Ho and Pru Smith)Blood Matters Program: Victorian audit of consent forblood transfusion Victorian Department of Health andAustralian and New Zealand Society of Blood Transfusion(Lachie Hayes and Aurelia Magat)Safety and efficacy of intravenous iron polymaltose inthird trimester of pregnancy(Lachie Hayes and Nonni Dimoska)

Research and project grantsGrants where Northern Health is the sole or lead agencyYear grant received Funding source Project name Investigators and affiliations Amount2011-12 Launceston General Assessment of bleeding Khalafallah A, Einoder B, $10,000Hospital Haematology after prophylaxis with Batten J, Hau RC, Hayes LResearch Trust endoxaparin or rivaroxabanagainst throboembolicdisease following hip andknee surgeryClinical Haematology ServiceResearch presentations and abstractsNationalNonni Dimoska, Safety and efficacy of intravenous iron polymaltosein third trimester of pregnancy: a single institutionperspective.Oral presentation at Australian and New Zealanda College ofObstetricians and Gynaecologists AGMOtherLachie Hayes, Safety and efficacy of intravenous iron polymaltosein third trimester of pregnancy as part of MercyHospital for Women Obstetric Medicine SeminarCollaborationsProfessor A. Khalafallah – Department of Haematology,Launceston General HospitalMr Raphael Hau – Department of Orthopaedic Surgery,Northern HealthDr Bernd Froessler, Consultant Anaesthetist, Lyell McEwinHospitalAustralasian Leukaemia Lymphoma Study GroupTransfusion Outcomes Research CollaborativeDr Ross Baker, Anticoagulation Related Events StudyCollaborative – starting 2013Dr Tracey King – Myeloma Nurse, Royal Prince AlfredHospital29

30 annual research report Northern Health 2012

Oncology DepartmentResearchers/staffAssoc Prof Shane White,Assoc Prof Niall Tebbutt,Dr Geoff ChongDr Josephine Stewart,Dr Frances Barnett.Dr. Despina Handolias,Ms Rajani lywan.Ms Lynda Harrison,Research projects in 2012Director of OncologyConsultant Medical OncologistConsultant. Medical OncologistConsultant Medical OncologistConsultant Medical OncologistConsultant Medical OncologistSenior Clinical Research NurseClinical Research NurseNew trials commenced in 2012:• A phase 3, multicenter, randomized, double-blind,placebo controlled study of Rilotumumab (AMG I 02)with Epirubicin, Cisplatin, and Capecitabine (ECX) asfIrst-line therapy in advanced MET -positive gastric orgastroesophageal junction adenocarcinoma.• An open-label, multicenter, randomized phase lb/11 studyof lrinotecan Plus E7820 Versus FOLFIRI in second-linetherapy in patients with locally advanced or metastaticcolon or rectal cancer.Successfully completed the following trials in 2012:• A randomized, 4-arm, placebo-controlled phase 2 trialof AMG 386 in combination with Bevacizumab andPaclitaxel or AMG 386 plus Paclitaxel; first-Line therapyin subjects with Her2-negative, metastatic or locallyrecurrent breast cancer.• A randomized, double-blind, placebo-controlled, multicenterphase 3 study of Denosumab as adjuvanttreatment for women with early-stage breast cancer athigh risk of recurrence (D-CARE)• A multicenter phase III randomized trial of adjuvanttherapy for patients with HER2-Positive node-positiveor high risk nodenegative breast cancer comparingchemotherapy plus Trastuzumab with chemotherapy plusTrastuzumab plus Bevacizumab.• A Multicentre international study of capecitabine +/-bevacizumab as adjuvant treatment of colorectal cancer(QUASAR 2).• A phase Ill trial evaluating the role of continuous letrozoleversus intermittent letrozole following 4 to 6 years of prioradjuvant endocrine therapy for postmenopausal womenwith hormone receptor positive, node positive, early stagebreast cancer (SOLE).CollaborationsNHMRCCancer council Victoria (CTMS)ANZ-BCTG (Australia and New Zealand Breast Cancer TrialsGroup)SponsorsPharmaceutical Companies:AMGEN AustraliaQuintilesANZ-BCTG (Australia and New Zealand Breast Cancer TrialsGroup)Oncology Department• A randomized, double blind, multi-center phase 2study to estimate the efficacy and evaluate the safetyand tolerability of Cisplatin & Capecitabine (CX) inCombination with AMG 386 or placebo in subjects withmetastatic gastric, gastroesophageal junction, or distalesophageal adenocarcinoma• A phase 2, randomized, double-blind, placebo controlledstudy of AMG 386 in combination with FOLFIRI insubjects with previously treated metastatic colorectalcarcinoma.Ongoing trials in 2012:• A randomized, multicenter, open- label, phase 3 studyto compare the efficacy and safety of Panitumumab andCetuximab in subjects with previously treated, wild-typeKRAS, metastatic colorectal cancer.31

Cardiology researchNorthern Health’s cardiology research program spans severalstreams of research: pharmaceutical and device-based studies;novel agents for acute coronary syndromes and wide-ranginginvestigator-initiated research undertaken in the cardiology clinicaltrials unit.Northern Health made headlines in 2012 when Director ofCardiology, Associate Professor William van Gaal performed aworld first heart procedure as part of the Preservation study, usingan injectable Bioabsorbable Cardiac Matrix that forms a temporaryflexible scaffold to support the recovery and repair of the hearttissue after a major heart attack.The pharmaceutical research stream currently includes 14 trials,some of which form part of multi-centre international trialsinvolving thousands of patients in the search for more effectivedrug treatments. These studies include trials of new bloodthinning agents, agents designed to reduce cholesterol andagents that work to reduce the impact of diabetes. Many trialsshow promising results, particularly in the fight against cholesterol,with a new inhibitor that has the potential to lower cholesteroldramatically with an injection once per month.Current investigator-initiated research includes studies of thephysiology of coronary artery disease and its assessment,measurement and outcomes. One of the larger projects, involving600 patients, seeks to determine how to best treat patients whore-present many years after having had bypass surgery. Treatingsuch patients can be technically challenging as there are oftenfewer opportunities to provide appropriate interventions and thereare presently no treatment guidelines available.Another significant study involving 300 non-English speakingpatients with heart disease is also in progress. The studyexamines cultural differences and how it relates to the timing of apatient’s initial presentation for treatment, pre-existing health statusand provision of information.Other studies include looking at ways to prevent heart attackfor patients undergoing surgery, a world first study that involvesinjecting caffeine and an analysis of risk using existing cardiologyscores to predict adverse outcomes such as readmission tohospital.Imaging is another area of current investigation with angiogramsbeing used in a range of scenarios to find blockages, view andmeasure the amount of fat that has accumulated in the plaque inthe artery and assess blood flow across narrowings. One suchstudy has looked at the use of angiograms through the radialartery in the wrist rather than through the groin but preliminaryfindings suggest this may be associated with a higher radiationburden. The innovative use of non-invasive imaging such ascardiac CT is also being investigated.32 annual research report Northern Health 2012

Researchers and staffAssociate Professor William J. van Gaal (Director)Dr Nagesh Anavekar MBBS MD FRACP FCSANZ(Head, Echocardiography)Dr Uwais Mohamed MBBS FRACP FCSANZ(Head, Electrophysiology)Associate Professor Peter BarlisDr Larry PonnuthuraiAssociate Professor Chiew WongDr Nilesh MehtaDr Chris LimDr Nima Rudd DMedSciDr Vivek MuhtaMrs Mary ParkMrs Elizabeth BuckleyResearch projects in 2012Research FellowResearch NurseResearch NurseAMICI - Principle investigator: Associate Professor Williamvan GaalA prospective, double blind, randomized, placebocontrolledclinical trial of intracoronary infusionof immunoselected, bone marrow-derived Stro3mesenchymal precursor cells (MPC) in the treatment ofpatients with ST-elevation myocardial infarction.AMG 145 - Principle investigator: Associate ProfessorWilliam van GaalA double-blind, randomized, placebo-controlled, multicentrestudy assessing the impact of additional LDLcholesterolreduction on major cardiovascular eventswhen AMG 145 is used in combination with statin therapyin patients with clinically evident cardiovascular diseaseAPPOSE - Principle investigator: Associate ProfessorPeter BarlisApposition assessed using optical coherencetomography of chromium stents eluting everolimus fromcobalt versus platinum alloy platforms. Sponsor: AbbottDevices: Xience Prime (Abbott) and Promus Element(Boston Scientific International)Aim: The purpose of the trial is to directly comparethe above stents in relation to stent scaffolding shape,position with the heart blood vessel and extent of tissuecoverage (at six months) using optical coherencetomography.ATLAS TIMI 51 - Principle investigator: Associate ProfessorWilliam van GaalA randomized, double-blind, placebo-controlled, eventdrivenmulti-centre study to evaluate the efficacy andsafety of Rivaroxaban in subjects with a recent acutecoronary syndrome. Number of patients in study = 25GARFIELD (Worldwide registry in atrial fibrillation) - Principleinvestigator: Associate Professor William van GaalNumber of patients in study = 49OPTIMA trial - Principle investigator: AssociateProfessor Peter BarlisOptical coherence tomography assessment of intimaltissue and malappostion in patients with coronary arterydisease: - A randomised comparison of BIOLIMUS-Eluting and EVEROLIMUS-Eluting stents.Number of patients in study = 45The Massachusetts General Hospital Optical CoherenceTomography Registry (The MGH OCT Registry) -Principle investigator: Associate Professor Peter BarlisStudy aims 1) to identify plaque characteristics on OCTthat are associated with adverse cardiac events 2)To identify characteristics of stented arteries that areassociated with adverse events including re-stenosis andstent thrombosisVISTA 16 - Principle investigator: Associate ProfessorWilliam van GaalVascular inflammation suppression to treat acutecoronary syndromes for 16 weeks. Number of patients instudy = 16PRESERVATION - Principle investigator: AssociateProfessor William van GaalA placebo controlled multi-centre randomised doubleblind trial to evaluate the safety and effectiveness ofIK-5001 for the prevention of remodelling of the ventricleand congestive heart failure after acute myocardialinfarctionCardiology research33

Intensive Care Unit34Researchers and staff 2012Dr John GreenDr Angaj GhoshDr Andrew CasamentoDr David CrosbieDr Graeme DukeMary ParkOlga BurgessKey research areasCritical care medicineMajor achievements in 2012annual research report Northern Health 2012Acting Director/Senior clinicianSenior clinician/PrincipalinvestigatorSenior clinicianSenior clinicianSenior clinicianSenior Research CoordinatorResearch nurse(newly appointed late 2012)Appointment of Director of Intensive Care Research,Dr Angaj GhoshAppointment of Research Nurse, 0.3EFT Ms Olga BurgessCompletion of CHEST project (66 participants)CYTOFAB study completedFuture research goalsCommencement of nurse-led research focus group toencourage and promote nurse-initiated research within theCritical Care Department.Research-based journal club.Participation in five large research trials:TRANSFUSE - old versus new blood in critically ill(recruitment to commence March 2013)ADRENAL - Steroids in sepsis (recruitment to commenceMarch 2013)HEAT - Temperature control in sepsis (recruitment tocommence March 2013)SPICE - Dexmedetomidine versus Propofol in ventilatedpatients (recruitment to commence May 2013)PHARLAP - A phase II RCT of an open lung strategy (basedon permissive hypercapnia, alveolar recruitment and lowairway pressure) in patients with ARDSCHARLI - Does nebulised Heparin prevent acute lung onjuryResearch projects in 2012DahLiaA randomised, double-blind, multi-centre placebo controlledtrial of dexmedetomidine for patients with agitation anddelirium in the Intensive Care Unit. Recruitment is ongoing atNorthern Health.Nephro-Protect2011 Northern Health’s Intensive Care Unit (ICU) began recruitingpatients into a multicentre trial currently being undertakenin a number of ICUs in Australia and New Zealand. Thetrial, ‘Nephro-protective effects of L-amino acids in criticallyill patients’, is a randomised controlled trial. The trial received$829,000 funding from the NHMRC to be provided overthree years. The trial enrolled the target number of participantsand recruitment was completed at the end of 2012.The intervention in this trial was to provide patients randomisedinto the intervention arm with additional protein(given via a central venous catheter), and the primaryoutcome was a reduction in kidney injury (measured as daysof clinically significant renal dysfunction). Secondary outcomesincluded duration of ICU and hospital stay, durationof ventilation, need for antibiotics, and other organ systemdysfunctions.CytofabA multi-centre, randomised, double blind, placebo controlledphase IIb study to compare the efficacy and safety oftwo dosing regimens of intravenous infusions of CytoFab(AZD9773) in adult patients with severe sepsis and/or septicshock. Recruitment was completed in 2012.CHESTA multi−centre randomised controlled trial of fluid resuscitationwith starch (6 per cent hydroxyethyl starch 130/0.4)compared to saline (0.9 per cent sodium chloride) inintensive care patients on mortality. There were 66 patientsrecruited at The Northern Hospital.DARE studyOngoing analysis of data from prospective observationalstudy of 10,000 patients discharged from ICU.Sedation practices and hospital length of stay for ventilatedICU patientsRetrospective audit of ICU, pharmacy, and Health InformationService HIS data to establish the association betweensedative practice and patient outcomes and length of stay.This study has been completed and publishedReview of tracheostomy practice, outcomes, andguidelinesRetrospective audit of 10,000 tracheostomy procedures inICU patients in Victoria.Tracheotomy practices in Victorian ICUs over the past 12years with a view to developing a prediction model for whowill need to have a tracheotomy.Patient safety and outcome in ICUEpidemiological investigation of patient safety and hospitaloutcome in critically ill and hospital separations.

Research publicationsPeer reviewed journalsBarker A, Duke GJ,, Santamaria JD. 2012, ‘Recent trends inVictorian risk-adjusted in-hospital mortality: 1999-2009,’Internal Medicine Journal, 1218-1223.In pressDuke GJ, Barker A, Knott C, Santamaria JD. ‘Recent trendsin the care of older persons admitted to ICU in Victoria,’Medical Journal of Australia.Duke GJ, Barker A, Rasekaba T, Hutchinson A, SantamariaJD. ‘Development and validation of the critical careoutcome prediction equation,’ Critical Care andResuscitation.Duke GJ, Barker A, Graco M, Santamaria JD. ‘A brief reviewof trends in Victorian intensive care,’ Critical Care andResuscitation.Jarman A, Duke GJ, Casamento A, Reade M. ‘Sedationpractices influence the duration of mechanical ventilationin intensive care,’ Anaesthesia and Intensive Care.Ghosh A, Tobin A, Duke G, Green J et al. ‘Timing of bloodtransfusion in relation to ICU admission - a single centreaudit,’ Anaesthesia and Intensive Care.Atan R, Crosbie D,Bellomo R. 2012, ‘Techniques of extracorporeal cytokineremoval: a systematic review of the literature,’ BloodPurification,33(1-3):88-100.Research presentations and abstractsInternationalGhosh A, Tobin A, Ried D, Santamaria J, Timing of Bloodtransfusion in ICU patients and association with mortality.American Thoracic Society ASM, San Francisco, May 2012Santamaria JD, Duke GJ, Pilcher D, Cooper DJ, A prospectivemulti-centre study of discharge from intensive care.Factors associated with readmission. American ThoracicSociety ASM, San Francisco, May 2012Santamaria JD, Duke GJ, Pilcher D, Cooper DJ, After-hoursdischarge from ICU is a risk factor for in-hospital mortalityin a large multicentre prospective study. AmericanThoracic Society ASM, San Francisco, May 2012Duke GJ, Rasekaba T, Graco M, Santamaria JD, Real timemonitoring of patient safety in Victorian public hospitals:implementation of thew VAED and the COPE model tomonitor intensive care services.American Thoracic Society ASM, San Francisco, May 2012Duke GJ, Baker A, Graco M, Resakaba T, Santamaria JD,Twelve year review of intensive care services in Victoria:casemix, resources, and outcomes. American ThoracicSociety ASM, San Francisco, May 2012NationalAndrew Casamento, Evaluation of the Potential Impactof the National Emergency Access Target (NEAT) onIntensive Care Workload at a Public Hospital.. ANZICSAdelaide 2012. Prize for “Best Presentation in the Qualityand Safety” section. Submitted to Medical Journal ofAustralia.Intensive Care Unit35

36 annual research report Northern Health 2012

PaediatricsPaediatricsResearchers and staffDr Simon Hauser, Clinical Services Director, Department ofPaediatricsAssociate Professor Wei Qi Fan, University of Melbourne andDepartment of PaediatricsResearch projects in 2012Shanthikumar S, Hauser SE. Paediatric assessment in ageneral metropolitan emergency department. Submittedto Journal of Paediatrics and Child Health September2012Hauser SE, Barker R (Paediatric Department) Vitamin Dinsufficiency in children with fractures and withoutfractures - joint collaboration with Department ofOrthopaedicsDe Silva M, Fan WQ. CRP versus I/T ratio in suspectedneonatal sepsisNguyen S, Hauser S. Impact on frequency of chestradiographs in bronchiolitis following educationalinterventionBarker R, Hauser S, Fan WQ. Evaluation of a neonatalhospital in the home programResearch publications• ‘Clinicians’ gut feeling about serious infections in children:Observational study. Rapid responses,’ British MedicalJournal published on-line 19 October 2012 invol 345 e6144.• Hauser S. ‘Conflicts of interest’ Journal of Paediatrics andChild Health, accepted for publication 2013.Research presentations and abstracts• Nazarian N, Hauser S, Hau RC. Vitamin D insufficiency inchildren with fractures. Northern Health Research WeekAugust 2012• Jayawardena N, Sathiaseelen M, Hauser S, FanWQ. Neonatal CPAP in a Level 2 nursery setting – aretrospective review. Perinatal Society of Australia andNew Zealand March 2012CollaborationsHauser S. Pilot arm of “Paediatric action on food allergy”project via the Murdoch Children’s Research Institute, theRoyal Children’s Hospital and Australian Paediatric ResearchNetwork37

38 annual research report Northern Health 2012

Orthopaedic researchThe aim of Northern Health’s recently established orthopaedic research program is to improve the quality of patientcare.Orthopaedic researchWith the largest group of orthopaedic patients including neck of femur fractures, joint replacements, hip fracturesand fractures in children, the orthopaedic research program covers a broad range of investigation and comprisesa mix of internal projects and external multi-site studies. The Northern Hospital is also one of only four hospitalsin the Victorian Orthopaedic Trauma Outcome Registry which has been operational for 10 years and enablesresearchers to follow up patients with orthopaedic trauma and examine how best to treat them.One of the multi-site studies the Northern Health orthopaedic team has been involved in is an investigation of DVTprevention after knee replacement that has been conducted in collaboration with Launceston General Hospital andCalvary Private Hospital (Launceston). This project is nearing completion and findings will soon be available fordissemination.The orthopaedic research program also has strong ties with other units within The Northern Hospital and regularlycollaborates with different teams such as the paediatric team to investigate vitamin D levels of children withfractures.Similarly, an upcoming collaboration with the cardiology unit will investigate ways to modify risk factors andimprove the care given to patients with neck of femur fractures as a result of previous studies from The NorthernHospital which have shown that patients with neck of femur fractures and evidence of cardiac injury have asignificantly higher rate of mortality.An ankle fracture project that is about to commence looks at how best to manage ankle fractures that have beenoperated on and the different types of care available after surgery. Investigations also look at different outcomemeasures and will use innovative measurement tools such as a purpose-built driving simulator designed to test thereaction time of a patient’s ankle at different times of their recovery.Results of the orthopaedic team’s recent award-winning draping study have just been published in the AustraliaNew Zealand Journal of Surgery and the findings have already led to changed practices amongst many Victoriansurgeons. The study looked at different ways of draping a patient’s leg prior to knee surgery to ensure the limbremains sterile and demonstrated that contamination was a real risk from current standard draping practices.The orthopaedic department is committed to fostering a research culture and making the department’s day-to-daypractice as evidence-based as possible. With a third of orthopaedic consultants currently engaged in researchactivity at Northern Health, the department aims to grow it research activity to ensure all consultants are involved inresearch work in five years’ time.39

Department of Orthopaedic SurgeryResearchers and staffMr Raphael HauDr Jo LenaghanMr David ShepherdMr Raghavan UnniMr Justin WongDr Saeed AsadollahiDr Sam BewsherDr Alan LochDr Navid NazarianDr Sophie HardyDr Minh PhamDr Justin EastonDr Grant CrawfordMrs Siew PerryJoanna ChristouKylie FitzpatrickMrs Lori McLeod-MillsMajor achievements in 2012Director of OrthopaedicsOrthopaedic SurgeonOrthopaedic SurgeonOrthopaedic SurgeonOrthopaedic SurgeonOrthopaedic RegistrarOrthopaedic RegistrarOrthopaedic RegistrarOrthopaedic RegistrarEmergency Medicine RegistrarHonorary Orthopaedic ResearchRegistrarOrthopaedic ResidentOrthopaedic InternANUM Operating TheatreOrthopaedic Case ManagerOrthopaedic Case ManagerResearch CoordinatorThe past twelve months have been a rewarding periodof growth for orthopaedic research at Northern Health.Researchers within the unit were awarded two SmallResearch Grants and a Victorian Orthopaedic Research Trustgrant. Early in the year the unit was awarded a VictorianDepartment of Health Developing Organisational CapacityGrant, to support specialist-in-training education andresearch resources.In 2012 the unit completed a retrospective project toestablish the factors that contribute to high mortality rates inpatients who sustain a hip fracture. The project was awardedthe best poster prize at the Royal Australian College ofSurgeons, Annual Victorian Scientific and Fellowship Meetingand was awarded second place for ‘Best overall Poster’during Northern Health Research Week. The outcomes of theproject were also presented at the International OsteoporosisFoundation 3rd Annual Asia-Pacific Osteoporosis Meeting inKuala Lumpur.Orthopaedic registrars and residents presented sevenposters on a broad range of clinical topics and three qualityprojects at Northern Health Research Week and the RoyalAustralian College of Surgeons, Annual Victorian Scientificand Fellowship Meeting.The growth of research capacity over the past 12 monthshas allowed the unit to collaborate with researchers fromLaunceston General Hospital and Calvary Private Hospitalto participate in a multi-centre phase IV randomised controltrial looking at the use of novel venous thromoembolicprophylactic agents in patients undergoing hip and kneereplacement surgery.Future research goalsIn 2013 the unit will commence a single site randomisedcontrol trial looking at early mobilisation and early weightbearing of patients following surgical management of anklefractures. The aim of the project is to establish if this changein post-operative management is safe and if it results in anearlier return to pre-injury function.An ageing population and increasing obesity rates meansthe demand for joint replacement surgery is increasing. Thetrend is that younger patients are having joint replacementsurgery which will mean more revision surgery. In 2013the Orthopaedic Unit and Department of Physiotherapywill collaborate on a large long term project investigatingthe outcomes for patients undergoing hip and kneereplacements. The project will follow patients for seven yearsand allow the research team to monitor trends which willdirectly improve clinical management of this patient group inthe future.The Orthopaedic Unit will continue to focus on our corebusiness. This includes research looking at methods toreduce mortality of patients following a hip fracture and atthe opposite end of the age scale, the incidence of vitaminD insufficiency in children who have sustained a fracturerequiring surgical management. Planned collaborationsfor 2013 include cardiology and infectious diseases units.Researchers within the unit will also be undertaking basicscience research in collaborations with the Surgical andOrthopaedic Research Laboratory at the University of NewSouth Wales.Research projects in 2012Anatomical features of the knee in patellofemoral dislocation:An MRI based study Justin Wong and Sam BewsherAssessment of bleeding after prophylaxis withendoxaparin or rivaroxaban against throboembolicdisease following hip and knee surgeryProfessor A Khalafallah , Bernie Einoder, John Batten,Raphael Hau and Lachlan HayesRisk factors for mortality in neck of femur fracturesAlan Lock, Minh Pham, Ali Humadi, Vivek Shridhar,Greg Chang and Raphael HauNorthern Health orthopaedic outcome scores – HipRaphael Hau, Jimmy Goulis, Anton Hams, SandieChapman and Justin WongNorthern Health orthopaedic outcome scores – KneeJustin Wong, Jimmy Goulis, Anton Hams, SandieChapman and Raphael HauOutcomes of operated ankle fractures treated with earlyweight bearing vs 6 weeks of plastering. A randomizedcontrol trialRaphael Hau, Navid Nazarian and Jo Lenaghan40annual research report Northern Health 2012

Prospective study on displaced distal radius fractures inchildrenSaeed Asadollahi, Keat Ooi, Ali Humadi and Raphael HauStudy into the cost-effectiveness of using early MRI todiagnose suspected scaphoid fractures: a comparisonwith current methodsResearch grantsSophie Hardy, Grant Crawford, Lori McLeod-Mills andRaphael HauVitamin D deficiency in children with fracturesRaphael Hau, Navid Nazarian, Anna Manolopoulos,Rebekah Barker, Lori McLeod-Mills and Simon HauserYear grant received Funding source Project name Investigators and affiliations Amount2012 Northern Health Vitamin D deficiency Hau RC, Hauser S, Nazarian N $5,000Small Grantsin children with fractures2012 Northern Health Outcomes of operated Hau RC, Nazarian N, Lenaghan J $5,000Small Grantsankle fractures treated2012 Victorian Orthopaedic with early weight bearing $3,500Research Trust vs 6 weeks of plastering -A randomized control trialDepartment of Orthopaedic SurgeryGrants involving Northern Health staff, but external lead agencyYear grant received Funding source Project name Investigators and affiliations Amount2011-12 Launceston General Assessment of bleeding Khalafallah A, Einoder B, $10,000Hospital Haematology after prophylaxis with Batten J, Hau RC, Hayes LResearch Trust endoxaparin or rivaroxabanagainst throboembolicdisease following hip andknee surgeryResearch publicationsBoekel P, Blackshaw R, Van Bavel D, Riazi A, Hau R. 2012,‘The sterile stockinette in orthopaedic surgery: a possiblepathway for infection,’ Australia and New Zealand Journal ofSurgery 82(11):838-43.Research presentations and abstractsInternationalNazarian N, Pham M, Lock A, Humadi A, Shridhar V, ChangG and Hau RC. Risk factors for mortality in neck of femurfractures.International Osteoporosis Foundation Regionals – 3rd Asia-Pacific Osteoporosis Meeting Kuala Lumpur, December2012.NationalBoekel P, Blackshaw R, Van Bavel D, Riazi A, Hau R. Thesterile stockinette in orthopaedic surgery: A possiblepathway for infection.AOA Victorian Branch Annual Scientific Meeting, Lorne,February 2012 – Best paper award and AustralasianSociety for Infectious Diseases ASM, Fremantle, March2012.OtherPresented at Northern Health Research Week August 2012and the Royal Australian College of Surgeons– VictoriaAnnual Scientific and Fellowship Meeting, October 2012Asadollahi S, Shepherd D and Hau RC. Combined elbowfracture-dislocation with Galeazzi fracture illustrated casereport and literature reviewEaston J, McLeod-Mills L and Hau RC. Theatre start timeauditBest surgical poster presentation – Northern Health ResearchWeekLock A, Pham M, Humadi A, Shridhar V, Chang G and HauRC. Risk factors for mortality in neck of femur fracturesSecond best poster presentation– Northern Health ResearchWeekBest poster presentation - RACS Victoria Annual Scientificand Fellowship meetingMcLeod-Mills and Hau RC. Evaluation of a Perspexpositioning device on post operative imaging followingtotal knee replacementMcLeod-Mills and Hau RC. Supporting clinical orthopaedicresearch at Northern HealthNazarian N, McLeod-Mills L, Hauser S and Hau RC. VitaminD deficiency in children with fracturesPerry S, McLeod-Mills and Hau RC. Orthopaedic Scrub NurseSurveyCollaborationsProfessor A Khalafallah, Launceston General HospitalDr Lachie Hayes – Department of Haematology,Northern HealthDr Simon Hauser – Department of Paediatric Medicine,Northern Health41

42 annual research report Northern Health 2012

Northern Clinical Research CentreHealth services evaluation researchEstimates vary, but between 10 and 20 per cent of hospitalized patients suffer some form of unintended harm duringtheir hospital stay. Hospital-acquired diagnoses are associated with an extra 10 days of stay in Australia and addnearly 20 per cent to total inpatient costs. Many of these can be prevented or reduced by applying current medicalknowledge.Northern Clinical Research CentreOver the last decade governments have created a range of institutions to monitor and publish hospital adverse events.What has been missing from these efforts, are practical supports for hospitals to systematically examine their ownperformance in order to target unintended outcomes. Reduction of complications will improve both patient health andhospital efficiency. In 2012, Associate Professor Terri Jackson joined Melbourne University and the Northern ClinicalResearch Centre (NCRC) to undertake a program of research on complications of hospital care that aims to increasethe use of routine diagnosis and cost data already collected for each patient admission. It will pilot an approachinvolving clinical groups setting priorities to reduce selected hospital-acquired diagnoses. Reports will be provided toclinicians enabling them to monitor outcomes (clinical and cost) over time.Routine hospital data is an under-utilised resource for quality improvement. Every hospital employs a staff of healthinformation managers and trained coders to extract information from each patient’s medical record on discharge. Thisinvestment in data recording, along with investment in a patient-level clinical costing system, has the potential to bothtarget and evaluate quality and safety programs across the hospital.The Classification of Hospital-Acquired Diagnoses (CHADx) is being used to group coded diagnosis data intospecialty-specific reports. The CHADx is a research and quality improvement tool developed for the AustralianCommission on Safety and Quality in Health Care by Dr Jackson and former colleagues at the University ofQueensland. Data on patient CHADx will give clinicians at The Northern Hospital (TNH) a picture of their highestfrequency and highest cost complications, and provide baseline rates and ways of measuring success of proposedquality improvement studies.Specific research questions to be answered using CHADx include:• What complications send patients to the intensive care unit at TNH?• Do hospitalized diabetes patients experience specific complications more frequently; is there a distinctive patternof risks for these patients?• What complications are most predictive of an early readmission to TNH?• How can we structure reports for busy clinicians to allow them to monitor their clinical outcomes more easily?These studies will demonstrate whether and how physicians use this information to identify complication that can bereduced. Doctors’ use of clinical data in quality improvement is highly context-specific, and dependent on a range oflocal predisposing and enabling factors. We will draw on and expand the literature on quality improvement by using acomprehensive (and reproducible) set of complications of care (CHADx). Publication of findings will encourage otherclinical units and other hospitals to take up this approach of engaging clinicians in quality improvement based on localevidence.Dr Jackson is working to develop a network of researchers in other states to be involved in benchmarking andoutcomes research using the coded patient data, and hopes to apply for a Partnership Grant from the National Healthand Medical Research Foundation later in 2013 to extend this work beyond TNH.43

Northern Clinical Research Centre cont’d44The NCRC is a multidisciplinary, clinical research unit, whichexamines interventions that may improve patient care anddecrease hospital utilisation, particularly for those withchronic disease and complex needs. The NCRC aims tointegrate clinical research methodology into the evaluationof current clinical practice and the development of newprograms of care, in order to inform service delivery atNorthern Health.Researchers and staffProfessor Peter BrooksDr Anastasia HutchinsonAssociate ProfessorTerri JacksonAssociate ProfessorGraeme HawthorneDr Graeme DukeResearch FellowDr Anna BarkerDr Sumit ParikhTshepo RasekabaDamian CrespShane GrantVicki LawlorChrissie RisteskiElsie ZhangHuman Research EthicsCheryle WilliamsLoretta GiummarraClinical trialsMary ParkElizabeth BuckleyRita WongOlga BurgessRajani IywanLynda HarrisonCoordinatorannual research report Northern Health 2012Exec Director ResearchNCRC DirectorHealth Economist/ HealthServices ResearcherEpidemiologist/BiostatisticianIntensivist HonoraryHonorary Research FellowIT programmer/DataAnalystResearch FellowProject Mx/ResearchNurseProject Mx/ResearchNurseResearch NurseResearch AssistantResearch NurseHREC Secretariat/Research AdministrativeOfficerResearch GovernanceOfficerCardiology – SeniorClinical Trials CoordinatorCardiology – ClinicalTrials CoordinatorCardiology – ClinicalTrials CoordinatorCritical Care – ClinicalTrials CoordinatorOncology – SeniorClinical Trials CoordinatorOncology – Clinical TrialsHealth Services researchResearch on complications of careThis research program (led by Associate Professor TerriJackson) uses routine diagnosis and cost data to determinethe impact of deviations in care and adverse events onpatient outcomes and acute care costs. This researchprogram aims to optimise the use of routinely collected datato provide clinicians’ with timely information on areas whereimprovements in care delivery should be focused.Monitoring and improving hospital performance usingadministrative dataCollaborative project with Dr Graeme Duke (IntensivistEastern Health), Dr Anna Barker (Centre Research Excellencein Patient Safety, Monash University) and Dr John Santamaria(Intensive Care, St Vincent’s Hospital). This is an ongoingproject which is evaluating the use of using risk-adjustedmortality prediction models derived from administrativedatasets to monitor hospital performance across Victoria.Quality indicatorsPrincipal Investigators Associate Professor Kwang Lim, DrCraig Aboltins and Dr Anastasia Hutchinson. The qualityindicators project is a collaborative project between NorthernHealth Clinical Medicine, The Quality and Safety Unit andthe NCRC. This project involves audit and feedback to themedical units on their adherence to best-practice guidelinesfor the management of pneumonia, chronic obstructivepulmonary disease and chronic heart failure. Outcomes ofthis project have included improvements in adherence toguidelines for the nest practice management of chronicheart failure and an associated decrease in acute carereadmissions in this group of patients.Chronic Diseases research programRetinal microvascular disease in patients with chronicdiseaseCollaborative project with Professor Judy Savige (Departmentof Medicine Northern Health, University of Melbourne). Thisproject investigates the use of retinal photography to identifymicrovascular disease and future risk of cardiovascularevents in patients with chronic disease.Observational epidemiology studies and clinical trialsin cardiac, endocrinology, neurology and respiratorydiseases.The NCRC staff provide clinical trial management andcoordination for clinical trials being conducted at NorthernHealth in cardiology, endocrinology, respiratory andneurology.

Research grantsGrants where Northern Health is the sole or lead agencyYear grant received Funding source Project name Investigators and affiliations Amount2012 Department of Hospital Mortality Duke G, Barker A, Rasekaba T,Health (Vic) Monitoring Project Barker A, Santamaria J $78,000Grants involving Northern Health staff, but external lead agencyYear grant received Funding source Project name Investigators and affiliations Amount2012 NHMRC- University Improving quality of care Gray L, Lim KLof Queensland in older adults $11,000Northern Clinical Research CentreConference presentationsOral presentationsHutchinson AF. - American Thoracic Society San Francisco2012 Long-term outcomes of a nurse-led respiratoryoutreach program for patients with Chronic ObstructivePulmonary Disease: Differences between frequent andinfrequent exacerbators in survival and acute healthcare utilisationHutchinson AF. TSANZ Canberra 2012 Long-termoutcomes of a nurse-led respiratory outreach programfor patients with Chronic Obstructive PulmonaryDisease: Developing indicators for best practice inchronic respiratory disease managementJackson TJ. ‘Essential components of an ABF (activitybased funding) system’ Sydney University ABF/Casemix Symposium 1. Sydney 30 November 2012Jackson TJ. ‘Measuring clinical and financial outcomes’Sydney University ABF/Casemix Symposium 1 Sydney30 November 2012Jackson TJ, Bohlouli B, Klarenbach SW. ‘Hospital-acquireddiagnoses in high volume CMGs’ presented at PatientClassification Systems International Conference,Avignon, 18 October, 2012Liu M, Jackson TJ, Fong A, Dean S, DeCoster C, Briggs T,Fan S, Quan H, Jette N. ‘Alternative Statistical Modelsfor Hospitalization Cost Records with an ExtremelySkewed Distribution’ presented at Patient ClassificationSystems International Conference, Avignon, 18 October,2012Workshop: Rodriguez JM, Jackson TJ, Paviot-Trombert B.‘A smooth introduction to casemix concepts’ PatientClassification Systems International Conference,Avignon, 16 October, 2012Jackson TJ. ‘Using ICD-9 & 10 coded data to identify suboptimalhospital care’ WHO International Classificationfor Patient Safety Reporting Expert Review Meeting,Tokyo 11-12 September 2012Published abstractsAl-Janaby H, Gocuk S, Goz K, Sharma N, Wong R,Hutchinson A, van Gaal W, Ponnuthurai L, Barlis P.Examining coronary stent apposition using opticalcoherence tomography. Northern Health ResearchWeek 2012Choy C, Tan N, Chew S, Colville D, Hutchinson A, SavigeJ. Microvascular retinopathy in patients with obstructivesleep apnoea: A cross sectional observational study.Northern Health Research Week 2012Duke G, Barker A, Graco M, Rasekaba TM, Santamaria J.Twelve Year review of Intensive care Services in Victoria:Casemix, Resources and Outcomes. ATS San FranciscoATS 2012Duke G, Barker A, Santamaria J, Graco M. Recent trends inVictorian in-hospital risk-adjusted mortality: 1999-2009.ATS San Francisco ATS 2012Gocuk S, Al-Janaby H, Goz K, Wong R, Sharma N, vanGaal W, Ponnuthurai L, Lim C, Mehta N, HutchinsonA, Barlis P. Assessing Coronary Atherosclerotic plaqueusing optical coherence tomography. Northern HealthResearch Week 2012Goz K, Al-Janaby H, Gocuk S, Wong R, Sharma N,Hutchinson A, van Gaal W, and Barlis P. Examiningcoronary stent tissue coverage using optical coherencetomography. Northern Health Research Week 2012Hutchinson AF. Thompson AF, Anderson GP, IrvingLB. Long-term outcomes of a nurse-led respiratoryoutreach program for patients with Chronic ObstructivePulmonary Disease: Differences between frequent andinfrequent exacerbators in survival and acute healthcare utilisation. ATS San Francisco 2012Rasekaba T, Graco M, Barker A, Hutchinson A, SantamariaJ, Duke GJ. Real-time monitoring of patient safety inVictorian Public Hospitals: Implementation of the VAEDand the COPE Model to monitor Intensive Care units.ATS Conference San Francisco 2012 & Northern HealthResearch Week 201245

Northern Clinical Research Centre cont’dRasekaba T, Lawlor V, Zhang QE, Zimmerman F, FeelyK, Risteski C, Jung P and Hutchinson AF. PreliminaryEvaluation of the COPD Assessment Test in participantsof pulmonary rehabilitation programs at Northern Health.Northern Health Research Week 2012.Tan N, Choy C, Ali F, Chew S, Colville D, Wong TY, KawasakiR, Hutchinson A, Savige J. Retinal arterioles and venulesare narrower in patients with obstructive sleep apnoea:A cross sectional observational study. Northern HealthResearch Week 2012PublicationsGraco M, Hutchinson A, Barker A, Lawlor V, Wong R,Fourlanos S. 2012, ‘Psychological measures did notpredict glycaemic outcome in a diabetes managementservice,’ Population Health Management, 15(3): 163-7.Rasekaba TM, Lim WK, Hutchinson AF. 2012, ‘Impact ofa chronic disease management program for patientswith diabetes on hospitalisation and acute care costs,’Australian Health Review, 36: 205-12.Barker AL, Kamar J, Tyndall TJ, White L, Hutchinson AF,Klopfer N, Weller C. ‘Implementation of pressure ulcerprevention best practice recommendations in acute care:an observational study,’ International Wound Journal,online April 2012.Rasekaba TM, Graco M, Risteski C, Jasper A, Berlowitz DJ,Hawthorne G, Hutchinson A. 2012, ‘Impact of a diabetesdisease management program on diabetes control andpatient quality of life,’ Population Health Management,15(1): 12-19.Duke G, Barker A, Santamaria J, Graco M. ‘Recent trends inVictorian risk-adjusted in-hospital mortality: 1999–2009,’Internal Medicine Journal, 1218-1223.Bozinovski S, Uddin M, Vlahos R, Thompson M, MerrittA-S, Wark PBA, Hutchinson A, Irving LB, Levy BDand Anderson GP. 2012, ‘Serum Amyloid A opposesLipoxinA4 signaling to increase lung inflammation inchronic obstructive pulmonary disease,’ PNAS, 109 (3):935-940.Health service evaluation reportsState-wide hospital mortality monitoring reportsDuke G, Rasekaba TM, Santamaria J, Barker A, HutchinsonAF. Real-time monitoring of patient safety in Victorianadult intensive care service. NCRC Report for theDepartment of Health (Victoria) and VICDRC, June 2012.Duke G, Rasekaba TM, Hutchinson AF, Santamaria J, BarkerA. Real-time monitoring of patient safety in the Victorianpublic hospital adult intensive care service: 2011-2012Fiscal Year Report. NCRC Report for the Department ofHealth (Victoria) and VICDRC, December 2012.46annual research report Northern Health 2012

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48 annual research report Northern Health 2012

Nursing ResearchNursing researchSpecial Care Nursery studyNorthern Health recently participated in an innovative multi-centre study (led by Louisa Ramudu from the nursingeducation unit) that investigated the coping responses of parents whose infants had been transferred from a cityNeonatal Intensive Care Unit (NICU) back to their local hospital’s level two Special Care Nursery. It had long beenrecognised that the transfer process represents a significant source of anxiety but there had been no studiesundertaken to measure coping styles. Parents had established trusting relationships, security of environment theyknow to go to place and people they don’t knowThe study was conducted in two parts: parents and health professionals, across six sites - one of which was TheNorthern Hospital. The parents study measured the quality of the transfer experience using a validated scale to gain anunderstanding of the parent’s perspective before, during and after the transfer. Overall results from 80 parents foundthat the transfer experience and reported perceptions were positive, but parents still displayed some stress as theywere forced to leave the familiar NICU environment and the trusting relationships they’d established with their infant’smedical carers and move to a new hospital and new stage of care.There was no significant difference in stress levels between mothers and fathers, and both vented emotions andnegative feelings. However there were pronounced differences in the coping styles used with fathers tending to useactive coping mechanisms for example taking active steps to circumvent stress or devising a practical plan. Fatherswere also more likely to turn to religion, prayer or meditation in times of stress.In contrast, mothers tended to display behavioural disengagement, often becoming more withdrawn. From a healthprofessional perspective this behaviour can often be misjudged, leading to questions such as why isn’t this mothervisiting her baby or why does this mother no longer want to participate in her infant’s care?The second part of the study involved 80 multidisciplinary health professionals: doctors, nurses and allied healthprofessionals from six study sites who participated in focus groups to explore their views of how parents coped andadjusted when their infant was transferred.Four clear themes emerged from the qualitative research:1. Health professionals were very aware of the causes of stress exhibited by parents2. Health professionals acknowledged many difficulties in preparing parents for transfer3. Health professionals were very aware of parents having to rebuild new relationships with new medical carers andhow difficult that must be – especially in the case of unexpected and sudden transfers4. Health professionals offered a broad range of support to parents including emotional support, moral support,sympathy, understanding and assistance with information.49

Nursing educationResearchers and staffJane MotleyLisa EvansLouisa RamuduDr Heather PisaniLeah HansenPramila NaiduAngela RuzzeneMayla VillaminDeb PedronKatia ForbesManager EducationStudent completions in 2012Director of Nursing, BundooraExtended Care Centre, NorthernHealthClinical Nurse Educator(neonates)/PhD StudentProgram and CourseRedevelopment, RMIT UniversityGraduate Nurse and MidwiferyProgram CoordinatorClinical Nurse EducatorClinical Nurse Consultant,Broadmeadows HealthService and Bundoora ExtendedCareCentreClinical Nurse Educator,Bundoora Extended Care Centre,Nursing EducationLouisa Ramudu, La Trobe University, Faculty of HealthSciences, Clinical Nurse Educator (Neonates), The NorthernHospital. Doctor of Nursing achieved in October 2012.Research projectsNursing educationThe development and evaluation of the SHINE e-learningprogram on knowledge of nursing staff who work in adementia specific unitInvestigators: Angela Ruzzene, Mayla Villamin and LisaEvansEvaluation of the traditional preceptorship model in achanged workforce: a localised studyInvestigators: Jane Motley, Leah Hansen, Pramila Naidu,and Dr Heather PisaniEvaluation of the STEP – Advanced Practice programInvestigators: Deb Pedron, Katia Forbes, Jane MotleyConsumer perspectivesHow parents cope and adjust with the down-transfer of theirinfants from Level 3 Neonatal Units to Level 2 SpecialCare Nurseries in Victoria, AustraliaInvestigators: Louisa Ramudu, Professor SusanMcDonald, Professor Shane Thomas, Helen Jenkin,Doreen Power, Lee Hopper, Barbara Capewell(Melbourne Health), Alyson Smith (Barwon Health),Laura Bignel (Mercy Hospital for Women), Sheri Waldron(Royal Children’s Hospital), Kathy Marshall (RoyalWomen’s Hospital).Research grantsGrants where Northern Health is the sole or lead agencyYear grant received Funding source Project name Investigators and affiliations Amount2011 June Allen practice Evaluation of the STEP Motley J, Pedron D, Forbes K $3000enhancement grant Advanced Practice program2012 Northern Health Evaluation of the traditional Motley J, Hansen L, Naidu P $5000Small Grant preceptorship model in a Pisani H(RMIT)changed workforce:a localised study50annual research report Northern Health 2012

Research publicationsResearch presentations and abstractsInternationalRamudu L, Mc Donald S, Thomas S. How Well Do ParentsCope Following Down-Transfer?17th Congress of the Federation of Asian and OceaniaPerinatal Societies and the 16th Annual Congress of thePerinatal Society of Australia and New Zealand, Sydney,March 2012Wong N, Pegler G, Ramudu L. Kangaroo Mother Care.4th Asia Pacific Congress of Paediatric Nursing, Sabah,East Malaysia, September 2012NationalRamudu L, Mc Donald S, Thomas S. Moving forward: Howdo parents cope with the down-transfer of their infants inVictoria?Victorian Association of Neonatal Nurses 5th AnnualSymposium (Keynote speaker), Melbourne, June 2012OtherRamudu L, Mc Donald S, Thomas S. The Coping Styles ofParents following the Down-transfer of theirinfants fromtertiary neonatal units to level 2 special care nurseries inVictoria.Northern Health Inaugural Nursing and MidwiferySymposium, The Northern Hospital, May, 2012.Ramudu L, Mc Donald S, Thomas S. The coping styles ofparents following the down-transfer of their infants fromtertiary neonatal units to level 2 special care nurseriesin Victoria, Australia (poster)Northern Health Research Week, The Northern Hospital,August, 2012Research presentations and abstractsRamudu L, Mc Donald S and Thomas S.2012, ;How well doparents cope following down-transfer?’ ⌠abstract⌡ Journalof Paediatrics and Child Health, 48 (Suppl. 1) 8-81.Northern Health Research Week posterpresentationEaston J, McLeod-Mills L and Hau RC. Theatre start timeauditBest surgical poster presentation – Northern Health ResearchWeekAn abstract for ‘The development and evaluation of theSHINE e-learning program on knowledge of nursingstaff who work in a dementia specific unit’ has beensubmitted to the Alzheimer’s Australia annual conferencein Hobart 2013.CollaborationsDr Sue Aberdeen DBMASDr Margaret Winbolt ACEBAC, La Trobe UniversityDr Heather Pisani, RMIT UniversityAssociate Professor Julie ConsidineNursing education51

52 annual research report Northern Health 2012

University partnershipsUniversity partnerships53

Deakin University – Northern Health Clinical Partnership54The Deakin University-Northern Health Clinical Partnershipwas established in 2007 with the aim of providing academic,clinical and professional leadership, building researchcapacity, and actively engaging in integration of evidenceinto clinical practice. Our research activities are focusedon improving the quality and safety of nursing care byoptimising clinical decision-making, use of researchevidence in practice, and ensuring effective workforce andservice delivery models.Key research areasResearch program 1: Clinical risk management- clinical deterioration, knowledge translation,implementation science, decision makingResearch program 2: Workforce development andservice delivery- emergency department service delivery systems,workforce development and redesign, advanced practiceand nurse practitioner roles, healthcare disaster responseand preparednessResearchers and staffAssociate Professor Julie Considine, NursingMs Elspeth Lucas, Casual Research FellowStudentsPhDJulia Morphet (PhD candidate, Deakin University)Thesis: Transition to specialty practice programs in Australianemergency nursing: workforce outcomes and economicanalysis. Supervisors: Associate Professor Julie Considine(Deakin University – Northern Health) and ProfessorBridie Kent (Deakin University – Eastern Health)intana Damkliang, PhD candidate, Deakin UniversityThesis: Development of a traumatic brain injury carebundle: clinical application of research evidence by Thaiemergency nurses. Northern Health Supervisor: ProfessorBridie Kent (Deakin University – Eastern Health) andAssociate Professor Julie Considine (Deakin University –Northern Health)Glenn Eastwood (PhD candidate, Deakin University)Thesis: A detailed examination of intensive care nurses’management of low-flow oxygen therapy. Northern HealthSupervisor: Professor Bev O’Connell (Deakin University –Southern Health) and Associate Professor Julie Considine(Deakin University)MastersMs Belinda Mitchell (Master of Nursing Practice candidateDeakin University)annual research report Northern Health 2012Topic: Sources of clinical risk in emergency care.Supervisors: Associate Professor Julie Considine (DeakinUniversity – Northern Health) and Professor Mari Botti(Deakin University)Ms Jen Hosking (Master of Nursing Practice candidate,Deakin University)Topic: Recognition of patients experiencing clinicaldeterioration in the emergency department.Supervisors: Professor Julie Considine (Deakin University –Northern Health) and Associate Professor Natisha Sands(Deakin University)Bachelor of Nursing HonoursCarissa Trotter (Bachelor of Nursing (Honours) candidate,Deakin University)Topic: Nurses’ use and documentation of clinical data inacute care settingsSupervisors: Associate Professor Julie Considine (DeakinUniversity – Northern Health) and Associate ProfessorJudy Currey (Deakin University)Jennifer Rawet, Bachelor of Nursing (Honours) candidate,Deakin UniversityTopic: Evaluation of track and trigger system foridentifying and responding to clinical deterioration inemergency department patients to improve patient safetySupervisors: Associate Professor Julie Considine (DeakinUniversity – Northern Health) and Associate ProfessorJudy Currey (Deakin University)Julie Preston (Bachelor of Nursing (Honours) Candidate,Deakin University)Thesis: Increasing critical care nurses’ diagnosticaccuracy of atrial electrograms by using an innovativeeducation programSupervisors: Associate Professor Judy Currey (DeakinUniversity) and Associate Professor Julie Considine(Deakin University – Northern Health)Research projects in 2012T3 Trial: Triage, Treatment and Transfer of patients with strokein emergency departmentsSandy Middleton, Chris Levi, Mark Fitzgerald, JulieConsidine, Jeremy Grimshaw, Catherine D’Este, RichardGerraty, Wah Cheung, Dominique Cadilhac, ElizabethMcInnesIdentification of factors which contribute to extended lengthof stay in the Emergency Department for patients fromresidential aged care facilities versus community settingsMaryann Street, Julie Considine, Goetz OttmanEmergency Department early warning systemJulie Considine, Elspeth Lucas, Bart Wunderlich

Nurses’ use and documentation of clinical data in acute caresettingsJulie Considine, Judy Currey J (Deakin University),Carissa Trotter (Deakin University)Evaluation of track and trigger system for identifying andresponding to clinical deterioration in EmergencyDepartment patients to improve patient safetyJennifer Rawet (Deakin University), Julie Considine, JudyCurrey J (Deakin University)A prospective evaluation of the impact of the nursepractitioner role on Emergency Department service andoutcomesGlenn Gardner (QUT), Anne Gardner (ACU), SandyMiddleton (ACU), Julie Considine, Cameron Hurst (QUT)& Phillip Della (Curtin University). PIus: Gerard FitzGerald(QUT), Luke LA (Lyell McEwin, SA), Andrew Finckh (StVincent’s Hospital, Sydney), Kevin Chu (Royal BrisbaneHospital) Australian Research Council – LinkageTransition to specialty practice programs in Australianemergency nursing: workforce outcomes and economicanalysisJulia Morphet (Deakin University), Julie Considine, BridieKent (Deakin University – Eastern Health)Research grantsGrants where Northern Health is the sole or lead agencyDevelopment of a traumatic brain injury care bundle: clinicalapplication of research evidence by Thai emergencynursesJintana Damkliang (Deakin University), Bridie Kent(Deakin University – Eastern Health), Julie ConsidineInterprofessional Graduate Program: a new graduateworkforce strategyJulie Considine, Tony Walker (Ambulance Victoria)Translation of evidence into pain management practices inacute care environmentsMari Botti (Deakin University – Epworth Healthcare),Bridie Kent (Deakin University – Eastern Health), TraceyBucknall (Deakin University – Cabrini Health), Megan-Jane Johnstone (Deakin University), Maxine Duke(Deakin University), Julie Considine, Bernice Redley(Deakin University – Epworth Healthcare), Richard deSteiger (University of Melbourne - Epworth Healthcare),Australian Research Council LinkageA detailed examination of intensive care nurses’management of low-flow oxygen therapyGlenn Eastwood (Deakin University), Bev O’Connell(Deakin University – Southern Health), Julie ConsidineSources of clinical risk in emergency careBelinda Mitchell (Deakin University), Julie Considine, MariBotti (Deakin University – Epworth Healthcare)University partnershipsYear grant received Funding source Project name Investigators and affiliations Amount2012-14 NHMRC Project Grant T3 Trial: Triage, Chief investigators $2,258,198Treatment and Middleton S of patients (ACU), Levi CTransfer with stroke (John Hunter), Fitzgerald M (The Alfred),in emergency Considine J (Deakin Universitydepartments – Northern Health), Grimshaw J(Ottawa Hospital Research Institute),D’Este C (The University ofNewcastle), Gerraty R(Epworth HealthCare),Cheung W (WestmeadHospital), Cadilhac D(National Stroke ResearchInstitute), McInnes E (ACU)2011-13 Australian Research A prospective Chief investigators $507,178Council Linkage evaluation of the Gardner G (QUT), Gardner AGrantimpact of the nurse Gardner A, (ACU),practitioner role on Considine J (Deakin Universityemergency – Northern Health), Hurst C (QUT),department Della P (Curtin University)service and Partner investigatorsoutcomesFitzGerald GJ (QUT),Christofis LA (Lyell McEwinHospital, SA), Finckh AS(St Vincent’s Hospital, Sydney),Chu K (Royal Brisbane Hospital)55

Deakin University – Northern HealthClinical Partnership cont’d56Research publicationsPeer reviewed journalsConsidine J, Shaban RZ, FitzGerald GJ, Thomas S andGraham CA. 2012, ‘Triage and ATS: Collateraldamagein the quest to improve ED performance,’ AustralasianEmergency Nursing Journal, 15(4):185-187.Considine J, Lucas E, Payne R, Stergiou HE, Kropman M andChiu H. 2012, ‘Analysis of three advancedpractice rolesin emergency nursing,’ Australasian Emergency NursingJournal, 15(4):219-228.Considine J, Lucas E, Wunderlich B. 2012, ‚The uptake ofan early warning system in one Australianemergencydepartment: a pilot study,’ Critical Care andResuscitation, 14(2):135-141.Considine J, Botti M and Thomas S. 2012, ‘Descriptiveanalysis of emergency department oxygen use inacuteexacerbation of chronic obstructive pulmonary disease,’Internal Medicine Journal, 42(4):e38-e47.FitzGerald GJ, Aitken P, Shaban R, Patrick J, Arbon P,McCarthy S, Clark M, Considine J, Finucane J,HolzhauserK and Fielding E. 2012, ‘Pandemic (H1N1) Influenza 2009and Australian emergency departments: Implications forpolicy, practice, and pandemic preparedness,’ EmergencyMedicine Australasi,. 24(2):159-165.Eastwood G, Peck L, Baldwin I, Considine J, Reade M andBellomo R. 2012, ‘Critical care nurses’ opinions and selfreportedpractice of oxygen therapy: A survey,’ AustralianCritical Care, 25(1):23-30.Considine J, Botti M and Thomas S. 2012,‘Descriptive analysis of oxygen use in Australianemergencydepartments,’ European Journal ofEmergency Medicine, 19(1):48-52.Considine J, Lucas E, Martin R, Stergiou HE, Kropman Mand Chiu H. 2012, ‘Rapid intervention and treatmentzone:redesigning nursing services to meet increasingemergency demand,’ International Journal of NursingPractice, 18(1):60-67.In pressMunroe B, Curtis K, Considine J and Buckley T. (‘The impactstructured patient assessment frameworks have onpatient care: An integrative review,’ Journal of ClinicalNursing, accepted 10/12/12.annual research report Northern Health 2012Considine J, Jones D and Bellomo, R. ‘Emergencydepartment rapid response systems: the case fora standardised approach to deteriorating patients,’European Emergency Medicine Journal, accepted28/11/2012.Considine J, Martin R, Williamson S and Currey J.‘Expanding nurse initiated x-rays in emergency care usingteam-based learning and one-of teams,’ AustralasianEmergency Nursing Journal, accepted 28/11/2012.Allen J, Currey J, Considine J. ‘Annual resuscitationcompetency assessments: a review of the evidence,’Australian Critical Care, accepted 03/07/2012.Considine J, Mohr M, Lourenco R, Cooke Rand AitkenM. ‘Characteristics and outcomes of patients requiringunplanned transfer from subacute to acute care,’International Journal of Nursing Practice, accepted05/06/2012.Research presentations and abstractsInternationalConsidine J, Botti M and Thomas S. Emergency Departmentmanagement of exacerbation of COPD: how evidencebasedis care delivery?8th Biennial Joanna Briggs International Colloquium:Channelling the Rivers of Knowledge to Improve GlobalPolicy and Practice. Chiang Mai, Thailand, November2012.Considine J, Wunderlich B and Lucas E. An evidence-basedapproach to recognising and responding to deterioratingemergency department patients.8th Biennial Joanna Briggs International Colloquium:Channelling the Rivers of Knowledge to Improve GlobalPolicy and Practice. Chiang Mai, Thailand, November2012.Considine J, Martin R, Currey J, Williamson S. Using teambasedlearning to expanding nurse initiated x-rays inemergency care.8th Biennial Joanna Briggs International Colloquium:Channelling the Rivers of Knowledge to Improve GlobalPolicy and Practice. Chiang Mai, Thailand, November2012.Considine J. Connecting research, education and clinicalpractice in emergency nursing: getting serious aboutsafety and quality of emergency care.10th International Conference for Emergency Nursing.Hobart, October 2012.

Munroe B, Curtis K, Buckley T and Considine J. The impactof a structured patient assessment on patients andclinicians.10th International Conference for Emergency Nurses.Hotel Grand Chancellor: Hobart, October 2012.Considine J, Botti M and Thomas S. Descriptive analysis ofemergency department oxygen use in Victoria.10th International Conference for EmergencyNurses,Hobart, October 2012.Martin R, Considine J, Williamson S and Currey J.Expandingnurse initiated x-rays in emergency care using teambasedlearning.10th International Conference for Emergency Nurses.Hobart, October 2012.Street M, Considine J, Ottmann G, Livingston T and KentB.. Reducing emergency department length of stay forpatients from residential aged care.10th International Conference for EmergencyNurses,Hobart, October 2012Hosking J, Considine J and Sands N. October2012Recognising clinical deterioration in the emergencydepartment: Point prevalence of emergency departmentpatients fulfilling MET criteria and patient outcomes.10th International Conference for Emergency Nurses,Hobart,.Rawet J, Considine J and Currey J. Evaluation of a track andtrigger system for recognising and responding to clinicaldeterioration in emergency department patients.10th International Conference for EmergencyNurses,Hobart, October 2012.Considine J. Rapid response in the emergency department.7th International Conference on Rapid ResponseSystems and Medical Emergency Teams, Sydney, May2012.Considine J. Strengthening emergency, trauma and disasternurses’ collaboration: the way forward.2012 International Conference on Trends in Emergency,Trauma, and Disaster Nursing: Using evidence to guidedecision-making and improve nursing care. Phuket,Thailand, April 2012.Considine J. Competency management in emergency anddisaster nursing.2012 International Conference on Trends in Emergency,Trauma, and Disaster Nursing: Using evidence to guidedecision-making and improve nursing care Phuket,Thailand, April 2012.Considine J. Predictors of deterioration and emergencynurses’ role in patient safety.2012 International Conference on Trends in Emergency,Trauma, and Disaster Nursing: Using evidence to guidedecision-making and improve nursing care. Phuket,Thailand, April 2012.Martin R, Considine J, Williamson S and Currey J. Expandingnurse initiated x-rays in emergency care.2012 International Conference on Trends in Emergency,Trauma, and Disaster Nursing: Using evidence to guidedecision-making and improve nursing care. Phuket,Thailand, April 2012.Considine J, Lucas E and Wunderlich B. An emergencydepartment early warning system for deterioratingpatients: a feasibility study.2012 International Forum on Quality and Safety inHealthcare. Paris, France (poster), April 2012.NationalConsidine J. Making better clinical decisions.Emergency SA Conference, Adelaide, August 2012.Considine J. Acute stroke: how can emergency care impacton better outcomes? Emergency SA Conference,Stamford Plaza Hotel: Adelaide, August 2012.Considine J. Basic Life Support: Understanding BLS practicefrom an evidence-based perspective.Australian Resuscitation Council Victorian Branch StateConference. Melbourne, June 2012.Preston J, Currey J and Considine J. Atrial electrogramdiagnostic accuracy improves after an innovativeeducation program.ANZICS/ACCCN Intensive Care Annual Scientific Meeting2012,Adelaide, October 2012.International collaborationsDr Katarina Göransson, Nurse Manager of Research,Emergency Department, Karolinska University Hospital,SolnaAssociate Professor Praneed Songwathana, Secretariat,Doctoral program in nursing committee / Coursecoordinator in advanced practice nursing (MasterInternational program), principal investigator of ResearchUnit, Department of Surgical NursingAssistant Professor Wipa Saesia, Master program in nursingcommittee, Course coordinator in advanced practicenursing (Master Thai program), Faculty’s research centrecommitteeUniversity partnerships57

Deakin University – Northern HealthClinical Partnership cont’dNational collaborationsProfessor Gerard Fitzgerald, Professor of Public Health(Emergency and Disaster Management), QueenslandUniversity of TechnologyProfessor Paul Arbon, Professor of Public Health (Nursing),Flinders University, South AustraliaProfessor Michele Clark, Professor and Assistant DeanResearch, Faculty of Health, Queensland University ofTechnologyProfessor Anne Gardner, Professor of Nursing-Tropical Heath,James Cook UniversityProfessor Glenn Gardner, Director of the Centre for ClinicalNursingQueensland University of Technology and Royal Brisbaneand Women’s HospitalProfessor Sandy Middleton, Director, Nursing ResearchInstitute, St Vincent’s and Mater Health Sydney -Australian Catholic University and Director, NationalCentre for Clinical Outcomes Research (NaCCOR),Australia, Australian Catholic UniversityProfessor Anne Gardner, Professor of Nursing in the Schoolof Nursing, Midwifery and Paramedicine, AustralianCatholic UniversityAssociate Professor Ramon Shaban, Clinical ResearchFellow, Princess Alexandra Hospital-Griffith UniversityDr Peter Aitken, Associate Professor, School of Public Health,Tropical Medicine and Rehabilitation Sciences, JamesCook University & Senior Staff Specialist, TownsvilleHospitalDr Lynette Cusack, Postdoctoral Research Fellow, FlindersUniversityDr Mayumi Kako, Research Assistant, Flinders UniversityMs Karen Hammad, Postgraduate Research Student, FlindersUniversityMs Kerri Holzhauser, Nursing Director Research, PrincessAlexandra Hospital and Adjunct Senior Research FellowGriffith UniversityMr Jamie Ranse, Adjunct Lecturer, Flinders University/ClinicalManager – Research, Emergency Department, CalvaryHealth CareLocal collaborationsProfessor Mari Botti, Director The Alfred/Deakin NursingResearch Centre and Chair, Epworth-Deakin Centre forClinical Nursing ResearchProfessor Tracey Bucknall, Director Cabrini - Deakin Centrefor Nursing ResearchProfessor Maxine Duke, Head of School and Professor ofNursing Development, School of Nursing and Midwifery,Deakin UniversityProfessor Megan-Jane Johnstone, Academic Chair inNursing, Deakin University / Director Quality and RiskManagement in Clinical and Aged Care Research ClusterProfessor Bridie Kent, Chair in Nursing, Deakin University -Eastern HealthProfessor Bev O’Connell, Deakin University - Southern HealthChair in NursingProfessor Shane Thomas, Professor of Primary CareResearch, Monash UniversityAssociate Professor Judy Currey, School of Nursing andMidwifery, Deakin UniversityAssociate Professor Tony Walker, General Manager RegionalServices, Ambulance VictoriaAssociate Professor Trish Livingston, Senior Research Fellow,Deakin University – Eastern Health Nursing Research UnitDr Herman Chiu, Emergency Physician, The NorthernHospital, Northern HealthMs Robynne Cooke, Chief Nursing Officer, Northern HealthMs Roslyn Martin, Emergency Nurse Practitioner, NorthernHealthMs Belinda Mitchell, Risk Management Advisor, VictorianManaged Insurance AuthorityMs Bart Wunderlich, Clinical Nurse Educator, EmergencyDepartment, Northern HealthMs Stacey Williamson, Postgraduate Emergency NursingCourse Coordinator, Northern HealthMs Annabel Milonas, Postgraduate Emergency NursingCourse Coordinator/Resuscitation Coordinator, NorthernHealth.58annual research report Northern Health 2012

University partnerships59

The University of Melbourne Department of Medicine60The University of Melbourne, Department of MedicineNorthWest Academic Centre (NWAC) headed by ProfessorJudy Savige continued with our major themes of research in2012 – inherited renal disease, its diagnosis and treatment;and microvascular disease, its influences, and ability topredict cardiac events. We have had some significantpublications in 2012 and further manuscripts are undergoingreview or revision.We continue to collaborate closely with clinical departments– Obstetrics and Gynaecology in 2011, and Cardiology andRespiratory Medicine in 2012. We continue to collaborateclosely also with the Northern Clinical Research CentreNCRC and are especially grateful for the statistical helpprovided by Dr Ana Hutchinson, Associate Professor GraemeHawthorne and Associate Professor Terri Jackson.In 2012, we had Honours students recruited throughMelbourne Health for the first time. The students undertooktheir tutorials at the Royal Melbourne Hospital but performedtheir research here at Northern Health. Our projects werevery popular and we had recruited six students, mainly onthe basis of very clinically-orientated projects. All six students(three supervised by Associate Professor Barlis) obtained anH1. Four have subsequently been accepted into medicineor dentistry. One of Peter’s students won a prize for the bestposter at Research Week.The University looks forward to the development of theScholarly Selective Program and already Northern Health has14 proposed projects covering topics as broad as aged care,orthopaedics, general surgery, genetics, paediatrics, healthservice improvement, on the university website for medicalstudents to choose from.Researchers and staffProfessor Judy Savige, Professor of MedicineAssociate Professor Peter BarlisDr Yanyan WangDr Hayat DagherAssociate Professor J Des Parkin (part-time, honorary)Associate Professor Deb Colville (part-time, honorary)Sujiva Ratnaike (part-time, hHonorary)PhD studentsMardhiah Mohammad (PhD)Vanessa Siva Kumar (PhD)Dongmao Wang (PhD)Kim Jeffs (PhD – co-supervised)annual research report Northern Health 2012OtherFariya Ali – Retinal microvascular abnormalities and changesin small vessel calibre in hypertension (awarded first classHonours). This study was a collaboration with AssociateProfessor Van Gaal from Cardiology. It demonstratedthat retinal arteriole narrowing correlated better with thedevelopment of cardiac left ventricular hypertrophy than anymeasurement on clinic or ambulatory BP testing.Nicholas Tan – Retinal microvascular abnormalities inobstructive sleep apnoea (awarded first class Honours).Our senior medical registrar, Dr Chee Choy, helped with therecruitment of patients and analysis of the results. This studydemonstrated increased small vessel disease in patientswith obstructive sleep apnoea.Oltana Agastra – Normal variants in the COL4A5 genein people from Chinese, Indian and African communities(awarded first class Honours). This study was to identifyfurther normal variants in the gene affected in X-linked Alportsyndrome, and whose mutation database we co-curate.We recruited normal individuals from these different racialbackgrounds from the Northern Health community of staffand students.Student completions in 2012Mardhiah Mohammad (PhD)Vanessa Siva Kumar (Ph D)Fariya Ali B Sc (H1)Nicholas Tan B Sc(H1)Oltana Agastra B Sc (H1)Kubra Goz B Sc (H1)Hala Al-Janaby B Sc (H1)Sena Gocuk B Sc (H1)Key research areas1. Genetics of inherited renal disease – Alport mutationdatabase; how missense and nonsense mutations causedisease2. Microvascular disease in chronic disease (chronic kidneydisease, chronic obstructive kidney disease) and inpregnancy (preeclampsia, diabetes and small for datesbabies)3. Bioinformatics - Protein interaction maps in inheriteddisease affecting the basement membrane and in cancer(BRCA1)

University partnerships61

The University of MelbourneDepartment of Medicine cont’d62Major achievements in 2012-13 and futureresearch goalsInherited diseases causing renal failureWe have continued our interest in inherited renal disease andhave begun to investigate some of the interesting families wehave come across in the past few years. We are collaboratingwith the Walter and Eliza Hall Institute in identifying thesenew genes through massive exomic sequencing and linkageanalysis. We are currently looking at two large families witha single kidney (renal agenesis) or IgA nephropathy whichrepresent two of the commonest causes of non-vascular kidneyfailure. We continue to curate our databases for mutationsin the COL4A5, COL4A3 and COL4A4 genes for Alportsyndrome and thin basement membrane nephropathy, andthe international Alport mutation consortium is producing itsfirst publication on further novel mutations in these conditions.The databases are co-curated with Dr Helen Storey from Guy’sHospital diagnostic testing laboratory. We have collaboratedwith Professor Sue Povey of University College London on amanuscript explaining mutation databases to clinicians.We have continued our interest in developing new treatmentsfor inherited renal disease in a collaboration with AssociateProfessor Ricardo at Monash University Stem Cell Centre, whois able to make kidney cells from skin cells from patients withsome of the diseases we study. Our former PhD students,Vanessa Siva Kumar and Mardhiah Mohammad were able todemonstrate a consistent increase in protein level (althoughthe protein was abnormal) in cell lines derived from patientswith nonsense or missense mutations after manipulation withprotein synthesis inhibitors or chemical chaperones, whichrepresent potential treatments.Associate Professor Des Parkin has worked on another aspectof inherited renal disease, looking at some of the affectedproteins and trying to work out how missense mutationshave their effect through altering the ability of their ligands(binding partners) to bind. Professor Savige has developedan analogous map for BRCA1, the protein affected in inheritedbreast cancer, and hopes to publish this later in the year.Microvascular disease, hypertension and cardiac riskOur previous University of Melbourne medical studentsundertaking a Bachelor of Medical Science degree haveexamined retinal small vessel abnormalities in many kinds ofchronic disease – chronic kidney disease, chronic obstructivepulmonary disease (COPD), autoimmune rheumatic disease,inflammatory bowel disease, cancer and ischemic heartdisease. All the study participants have had retinal photographyand retinal vessels in the photographs have been measuredusing a computer-assisted program.annual research report Northern Health 2012The results have demonstrated small vessel dilatation ininflammatory disease and narrowing with atherosclerosis.Our students in 2012 investigated whether retinal small vesselcalibre was a better predictor of left ventricular hypertrophy thana clinic BP or any measure on ambulatory BP monitoring (FariyaAli). Indeed it demonstrated that this was so, and a projectbuilding on this that investigates whether the retinal arteriolesize returns to normal as the hypertrophy resolves has beensubmitted as an NHMRC grant. Our other student (NicholasTan) together with Dr Chee Choy has demonstrated that theretinal arterioles are smaller in patients with obstructive sleepapnoea than with COPD, and that this might contribute to theincreased myocardial risk in these patients.Advanced Cardiac Imaging Group led by AssociateProfessor Peter BarlisThe focus of the Cardiovascular Imaging Group led byAssociate Professor Peter Barlis is to use novel imagingmethods to better help our understanding of coronary arterydisease and the treatments available, particularly coronarystents. Three honours students worked on various projectsfocussing on the application of optical coherence tomography(OCT) to assess human atherosclerosis and coronary stents.Two multi-centre randomised clinical trials are currentlyunderway and led by Professor Barlis examining how thebody reacts to the insertion of different types of stent devices.Our group is also collaborating with Harvard University on alandmark international registry of patients with heart diseasehaving angiography and OCT imaging. The group has benefitedby the close links it has established with the Northern ClinicalResearch Centre.StudentsKubra Goz – Examining atherosclerotic plaque coverage usingoptical coherence tomography (awarded first class Honours).Supervised by Associate Professor Peter Barlis. This projectassessed whether different coronary stents resulted in differentamounts of coverage.Hala Al-Janaby – Examining atherosclerotic plaque appositionusing optical coherence tomography(awarded first classHonours). Supervised by Associate Professor Peter Barlis. Thisproject determined the factors that led to stents separating fromthe walls of the coronary vessels.Sena Gocuk- Examining atherosclerotic plaque using opticalcoherence tomography (awarded first class Honours).Supervised by Associate Professor Peter Barlis. This projectcharacaterised the features of vulnerable plaque – its character,extent and circumference.

Research grantsGrants where Northern Health is the sole or lead agencyYear grant received Funding source Project name Investigators and affiliations Amount2012 Alport Foundation Characterisation of stem Savige J $20,000of Australiacells derived from patientswith Alport syndrome:a model for developingtreatmentsUniversity partnershipsResearch publicationsPeer reviewed journalsSavige J, Gregory M, Gross O, Kashtan C, Ding J, FlinterF. 2013, ‘Expert guidelines for the management ofAlport syndrome and TBMN,’ Journal of the AmericanSociety of Nephrology, –epublished ahead of print.Savige J. 2012, ‘Alport syndrome: About time - treatingchildren with Alport syndrome,’ Nature ReviewsNephrology, 29: 375-6.Newk-Fon Hey Tow FK, Ooi QL, Wong TY, Kawasaki R,Colville D, Mount P, Savige J. 2012, ‘Microvasculardilatation after haemodialysis is determined by thevolume of fluid removed and fall in mean arterialpressure,’ Kidney and Blood Pressure Research,35:644-8.San Antonio JD, Parkin JD, Savige J, Orgel JPRO,Jacenko O. ‘Collagen interactomes: mappingfunctional domains and mutations on fibrillar andnetwork-forming collagens, in Karamanos: ExtracellularMatrix: Pathobiology and Signaling, De Gruyter, Berlin.Chong CP, van Gaal WJ, Ryan JE, Profitis K, Savige J,Lim WK. 2012, ‘Does cardiology intervention improvemortality for post-operative troponin elevationsafter emergency orthopedic –geriatric surgery? Arandomised controlled study,’ Injury 43: 1193-8.Chong CP, Lim WK, Velkoska E, van Gaal WJ, RyanJE, Savige J, Burrell LM. 2012, ‘N-terminal probrainnatriuretic peptide and angiotensin-convertingenzyme-2 levels and their association with postoperativecardiac complications after emergencyorthopaedic surgery,’ American Journal of Cardiology,109; 1365-73.Chong CP, Gaal WJ, Profitis K, Ryan JE,Savige J, Lim WK. 2013, ‘Electrocardiograph changes,troponin levels and cardiac complications afterorthopaedic surgery,’ Annals Academy of MedicineSingpore, 42: 24-32.In pressOkada M, Wong TY, Kawasaki R, Baharuddin NB, ColvilleD, Savige J. ‘Retinal venular calibre is increased inpatients with autoimmune rheumatic disease: a casecontrolstudy,’ Current Eye Research.Wang YY, Sivakumar V, Mohammad M, Colville D, StoreyH, Flinter F, Dagher H, Savige J. ‘Clinical and geneticfeatures in autosomal recessive and X-linked Alportsyndrome,’ Pediatric Nephrology. .The International Alport Mutation Consortium; JudySavige, Elisabet Ars, Dev Batish, Richard GH Cotton,David Crockett, Hayat Dagher, Constantinos Deltas,Jie Ding, Frances Flinter, Genevieve Pont-Kingdon,Nizar Smaoui, Roser Torra, Helen Storey. Databasesfor COL4A5 variants in X-linked Alport syndrome willimprove accuracy, testing efficiency and phenotypeprediction. Pediatric Nephrology. .Storey H, Savige J, Sivakumar V, Flinter FA. ’Clinical andmolecular features in 40 unrelated individuals withautosomal recessive Alport syndrome,’ Journal of theAmerican Society of Nephrology..Research presentations and abstractsProfessor Savige together with Professor Sue Povey inLondon hosted a mini-symposium on ‘Curating ahuman variant database in inherited renal disease’, inJune 2012 at University College, London.Invitations to speakInternationalUniversity of Cambridge: How a university makes itselfvaluable to a health service, 150th anniversary ofUniversity of Melbourne Medical School in Europe,June 2012Guy’s Hospital, Department of Nephrology: Expertguidelines on the diagnosis and management ofAlport syndrome and Thin basement membranenephropathy, June 2012Biomarkers to assess ANCA-associated disease activity.Asia-Pacific ANCA-vasculitis Symposium, April 2012NationalAnnual Tuberous sclerosis Patient Support Group meeting,Royal Children’s Hospital, June 2012Second Alport Patient Support group meeting, Newcastle,September 2012Royal Brisbane Hospital: Inherited renal disease,discussion of cases, September 201263

The University of MelbourneDepartment of Medicine cont’d64Queensland Renal group: How to diagnose inherited renaldisease, September 2012RACP Physician Education Program lecture series: Vasculitis,September 2012Investigations in Medicine: Genetics for physicians, PhysicianEducation Program, September 2012Inherited causes of renal failure, Monash Medical Centre,May 2013Inherited causes of renal failure, Royal Children’s Hospital,May, 2013Inherited causes of renal failure, Murdoch Children’sResearch Institute, May 2013PostersV Sivakumar, M Mohammad, D Colville, H Storey, F Flinter, JSavige. Comparison of the Clinical features in autosomalrecessive and X-linked Alport syndrome.Poster presentation, American Society of Nephrology AnnualMeeting, San Diego, November, 2012Savige J, Dagher H, Povey S. Assessment of DNA variantdatabases for inherited kidney diseases for clinicalrelevance, accessibility, expertness of curation andcurrency.Human Variome Project meeting, UNESCO, Paris, June 2012.Savige J, Dalgleish R, Cotton RGH, Den Dunnen JT, MacraeF, Povey S. Clinician involvement is critical to ensure DNAvariant databases are clinically-relevant, current, accurate,freely-available and sustainable. Human Variome Projectmeeting, UNESCO, Paris, June 2012.Northern Health Research WeekChong C, Lim WK, Velkoska E, van Gaal WJ, Ryan JE, SavigeJ, Burrell LM. N-terminal pro-brain natriuretic peptideand angiotension converting enzyme 2 levels and theirassociation with post-operative cardiac complicationsafter emergency orthopedic surgery.Poster, Northern Health Research week.Savige J, Dagher H, Povey S. Assessment of DNA variantdatabases for inherited kidney diseases for clinicalrelevance, accessibility, expertness of curation andcurrency. Poster, Northern Health Research week.Choy C, Tan N, Colville D, Hutchinson A, Savige J.Microvascular retinopathy in patients with obstructivesleep apnoea: a cross-sectional observational study.Poster, Northern Health Research week.Tan N, Choy C, Ali F, Chew S, Colville D, Wong TY, KawasakiR, Hutchinson A, Savige J. Retinal arterioles and venulesare narrower in patients with obstructive sleep apnoea:annual research report Northern Health 2012a cross-sectional observational study. Poster, NorthernHealth Research week.Agastra O, Wang YY and Savige J. Normal variants inCOL4A5 gene for X-linked Alport syndrome in Chinese,African and Indian ethnicities.Poster, Northern Health Research week.Savige J, Sivakumar V, Mohammad M, Colville D, Storey H,Flinter F, Wang Y. Comparison of the clinical features inX-linked and autosomal recessive Alport syndrome.Poster, Northern Health Research week.CollaborationsNorthern Health (General Medicine, Nephrology, Cardiology,Respiratory Medicine, Radiology)Ecosse Lamoureux, Tien Wong and Ryo Kawasaki, Centrefor Eye Research Australia and National University ofSingaporeSharon Ricardo, Stem Cell Centre, Monash Medical CentreMelanie Bahlo, Bioinformatics Department, Walter and ElizaHall InstituteJames San Antonio, Orthovita, Philadelphia, Richard Farndale,Cambridge University, Raymond Dalgleish, University ofLeicester, and Xavier Jeunemaitre, INSERM, ParisProf Sue Povey, University College LondonHelen Storey and Frances Flinter, Guy’s Hospital, LondonOther activitiesProfessor Savige continues to act as a referee for theNHMRC, Wellcome Trust (UK). MRC Fellowships (UK),National Kidney Foundation (UK), NZ MRC Grants,Kidney Research Of Canada, and for presentations at theInternational Congress of Nephrology, and ANZ Societyof Nephrology Annual Scientific meeting. In 2012 she hasbeen a referee for Journal of the American Society ofNephrology, Clinical Journal of the American Society ofNephrology, Nature Nephrology, and a number of otherjournals.

The University of Melbourne,Department of General SurgeryUniversity partnershipsThe University Department of Surgery at the Northern Hospitalis in the early stages of developing a research program.We have an Honours student for the first time in 2013 andlook forward to further growth with the introduction of theUniversity of Melbourne Scholarly Selectives in the 2013-14academic year.Researchers and staffAssociate Professor Hamish EwingMs Karen BarclayOtherMiss Jessica Wisely, University of Melbourne, Honoursstudent‘The impact of an ERAS program of management ofemergency surgery’Northern Health supervisor – Karen BarclayMs Fiona Holland, The Northern Hospital and University ofMelbourne‘The effects of acculturation on presentation of ColorectalCancer’‘Factors affecting quality of life after treatment forColorectal Cancer’Northern Health supervisor – Karen BarclayDr Dominic Chow, The Northern Hospital and University ofMelbourneRenal function in elective colorectal patients in the settingof an enhanced recovery after surgery (ERAS) protocolNorthern Health supervisor – Karen BarclayDr Paul-Jon Goh, The Austin and Northern Clinical School,University of Melbourne‘The relationship between sociodemographic factorsand stage of presentation of Colorectal Cancer at theNorthern Hospital’Northern Health supervisor – Karen Barclay*Dr Ojas Mehta, The Austin and Northern Clinical School,University of Melbourne ‘Factors influencing intraoperativehypothermia during emergency and electivecolorectal surgery’Northern Health supervisor – Karen Barclay*Dr Ying-Yan Zhu, The Austin and Northern Clinical School,University of Melbourne ‘Peri-operative management ofcolorectal surgery – the impact of an enhanced recoveryprogram’Northern Health supervisor – Karen Barclay*Key research areas• Peri-operative management in colorectal surgery• Patient factors affecting outcome in colorectal surgery• Practice assessment and quality improvement in surgery• Defining the patterns of presentation and stage ofcolorectal cancer in the Northern Health catchment area• Community interventions to diagnose colorectal cancerearlier and improve outcome following diagnosisMajor achievements in 2012 and futureresearch goalsThe University Department of Surgery continues to providesupport for young researchers keen to explore ideas andcommence a research career. The development of a closeliaison with Northern Health’s Health Information team andthe support of a research assistant have allowed the projectsto flourish, with expected increase in publications andpresentations over the coming year.Research projects in 2012The effect of acculturation on stage at presentation ofcolorectal cancerHolland F 1 , P Poon 1 , Hutchinson A 1 , & Barclay K 1, 21The Northern Hospital and the 2 University of MelbourneQuality of Life after treatment for Colorectal Cancer –a PILOT studyHolland F 1 , P Poon 1 , Hutchinson A 1 , & Barclay K 1, 21The Northern Hospital and the 2 University of MelbourneIncreased use of guidelines could reduce the burden ofcolonoscopic procedures for disease follow-upBarclay K 1, 2 , & Poon P 11The Northern Hospital and the 2 University of MelbourneSocio-economic and demographic characteristics of patientsundergoing surgery for colorectal cancer at The NorthernHospitalGoh PJ 2 , Barclay K 1, 2 , & Poon P 11The Northern Hospital and the 2 University of MelbourneRenal function in elective colorectal patients in the setting ofan enhanced recovery after surgery (ERAS) protocolChow D 1 , & Barclay K 1, 21The Northern Hospital and the 2 University of Melbourne65

The University of Melbourne,Department of General Surgery cont’dEnhanced recovery after surgery (ERAS): The NorthernHealth experienceBarclay K 1, 2 , Poon P 1 , & Zhu Y 1, 21The Northern Hospital and the 2 University of MelbourneIntraoperative hypothermia in patients undergoingemergency and elective colorectal surgeryMehta O 2 , Barclay K 1, 2 , & Poon P 11The Northern Hospital and the 2 University of MelbourneThe management of malignant colorectal polyps in a tertiarysettingBarclay K 2, 3 , Crowley P 1 , & Bui A 1, 21The Austin and 2 Northern Hospitals and the 3 University ofMelbourneMoving forward with confidence - increasing the capacity forself-management in cancer survivorsKaren Barclay in association with North EasternMetropolitan Integrated Cancer Service Project Group,Austin Health, Box Hill HospitalResearch grantsGrants where Northern Health is the sole or lead agencyYear grant received Funding source Project name Investigators and affiliations Amount2011 Northern Health Quality of life after treatment Holland F, P Poon, Hutchinson A, 4500.00Small Grants Award for colorectal cancer – Barclay K,a PILOT studyThe Northern Hospitaland the University ofMelbourneGrants involving Northern Health staff, but external lead agencyYear grant received Funding source Project name Investigators and affiliations Amount2011 Department of Health Moving forward with Northern Health, Austin Health, 293,000confidence - increasing Box Hill Hospital and NEMICSthe capacity for selfmanagement in cancersurvivors66Research publicationsIncreased use of guidelines could reduce the burden ofcolonoscopic procedures for disease follow-up BarclayK, The Northern Hospital and the University of Melbourne(under review)Research presentations and abstractsAustralasian College of Surgeons, Annual ScientificConference, Kuala Lumpar, Malaysia, May 2012Increased use of guidelines could reduce the burden ofcolonoscopic procedures for disease follow-up. Barclay Kand Poon P.The safety and efficacy of an ‘All-comers’ approach to anenhanced recovery program in colorectal surgeryBarclay K.Long-term outcome of malignant colorectal polypsBarclay K, Crowley P and Bui A.annual research report Northern Health 2012The impact of follow-up after colonoscopy on surgical outpatientworkloadBarclay Kand Poon P.ANZGOSA, Sydney, Australia, September 2012Choledocholithiasis at The Northern Hospital: Patterns ofinvestigation and interventionMian M, Joglekar S and Barclay K.AGVSFM, Melbourne, Australia, October 2012 (Winner,Best Student Presentation)Peri-operative hypothermia in patients undergoing majorcolorectal surgery at Northern HospitalMehta O and Barclay K.

The University of Melbourne,Department of PsychiatryUniversity partnershipsResearchers and staffAssociate Professor Suresh SundramDr Russell D’SouzaMs Sumathy, SathiyamoorthyMs Fiona BoleMs Sukanthy SanjeevanDr Sujeevan SinnatambyStudentsPhDDr Sujeevan SinnatambyDr Vaidyanathan SwaminathanMs Jody StanleyMs Hayley DarkeMs Teresa KellyMr Daniel BennetMs Amy DluzniakMs Zexi AllanKey research areasDepartment of Psychiatry,University of MelbourneDepartment of Psychiatry,University of MelbourneDepartment ofPsychology, University ofMelbourneDepartment ofPsychology, University ofMelbourneDepartment of Nursing,University of MelbourneStudent completions in2012Department ofPsychology, University ofMelbourneDepartment ofPsychology, University ofMelbourneDepartment of Psychiatry,University of MelbourneBiological psychiatry, biomarker and treatment discovery inpsychotic disordersMajor achievements in 2012 and futureresearch goalsCompleted a number of major international clinical trials;ongoing clinical research studies investigating blood,genetic and neurophysiological biomarkers; receivedsmall grant funding from Marion and EH Flack Trust forclinical research projects.Research projects in 2012Identification of biomarkers of treatment-resistantschizophrenia and other psychotic disorders: Can wepredict clozapine response?Suresh Sundram et al.Effect of Catechol-O-Methyltransferase COMT Val 158Metgenotype on sensory integration in schizophreniaSuresh Sundram et al.A double-blind, placebo-controlled, parallel-group, fixeddosagestudy to evaluate the efficacy and safetyof Armodafinil treatment (150 and 200 mg/day) asadjunctive therapy in adults with major depressionassociated with bipolar I disorderSuresh Sundram and Russell D’SouzaIs EGF system dysfunction associated with schizophreniasubtypes: ASRB database studySuresh Sundram, Vaidy Swaminathan et al.A six-month, open-label, flexible dosage (150-200mg/day)extension study of the safety and efficacy of Armodafiniltreatment as adjunctive therapy in adults with majordepression associated with bipolar 1 disorder - HREC/11/MH/19Suresh Sundram and Russell D’SouzaVictorian sites–Safety, tolerability and treatment response of paliperidonepalmitate in subjects with schizophrenia when switchingfrom oral antipsychoticsRussell D’Souza and Suresh SundramA quality use of medicine clinical registry to assess clinicaloutcomes in patients with schizophrenia treated withintramuscular injections of paliperidone palmitate(PEARL)Suresh Sundram and Russell D’SouzaAn open-label, multi-centre, rollover, long-term studyof Aripipazole Intramuscular Depot in patients withschizophrenia - HREC/10/MH/94Suresh Sundram and Russell D’SouzaPutting the community into Community Care Unit: Aconsumer peer support research and developmentprojectAllan Pinches, Suresh Sundram et al.67

The University of Melbourne,Department of Psychiatry cont’dExamining the effects of serotonin on perceptual awarenessand attentionOlivia Carter and Suresh SundramA 52 week, multi-centre, open label study to evaluate theeffectiveness of Aripiprazole Intramuscular Depot asmaintenance treatment in patients with schizophreniaASPIRE OPEN-LABEL (Aripiprazole Intramuscular DepotProgram in schizophrenia)Suresh Sundram and Russell D’SouzaThe problem of integrating visual and auditory inf ormationacross space in schizophreniaOlivia Carter, Suresh Sundram et al.A tissue bank for the collection, storage and analysis of DNAand other biological materials from consenting individualsfor the purpose of psychiatric researchSuresh Sundram et al.Schizophrenia Treatment Adherence Investigation:Investigating the role of the epidermal growth factorsystem in clozapine treated subjects with schizophreniaSuresh Sundram et al.Research presentationsIndo Global Psychiatry Initiative 2012, Kochi, IndiaVietnamese Psychiatric Association Annual Meeting 2012,Hanoi, VietnamAsia-Pacific Coroners’ Meeting 2012, Sydney, AustraliaSouth Asian Association for Regional Cooperation, AnnualPsychiatry Meeting 2012, Colombo Sri LankaSundram S, Vikas A, Kenchaiah B. 2011, ‘The third worldcongress of Asian psychiatry, Melbourne, Australia, AsianJournal of Psychiatry,4(3):230-1. Epub 2011 Sep 16.Furtos J, Sundram S. Asian J. 2012, ‘Globalisation and mentalhealth: the Lyon Declaration,’PsychiatrySep;5(3):283-5.Epub 2012 Aug 24.Scarr E, Sundram S, Deljo A, Cowie TF, Gibbons AS, JuzvaS, Mackinnon A, Wood SJ, Testa R, Pantelis C, Dean B.2012, ‘Muscarinic M1 receptor sequence: preliminarystudies on its effects on cognition and expression,’Schizophrenia Research,138(1):94-8. Epub 2012 Mar 4.Pereira A, Sugiharto-Winarno A, Zhang B, Malcolm P, FinkG, Sundram S. 2012, ‘Clozapine induction of ERK1/2 cellsignalling via the EGF receptor in mouse prefrontal cortexand striatum is distinct from other antipsychotic drugs,’International Journal of Neuropsychopharmacology,15(8):1149-60. Epub 2011 Sep 27.In pressMohan I, Lowe M, Sundram S. Comorbid situs inversus totalisand schizophrenia in a young male. Australia and NewZealand Journal of Psychiatry accepted 19/02/13.CollaborationsDr Olivia Carter,Dr Meredith McKague,Professor Michael BerkDr Seetal DoddProf Cyndi Shannon-WeickertUniversity of MelbourneUniversity of MelbourneDeakin UniversityDeakin UniversityUniversity of NSW68Research publicationsPeer reviewed journalsSmith J, Jones J. 2012, ‘Analysis of the emergency careexperience,’ Australian and New Zealand Journal ofPublic Health, 53(1): 74-82.Pereira A, Zhang B, Malcolm P, Sundram S. 2013, ‘Clozapineregulation of p90RSK and c-Fos signaling via theErbB1-ERK pathway is distinct from olanzapine andhaloperidol in mouse cortex and striatum,’ Progress inNeuropsychopharmacology and Biological Psychiatry,10;40:353-63.Mohan I, Sundram S. 2012, ‘Successful use ofelectroconvulsive therapy in a patient with atrial septaldefect,’ Australia and New Zealand Journal of Psychiatry,[Epub ahead of print]annual research report Northern Health 2012

Broadmeadows Health Service35 Johnstone Street Broadmeadows Vic 3074T. (03) 8345 5000 F. (03) 8345 5655Bundoora Extended Care Centre1231 Plenty Road Bundoora Vic 3083T. (03) 9495 3100 F. (03) 9467 4365Craigieburn Health ServiceCraigieburn Road West Craigieburn Vic 3064T. (03) 8338 3000 F. (03) 8338 3110Panch Health Service300 Bell Street Preston Vic 3072T. (03) 9485 9000 F. (03) 9485 9010The Northern Hospital185 Cooper Street Epping Vic 3076T. (03) 8405 8000 F. (03) 8405 8524www.nh.org.auscan here todownload