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Annual Research Report 2009Broadmeadows Health Service Bundoora Extended Care Centre Craigieburn Health Service Panch Health Service The Northern Hospital

8Research publicationsBooks / Book chapters:Davidson, M, Smith RA, Stone, N, 2009. Chapter 9: Interprofessionaleducation: Sharing the wealth In Clinical education: Evidence,practice and understanding. In Delany, C and Molloy, E., ClinicalEducation in the Health Professions: An Educator’s Guide.Churchill Livingston, Australia.Hill K, Schwarz J and Winbolt M. 2009 Supporting independentfunction and preventing falls. In: Nay et al – “Interdisciplinary careof older people: Issues and innovations”. Elsevier, Oxford, UK.Hill K, Waterston J, Murray K. 2009 Vestibular dysfunction andheadache: Assessment and management. In: Headaches, bruxismand related conditions: Diagnosis and multidisciplinaryapproaches to management. Ed: Selvaratnam P, Niere K, ZuluagaM, Oddy P. Elsevier, Oxford, UK.Nay R, Edvardsson D, Fleming R, Bird M, Hill K. 2009 PersonCentred Care. In: Nay et al – “Interdisciplinary care of olderpeople: Issues and innovations”. Elsevier, Oxford, UK.Peer Reviewed Journals:Basic D, Khoo A, Conforti D, Rowland J, Vrantsidis F, Hill K, Harry J,Lucero K, Prowse R. 2009. The Rowland Universal DementiaAssessment Scale (RUDAS), the MMSE and the GPCOG in amulticultural cohort of community-dwelling older persons withearly dementia. Australian Psychologist 44:1; 40-53.Basic D, Rowland J, Conforti D, Vrantsidis F, Hill K, LoGiudice D,Harry J, Lucero K, Prowse R. 2009. The validity of the RowlandUniversal Dementia Assessment Scale (RUDAS) in a multiculturalcohort of community-dwelling older persons with early dementia.Alzheimer’s disease and associated disorders 23(2):124-9.Bird ML, Hill K, Williams A, Ball M. 2009. Effects of resistance andflexibility exercise interventions on balance and related measuresin older adults. Journal on Ageing and Physical Activity. 17: 444-454.Batchelor F, Hill K, Mackintosh S, Said C, Whitehead C. 2009. TheFLASSH study: protocol for a randomised controlled trialevaluating falls prevention after stroke and two sub-studies. BMCNeurology. 9(1):14.Hill K. 2009. Invited commentary: Don’t lose sight of theimportance of the individual in falls prevention interventions.BMC Geriatrics 9:13.Hill AM, Hill KD, Brauer S, Oliver D, Hoffmann T, Beer C, McPhail S,Haines TP. 2009. Evaluation of the effect of patient education onrates of falls in older hospital patients: Description of arandomised controlled trial. BMC Geriatrics 9:14.Hill AM, McPhail S, Hoffman T, McKenna K, Hill K, Oliver D, Beer C,Brauer S, Haines T. 2009. A randomized trial of DVD versuswritten delivery of patient education materials for the provision offalls prevention education. Journal of the American GeriatricsSociety. 57(8):1458-1463.Hill K, LoGiudice D, Lautenschlager N, Said C, Dodd K, Suttanon P.2009 Effectiveness of balance training exercise in people withmild to moderate severity Alzheimer’s disease: Protocol for arandomised trial. BMC Geriatrics 9:29.Lamoureux E, Fenwick E, Moore K, Klaic M, Borschmann K, Hill K.2009 Impact of distance and near vision impairment ondepression and vision-specific quality of life in older people livingin residential care. Investigative Opthalmology and VisionSciences 50(9):4103-9.Mackintosh S, Fryer C, Hill K. 2009. Telephone and Face-to-FaceInterviews to Generate Similar Falls Circumstances Informationfrom Community-Dwelling Adults with Stroke: test – retestdesign. Australian and New Zealand Journal of Public Health33(3):295-6.Paterson K, Hill K, Lythgo N, Maschette W. 2009 Gait variability inyounger and older adult women is altered by overground walkingprotocol. Age and Ageing 38(6):745-8.Russell M, Hill K, Blackberry I, Gurrin L, Dharmage S, Day L. 2009.Development of the falls risk for older people in the community(FROP-Com) screening tool. Age and Ageing 38(1):40-6.Sims J, Hill K, Hunt S, Haralambous B. 2009 Physical activityrecommendations for older Australians. Australasian Journal onAgeing. 28: 139-143.Stapleton C, Hough P, Bull K, Hill K, Greenwood K, Oldmeadow L.2009. A 4-item falls-risk screening tool for sub-acute andresidential care: The first step in falls prevention. AustralasianJournal on Ageing 28(3): 139-143.Vrantsidis F, Hill K, Moore K, Webb R, Hunt S, Dowson L. 2009.Getting Grounded Gracefully©: Effectiveness and acceptability ofFeldenkrais in improving balance related outcomes for olderpeople: a randomised trial”. Journal on Aging and PhysicalActivity17:57-76.In Press:(IN PRESS) Fearn M, Hill K, Williams S, Mudge L, Walsh C, McCarthyP, Walsh M, Street A. Balance dysfunction in adults withhaemophilia. Haemophilia.(IN PRESS) Hill K, Fearn M, Williams S, Mudge L, Walsh C, McCarthyP, Walsh M, Street A. Effectiveness of a balance training homeexercise program for adults with haemophilia: A pilot study.Haemophilia Oct 5. [Epub ahead of print].(IN PRESS) Petty J, Hill K, ElHaber N, Paton L, Lawrence K, Berkovic S,O’Brien T, Wark J. Chronic anti-epileptic medication (AED) use isassociated with reduced balance – an AED-discordant twin andsibling matched pair study. Epilepsia. Aug 8. [Epub ahead of print](IN PRESS) Williams S, Brand C, Hill K, Hunt S, Moran H. Feasibilityand outcomes of a home based exercise program on improvingbalance and gait stability in women with lower limb osteoarthritisor rheumatoid arthritis: A pilot study. Archives of Physical Medicineand Rehabilitation.Research presentations & abstractsInternational:Considine J, Wellington P, Hill K, Smith R, Gannon J, Graco M, BehmC, Weiland T, McCarthy S, Corrie S. Analysis of the emergency careexperience of older people and their carers. 7th InternationalConference for Emergency Nurses, Gold Coast, October 2009.de Morton NA. The DEMMI. Ageing research seminar at theUniversity of British Columbia, Centre for Hip Health and Mobility.Vancouver, Canada, August 2009.

de Morton NA. The translation and validation of the MandarinDEMMI. Prince of Wales Hospital, Hong Kong, July 2009.Hill K, Considine C, Smith R, Gannon J, Graco M, Behm C, Weiland T,Wellington P, McCarthy S, Corrie S. Responding to the ageingprofile of emergency department patients. New ZealandAssociation of Gerontology and Age Concern New ZealandConference, Wellington, New Zealand, Oct 2009.Smith R, Smith J, Schofield C. What gets measured, gets done -discussing the link between placement assessment andinterprofessional competencies ANZAME - Australian NewZealand Association of Health Professional Educators,Launceston, July 2009.Smith R, Davidson, M, Smith J, Dodd, K, Schofield C. Learningtogether to work together - student team work for better healthIPCE - A Regional Network Approach ANZAME - Australian NewZealand Association of Health Professional Educators,Launceston, July 2009.Watkin D, Delaney C. Facilitating IPE goals in clinical education;identifying key elements for the teaching approach ANZAME -Australian New Zealand Association of Health ProfessionalEducators, Launceston, July 2009.National:Andrews S, Robinson A, Churchill B, Haines T, Haralambous B, HillK, Nitz J, Moore K. Facilitating best practice falls preventionthrough an action research approach. Australian Association ofGerontology Conference, Canberra, Nov 2009.Blackberry I, de Mel G, Galvin P, Hill K, Liaw S, Russell M, Taylor J.The risk of future falls among older people following an EDpresentation due to a future fall: Findings from patientinterviews in metropolitan, regional and rural Victoria. 9thNational Conference on Injury Prevention and Safety Promotion,Melbourne, July 2009.Butters T, Mannix R, Sandilands D. Interdisciplinary ChronicWound Care Services Involving Podiatry – A StrengthenedModel Of Care. Australasian Podiatry Conference, Gold Coast,May 2009.Butterworth P. The Role of Podiatry In Managing OrthopaedicsWaitlists. Australasian Podiatry Conference, Gold Coast,May 2009.Coyne R, Cavka B, Smith J. Osteoarthritis Hip and Knee Service(OAHKS) Optimising the Patient Journey: Beating the WaitingGame. Change Champion Conference, Cairns, 17-18 September2009.Davenport S & de Morton NA. The reliability and validity of the deMorton Mobility Index in healthy community dwelling olderadults. National Australian Physiotherapy Conference, Sydney,Oct, 2009.Edgar J, Smith, J, Smith R. Developing a new paediatricworkforce in outer metropolitan Melbourne", APA NationalPaediatric Physiotherapy Conference in Sydney, October, 2009.Guerra M, Cavka B. Optimising the patient journey: conservativeand surgical management. DHS OAHKS Forum, Melbourne,July 2009.Haines T, Moore K, Hill K, Robinson A, Nitz J, Haralambous B. Canthe safety culture of residential aged care facilities be impactedupon by an action-research strategy to implement best practiceguidelines for prevention of falls? Australian Association ofGerontology Conference, Canberra, Nov 2009.Haines T, Hill AM, Hill KD, Hoffman T, Brauer S, Oliver D, Beer C,McPhail S. Multimedia patient education for prevention of inhospitalfalls: a randomised controlled trial. AustralianAssociation of Gerontology Conference, Canberra, Nov 2009.Harris B, Nolan J, Govier A, Harris B, de Morton NA. What is themobility status at hospital discharge for older acute medicalpatients? National Australian Physiotherapy Conference, Sydney,Oct, 2009.Hill K, Smith R, Gratton-Vaughan J, Dodd K. Professor of alliedhealth: a new approach to building collaborative research andactivity in allied health. National Allied Health ProfessionalsConference, Canberra, Oct 2009.Hill K (invited speaker). Falls clinics – what is their future?National Falls Prevention Summit, Brisbane, Oct 2009.Hill K (invited speaker). Falls prevention after stroke – are wetaking it seriously? National Falls Prevention Summit, Brisbane,Oct 2009.Hill K (invited speaker). Seven years in seven minutes:Gerontological Physiotherapy. Australian Association ofPhysiotherapy Conference, Sydney, Oct 2009.Hill K (invited speaker). Are our universities producing a newgeneration of aged care physiotherapists? AustralianAssociation of Physiotherapy Conference, Sydney, Oct 2009.Lewis J & de Morton NA. Normative data for the de MortonMobility Index. National Australian Physiotherapy Conference,Sydney, Oct, 2009.McDonald T, Freeman K. Are nutritionally at risk cancer patientsappropriately referred for dietetic intervention in a dayoncology setting at the Northern Hospital? DieticiansAssociations of Australia Conference, Darwin, May 2009.McDonald E, Hill K, Punt D. Measurement of recovery in subacute stroke patients with laterpulsion. Australian PhysiotherapyAssociation Conference, Sydney, Oct 2009.Moore K, Haines T, Haralambous B, Hill K, Nitz J, Robinson A.Physical environments in residential aged care. AustralianAssociation of Gerontology Conference, Canberra, Nov 2009.Nolan J & de Morton NA. Rasch analysis of the Elderly MobilityScale. National Australian Physiotherapy Conference, Sydney,Oct, 2009.O’Brien T, de Morton NA, Thomas S, Govier A, Sherwell K, Harris B,Markham N, Govier. A head to head comparison of the deMorton Mobility Index (DEMMI) and Elderly Mobility Scale (EMS)in an older acute medical population. National AustralianPhysiotherapy Conference, Sydney, Oct, 2009.Robinson A, Churchill B, Andrews S, Haines T, Haralambous B, HillK, Nitz J, Moore K. Developing an evidence based approach tofalls prevention: Addressing professional isolation in aged care.Australian Association of Gerontology Conference, Canberra,Nov 2009.Schofield C, Barker A. Comparative accuracy of two methods ofpredicting discharge destination of hip and knee arthroplastypatients. Australian Physiotherapy Association Conference,Sydney, October 2009.9Northern Health Annual Research Report 2009

Smith, J. Smith R, Spring A, Champ P & Chapman S. Developing aSustainable Allied Health Workforce: meeting the challenge. 8thNational Allied Health Conference, Canberra, October 2009.Smith R, Pilling S, Champ P. Allied Health Graduate Program –supporting new graduates to learn from each other. 8th NationalAllied Health Conference, Canberra, October 2009.Smith R, Dodd K, Davidson M, Smith J, Schofield C. Learningtogether to work together: Facilitating collaboration throughinterprofessional clinical education. 8th National Allied HealthConference, Canberra, October 2009.Smith R, Steel C, Champ P, Smith J, Spring A, Wilson K. Supervision –A comprehensive approach to support retention anddevelopment. 8th National Allied Health Conference, Canberra,October 2009.CollaborationsAllied Health Research collaborations include other groups withinNorthern Health and colleagues from La Trobe University,University of Melbourne, Deakin University, Monash University,National Ageing Research Institute, University of South Australiaand University of Western Australia, and from other healthservices, including St Vincent’s Health and Bendigo Health.Northern Health Research Week 2009Allied Health researchers and clinicians contributed 10abstracts/posters for Northern Health Research Week in 2009 andone of the podium presentations. These are included in theResearch Week section of the report.Smith R, Smith J, Dodd K, Davidson M, Schofield, C. Learningtogether to work together - student team work for better healthIPCE - A Regional Network Approach, Rural Workforce AssociationVictoria, May 2009.10

Australian Centre for EvidenceBased Aged Care (ACEBAC)Researchers/ staffProfessor Rhonda NayDr Susan KochDr Deirdre FetherstonhaughDr Margaret WinboltDr Tenzin BathgateDr Michael BauerLinda McAuliffeSamantha NugentLisa DerndorferADJUNCT AND AFFILIATES:Dr Michael DorevitchDr David EdvardssonMs Cathie EdgarDr Sally GarrattProfessor Joe IbrahimMrs Jane MotleyDr Michael MurrayDr Chris ThompsonDirector ACEBACAssociate Professor, DirectorACEBAC (Collaborations)Deputy Director ACEBAC, SeniorResearch FellowResearch FellowResearch OfficerResearch FellowResearch Officer (PT)Administration Officer (PT)PA to Professor/AdministrationOfficer (PT)Geriatrician, Adjunct ProfessorAssistant Professor, UmeaUniversity, SwedenClinical Wound Consultant,Bundoora Extended Care CentreIndependent ConsultantGeriatricianNurse Educator, BundooraExtended Care CentreAssociate Professor, Director ofGeriatrics – St Vincent’s HealthNurse Unit Manager, BundooraExtended Care Centre, AdjunctSenior LecturerJames KevinMaie TonumaPauline WongAmanda CharlesCatherine EdgarJennifer LeverThe assessment of student nurses duringtheir clinical placements.Language and nursing practice.Families’ experiences of their interactionswithin an intensive care environment.Reportable deaths.A study of the type of wound careprovided to people with dementia.Care of the older person with mentalhealth issues.Nantawan Teerapong The development of self care model inhypertension patients.Other:Doctor of NursingLisa ClinnickChemical restraint in aged care.Student completions in 2009PhD:Pei-Ling HsiehMajor achievements in 2009The quality of family care and relatedfactors to dementia in Taiwan.The 3rd edition of Nay, R. & Garratt, S. ‘Older people: Issues andInnovation in care (3rd Ed) was published by Elsevier.In 2009 the Deputy Director – Collaborations, AssociateProfessor Susan Koch resigned from her position at ACEBAC.REVIEWERSBrent HodgkinsonEmily HaeslerStudentsACEBAC was accepted as a collaborative centre of theInternational Association of Geriatrics and Gerontology (IAGG).65 proposals were received and only 29 were accepted.The Institute for Social Participation (ISP) was established.ACEBAC developed a tool to measure person-centredness inresidential aged care facilities (P-CAT).PhD:Fay AldersonMelanie BishPam JohnsonPerson Centred Care and its implicationsfor interdisciplinary practice (Deferred).Professional identity for Division Twonurses (with Dr Mandy Kenny, Bendigo).Assessing pain in people with dementia.On NHMRC funded scholarship withAssoc Prof S. Gibson - NARI.Research projects in 2009Nay, R., Fetherstonhaugh, D., Ibrahim, J., Winbolt, M., Koch, S. &Wells, Y. Strengthening care outcomes for residents with evidence(SCORE). Victorian Department of Human Services.Nay, R., Edvardsson, D. & S Gibson. The development of a tool tomeasure person centered care. ANZ - J.O. & J.R. Wicking Trust.11Northern Health Annual Research Report 2009

12ACEBAC, NARI Bendigo Health, Monash University, St Vincent’sHealth, University of Melbourne, University of Tasmania.Dementia Training Study Centre for Vic and Tas. TIME for dementia(Training, Innovation, Mentoring and Education). AustralianGovernment Department of Health & Ageing.QUT, ACEBAC, Alzheimer’s Australia, Hammond Care, ACH SA,Baptist Care NSW & ACT. Systematic review – consumer directedcare – the evidence base for flexible community care andaccommodation models for people with dementia. DementiaCollaborative Research Centres 3, Australian GovernmentDepartment of Health & Ageing.Lead by NARI. Encouraging Best Practice in Residential Aged Care inPain (EBPRAC). Australian Government Department of Health &Ageing.UTS, ACEBAC, QUT. ENABLE. Person-centred evidence-basedapproaches to behaviour management. Australian GovernmentDepartment of Health & Ageing.Completed projects during 2009Koch, S., Ibrahim, J. & Wells, I. Public sector residential aged careservices quality indicator validation project. Victorian Department ofHealthBauer, M. & Nay, R. Collaborative caregiver-family relationships in thecare of older hostel residents. Windermere Foundation SpecialGrantNay, R. Innovative workforce responses to a changing aged careenvironment . Victorian Department of HealthDementia Collaborative Research Centre (DCRC). Pain in acutecare. Department of Health & AgeingDementia Collaborative Research Centre (DCRC). Development ofa tool to measure person-centredness. Department of Health &AgeingResearch grants 2009Bauer, M., Fetherstonhaugh, D., McAuliffe, L. The development of avalid and reliable survey tool to measure the constructiveness of stafffamilyrelationships in Australian residential aged care settings fromthe perspective of staff. Faculty of Health Science grant, La TrobeUniversity.Koch,S., Rayner, J., Bauer, M. The use of complementary andalternative medicine (CAM) in Victorian residential aged-care facilities.Faculty of Health Science grant, La Trobe University.Monash University, ACEBAC. Managing extreme hot weather inpublic sector residential aged care services. Victorian Departmentof Health.Monash University, ACEBAC. Real time evaluation and support forresidential aged care services managing extreme hot weather insummer 2010. Victorian Department of Health.Research publicationsPeer Review Journals:McAuliffe, L., Nay, R., O’Donnell, M. & Fetherstonhaugh, D. (2009)‘Pain assessment in older people with dementia: Literature review.’Journal of Advanced Nursing, 65(1), 2-10.Edvardsson, D. ‘Balancing between being a person and being apatient – a qualitative study of patient specific hospital clothing.’International Journal of Nursing Studies, 46(1), 4-11.Bauer, M., Nay, R. & McAuliffe, L. (2009) ‘Catering to love, sex andintimacy in residential aged care: What information is provided toconsumers?’ Sexuality and Disability, 27(1), 3-9.Bauer, M., Fitzgerald, L., Haesler, E. & Manfrin, M. (2009) ‘Hospitaldischarge planning for frail older people and their family. Are wedelivering best practice?’ A review of the evidence. Journal ofClinical Nursing. 18(18)2539-2546.Edvardsson, D., Fetherstonhaugh, D., Nay, R. & Gibson, S. (2009)‘Development and initial testing of the Person-centered CareAssessment Tool (P-CAT)’ International Psychogeriatrics, online.Edvardsson, D., Sandman, P.O. & Rasmussen, B. (2009)‘Construction and psychometric evaluation of the Swedishlanguage Person-centred Climate Questionnaire – staff version’Journal of Nursing Management. 17, 790-795.Bauer, M., McAuliffe, L., Nay, R., Fetherstonhaugh, D. (2009) ‘Sex inthe City and Older People.’ XIXth International Association ofGerontology and Geriatrics (IAGG) World Congress. The Journal ofNutrition, Health and Aging. 13(1) S173.Bauer, M., Fitzgerald, L., Koch, S. & King, S. (2009) ‘Hit and miss’:How family carers perceive hospital discharge for people withdementia.’ Australasian Journal on Ageing. 28 (Supplement 2)A43-A44Davis, S., Byers, S., Nay, R. & Koch, S. (2009) ‘Guilding design ofdementia friendly environments in residential care settings.’Dementia 8 (2) 185-203Edvardsson, D., Koch, S. & Nay, R. (2009) ‘Psychometric evaluationof the English language Person-Centred Climate Questionnaire –patient version. Western Journal of Nursing Research 31 (2) 235-245Edvardsson, D., Sandman, P.O., Nay, R & Karlsson, S. (2009)‘Predictors of job strain in residential dementia care nursing staff.’Journal of Nursing Management. 17:59-65Fetherstonhaugh, D. (2009) ‘Dialysis: A paradigm case of rationingmedical treatment.’ Renal Society of Australasia Journal 5(2)88-94Fetherstonhaugh, D. (2009) ‘A potted version of the early days ofdialysis.’ Renal Society of Australasia Journal 5(2)45-48Winbolt, HM. (2009) ‘Taking the team approach to translation ofevidence into aged care nursing practice.’ Australasian Journal onAgeing 28 (Supplement 2) A86-A87Winbolt, HM, Koch, S. & Nay, R. (2009) ‘The care conundrum:Changing the culture of gerontic nursing from task orientation toevidence-based practice.’ Australasian Journal on Ageing 28(Supplement 2) A86.Other:Books, Monographs & Reports:Nay, R. & Garratt, S. (2009) ‘Older people: Issues and Innovations inCare (3rd ed.)’ Elsevier.Bauer, M., Fitzgerald, L., Koch, S. & King, S. (2009) Alzheimer’sAustralia Research Dementia Grant Final Report, March 2009.‘Improving hospital discharge preparation and support forfamilies of patients with dementia.’Bauer, M., Nay, R. Bathgate, T., Fetherstonhaugh, D., Winbolt, M. &McAuliffe, L. (2009) Final Report March 2009. ConstructiveStaff/Family Relationships in Residential Aged Care. Departmentof Health and Ageing.

Chapters:Nolan, M., Edvardsson, D., Choowattanapakorn., Oo.,C (2009)Care and support for older people: some internationalreflections. In Nay, R. & Garratt, S. Caring for Older People: Issuesand Innovations (3rd Ed.). Elsevier. (pp.3-8).Nay, R., Bird, M., Edvardsson, D., Fleming, R. & Hill, K. (2009)Person-centred care. In Nay, R. & Garratt, S. Caring for OlderPeople: Issues and Innovations (3rd Ed.). Elsevier. (pp.107-119).Ibrahim, J., Koch, S., Holland, A. & Howie, L. (2009) Quality andsafety while enhancing rights and respecting risk. In Nay, R. &Garratt, S. Caring for Older People: Issues and Innovations(3rd Ed.). Elsevier. (pp.120-135).Nolan, M., Bauer, M. & Nay, R. (2009) Supporting family carers:implementing a relational and dynamic approach. In Nay,R. & Garratt, S. Caring for Older People: Issues and Innovations(3rd Ed.). Elsevier. (pp.136-152).Koch, S., Hunter, P. & Nair, K. (2009) Older people in acute care. InNay, R. & Garratt, S. Caring for Older People: Issues andInnovations (3rd Ed.). Elsevier. (pp.153-167).Davis, S., Dorevitch, M. & Garratt, S. (2009) Person-centredcomprehensive geriatric assessment. In Nay, R. & Garratt, S.Caring for Older People: Issues and Innovations (3rd Ed.).Elsevier. (pp.168-188).Hill, K., Schwarz, J. & Winbolt, M. (2009) Supporting independentfunction and preventing falls. In Nay, R. & Garratt, S. Caring forOlder People: Issues and Innovations (3rd Ed.). Elsevier.(pp.189-215).Gibson, S., Scherer, S., Katz, B. & Nay, R. (2009) Persistent pain inthe older person. In Nay, R. & Garratt, S. Caring for Older People:Issues and Innovations (3rd Ed.). Elsevier. (pp.261-291).Bauer, M., McAuliffe, L. & Nay, R. (2009) Sexuality and thereluctant health professionals. In Nay, R. & Garratt, S. Caring forOlder People: Issues and Innovations (3rd Ed.). Elsevier.(pp.292-309).Ozanne, E., Naughtin, G., Kurrle, S. & Koch , S. (2009) Interventionin a situation of elder abuse and neglect. In Nay, R. & Garratt, S.Caring for Older People: Issues and Innovations (3rd Ed.).Elsevier. (pp.310-321).Fetherstonhaugh, D., Street, A. & Abbey, J. (2009) End-of-lifedecision making for older people. In Nay, R. & Garratt, S. Caringfor Older People: Issues and Innovations (3rd Ed.). Elsevier.(pp.322-336).Garratt, S. (2009) Developing ethical clinical governance.In Nay, R. & Garratt, S. Caring for Older People: Issues andInnovations (3rd Ed.). Elsevier. (pp.339-350).Horner, B., Soar, J. & Koch, B. (2009) Assistive technology:Opportunities and implications. In Nay, R. & Garratt, S. Caring forOlder People: Issues and Innovations (3rd Ed.). Elsevier.(pp.391-412).Nay, R., Katz, B., Le Couteur, D. & Murray, M. (2009) Innovativeresponses to a changing health care environment. In Nay, R. &Garratt, S. Caring for Older People: Issues and Innovations(3rd Ed.). Elsevier. (pp.413-425).Koch, S., Brodaty, H., Rees, G. & Ames, D. (2009) Collaboration inageing research and education. In Nay, R. & Garratt, S. Caring forOlder People: Issues and Innovations (3rd Ed.). Elsevier.(pp.426-441).Winbolt, M., Nay, R. & Fetherstonhaugh, D. (2009) Taking a TEAM(Translating Evidence into Aged care Methods) approach topractice change. In Nay, R. & Garratt, S. Caring for Older People:Issues and Innovations (3rd Ed.). Elsevier. (pp.442-455).Daly, J., Jackson, D. & Nay, R. (2009) Visionary leadership for a‘greying’ health care system. In Nay, R. & Garratt, S. Caring forOlder People: Issues and Innovations (3rd Ed.). Elsevier.(pp.468-479).Bauer, M. (2009) Hygiene. In Dempsey, J., French, J., Hillage,S. & Wilson, V. Fundamentals of Nursing & Midwifery: A PersonCentred Approach to Care. Lippincott Williams & Wilkins,Sydney. (pp.862-907).Bauer, M. (2009) Rest and Sleep. In Dempsey, J., French, J.,Hillage, S. & Wilson, V. Fundamentals of Nursing & Midwifery:A Person Centred Approach to Care. Lippincott Williams& Wilkins, Sydney. (pp.1002-1025).Other:Nay, R. (2009) ‘Sexuality in the aged.’ Geriatric Medicine inGeneral Practice. Volume 2. July 2009Bauer, M., Fitzgerald, L., Koch, S. (2009) ‘Patients with dementiabeing discharged from hospital – preparation and support forfamilies.’ RCNA Connections 12(1) p21.Bauer, M. & Bathgate, T. (2009) ‘Constructive staff-familyrelationships in aged care.’ AGENDAS Aged and CommunityServices Australia. 52, p27.Research presentations & abstractsInternational:Bauer, M. ‘Improving hospital discharge preparation andsupport for families of patients with dementia.’ 24th Conferenceof Alzheimer's Disease International. Singapore - MarchBauer, M. ‘Family carers’ perceptions of hospital dischargepreparation for an older person with a dementia.’ 9thInternational Family Nursing Conference, Reykjavik, Iceland -JuneMcAuliffe, L. ‘Sex in the city and older people.’ 19th IAGG WorldCongress of Gerontology and Geriatrics, Paris – 5-9 JulyBauer, M. ‘Keep on Rockin’: Sexuality and Ageing symposium.’Invited Speaker. Canadian research network for care in thecommunity. Toronto – 20 OctoberFetherstonhaugh, D. ‘Person Centred Care’ BUPA. New Zealand– 4-5 NovemberNational:Nay, R. ‘Sexuality & Dementia.’ Pfizer Master Class in Alzheimer’sDisease. Sydney - 2 MayNay R & Fetherstonhaugh, D ‘From boardroom to bathroom –embedding person-centred care’ (Invited speaker) Aged CareStandards and Accreditation Agency Better Practice Event,Adelaide 28 May13Northern Health Annual Research Report 2009

14Fetherstonhaugh, D. ‘Person-centredness in aged care - an ethicalresponsibility but how can we measure it?’ Alzheimer’s AustraliaAnnual National Conference, Adelaide, 3-5 JuneFitzgerald, L. Bauer, M. Koch, S. & King, S. ‘Hospital dischargeplanning for older people with Alzheimer’s disease or dementiaand their family carer.’ 13th Alzheimer's Australia NationalConference 2009. Adelaide - JuneNay, R. ‘Why do we have to measure everything? It just takes usaway from bedside care.’ ACSAA Better Practice event.Launceston - 26 JuneNay, R. ‘From Boardroom to bathroom: embedding personcentred care.’ ACSAA Better Practice event. Sydney – 24 JulyNay, R. ‘What will the next generation of consumers want fromaged care – cutting through the red tape.’ Catholic HealthAustralia National Conference. Hobart – 17 AugustKing, S. ‘Family care of older patients with a dementia:perceptions of hospital discharge planning and preparation.’The 4th International conference on community health nursingresearch. Adelaide – AugustNay, R & Fetherstonhaugh, D. ‘From Boardroom to bathroom:embedding person centred care.’ ACSAA Better Practice event.Melbourne – 11 SeptemberBeattie, E. Moyle, W & Fetherstonhaugh, D. ‘Decisional capacityof persons with dementia involved in research.’ DCRC Nationaldementia research forum. Sydney – 24 SeptemberFetherstonhaugh, D. ‘From Boardroom to bathroom: embeddingperson centred care.’ ACSAA Better Practice event. Perth –16 OctoberNay, R. ‘From Boardroom to bathroom: embedding personcentred care.’ ACSAA Better Practice event. Brisbane –6 NovemberFetherstonhaugh, D. ‘Person Centred Care’ Prime Life Conference.24-25 NovemberBauer, M. ‘Hit and Miss: How family carers perceive hospitaldischarge for people with dementia.’ 42nd National AustralianAssociation of Gerontology Conference. Canberra – 26 NovemberWinbolt, M. ‘Changing the culture of gerontic nursing from taskfocusedand routinised care to practice that is evidence-basedand person centre’ AAG national conference. Canberra –26 NovemberOther:Workshops/SeminarsNay, R. ‘Consumer directed care planning with peopledemonstrating behaviours of concern.’ La Trobe CommunityHealth Service. 4 MarchEdgar, C (for R Nay). ‘Nursing Issues.’ Australian Pain Society 29thAnnual Scientific Meeting. Sydney - 5 AprilNay, R. ‘What will the Aged Care Workforce look like in the future –what needs to change?’ ACCV Workforce Seminar. Melbourne –21 AprilNay, R. Bendigo Health Home Support Nurses. Melbourne -23 AprilNay, R. ‘Constructive family/staff relationships in aged care: fromsystematic review to audit tool.’ Griffith University Research Centrefor Clinical & Community Practice Innovation. Queensland -24 AprilBauer, M. & Bathgate, T. ‘Constructive Staff/Family Relationships inResidential Aged Care.’ Aberdeen Aged Care, Melbourne - 30 AprilBauer, M. Winbolt, M, Nay, R., Edgar, C., Meyer, C. John FawknerHospital - Staff Education on ‘Older People in Acute Care.’Melbourne – April - MayNay, R., Bauer, M. & McAuliffe, L. ‘Sexuality.’ Caulfield GeneralMedical Centre. Melbourne – August - OctoberBauer, M. ‘Health Assessment.’ SCORE research sites. AugustBauer, M. & Bathgate, T. ‘Constructive staff-family relationships inresidential aged care – research findings.’ Centre for culturaldiversity in ageing. Melbourne – 28 AugustNay, R. ‘Clinical leadership and innovative responses’. Departmentof Human Services. Melbourne – 28 AugustNay, R. & Fetherstonhaugh, D. ‘Person centred care’ The PinesLodge. Adelaide – 8-9 SeptemberNay, R. ‘What is PCC? Connecting your role, your background,your management style and Person centred care’. BECC ANUMBoot Camp. Melbourne – 18 SeptemberWinbolt, M. ‘Dementia education’ Casey Hospital, ‘Workingtogether to improve dementia care’ Seminar - 21 SeptemberBauer, M & Fitzgerald, L. ‘Hospital discharge planning for olderpeople with dementia and their family carer’. Austin Health,Melbourne – September.Nay, R. ‘Reality or Rhetoric – exploring elder abuse, advanced caredirectives and the behavioural and psychological symptoms ofdementia’. RDNS Dementia Master Class. Melbourne –15 OctoberNay, R. ‘Ageing & Social participation’. Life/Writing Narratives ofAgeing, Illness & Renewal. Melbourne – 16 OctoberWinbolt, M. ‘Resident rights and risk taking’. AAG Seminar.Hamilton – 16 OctoberBathgate, T., Bauer, M., Nay, R., Fetherstonhaugh, D., Winbolt,M. & McAulliffe, L. ‘Constructive staff/family relationships inresidential aged care.’ Aberdeen Aged Care, Melbourne – OctoberBathgate, T., Bauer, M., Nay, R., Fetherstonhaugh, D., Winbolt,M. & McAulliffe, L. ‘Constructive staff/family relationships inresidential aged care.’ Lynden Aged Care, Melbourne – OctoberBathgate, T., Bauer, M., Nay, R., Fetherstonhaugh, D., Winbolt,M. & McAulliffe, L. ‘Constructive staff/family relationships inresidential aged care.’ Bundoora Extended Care Centre,Melbourne – OctoberFetherstonhaugh, D. ‘Clinical risk management for aged care inhealth services.’ Aged Care Quality Improvement Seminar,Melbourne - 11 NovemberNay, R. ‘Meeting residents needs in the changing aged careenvironment: Innovative care principles.’ Aged Care QualityImprovement Seminar, Melbourne – 11 NovemberNay, R. & Winbolt, M. ‘Translating research into practice workshop.’AAG National conference. Canberra – 26 November

Fetherstonhaugh, D. ‘Evidence-based practice and SCORE’. AAGForum. Melbourne – 9 DecemberNay, R., Winbolt, M., Garratt, S., Ibrahim, J., Murray, M. TIME fordementia workshop series. March – NovemberPoster Presentation:McAuliffe, L. ‘Pain assessment in the older person withdementia.’ 29th Annual Scientific meeting of the Australian PainSociety, Sydney. 7 AprilHunt, S. ‘Changing practice: understanding the barriers toappropriate pain management in residential aged care.’ XIXthIAGG Congress, Paris. 5-9 JulyJohnson, P. ‘Reviewing the Assessment of Pain in Older Peoplewith Dementia’ 12th Congress of the International Associationfor Study of Pain, Glasgow. August 2009BECC Aged Care Update Seminar Series:Nay, R. Bundoora Extended Care Centre. Melbourne –25 FebruaryMcAuliffe, L. ‘Pain assessment in older people: What does thelatest research say?’ Bundoora Extended Care Centre – 21 AprilFetherstonhaugh, D. ‘Person Centred care.’ Bundoora ExtendedCare Centre – 10 AugustACEBAC Seminar Series:Dr Dina LoGiudice, Melbourne Health ‘Dementia in remoteIndigenous Populations’ – 20 MarchCollaborationsACEBAC Board members, Alzheimer’s Australia, Alzheimer’sAustralia Tas, Alzheimer’s Australia Vic, Bendigo Health,Bundoora Extended Care Centre, Curtin University, Departmentof Health, Griffith University, Hammond Care, Monash University,National Ageing Research Institute (NARI), QueenslandUniversity of Technology, Royal College of Nursing Australia,Royal Freemasons Homes of Victoria, St Vincent’s Health,Sheffield University, Southern Cross Aged Care, TLC Aged Care,Umea University, University of Melbourne, University ofTasmania & University of Technology Sydney15Northern Health Annual Research Report 2009

Cardiovascular ClinicalResearch Department16Researchers/staffDr William J. van Gaal MBBS MSc FRACP FCSANZ FESC (Director)Dr Nagesh S. Anavekar MBBS MD FRACP FCSANZ(Joint Head, Echocardiography)Dr Chiew Wong MBBS Phd FRACP FCSANZ(Joint Head, Echocardiography)Dr Uwais Mohamed MBBS FRACP FCSANZ(Head, Electrophysiology)Dr Peter Barlis MBBS MPH Phd FRACP FCSANZ FESCDr Larry Ponnuthurai FRACP FCSANZDr Nilesh MehtaMrs Mary Park – Research NurseMrs Elizabeth Buckley – Research NurseMajor achievements in 2009Top 5 recruiter in Australia (Dalheart)Top 5 recruiter in Australia (ATLAS)23 research publications in 2009Research projects in 2009DALHEARTA phase III, double-blind, randomized placebo-controlled study,to evaluate the effects of RO4607381 on cardiovascular risk instable CHD patients, with a documented recent Acute CoronarySyndrome.Principle investigator: Dr William van GaalNumber of patients in study = 25DMACSA Quality Improvement Initiative on the Discharge Managementof Acute Coronary Syndromes (DMACS). The DischargeManagement of Acute Coronary Syndromes (DMACS) projectaims to promote as best practice recommendations of theNational Heart Foundation of Australia and the Cardiac Society ofAustralia and New Zealand guidelines relating to themanagement of Acute Coronary Syndromes (ACS) patients at thepoint of discharge in Australian hospitals.Principle investigator: Dr William van GaalNumber of patients in study = 100PROTECTPatient Related Outcomes with Endeavour versus CypherStenting Trial.Principle investigator: Dr William van GaalNumber of patients in study = 28ATLAS TIMI 51A Randomized, Double-Blind, Placebo-Controlled, Event-DrivenMulticenter Study to Evaluate the Efficacy and Safety ofRivaroxaban in Subjects with a recent acute coronary syndromePrinciple investigator: Dr William van GaalNumber of patients in study = 18PROTECTION AMIInhibition of δ-PROTEin kinase C for the reduction of infarct size inAcute Myocardial Infarction.Principle investigator: Dr William van GaalNumber of patients in study = 4SPIRIT WomenA prospective, open label, single arm, multi-centre studyevaluating performance of the XIENCE V stent in the treatment offemale patients with coronary artery lesions.Principle investigator: Dr William van GaalNumber of patients in study = 5PREDICT STUDYPerceived risk of ischemia and bleeding In Acute CoronarySyndromesPrinciple investigator: Dr William van GaalNumber of patients in study = 15Research grantsDr Peter Barlis – Northern Health $5000 research grantResearch publicationsAguiar-Souto P, Barlis P, Di Mario C. Optical coherencetomography. Ancient topics, modern perspectives. Rev EspCardiol. 2009 Jul;62(7):806.Anavekar NS, Oh JK. Doppler echocardiography: A contemporaryreview. J Cardiol. 2009 Dec;54(3):347-58. Epub 2009 Oct 22.Anavekar NS, Murphy JG. Aspirin and infective endocarditis: anancient medicine used to fight an ancient disease-but does itwork? J Infect. 2009 May;58(5):329-31. Epub 2009 Mar 26.Barlis P, van Soest G, Serruys PW, Regar E. Intracoronary opticalcoherence tomography and the evaluation of stents. Expert RevMed Devices. 2009 Mar;6(2):157-67.

Barlis P, Gonzalo N, Di Mario C, Prati F, Buellesfeld L, Rieber J,Dalby MC, Ferrante G, Cera M, Grube E, Serruys PW, Regar E.A multicentre evaluation of the safety of intracoronary opticalcoherence tomography. EuroIntervention. 2009 May;5(1):90-5.Barlis P, Schmitt JM. Current and future developments inintracoronary optical coherence tomography imaging.EuroIntervention. 2009 Jan;4(4):529-33.Camenzind E, Wijns W, Mauri L, Boersma E, Parikh K, Kurowski V,Gao R, Bode C, Greenwood JP, Gershlick A, O'Neill W, Serruys PW,Jorissen B, Steg PG; PROTECT Steering Committee andInvestigators. Rationale and design of the Patient RelatedOuTcomes with Endeavor versus Cypher stenting Trial(PROTECT): randomized controlled trial comparing theincidence of stent thrombosis and clinical events after sirolimusor zotarolimus drug-eluting stent implantation. Am Heart J.2009 Dec;158(6):902-909.e5.Barlis P, Dimopoulos K, Tanigawa J, Dzielicka E, Ferrante G, DelFuria F, Di Mario C. Quantitative analysis of intracoronary opticalcoherence tomography measurements of stent strut appositionand tissue coverage. Int J Cardiol. 2009 Jan 18.Chong CP, van Gaal WJ, Savige J, Lim WK. Cardiac injury andtroponin testing after orthopaedic surgery. Injury. 2009 Nov 2.Ghimire G, Spiro J, Kharbanda R, Roughton M, Barlis P, Mason M,Ilsley C, Di Mario C, Erbel R, Waksman R, Dalby M. Initialevidence for the return of coronary vasoreactivity following theabsorption of bioabsorbable magnesium alloy coronary stents.EuroIntervention. 2009 Jan;4(4):481-4.Gonzalo N, Barlis P, Serruys PW, Garcia-Garcia HM, Onuma Y,Ligthart J, Regar E. Incomplete stent apposition and delayedtissue coverage are more frequent in drug-eluting stentsimplanted during primary percutaneous coronary interventionfor ST-segment elevation myocardial infarction than in drugelutingstents implanted for stable/unstable angina: insightsfrom optical coherence tomography. JACC Cardiovasc Interv.2009 May;2(5):445-52.Gonzalo N, Garcia-Garcia HM, Regar E, Barlis P, Wentzel J,Onuma Y, Ligthart J, Serruys PW. In vivo assessment of high-riskcoronary plaques at bifurcations with combined intravascularultrasound and optical coherence tomography. JACCCardiovasc Imaging. 2009 Apr;2(4):473-82.Karamitsos TD, Arnold JR, Pegg TJ, Cheng AS, van Gaal WJ,Francis J, Banning A, Neubauer S. Tolerance and safety ofadenosine stress perfusion cardiovascular magnetic resonanceimaging in patients with severe coronary artery disease. Int JCardiovasc Imaging. 2009 Mar;25(3):277-83.Lee W, Profitis K, Barlis P, Van Gaal WJ. Stroke and Takotsubocardiomyopathy: Is there more than just cause and effect? Int JCardiol. 2009 Mar 25.Lin G, Anavekar NS, Webster TL, Rea RF, Hayes DL, Brady PA.Long-term stability of endocardial left ventricular pacing leadsplaced via the coronary sinus. Pacing Clin Electrophysiol. 2009Sep;32(9):1117-22.Moore P, Barlis P, Spiro J, Ghimire G, Roughton M, Di Mario C,Wallis W, Ilsley C, Mitchell A, Mason M, Kharbanda R, Vincent P,Sherwin S, Dalby M. A randomized optical coherencetomography study of coronary stent strut coverage and luminalprotrusion with rapamycin-eluting stents. JACC CardiovascInterv. 2009 May;2(5):437-44.Ronco C, Chionh CY, Haapio M, Anavekar NS, House A, BellomoR. The cardiorenal syndrome. Blood Purif. 2009;27(1):114-26.Epub 2009 Jan 23.Rozen WM, Rajkomar AK, Anavekar NS, Ashton MW. Postmastectomybreast reconstruction: a history in evolution. ClinBreast Cancer. 2009 Aug;9(3):145-54.Schwartz GG, Olsson AG, Ballantyne CM, Barter PJ, Holme IM,Kallend D, Leiter LA, Leitersdorf E, McMurray JJ, Shah PK, TardifJC, Chaitman BR, Duttlinger-Maddux R, Mathieson J; dal-OUTCOMES Committees and Investigators. Rationale anddesign of the dal-OUTCOMES trial: efficacy and safety ofdalcetrapib in patients with recent acute coronary syndrome.Am Heart J. 2009 Dec;158(6):896-901.e3.Testa L, van Gaal WJ, Biondi Zoccai GG, Agostoni P, Latini RA,Bedogni F, Porto I, Banning AP. Myocardial infarction afterpercutaneous coronary intervention: a meta-analysis oftroponin elevation applying the new universal definition. QJM.2009 Jun;102(6):369-78. Epub 2009 Mar 13.Tyczynski P, Ferrante G, Kukreja N, Moreno-Ambroj C, Barlis P,Ramasami N, De Silva R, Beatt K, Di Mario C. Optical coherencetomography assessment of a new dedicated bifurcation stent.EuroIntervention. 2009 Nov;5(5):544-51.van Gaal WJ, Ponnuthurai FA, Selvanayagam J, Testa L, Porto I,Neubauer S, Banning AP. The Syntax score predicts periproceduralmyocardial necrosis during percutaneous coronaryintervention. Int J Cardiol. 2009 Jun 12;135(1):60-5. Epub 2008Jun 25.Woodcocka E, Grubba D, Filtza1 T, Marascob S, Luoa J, McLeod-Drydena T, Kayea D, Sadoshimac J, Dua X, Wong C, McMullena J,Dartad A. Selective activation of the "b" splice variant ofphospholipase Cβ1 in chronically dilated human and mouseatria. Journal of Molecular and Cellular Cardiology 2009 47, 5,676-683.Research presentations & abstractsInternational:European Society of Cardiology, Barcelona, 2009. Dr Williamvan Gaal – Myocardial Injury following Coronary Artery Bypassversus Angioplasty.National:Cardiac Society of Australia, Sydney, 2009. Dr William van Gaal– Myocardial Injury following Coronary Artery Bypass versusAngioplastyOther:Northern Health Research Week, 2009. Dr William van Gaal -Keynote speaker “Evidence Based Cardiology”CollaborationsOxford Heart Centre, Oxford, United Kingdom17Northern Health Annual Research Report 2009

Deakin University/NorthernHealth Clinical Partnership18Researchers/staffDr. Julie Considine, Senior Research FellowMs Elspeth Lucas, Casual Research FellowStudentsPhD:Mr Glenn Eastwood (PhD Candidate, Deakin University /Manager of ICU Research & MET Audit Office, Austin Health)Masters:Ms Elaine Killeen (Master of Nursing Practice Candidate, DeakinUniversity / Quality, Safety and Risk Coordinator - Acute Services,Northern Health)Ms Belinda Mitchell (Master of Nursing Practice CandidateDeakin University / Clinical Risk Coordinator, The NorthernHospital)Ms Leesa Clancy, (Master of Nursing Practice Candidate DeakinUniversity / Clinical Nurse Specialist, Emergency Department,The Northern Hospital)Major achievements in 2009The activities of the Deakin University-Northern Health ClinicalPartnership continued to increase during 2009. The five researchstreams: clinical decision making, evidence based practice,clinical risk management, health service & workforce evaluationand preventative health have all grown into well establishedprograms of research. The Partnership attracted $211K inresearch funding with (Deakin University – Northern Health staffas CI) including NHMRC and ARC funded grants and under thePartnership, Northern Health participated in research andprojects totaling $387K during 2009. The impact of theemergency care research undertaken by the Deakin University-Northern Health Clinical Partnership has grown. The DeakinUniversity-Northern Health Clinical Partnership presented fiveoral papers at the International Conference for EmergencyNurses in October and after reading research papers related toadvanced nursing practice, Dr Julie Considine was an invitedguest at Kwong Wah Hospital, Hong Kong in December 2009.She met with senior emergency department medical andnursing to provide advice about extending the scope ofpractice for emergency nurses and share experiences ofimplementing advanced practice nursing roles in theemergency department at The Northern Hospital.Research projects in 2009Clinical Decision Making• Reliability of triage category allocation in the PrincessAlexandra Hospital Emergency Department (Isoardi K,Holzhauser K, Cooke M, Considine J, McNeill I & Shaban R).Site: Princess Alexandra Hospital, Queensland• Analysis of gender validity of the Australasian Triage Scale(ATS) and Adaptive Process Triage (ADAPT). (Göransson K,Ekwall A & Considine J). Sites: Northern Health - TheNorthern Hospital, Malmö University Hospital (UMAS),SwedenClinical risk management• Characteristics and outcomes of patients requiring transferfrom continuing to acute care ( Mohr M, Considine J, CookeR, Lourenco R & DeFrancesco E)• Responding to Medical Emergencies: SystemCharacteristics Under Examination (RESCUE) (Bucknall T,Jones D, Barrett J, Bellomo R, Ruseckaite R / Botti M,Considine J, Currey J, Dunning D, Levinson M, Livingston T,O’Connell B.). Sites: Northern Health, Cabrini Health,Epworth Healthcare, The Alfred, Southern Health, BarwonHealth, Eastern Health & Austin Health• Outcome of emergency department patients with nontraumatichypotension (Smit D, Cheng P, Considine J &Duke G)• Predictors of hospital admission in patients with ChronicObstructive Pulmonary Disease (COPD) in the EmergencyDepartment (Considine J, Botti M, Thomas S & Worrall-Carter L). Sites: Northern Health, Eastern Health, EpworthHealthcare• Clinical risk in emergency care (Mitchell, B, Considine J& Botti M)• Exhaled versus arterial carbon dioxide levels (Killeen E,Considine J & Currey J)Evidence based practice• Translation of evidence into pain management practices inacute care environments (Botti M, Kent B, Bucknall T,Johnstone M, Duke M, Considine J, Watts R, Redley B,de Steiger R)• Evaluation of oxygen use in Victorian EmergencyDepartments (Considine, J, Botti M & Thomas S). sites:Northern Health, The Alfred, Bendigo Health

Health service evaluation• Team-Based Learning: Educational innovations to improvestudent engagement and learning outcomes. (Currey J,Story I, Oldland E, Considine J, Glanville D, McGrath-ChampS, Clarkeburn H)• Disaster content of post-graduate emergency nursingprograms in Australia (Ranse J, Arbon P, Considine J, ShabanR, Mitchell B, Lenson S.)• Understanding the willingness of emergency nurses torespond to a health care disaster. (Arbon P, Cusack L, KakoM, Considine J, Shaban R, Ranse J, Mitchell B, Duong K).Sites: Northern Health (Vic), Princess Alexandra Hospital(Qld), Calvary Health Care (ACT), Royal Adelaide Hospital(SA)• Emergency Department impact and patient profile ofH1N1 Influenza 09 outbreak in Australia: A national survey.(Fitzgerald G, Shaban R, Arbon P, Aitken P, Considine J& Clark M, Finucane J, McCarthy S, Cloughessy L,Holzhauser K)• Evaluation of advanced practice emergency nursing roles:Clinical Initiatives Nurse & Fast Track. (Considine J, Martin R,Kropman M, Stergiou H, Chiu H, Lucas, E)• Promoting a positive patient experience for older people inthe Emergency Department (ED) project (Hill K, ConsidineJ, Smith R, Graco M, Gannon J, Behm C & Weiland T). Sites:Northern Health (Vic), St Vincent’s Health (Vic), BendigoHealth (Vic)• Presentation to emergency departments due tochemotherapy-induced complications: opportunities forimproving service delivery. (Livingston PM, Considine J,O’Connell B & Botti M)Preventative health & health promotion• Prevalence of overweight children in EmergencyDepartment populations. (Considine J, Smit D, Stergiou H,Hauser S & Waddell D). Sites: Northern Health, EasternHealthResearch grantsBotti M, Kent B, Bucknall T, Johnstone M, Duke M, Considine J,Watts R, Redley B, de Steiger R. Translation of evidence into painmanagement practices in acute care environments. 2009Australian Research Council Linkage ($140,000)Fitzgerald G, Shaban R, Arbon P, Aitken P, Considine J & Clark M.(AIs: Finucane J, McCarthy S, Cloughessy L, Holzhauser K).Emergency Department impact and patient profile of H1N1Influenza 09 outbreak in Australia: A national survey. NationalHealth & Medical Research Council ($106,136)Bucknall T, Jones D, Barrett J, Bellomo R, Ruseckaite R. (AIso: BottiM, Considine J, Currey J, Dunning D, Levinson M, Livingston T,O’Connell B). Responding to Medical Emergencies: SystemCharacteristics Under Examination (RESCUE). AustralianCommission on Safety and Quality in Health Care ($50,000)Currey J, Duke M, Considine J, Copley D, Oldland E & Story I. Thetransformative use of small groups: using team-based learningto improve learning outcomes. 2009 Deakin University StrategicTeaching & Learning Grant Scheme (STALGS) ($48,000)Arbon P, Cusack L, Kako M, Considine J, Shaban R, Ranse J,Mitchell B, Duong K. Understanding the willingness ofemergency nurses to respond to a health care disaster. 2009Flinders University Faculty of Health Sciences, School of Nursingand Midwifery Industry Partnership Research Grant ($38,000)Considine J. (AIs: Martin R, Kropman M, Stergiou H, Chiu H,Lucas, E). Evaluation of advanced practice emergency nursingroles: Clinical Initiatives Nurse & Fast Track. VictorianDepartment of Human Services ($14,000)Mohr M, Considine J, Cooke R, Lourenco R & DeFrancesco E.Characteristics and outcomes of patients requiring transfer fromcontinuing to acute care. 2009 Northern Health Small ResearchGrant ($4,921)Ranse J, Arbon P, Considine J, Shaban R, Mitchell B, Lenson S.Disaster content of post-graduate emergency nursing programsin Australia. 2009 College of Emergency Nursing Australasia BenMorley Scholarship ($1000)Research publicationsPeer Reviewed Journals:Considine J & Currey J (2009). Termination of resuscitation:Potential benefits of clinical prediction rules. AustralianCritical Care, 22(4), 192-194. [Research Review]Gerdtz M, Chu M, Collins M, Considine J, Crellin D, Sands N,Stewart C & Pollock W. (2009) Factors influencingconsistency of triage using The Australasian Triage Scale:implications for guideline development. EmergencyMedicine Australasia, 21(4):277-285.Considine J, Livingston P, Bucknall T & Botti M. (2009). A reviewof the role of emergency nurses in management ofchemotherapy related complications. Journal of ClinicalNursing, 18(18): 2649-2655. IF = 1.376McGillivray B & Considine J. (2009). Implementation of evidenceinto practice: development of a tool to improve emergencynursing care of acute stroke. Australasian EmergencyNursing Journal, 12(3):110-119Considine J & Mitchell B. (2009). Chemical, biological andradiological (CBR) incidents: preparedness and perceptionsof emergency nurses. Disasters: The Journal of DisasterStudies, Policy and Management. 33(3):482-497. IF = 0.615Considine J, Thomas S. & Potter R. 2009. Predictors of critical careadmission in emergency department patients triaged aslow to moderate urgency Journal of Advanced Nursing.65(4): 8181-827. IF = 1.442Eastwood G, O'Connell B & Considine J. 2009. Patients’ andnurses’ perspectives of oxygen therapy: a qualitative study.Journal of Advanced Nursing. 65(3):634-641. IF = 1.44219Northern Health Annual Research Report 2009

20Published abstracts:Considine J, Kropman M & Stergiou HE. November 2009. Doestype of clinician influence ED fast track performance?Australasian Emergency Nursing Journal. 12(4): 157Considine J, Wellington P, Hill K, Smith R, Gannon J, Graco M,Behm C, Weiland T, McCarthy S & Corrie S. November 2009.Analysis of the emergency care experience of older peopleand their carers. Australasian Emergency Nursing Journal.12(4):174-175.Killeen E, Considine J & Currey J. November 2009. Exhaled versusarterial carbon dioxide levels: Improving the identification ofhypercapnia. Australasian Emergency Nursing Journal. 12(4):161Livingston PM, Craike M, Considine J, Botti M & O’Connell B.November 2009. Presentation to Emergency Departmentsdue to chemotherapy induced complications: Opportunitiesfor improving service delivery. Australasian EmergencyNursing Journal. 12(4): 181.Mitchell B, Considine J, Botti M. November 2009. Clinical riskmanagement: “What are the sources of clinical risk inEmergency care?” Australasian Emergency Nursing Journal.12(4):175In Press:Considine J, Kropman M, & Stergiou H. (in press). Effect of cliniciandesignation on ED fast track performance. EmergencyMedicine Journal, accepted 26/11/2009 IF = 1.347Eastwood G, O'Connell B & Considine J. (in press). Oxygen deliveryto patients after cardiac surgery: a medical record audit.Critical Care & Resuscitation, accepted 09/09/2009Considine J & Fielding K. (in press). Sustainable workforce reform:case study of Victorian nurse practitioner roles, AustralianHealth Review, accepted 19/08/2009Considine J, Botti M & Thomas S. (in press). Emergencydepartment management of acute exacerbation of COPD:audit of compliance with evidence-based guidelines. InternalMedicine Journal, accepted 01/06/2009. IF = 2.027Considine J, McGillivray B. (in press). An evidence-based practiceapproach to improving nursing care of acute stroke in anAustralian emergency department. Journal of Clinical Nursing,accepted 12/03/2009Research presentations & abstractsInternational:InvitedConsidine J. May 2009. Initial management of acute stroke: reviewof current evidence. Australian Resuscitation Council: 7thSpark of Life Conference. Grand Chancellor: Hobart.RefereedConsidine J, Botti M, Thomas S. October 2009. How evidencebasedis ED management of exacerbation of COPD? 7thInternational Conference for Emergency Nurses. Jupiter'sCasino: Gold Coast.Considine J, Kropman M, Stergiou H E. October 2009. Does typeof clinician influence ED fast track performance? 7thInternational Conference for Emergency Nurses. Jupiter'sCasino: Gold Coast.Considine J, Wellington P, Hill K, Smith R, Gannon J, Graco M,Behm C, Weiland T, McCarthy S, Corrie S. October 2009.Analysis of the emergency care experience of older peopleand their carers. 7th International Conference for EmergencyNurses, Jupiter's Casino: Gold Coast.Mitchell B, Considine J & Botti M. October 2009. Clinical RiskManagement: What are the sources of clinical risk inEmergency care? 7th International Conference for EmergencyNurses. Jupiter's Casino: Gold Coast.Killeen E, Considine J, Currey J. October 2009. Exhaled versusarterial carbon dioxide levels: improving the identification ofhypercapnia. 7th International Conference for EmergencyNurses. Jupiter's Casino: Gold Coast.Livingston P, Craike M, Considine J, Botti M & O'Connell B. October2009. Presentation to Emergency Departments due tochemotherapy-induced complications: Opportunities forimproving service delivery. 7th International Conference forEmergency Nurses. Jupiter's Casino: Gold Coast. (posterpresentation)Hill K, Considine J, Smith R, Gannon J, Graco M, Behm C, WeilandT, Wellington P, McCarthy S, Corrie S. October 2009.Responding to the ageing profile of Emergency Departmentpatients. New Zealand Association of Gerontology & AgeConcern New Zealand Conference 2009. WellingtonConvention Centre: New ZealandNational:InvitedConsidine J. May 2009. Initial management of acute stroke: reviewof current evidence. Australian Resuscitation Council: 7thSpark of Life Conference. Grand Chancellor: Hobart.Considine J. April 2009. Making better decisions by understandingerrors and biases. Sydney Children’s Hospital 3rd AnnualEmergency & Paediatric Care Conference: ‘Hand in Hand’.Sydney Children’s Hospital: Sydney.Considine J. April 2009. Attitudes, change and febrile kids: Therewards and perils of implementing evidence-based practicein paediatric fever management. Sydney Children’s Hospital3rd Annual Emergency & Paediatric Care Conference: ‘Hand inHand’. Sydney Children’s Hospital: Sydney.RefereedCheng P, Smit D, Considine J & Duke G. October 2009. Outcome ofemergency department patients with non-traumatichypotension. Peripheral Hospitals Emergency MedicineConference: Spring Seminar on Emergency Medicine. CableBeach Club Resort: Broome, Western Australia.

CollaborationsInternational collaborations:• Dr Anna Ekwall, Nurse Researcher / Clinical Lecturer,Department of Nursing, Lund University, Lund, Sweden• Dr Katarina Göransson, Nurse Manager of Research,Emergency Department, Karolinska University Hospital,SolnaNational collaborations:• Prof Paul Arbon, Professor of Public Health (Nursing),Flinders University, SA• Professor Michele Clark, Professor and Assistant DeanResearch, Faculty of Health, Queensland University ofTechnology• Professor Gerard Fitzgerald, Professor of Public Health(Emergency and Disaster Management), QueenslandUniversity of Technology• Professor Anne Gardner, Professor of Nursing-TropicalHeath, James Cook University• Dr Peter Aitken, Associate Professor, School of PublicHealth, Tropical Medicine & Rehabilitation Sciences, JamesCook University & Senior Staff Specialist, Townsville Hospital• Dr Lynette Cusack, Postdoctoral Research Fellow, FlindersUniversity• Dr Mayumi Kako, Research Assistant, Flinders University• Ms Karen Duong, Postgraduate Research Student, FlindersUniversity• Ms Kerri Holzhauser, Nursing Director Research, PrincessAlexandra Hospital & Adjunct Senior Research FellowGriffith University• Ms Shane Lenson, Manager, Emergency Department,Calvary Health Care• Mr Jamie Ranse, Adjunct Lecturer, Flinders University /Clinical Manager – Research, Emergency Department,Calvary Health CareLocal collaborations:• Professor Mari Botti, Director The Alfred / Deakin NursingResearch Centre & Chair, Epworth-Deakin Centre for ClinicalNursing Research• Professor Tracey Bucknall, Director Cabrini - Deakin Centrefor Nursing Research• Professor Maxine Duke, Head of School and Professor ofNursing Development, School of Nursing, Deakin University• Professor Keith Hill, Professor of Allied Health, LatrobeUniversity - Northern Health• Professor Megan-Jane Johnstone, Academic Chair inNursing, Deakin University / Director Quality and RiskManagement in Clinical and Aged Care Research Cluster• Professor Bridie Kent, Chair in Nursing, Deakin-EasternHealth• Professor Bev O’Connell, Deakin University - SouthernHealth Chair in Nursing• Professor Shane Thomas, Professor of Primary CareResearch, Monash University• Dr Herman Chiu, Emergency Physician, The NorthernHospital, Northern Health• Dr Judy Currey, Senior Lecturer / Co-ordinator PostgraduateCritical Care and Perioperative Programs, Deakin University• Dr Simon Hauser, Director of Paediatrics, Northern Health• Dr Trish Livingston, Senior Research Fellow, DeakinUniversity – Eastern Health Nursing Research Unit• Dr DeVilliers Smit, Emergency Physician Research, TheNorthern Hospital, Northern Health• Dr Helen Stergiou, Director of Emergency Medicine, TheNorthern Hospital, Northern Health• Dr Ian Story, Educational Developer, Faculty of Health,Medicine, Nursing and Behavioural Sciences, DeakinUniversity• Dr Tracey Weiland, Senior Research Fellow, EmergencyPractice Innovation, Centre, St. Vincent’s HospitalMelbourne• Ms Christine Behm, Project Manager, Enhancing Care forOlder People, St Vincent's Hospital, Melbourne• Ms Robynne Cooke, Chief Nursing Officer Northern Health/ director of nursing, Bundoora Extended Care Centre• Ms Deana Copley, Lecturer, School of Nursing, DeakinUniversity• Ms Emily DeFrancesco, Acting Manager, Health InformationServices, Broadmeadows Health Service• Mr John Gannon, Researcher, Northern Clinical ResearchCentre• Ms Marine Graco, Coordinator, Northern Clinical ResearchCentre• Mr David Glanville, Research Fellow, Deakin University• Ms Rosemary Lourenco, Registered Nurse, GeriatricEvaluation and Management (GEM) Unit, BroadmeadowsHealth Service• Ms Elspeth Lucas, Registered Nurse, EmergencyDepartment, The Northern Hospital• Ms Belinda Mitchell, Clinical Risk Coordinator, AcuteServices, Northern Health• Ms Marie Mohr, Director of Nursing, Broadmeadows HealthService• Ms Elizabeth Oldland, Lecturer, School of Nursing, DeakinUniversity• Mr Ramon Shaban, Clinical Research Fellow, PrincessAlexandra Hospital-Griffith University• Ms Robyn Smith, Health Service Manager, Allied HealthLearning and Research, Northern Health21Northern Health Annual Research Report 2009

Northern ClinicalResearch Centre22Research and Health Services Evaluationprojects in 2009-2010The NCRC is a multidisciplinary, clinical research unit, whichexamines interventions that may improve patient care anddecrease hospital utilisation, particularly for those with chronicdisease and complex needs. The NCRC aims to integrate clinicalresearch methodology into the evaluation of current clinicalpractice and the development of new programs of care, in orderto inform service delivery at Northern Health. In 2009 The NCRChas collaborated with a number of clinicians and researchersacross Northern Health to develop their health services evaluationresearch program.Researchers/staffProfessor Judy SavigeA/Professor Kwang LimDr Graeme DukeDr Anastasia HutchinsonDr Anna BarkerMarnie GracoJohn GannonNadia GagliardiResearch Projects in 2009Dr Carol ChongAmy ClarkAndrea JasperShane GrantVicki LawlorTshepo RasekabaChrissie RisteskiRita Wong1. Evaluation of the Northern Alliance HospitalAdmission Risk Program.This is a collaborative health services evaluation project betweenthe NCRC and Northern Alliance Hospital Admission Risk program(NA-HARP). This project evaluated: the impact of the NA-HARPprograms on acute health care utilisation and improvement inpatient clinical outcomes following program participation. Thisproject was funded by NA-HARP.2. Is acculturation the nexus between chronicphysical illness and depression and anxietyin a culturally and linguistically diversepopulation?This is a collaborative project between the NCRC and Dr SureshSundram (Director) Northern Psychiatry Research Centre. Theproject investigated the prevalence of anxiety and depression inpatients from Culturally and Linguistically Diverse backgroundswith Chronic Physical Illness (Chronic Respiratory Disease, ChronicHeart failure or Diabetes). This project was funded through aBeyond Blue Research Grant.3. Improving the quality of care for olderpeople-Development of Quality Indicatorsfor the frail, elderly in acute care.‘ Clinical outcomes, staff and carer perceptions of acutehospitalisation of older patients.- InterRai Project.’Collaborative project with Prof Len Gray Academic Unit inGeriatric medicine, the University of Queensland. PrincipleInvestigator at NH A/Prof Kwang Lim. This project evaluated theuse of the InterRai Comprehensive Patient Assessment Tool topredict patient outcomes following admission to acute care. Thisproject was funded by the NHMRC, Research Grant No: 569682.4. TREAT- Telemedicine in Residential agedcare facilities to Enhance Assessment andTreatment.This project investigated the use of telemedicine to enhancegeriatrician assessment in residential aged care facilities.Collaborative project with A/Prog Kwang Lim, the Hospital in theHome Service and the rapid residential response services (RECIPE& RRS) at TNH. This project was funded in 2009 by the Departmentof Health (Victoria).5. Monitoring and Improving HospitalPerformance using Administrative DataCollaborative project with Dr Graeme Duke (Director of IntensiveCare, TNH), Dr Anna Barker and Dr John Santamaria (IntensiveCare, St Vincents Hospital). This is an ongoing project which isevaluating the use of using Risk-Adjusted Mortality PredictionModels derived from administrative datasets to monitor hospitalperformance across Victoria.6. Retinal microvascular disease in patientswith chronic diseaseCollaborative project with Prof Judy Savige (Department ofMedicine (Northern Health, University of Melbourne). This projectis investigating the use of retinal photography to identifymicrovascular disease and future risk of cardiovascular events inpatients with chronic disease.7. PREVENTING PRESSURE ULCERS And FALLSIN ACUTE CARE: Does nurse experienceaffect accuracy of risk assessment scoringand application of prevention strategies?Collaborative Project with NH Injury Prevention Unit (JeanetteKamar) and Dr Anna Barker. This project investigated whethernurse experience influenced the accuracy of pressure ulcer andfalls risk assessment tools. This project was funded by a NH SmallResearch Grant.

8. Evaluation of A Rapidly Set-up InfluenzaAssessment Clinic: ( H1N1-09 Pandemic).Collaborative Project with Dr Sam Hume (Infectious DiseaseConsultant), Leanne Boase (ED Nurse Practitioner) and CraigAboltins (Infectious Diseases Consultant). This project wasfunded by a NH Small Research Grant.9. Northern Health Junior medical StaffWorkforce Capacity Review 2009-2012.Collaborative project with the Northern Health Clinical SupportServices, project leader Julie Shalders (manager).This project isreviewing the current junior medical workforce at NorthernHealth and working on strategies to align the structure of themedical workforce at NH with future areas of growth as outlinedin the strategic plan. This project is funded by a Department ofHealth (Victoria), ‘Developing organizational Capacity (DOC)’grant.10. Statistical ConsultingThe NCRC has provided statistical consulting services to theMedical, Obstetrics & Gynaecology, and Orthopaedic Units atNH for quality assurance audits.Raphael Hau and J. Hang from the Orthopaedic Unit conducteda study investigating ‘Risk factors associated withredisplacement after closed reduction of distal radial fractures inchildren’.The Obstetrics & Gynaecology Unit conducted a qualityassurance audit looking at maternal and child outcomes inpregnant women with a Body Mass Index >35.RESEARCH GRANTSBeyond Blue - Anxiety & Depression in CALDPopulation with Chronic Disease $98,000.00University of Queensland – ImprovingQuality of care in Older Adults $26,650.00Department of Health (Victoria)-Telemedicine Project Grant $49,758.00NH Small Research Grants1. Preventing pressure ulcers andfalls in acute care: Does nurse experienceaffect accuracy of risk assessment scoring andapplication of prevention strategies? $3,800.002. Evaluation of A Rapidly Set-up InfluenzaAssessment Clinic: (H1N1-09 Pandemic). $4,928.00PublicationsAmartya B, Brand C, Hutchinson A, Landgren F. Jones C. (2009)Hospital Admission Risk Program (HARP) for Chronic RespiratoryDiseases: Program Guidelines. Published by Project HealthApril 2009.Amartya B, Brand C, Hutchinson A, Landgren F. Jones C. (2009)Hospital Admission Risk Program (HARP) for Chronic RespiratoryDiseases: A Literature Review. Published by Project HealthApril 2009.Barker A, J. Kamar, T. Tyndal, L. White, A. Hutchinson. Preventingpressure ulcers in acute care: Does nurse experience affectaccuracy of risk assessment scoring and application ofprevention strategies? Submitted for ReviewDuke GJ, Santamaria J, Shann F, Stow P. Ernest D, George C,Critical Care Outcome Prediction Equation (COPE) for AdultIntensive. Critical Care & Resuscitation,2008:10:35-41Duke GJ, Graco M, Santamaria J, Shann F, Validation of theHospital Outcome Prediction Equation (HOPE) Model forMonitoring Clinical Performance. Int Med Journal 2009;39:283-289Duke GJ, Barker A, Santamaria J, Ten year review of VictorianIntensive Care Services based on Routine Administrative Data.2010 (in press.)Duke GJ, Barker A, Graco M, Santamaria J. Ten year review ofVictorian Major Hospital Acute Services based on RoutineAdministrative Data. 2010 (in press.)Hutchinson AF, M.A. Thompson, C.A. Brand, J. Black, G.P.Anderson, L.B. Irving . Assessing severity of exacerbations ofChronic Obstructive Pulmonary Disease in a community-caresetting: Development of a clinical prediction model. Journal ofAdvanced Nursing - Accepted April 2010Hutchinson AF, Black J, Thompson MA, Bozinovski S, Brand CA,Smallwood DM, Irving LB, Anderson GP. Identifying viralinfections in vaccinated Chronic Obstructive Pulmonary Disease(COPD) patients using clinical features and inflammatorymarkers. Influenza and Other Respiratory Viruses. PublishedOnline: Dec 9 2009Hutchinson AF, Respiratory Expert Group. Therapeuticguidelines: respiratory. Version 4. Melbourne: TherapeuticGuidelines Limited; 2009. http://www.tg.org.auHutchinson AF, Brand CA., Irving LB, Thompson P, Campbell D.Acute Care Costs of patients admitted for management ofCOPD exacerbations: contribution of disease severity, infection,and chronic heart failure. (Accepted Internal Medicine JournalDecember 2009).Page K, A.Barker, J. Kamar. Development and validation of apressure ulcer risk assessment tool for acute patients. Submittedfor ReviewDepartment of Human Services Victoria,Australia (DHS) ReportsDHS Hospital Admission Risk Program (HARP) EvaluationsNA-Alliance HARP ReportsGannon J, Atkinson J, Shanahan-McKenna L, Hutchinson A.The nature of how Northern Coordinated Health Care serviceclinicians facilitate partnerships with and between clients andtheir general practitioners: A descriptive qualitative study.-Executive Summary & Synopsis of Key Findings. April 2010.Rasekaba T, Risteski, C, Hutchinson A. NA-Hospital AdmissionRisk Program Report 2009. “Impact of the NA-HARP programs onAcute Health Utilisation at Northern Health”.Risteski C, Jasper A, Hutchinson A. Client and Carer Satisfactionwith the services provided by clinicians from the NorthernAlliance – HARP Program in 2008 - 9.23Northern Health Annual Research Report 2009

Northern HealthGP Liaison ProgramResearchers/staffRhonda JenningsOther:Mentoring a NH staff member to work up a small grantsapplicationMajor achievements in 2009MedGap Project poster received 1st prize in the annual NHResearch Week awards. This poster presented NH data onlyResearch projects in 2009Co researcher on a research project to explore the model of careto reduce the risk of medication related problems at the hospitalinterface. (MedGap Project). This 2 year project funded by theWicking Foundation is a collaborative with the Austin Pharmacy,BECC Medical Services (Dr Penny Harvey) and NH Pharmacy (MrLiam Carter). This is the second year of the project.Research grantsNilResearch publicationsNilResearch presentations & abstractsNational:A presentation titled, “Improving Medication Management in theTransition from Hospital to a Residential Aged Care Facility”, TheNational GP Liaison Conference, Adelaide, Sept 2009, Jennings R.,Cincotta M., & Harvey P.24

Northern HealthOncology DepartmentResearchers/staffDr Shane White Director of OncologyAssoc Prof Niall Tebbutt Consultant Medical OncologistDr Geoff Chong Consultant Medical OncologistDr Frances Barnett Consultant Medical OncologistDr Josephine Stewart Consultant Medical OncologistMs Lynn Rodoreda Clinical Research NurseMs Rajani Iywan Clinical Research NurseMajor achievements in 2009Successfully completed recruitment for the following long-termstudies:A Randomized, Double Blinded, Multi-Center Phase 2 Study toEstimate the Efficacy and Evaluate the Safety and Tolerability ofCisplatin & Capecitabine (CX) in Combination with AMG 386 orPlacebo in Subjects with Metastatic Gastric, GastroesophagealJunction, or Distal Esophageal AdenocarcinomaStudy D8480C00013 – A Randomised, Double-blind,Multicentre Phase II/III Study to Compare the Efficacy ofCediranib (RECENTINTM, AZD2171) in Combination with 5-fluorouracil, Leucovorin, and Oxaliplatin (FOLFOX), to theEfficacy of Bevacizumab in Combination with FOLFOX inPatients with Previously Untreated Metastatic Colorectal CancerA Randomized, 4-Arm, Placebo-Controlled Phase 2 Trial ofPaclitaxel in Combination with Bevacizumab and AMG 386 orPaclitaxel plus AMG386 as First-Line Therapy in Subjects withHer2-Negative, Metastatic or Locally Recurrent Breast CancerResearch projects in 2009A Randomized, Double Blinded, Multi-Center Phase 2 Study toEstimate the Efficacy and Evaluate the Safety and Tolerability ofCisplatin & Capecitabine (CX) in Combination with AMG 386 orPlacebo in Subjects with Metastatic Gastric, GastroesophagealJunction, or Distal Esophageal AdenocarcinomaStudy D8480C00013 – A Randomised, Double-blind,Multicentre Phase II/III Study to Compare the Efficacy ofCediranib (RECENTINTM, AZD2171) in Combination with 5-fluorouracil, Leucovorin, and Oxaliplatin (FOLFOX), to theEfficacy of Bevacizumab in Combination with FOLFOX inPatients with Previously Untreated Metastatic Colorectal CancerA Randomized, 4-Arm, Placebo-Controlled Phase 2 Trial ofPaclitaxel in Combination with Bevacizumab and AMG 386 orPaclitaxel plus AMG386 as First-Line Therapy in Subjects withHer2-Negative, Metastatic or Locally Recurrent Breast CancerA Multicenter, Double-Blind, 3-Arm, Phase 2 Study in Subjectswith Unresectable Locally Advanced or Metastatic Gastric orEsophagogastric Junction Adenocarcinoma to Evaluate theSafety and Efficacy of First-line Treatment with Epirubicin,Cisplatin, and Capecitabine(ECX) plus AMG 102A Phase 2, Randomized, Double Blind, Placebo Controlled Studyof AMG 386 in Combination with FOLFIRI in Subjects withPreviously Treated Metastatic Colorectal CarcinomaA Multicenter Phase III Randomized Trial of Adjuvant Therapy forPatients with HER2-Positive Node-Positive or High Risk Node-Negative Breast Cancer Comparing Chemotherapy PlusTrastuzumab with Chemotherapy Plus Trastuzumab PlusBevacizumabMulticentre international study of capecitabine +/-bevacizumab as adjuvant treatment of colorectal cancer(QUASAR 2)Research grantsNilResearch publicationsSeah JA, Chionh F, Deb S, Chakrabarti A, White S. Pathologicalfeatures, clinical outcomes and treatment patterns of earlystagetriple negative (TN) breast cancer in an Australianpopulation (accepted ASCO 2010)Research presentations & abstractsOther:Northern Health Research Week 2009 Abstract: An audit on thecomplications associated with arm ports.CollaborationsNilSponsorsPharmaceutical Companies:AMGEN AustraliaQuintiles25Northern Health Annual Research Report 2009

Northern PsychiatryResearch Centre26Researchers/staffAssoc Prof. Suresh SundramDr. Russell D’SouzaMs. Fiona BoleMs. Sumathy SathiyamoorthyMs Ondina ModestiDr Olivia CarterDr Rohit LodhiStudentsPhD:Dr Sinnatamby Sujeevan (PhD)Dr Vaidyanathan Swaminathan (PhD)Other:Sarah ArnoldLydia BrownStudent completions in 2009Other:Tabitha Nash BSc (Hons)Major achievements in 2009A study examining the role of acculturation in mediating anxietyand depressive symptoms in people with chronic physical illnessfunded by beyondblue and in collaboration with the NorthernClinical Research Centre was undertaken with results to besubmitted for publication shortly. A new model of care for acuteadult general psychiatry inpatient units was developed inconjunction with Ms Alison Harrington and Mr Gary Ennis of theNorthern Psychiatry Inpatient Unit. It reduced incidents of assaultand violence, was much preferred by staff and did not increaseabsconding. These results will be submitted shortly forpublication. Dr Sinnatamby Sujeevan who commenced his PhDwith us has been collaborating with Barwon Health on a largestudy to develop biomarkers for predicting response to the mosteffective but toxic antipsychotic drug clozapine. Ms Tabitha Nashwho undertook her Honours year with us in conjunction with DrOlivia Carter from the Department of Psychology, University ofMelbourne received a high first class honours result for herresearch thesis.Research projects in 2009Clinical TrialsA double-blind, randomised, placebo-controlled, multicentre,relapse-prevention study with two doses of Lu AA21004 inpatients with Major Depressive DisorderA Ten-Week, Multicenter, Randomized, Double-Blind, Placebo andActive-Controlled, Parallel-Group, Flexible-Dose Study Evaluatingthe Efficacy, Safety, and Tolerability of GSK372475 (1.5 mg/day to2.0 mg/day) or Extended Release Venlafaxine XR (150 mg/day to225 mg/day) Compared to Placebo in Adult Subjects Diagnosedwith Major Depressive Disorder.A 52-week, Multicenter, Open-label Study to Evaluate theEffectiveness of Aripiprazole Intramuscular Depot as MaintenanceTreatment in Patients with Schizophrenia “ASPIRE OPEN-LABEL”(Aripiprazole Intramuscular Depot Program in Schizophrenia)Protocol R092670-SCH-3009 Safety, Tolerability and TreatmentResponse of Paliperidone Palmitate in Patients with SchizophreniaWhen Switching form Oral Antipsychotics.A Double-Blind, Placebo-Controlled, Parallel-Group, Fixed-DosageStudy to Evaluate the Efficacy and Safety of Armodafinil Treatment(150 and 200 mg/day) as Adjunctive Therapy in Adults With MajorDepression Associated With Bipolar I DisorderPhase 3Investigator StudiesThe problem of integrating visual and auditory information acrossspace in schizophreniaThe Identification of co-morbid substance use disorder in inpatientwith psychiatric illnessInvestigating the role of the epidermal growth factor system inclozapine treated subjects with schizophreniaDevelopment of a new model of care for acute adult generalpsychiatry inpatient unitsIs acculturation the nexus between chronic physical disease anddepression and anxiety in a culturally and linguistically diversepopulation?Research grantsNHMRC Project Grant (2010-2012) $351439 (with University ofMelbourne and Howard Florey Institute); Beyondblue VCoE (2009)$97000 (with Northern Clinical Research Centre); One-in-FiveAssoc. (2009) $150000

Research publicationsPeer Review Journals:Keks NA, Hill C, Sundram S, Graham A, Bellingham K, Dean B,Opeskin K, Dorissa A, Copolov DL. Evaluation of treatment in 35cases of bipolar suicide. Aust N Z J Psychiatry. 2009Jun;43(6):503-8.D’Souza R, Piskulic D and Sundram S. A brief dyadic group basedpsychoeducation program improves relapse rates in recentlyremitted bipolar 1 disorder: a pilot randomised controlled trial. JAffective Disorders 2010; 120(1-3):272-6Happell B, Sundram S, Wortans J, Johnstone H, Ryan R andLakshmana R. Assessing nurse initiated care and treatment in amental health crisis and assessment treatment team. PsychiatricServ 2009; 60(11):1527-31.Pereira A, Fink G and Sundram S. Clozapine induced ERK1 andERK2 signaling in prefrontal cortex is mediated by the EGFreceptor. J Mol Neurosci 2009;39(1-2):185-98.Gibbons A.S., Scarr E., McLean C., Sundram S., Dean B. Decreasedmuscarinic receptor binding in the frontal cortex of bipolardisorder and major depressive disorder subjects. Journal ofAffective Disorders 2009:116:184–191Berk M, Gama CS, Sundram S, Hustig H, Koopowitz L, Molloy H,Rowland C, Monkhouse A, Bole F, Sathiyamoorthy S, Piskulic D,Dodd S. Mirtazapine add-on therapy in the treatment ofschizophrenia with atypical antipsychotics: A double-blind,randomised, placebo-controlled clinical trial. HumanPsychopharmacology 2009 Apr;24(3):233-8.Graco M, Berlowitz DJ, Fourlanos, S and Sundram S. Depressionis greater in non-English speaking hospital outpatients withType 2 Diabetes. Diabetes Research and Clinical Practice 2009Feb;83(2):e51-3.Sundram S, Karim ME, Ladrido-Ignacio L, Maramis A, Mufti KA,Nagaraja D, Shinfuku N, Somasundaram D, Udomratn P,Yizhuang Z, Ahsan A, Chaudhry HR, Chowdhury S, D'Souza R,Dongfeng Z, Firoz AHM, Hamid MA, Indradjaya S, Bada Math S,Mustafizur RAHM, Naeem F and Wahab MA. Psychosocialresponses to disaster: An Asian perspective. Asian J Psychiatry2008 Sept;1(1): 7-14Piskulić D, Olver JS, Maruff P, Norman TR. Treatment of cognitivedysfunction in chronic schizophrenia by augmentation ofatypical antipsychotics with buspirone, a partial 5-HT(1A)receptor agonist. Hum Psychopharmacol. 2009 Aug;24(6):437-46.Pietrzak RH, Olver J, Norman T, Piskulic D, Maruff P, Snyder PJ. Acomparison of the CogState Schizophrenia Battery and theMeasurement and Treatment Research to Improve Cognition inSchizophrenia (MATRICS) Battery in assessing cognitiveimpairment in chronic schizophrenia. J Clin Exp Neuropsychol.2009 Jan 14:1-12.Pietrzak RH, Snyder PJ, Jackson CE, Olver J, Norman T, Piskulic D,Maruff P. Stability of cognitive impairment in chronicschizophrenia over brief and intermediate re-test intervals. HumPsychopharmacol. 2009 Mar;24(2):113-21.Snyder PJ, Jackson CE, Piskulic D, Olver J, Norman T, Maruff P.Spatial working memory and problem solving in schizophrenia:the effect of symptom stabilization with atypical antipsychoticmedication. Psychiatry Res. 2008 Sep 30;160(3):316-26.Other:Sargent G, Sundram S, Bormanis M, Campara J, Niklaus K,Whelan K, Warner J and Schnabl L. Uncovering Psychology.Cambridge University Press, Melbourne 2009.In Press:Sundram S. The mental health of refugees and asylum seekers inAustralia. Medicine Today (in press 2009).Deva MP, D'Souza R, and Sundram S. Regional update: CookIslands. Asian Journal of Psychiatry. (in press 2009).Research presentations & abstractsInternational: Asian Schizophrenia Workshop, Osaka, January2009; International Congress on Schizophrenia Research, March2009, San Diego.National:Australian Neuroscience Society, Canberra, January 2009CollaborationsProfessor Michael Berk University of Melbourne; Mr Luca CocchiMelbourne Neuropsychiatry Centre; Ms Tiffany Cowie Universityof Melbourne; Professor Brian Dean Mental Health ResearchInstitute; Dr Seetal Dodd University of Melbourne; Dr JohnFarhall La Trobe University; Ms Marnie Graeco Northern Hospital;Professor Brenda Happell Central Queensland University;Ms Alison Harrington Northern Area Mental Health Service; DrAlexander Holmes University of Melbourne; Dr Ana HutchinsonNorthern Clinical Research Centre; Professor Tim LambertUniversity of Sydney; Dr Ken McAnally Defense ScienceTechnology Organization; Professor Ralph Martins Edith CowanUniversity; Dr Meaghan O’Donnell University of Melbourne;Dr Elizabeth Scarr University of Melbourne; Dr Elizabeth ThomasScripps Institute; Dr Stephen Wood Melbourne NeuropsychiatryCentre27Northern Health Annual Research Report 2009

The Northern Hospital,Critical Care Department28Researchers/staffDr Graeme Duke, Director Critical CareA/Prof Michael Reade, Director Critical Care Trials ResearchMs Mary Park, Research co-ordinatorStudentsOther:Registrar projects1. A trial of axillary vein central line insertion using ultrasoundguidance2. A prospective study examining functional outcomes ofelderly patients 6 months post discharge from intensive careunitStudent completions in 2009NoneResearch projects in 2009The Northern Hospital remains a leading centre of health servicesand outcomes research relevant to critical care. In 2009 Dr Dukeled collaborative studies investigating a method of quantitativelymonitoring hospital quality, and interventions to circumventcritical care access block. He also contributed to studies assessingthe impact of the 2009 H1N1 influenza pandemic.Critical Care clinical trials research commenced at the NorthernHospital in 2009, with the enrolment of our first patient in theinternational randomised controlled trial of activated protein C insepsis, PROWESS-SHOCK. Preparations are nearly complete tocommence enrolling patients in the ANZICS-CTG sponsored trialof hydroxyethyl starch vs. saline for fluid resuscitation in criticalillness (CHEST) and a locally-designed trial of sodium bicarbonateto reduce the risk of acute renal failure in septic patients with ahigh level of neutrophil-gelatinase associated lipocalin (NGAL). Weare also at the early stages of designing a multi-centre trial ofdexmedetomidine to treat ICU-acquired agitation and delirium.Research grantsNil.Research publicationsDr DukeANZIC Influenza Investigators, Webb SA, Pettilä V, Seppelt I,Bellomo R, Bailey M, Cooper DJ, Cretikos M, Davies AR, Finfer S,Harrigan PW, Hart GK, Howe B, Iredell JR, McArthur C, Mitchell I,Morrison S, Nichol AD, Paterson DL, Peake S, Richards B, StephensD, Turner A, Yung M. Critical care services and 2009 H1N1influenzain Australia and New Zealand. N Engl J Med. 2009Nov12;361(20):1925-34. Epub 2009 Oct 8. PubMed PMID:19815860.Kaufman MA, Duke GJ, McGain F, French C, Aboltins C, Lane G,Gutteridge GA.Life-threatening respiratory failure from H1N1influenza 09 (human swineinfluenza). Med J Aust. 2009 Aug3;191(3):154-6. PubMed PMID: 19645645.Duke GJ, Buist MD, Pilcher D, Scheinkestel CD, Santamaria JD,Gutteridge GA,Cranswick PJ, Ernest D, French C, Botha JA.Interventions to circumvent intensivecare access block: aretrospective 2-year study across metropolitan Melbourne.Med JAust. 2009 Apr 6;190(7):375-8. PubMed PMID: 19351312.Duke GJ, Graco M, Santamaria J, Shann F. Validation of the hospitaloutcomeprediction equation (HOPE) model for monitoringclinical performance. Intern Med J. 2009 May;39(5):283-9. Epub2009 Mar 17. PubMed PMID: 19292775.A/Prof ReadeMayr FB, Yende S, Dʼangelo G, Barnato AE, Kellum JA, Weissfeld L,Yealy DM,Reade MC, Milbrandt EB, Angus DC. Do hospitalsprovide lower quality of care to black patients for pneumonia? CritCare Med. . [Epub ahead of print] PubMed PMID:20009756.Reade MC. Should we question if something works just becausewe don't know howit works? Crit Care Resusc. 2009 Dec;11(4):235-6. PubMed PMID: 20001869.Bellomo R, Warrillow SJ, Reade MC. Why we should be wary ofsingle-center trials. Crit Care Med. 2009 Dec;37(12):3114-9. Review.PubMed PMID: 19789447.Reade MC, Delaney A, Bailey MJ, Harrison DA, Yealy DM, Jones PG,Rowan KM, Bellomo R, Angus DC. Prospective meta-analysis usingindividual patient data in intensive care medicine. Intensive CareMed. 2010 Jan;36(1):11-21. Epub 2009 Sep 18. PubMed PMID:19760395.Milbrandt EB, Reade MC, Lee M, Shook SL, Angus DC, Kong L,Carter M, Yealy DM, Kellum JA; GenIMS Investigators. Prevalenceand significance of coagulation abnormalities in communityacquiredpneumonia. Mol Med. 2009 Nov-Dec;15(11-12):438-45.Epub 2009 Sep 8. PubMed PMID: 19753144; PubMed CentralPMCID: PMC2743205.

Crosbie DC, Sugumar H, Simpson MA, Walker SP, Dewey HM,Reade MC. Late-onset ornithine transcarbamylase deficiency: apotentially fatal yet treatable cause of coma. Crit Care Resusc.2009 Sep;11(3):222-7. PubMed PMID: 19737127.Reade MC, O'Sullivan K, Bates S, Goldsmith D, Ainslie WR,Bellomo RDexmedetomidine vs. haloperidol in delirious, agitated,intubated patients: a randomised open-label trial. Crit Care.2009;13(3):R75. Epub 2009 May 19. PubMed PMID: 19454032;PubMed Central PMCID: PMC2717438.Egi M, Bellomo R, Reade MC. Is reducing variability of bloodglucose the real but hidden target of intensive insulin therapy?Crit Care. 2009;13(2):302. Epub 2009 Apr 6. PubMed PMID:19435472; PubMed Central PMCID: PMC2689479.Reade MC, Yende S, D'Angelo G, Kong L, Kellum JA, Barnato AE,Milbrandt EB, Dooley C, Mayr FB, Weissfeld L, Angus DC; Geneticand Inflammatory Markers of Sepsis Investigators. Differences inimmune response may explain lower survival among older menwith pneumonia. Crit Care Med. 2009 May;37(5):1655-62.PubMed PMID: 19325487; PubMed Central PMCID:PMC2760065.Reade MC, Angus DC. The clinical research enterprise in criticalcare: what's right, what's wrong, and what's ahead? Crit CareMed. 2009 Jan;37(1 Suppl):S1-9. PubMed PMID: 19104206.Haase M, Haase-Fielitz A, Bellomo R, Devarajan P, Story D,Matalanis G, Reade MC, Bagshaw SM, Seevanayagam N,Seevanayagam S, Doolan L, Buxton B, Dragun D. Sodiumbicarbonate to prevent increases in serum creatinine aftercardiac surgery: a pilot double-blind, randomized controlledtrial. Crit Care Med. 2009 Jan;37(1):39-47. PubMed PMID:19112278.Research presentations & abstractsInternational:Mayr, F.B., Yende, S., Milbrandt, E.B., Kellum, J.A., Reade, M.C. &Angus, D.C. (2008). Racial disparities in quality of care incommunity-acquired pneumonia. Critical Care, 12(Suppl. 2),S166-7.Reade, M.C., O’sullivan, K., Bates, S., Goldsmith, D., Ainslie, W.R.St.J.& Bellomo, R. (2009) Dexmedetomidine vs. haloperidol tofacilitate extubation of delirious agitated intubated patients.American Journal of Respiratory and Critical Care Medicine, 179,A1562.National:Reade, M.C. (2009). Dexmedetomidine or Haloperidol to LessenICU Agitation - the DaHLIA trial. ANZICS Clinical Trials Group11th Annual Meeting on Clinical Trials in Intensive Care, Noosa,AustraliaCollaborationsAustin Hospital Intensive Care Research UnitAustralian and New Zealand Intensive Care Research CentreThe George Institute for International HealthThe Australian and New Zealand Intensive Care Society ClinicalTrials Group29Northern Health Annual Research Report 2009

The Northern Hospital,Department of Medicine30Researchers/staffAssoc Professor Kwang LimDr Craig AboltinsDr John ArcherStudentsDr Barbara Hayes-PhDDr Carol Chong-PhDDr Kim Jeffs-PhDMajor AchievementsThe Division of Medicine has continued to improve its researchoutput with a number of trials and research publications. We have3 higher degree students, 2 doing PhDs (Dr Kim Jeffs and DrBarbara Hayes) and one doing an MD (Dr Carol Chong).Recruitment for these trials has been completed and analysis iscurrently being performed.Research projects in 2009PhD study at The University of Melbourne, with the researchbeing undertaken within Northern Health. Research question: “Isthere an ethical difference between offering cardiopulmonaryresuscitation and offering other medical treatments?” Dr BarbaraHayesPhD -Delirium study-randomised controlled trial-Dr Kim JeffsMD-Cardiac injury after orthopaedic surgery in older patients- DrCarol ChongExpert panel for development of Frail Quality Indicators in AgedPatientsRecruited patients for study and participated in expert panel fordevelopment in Qulaity Indicators for frail aged medicalinpatients.NHMRC funded, Lead Professor Len Gray from UQTREAT: (Telemedicine in Residential aged care facilities to EnhanceAssessment and Treatment) Use of telemedicine to enhancegeriatrician assessments in residential care facilities-trial forDepartment of Human Services-Associate Professor Kwang Limand Northern Clinical Research Centre.Research grantsTREAT study (Telemedicine in Residential aged care facilities toEnhance Assessment and Treatment) Use of telemedicine toenhance geriatrician assessments in residential care facilities-trialfor Department of Human ServicesFrail Quality Indicators in Aged Patients. NHMRC, Professor LenGray Chief Investigator, University of Queesnland.H1N1 (Swine) influenza: development of a clinical case definitionand review of epidemiology and antiviral resistance patterns.Joseph Toressi, Lyndsay Grayson, Paul Johnson, Craig Aboltins,Ian Barr I, Jim Black, Allen Cheng. The Austin Hospital, TheNorthern Hospital, The Alfred Hospital. NHMRC 2009.Evaluation of a rapidly deployed community based influenzaclinic in response to the 2009 human swine influenza pandemic.Sam Hume, Ana Hutchinson, Leanne Boase, Craig Aboltins. TheNorthern Small Grants 2009.Improving the management of patients with tuberculosis inVictoria. St Vincent’s Hospital and University of Melbourne. DarbyJ, Buising K, Aboltins C, Black J. John Burge Trust 2009-2012.Quantiferon gold in the diagnosis of extrapulmonary tuberculosis.Burnet Institute, St Vincent’s Hospital, Universtity of Melbourne, StJohn of God Medical College Bangalore. Cox H, Aboltins C,D’Souza G, Shet A, Parikh H, Harper J, Biggs B, Sheorey H, Kumar K,Dharan. German Leprosy and Tuberculosis Relief Association andAustralia India Council 2008-2011.Research publicationsChong CP, van Gaal W, Savige J, Lim WK. Cardiac injury afterorthopaedic surgery and the role of troponin testing. Injury (inpress, accepted October 2009)Chong CP, Lam QT, Ryan JE, Sinnappu RN, Lim WK. Long termimpact of Troponin I after emergency orthopaedic-geriatricsurgery. Internal Medical Journal (in press, accepted June 2009)Chong CP, Lim WK, Savige J. Orthopaedic-geriatric models of careand their effectiveness. Australasian Journal on Ageing (in pressaccepted April 2009)Chong CP, Lam QT, Ryan JE, Sinnappu RN, Lim WK. In reply to:Postoperative myocardial damages are a key issue in patient’soutcome after hip fracture. Age and Ageing, 2009; 38 (4):489.Lim WK, Chong CP, Gideon C, Gray L. Australian and New ZealandSociety for Geriatric Medicine Position Statement No. 15 –Discharge Planning. Australasian journal on Ageing , 2009: 28 (3):158-164.Chong CP, Lam QT, Ryan JE, Sinnappu RN, Lim WK. Incidence ofpost-operative Troponin I rises and one year mortality afteremergency orthopaedic surgery in older patients. Age andAgeing, 2009; 38 (2):168-174.

Chong CP, Christou J, Fitzpatrick K, Wee R, Lim WK: Descriptionof an orthopaedic-geriatric model of care in Australia with 3year data. Geriatrics and Gerontology International, 2008; 8: 86-92.Denholm JT, Gordon CL, Johnson PD, Hewagama SS, StuartRL, Aboltins C, Jeremiah C, Knox J, Lane GP, Tramontana AR,Slavin MA, Schulz TR, Richards M, Birch CJ and Cheng AC.Hospitalised adult patients with pandemic (H1N1) 2009influenza in Melbourne, Australia. MJA 2010; 192 (2): 84-86.Kaufman MA, Duke GJ, McGain F, French C, Aboltins C, LaneGand Gutteridge GA. Life-threatening respiratory failure fromH1N1 influenza 09 (human swine influenza). MJA 2009; 191 (3):154-156.Hayes, B. 2010. 'Trust and distrust in CPR decisions'. Journal ofBioethical Inquiry 7(1): 111-122Gardner H, Lawn N, Fatovich DM, Archer JS. Acute hippocampalsclerosis following ecstasy ingestion. Neurology. 2009 Aug18;73(7):567-569Datta S, Hart GK, Opdam H, Gutteridge G, Archer J. Post hypoxicmyoclonic status: the prognosis is not always hopeless. CriticalCare and Resuscitation. 2009 Mar;11(1):39-41Lillywhite LM, Saling MM, Harvey AS, Abbott DF, Archer JS, VearsDF, Scheffer IE, Jackson GD. Neuropsychological and functionalMRI studies provide converging evidence of anterior languagedysfunction in BECTS. Epilepsia. 2009 Oct;50(10):2276-2284Conference papers and abstractsHaywood C, Chong C, Barker A, Lim WK. Emergencydepartment length of stay (EDLOS), age and mortality study atThe Northern Hospital. Australasian Journal of Ageing. Volume28, Supplement 1, September 2009, A17.Chong CP, Lam QT, Ryan JE, Sinnappu RN, Lim WK. Impact oftroponin I on long term mortality after emergency orthopaedicsurgery in older patients. Journal of Nutrition, Health andAging. Volume 13, Supplement 1, 2009, S413.Haksoz, M, Lim, K, Sinnappu R: Venous Thrombo-embolismprophylaxis in acute hospitals -do protocols that improveadherence to guidelines improve outcomes? Australasianjournal on ageing. Volume 28, supplement 1, September 2009A25.Hayes B, July 2009. 'Role of trust in end-of-life discussions'presented at combined Australasian BioethicsAssociation/Australian and NZ Association of Health, Law &Ethics/Australasian Association of Health Law Conference inChristchurch, New Zealand.Hayes B, Sept 2009. 'Features of ethical end-of-life discussions'presented at combined Palliative Care Australia/Asian PacificHospice Conference in Perth, AustraliaHayes B and Fabri AM from NH Advance Care Planning programNov 2009. 'Advance Care Planning in 3-steps' presented atCommunity Case Managers Conference in Moorabbin.31Northern Health Annual Research Report 2009

The Northern Hospital,Emergency DepartmentResearchers/staffDr. de Villiers SmitEmergency Physician8. Tucker A, Smit de V et al. Higher Order Cognition, Behaviourand Affect in Children Following Mild Traumatic Brain Injury.Collaboration with Victoria University.32Emergency Medicine Registrars involved inresearch projects:Dr. Michelle MokDr. Saad AlnoamanDr. Simon SmithDr. Jeremy StevensDr. Robert MelvinDr. Shu OoiMajor achievements in 2009The research culture established in previous years continues togrow. We’ve obtained An NHMRC grant ($400K) to conduct alarge multicentre trial into the effectiveness of acupuncture in theemergency setting. This is a world-first study that has alreadygenerated substantial international interest.Research projects in 20091. Mok M, Smit de V, Considine J. The use of acupuncture for thetreatment of acute ankle sprains in the EmergencyDepartment: a randomised controlled pilot study.2. Alnoaman S, Smit de V, O’Reilly G. Clinical predictors ofcomplicated appendicitis in the Emergency Department.3. Smit de V, Smith S, Ackland H. The effect of an evidencebasedcervical spine protocol and education on patientmanagement and flow in the Emergency Department.4. Taylor D, Smit de V et al. Pilot study of the effect of caffeine onadenosine dosage in patients with supraventriculartachycardia. Collaboration with TNH, The Austin, RoyalMelbourne and Casey Hospitals.5. Xue C, Smit de V et al. The use of complementary medicineby patients attending the emergency department of a majormetropolitan hospital and their communication with medicalstaff. Collaboration with RMIT6. Cohen M, Smit de V, Taylor D et al. Multiple EmergencyDepartment Acupuncture Trials (MEDACT Project).Collaboration with TNH, RMIT, The Epworth Hospital and TheAlfred Hospital.7. Xue C, Smit de V et al. Evaluation of providing acupuncturefor pain management in the Emergency Department on TheNorthern Hospital. Collaboration with RMIT.9. Considine J, Craike M, Smit de V, Waddell D, Stergiou H,Hausser S. The role of Emergency Departments in Screeningand referral of Obese and Overweight Children.10. Melvin R, Smit de V, Duke G, O’Reilly G. Ultrasound-guidedaxillary vein approach to the subclavian vein versustraditional infraclavicular subclavian vein cannulation forcentral venous access: a Prospective Randomised pilot study.11. Ooi, Shu-Haur, Smit de V. Does a power nap have an effect onthe cognitive performance of medical staff in the EmergencyDepartment?12. Cheng P. Smit de V, Considine J, Duke G. Outcome ofemergency department patients with non-traumatichypotension.Research grants1. Outcome of emergency department patients with nontraumatichypotensionInvestigators: Smit de V, Considine J, Duke G.TNH Small Grant: $4750.652. Evaluation of providing acupuncture for pain management intheEmergency Department of The Northern Hospital.Investigators:Xue C, Smit D, Taylor D Mc D, Zhang T.DHS Grant: $ 48,000.Collaboration with RMIT3. Multiple Emergency Department Acupuncture Trials(MEDACT Project).Principle Investigators: Cohen M, Smit D, Taylor D, Cameron P,Xue C, Parker R et al. .NHMRC Project Grant: $400, 023.Collaboration with RMIT, The Epworth and The AlfredHospital.Research publicationsPeer Review Journals:Lokuge A, Lam L, Cameron P, Krum H, Smit de V, BystrzyckiA,Naughton M, Eccleston D, Flannery G, Federman J, SchneiderHG. B-Type Natriuretic Peptide Testing and the Accuracy of HeartFailure Diagnosis in the Emergency Department. Circulation:Heart Failure. 2010. 3:104 – 110.

Schneider HG, Lam L, Lokuge A, Krum H, Naughton M, Smit de V,Bystrzycki A, Eccleston D, Federman J, Flannery G, Cameron P. B-Type Natriuretic Peptide Testing, Clinical Outcomes, and HealthServices Use in Emergency Department Patients With Dyspnea:A Randomized Trial. Ann Intern Med. 2009;150:365-371.Cabalag M, Taylor D, Knott J, Buntine P, Smit, de V, Meyer A.Recent caffeine ingestion reduces adenosine efficacy in thetreatment of paroxysmal supraventricular tachycardia.Academic Emergency Medicine, 2009, 16:1-9Research presentations & abstractsPoint-of care B-natriuretic peptide predicts 30 day mortality inpatients presenting to the emergency department with acutedyspnoea. Evans K, Reid C, Brennan A, Finlay A, Miels J, Smit de V,Andrianopoulos N, Krum H, Eccleston D. 57th Annual ScientificMeeting, Cardiac Society of Australia and New Zealand, August2009, Sydney, Australia.Outcome of emergency department patients with nontraumatichypotension. Cheng P, Smit de V, Considine J, Duke G.Australasian College for Emergency Medicine Scientific Meeting, 6-9th of October, Broome, Australia.The effect of an evidenced –based cervical spine protocol andeducation on patient management and flow in the EmergencyDepartment. Smith S, . Smit de V, Ackland. Action09 - the AnnualScientific Meeting of the Australasian College for EmergencyMedicine, November 2009, Melbourne.The Introduction of an acupuncture program in an AustralianEmergency Department, Smit de V, Taylor D, Cameron P.Action09 - the Annual Scientific Meeting of the AustralasianCollege for Emergency Medicine, November 2009, Melbourne.The use of acupuncture as an adjunct to conventionaltreatment in the Emergency Department. Smit de V, Taylor D,Cameron P. Action09 - the Annual Scientific Meeting of theAustralasian College for Emergency Medicine, November 2009,Melbourne.The use of acupuncture for the treatment of acute ankle sprainsin the emergency department. Smit de V, Mok M, Considine J,Alcaster N. Action09 - the Annual Scientific Meeting of theAustralasian College for Emergency Medicine, November 2009,Melbourne.Acupuncture vs conventional treatment in emergencymedicine. Smit de V. Action09 - the Annual Scientific Meeting ofthe Australasian College for Emergency Medicine, November 2009,Melbourne.Black Saturday- examining the statewide disaster response tothe Victorian Bushfires. Smit de V. Action09 - the Annual ScientificMeeting of the Australasian College for Emergency Medicine,November 2009, Melbourne.Clinical predictors of complicated appendicitis in theEmergency Department. Alnoaman S, Smit de V, O’Reilly G,Action09- the Annual Scientific Meeting of the Australasian Collegefor Emergency Medicine, November 2009, Melbourne.Collaborations1. Professor Peter Cameron, Department of Epidemiology andPreventative Medicine – Monash University2. A/Prof David Mc D Taylor, Director of Emergency andGeneral Medicine Research – Austin Health.3. Dr. Alan Tucker, Senior Lecturer, School of Psychology –Victoria University.4. Prof. Marc Cohen, Professor of Complementary Medicine –School of Health Sciences, RMIT University5. Professor Charlie Xue, Professor and Head, Division ofChinese Medicine, School of Health Sciences, RMITUniversity, Director, WHO Collaborating Centre forTraditional Medicine.33Northern Health Annual Research Report 2009

The Northern Hospital,PaediatricsResearchers/ staffDr Simon Hauser, Dept. of PaediatricsResearch publicationsIn Press:Simon Hauser, Wei Qi Fan, Karen Kiang. Neonatal stabilityfollowing transfer from Tertiary Centres. Journal of Paediatrics &Child HealthResearch presentations & abstractsNilCollaborationsFan WQ, Hauser S, An Emerging Problem: Significant vitamin Ddeficiency in fair skinned children. submitted for publicationJournal of Paediatrics & Child Health December 2009The Northern Hospital,Pharmacy DepartmentResearchers/staffPeter StuchberyStudentsPhD:Peter Stuchbery (Doctor of Health Science)Student completions in 2009PhD:Peter Stuchbery (Doctor of Health Science) – under examinationMajor achievements in 2008Completion of research project – described below.Systems. In 2008 final analysis of the data took place and in 2009the report was completed.The Pharmacy Departments of The Northern Hospital, Epping andWestern Hospital, Footscray, participated in the research.Research grantsNilResearch publicationsPeer Review Journals:Stuchbery P, Kong DCM, DeSantis GN, Lo SK. Clinical pharmacyworkload in medical and surgical patients: effect of patientpartition, disease complexity and major disease category.International Journal of Pharmacy Practice 2010: 18; 1-8.34Research projects in 2009[ongoing]Examining the provision of clinical pharmacy services accordingto patients’ diagnosis-related- group classification. Earlier, in 2007,we completed all data collection associated with a project thatmeasures how clinical pharmacy activity, (Pharmaceutical ClinicalPathway, RiskMan interventions, pharmaceutical review activities)correlate with patient acuity. We also completed the softwaredevelopment that enabled the association of pharmacists’ activityrecords with information in two hospitals’ Patient AdministrationResearch presentations & abstractsNational:Stuchbery P, Kong DCM, DeSantis GN, Lo SK. Clinical pharmacyworkload by patient disease classification in medical and surgicalpatients. Allied Health Professions Australia. 2009 National AlliedHealth Conference, Canberra, October 2009.CollaborationsPharmacy Department, Western Hospital, Footscray.

The University of MelbourneDepartment of Medicine(Northern Health)Researchers/ staffProf Judy SavigeDr Yan Yan WangDr Lin RigbyA/Prof Deb Colville (part time)A/Prof Des Parkin (part time)StudentsRachel Tan (PhD)Mardhiah Mohammad (PhD)Vanessa Siva Kumar (PhD)Lisa Cheng (B Med Sci)Qui-Lun Ooi (B Med Sci)Foong Kien Newk-Fon Hey (B Med Sci)Alex Wong (B Med Sci)David Ng (B Med Sci)Dr Carol Chong (co supervised)Dr Kim Jeffs (co supervised)Student completions in 2009Nicholas Ho Weiming (B Med Sci - H1)Mohd Afzal Alias (B Med Sci – H1)Norasyiqin Bahariddin (B Med Sci – H2A)Sky Chew Kai Huang (B Med Sci – H1)Major achievements in 2009Our major achievements have related to our work on inheritedrenal disease and the use of retinal vascular changes to predictcardiac risk. In Alport syndrome we have used cell linesestablished from patients to examine the effect of manipulatingmissense and nonsense mutations to produce more protein.These studies have demonstrated that the use of chaperonesand other chemicals may be a feasible treatment for thesepatients in the long term.A highlight of the year was Northern Health hosting the AlportSyndrome Inaugural Support Group Meeting. This was a day oftalks with more than 40 attendees including the treasurer of theInternational Alport Foundation who had flown in from theUnited States. In addition to this we have also established amutation database for mutations in Alport syndrome andrelated diseases, which is hosted by the University of Leiden. Wehave international funding to support this.The second aspect of our research is related to microvasculardisease and in particular using retinal microvascular changes topredict increased cardiac risk in patients with renal failure. Thiswork is a collaboration with Prof Tien Wong and Dr RyoKawasaki of CERA and the University of Singapore. This work hasyielded some very interesting results that show that bloodvessels in the eye get smaller in patients as they develop renalfailure. These changes do not reverse, but they are halted withrenal transplantation. Furthermore during dialysis the vesselsdilate.We have also shown that the vessels are dilated in othersystemic inflammatory diseases using patients from NorthernHealth; these include patients with inflammatory bowel diseaseand with COPD and also those with cancer. We think thisdilatation occurs because of systemic inflammation itself. Allpatients with inflammatory diseases have an increase risk ofcardiac death, especially those with kidney disease. This workhas formed one of our current NHMRC applications. It may bethat a simple examination of the patient’s eyes will demonstratethey have an increased risk of cardiac events including deathwithin the following two years.Research projects in 2009• An assay for X-linked Alport syndrome• The use of retinal examination to identify patients withchronic kidney disease and inflammatory disorders at riskof cardiovascular diseaseResearch grantsInternational Alport Foundation - $10,000Northern Health Research, Education and Equipment Grant -$7,500Research publicationsPeer Review Journals:Tan R, Colville D, Wang YY, Rigby L, and Savige J. AlportRetinopathy Results from "Severe" COL4A5 Mutations andPredicts Early Renal Failure. Clin J Am Soc Nephrol. 2009:5:34-8.Savige J, Trevisin M, Hayman M, and Pollock W. Mostproteinase3-and myeloperoxidase-antineutrophil cytoplasmicantibodies enzyme-linked immunosorbent assays perform lesswell in treated small-vessel vasculitis than in active disease.APMIS 2009:117:60-62.35Northern Health Annual Research Report 2009

36Savige J, Liu J, Cabrera DeBuc D, Handa JT, Hageman GS, Wang YY,Parkin JD, Vote B, Fassett R, Sarks S, and Colville D. Retinalbasement membrane abnormalities and the retinopathy of Alportsyndrome. Invest. Ophthalmol. Vis. Sci. 2009:Epub ahead of print.Savige J and Colville D. Opinion: Ocular features aid the diagnosisof Alport syndrome. Nat Rev Nephrol 2009:5:356-360.Pollock W, Jovanovich S, and Savige J. Antineutrophil cytoplasmicantibody (ANCA) testing of routine sera varies in differentlaboratories but concordance is greater for cytoplasmicfluorescence (C-ANCA) and myeloperoxidase specificity (MPO-ANCA). Journal of Immunological Methods 2009:347:19-23.Liu J, Colville D, Wang YY, Baird PN, Guymer RH, and Savige J. Thedot-and-fleck retinopathy of X linked Alport syndrome isindependent of complement factor H (CFH) gene polymorphisms.British Journal of Ophthalmology 2009:93:379-382.Kaput J, Cotton RGH, Hardman L, Watson M, Al Aqeel AI, Al-AamaJY, Al-Mulla F, Alonso S, Aretz S, Auerbach AD, Bapat B, Bernstein IT,Bhak J, Bleoo SL, Blocker H, Brenner SE, Burn J, Bustamante M,Calone R, Cambon-Thomsen A, Cargill M, Carrera P, Cavedon L,Cho YS, Chung YJ, Claustres M, Cutting G, Dalgleish R, den DunnenJT, Diaz C, Dobrowolski S, dos Santos MRN, Ekong R, Flanagan SB,Flicek P, Furukawa Y, Genuardi M, Ghang H, Golubenko MV,Greenblatt MS, Hamosh A, Hancock JM, Hardison R, Harrison TM,Hoffmann R, Horaitis R, Howard HJ, Barash CI, Izagirre N, Jung J,Kojima T, Laradi S, Lee YS, Lee JY, Gil-da-Silva-Lopes VL, Macrae FA,Maglott D, Marafie MJ, Marsh SGE, Matsubara Y, Messiaen LM,Moslein G, Netea MG, Norton ML, Oefner PJ, Oetting WS, O'LearyJC, de Ramirez AMO, Paalman MH, Parboosingh J, Patrinos GP,Perozzi G, Phillips IR, Povey S, Prasad S, Qi M, Quin DJ, Ramesar RS,Richards CS, Savige J, Scheible DG, Scott RJ, Seminara D, ShephardEA, Sijmons RH, Smith TD, Sobrido MJ, Tanaka T, Tavtigian SV, TaylorGR, Teague J, Topel T, Ullman-Cullere M, Utsunomiya J, van KranenHJ, Vihinen M, Webb E, Weber TK, Yeager M, Yeom YI, Yim SH andYoo HS. Planning the Human Variome Project: The Spain Report.Human Mutation 2009:30:496-510.Gross O, Borza DB, Anders HJ, Licht C, Weber M, Segerer S, Torra R,Gubler MC, Heidet L, Harvey S, Cosgrove D, Lees G, Kashtan C,Gregory M, Savige J, Ding J, Thorner P, Abrahamson DR, AntignacC, Tryggvason K, Hudson B, and Miner JH. Stem cell therapy forAlport syndrome: the hope beyond the hype. Nephrology DialysisTransplantation 2009:24:731-734.Colville D, Wang YY, Tan R, and Savige J. The retinal "lozenge'' or"dull macular reflex'' in Alport syndrome may be associated with asevere retinopathy and early-onset renal failure. British Journal ofOphthalmology 2009:93:383-386.Research presentations & abstractsInternational:Collagen type IV map; Gordon Conference on Collagens; NewLondon; United States.A linear protein map of collagen type IV; American Society ofNephrology Annual Meeting; San Diego; United States.How to test for ANCA; 14th International ANCA Workshop;Copenhagen; Denmark.ANCA in convalescent disease; 14th International ANCAWorkshop; Copenhagen; Denmark.The type IV collagen map; Human Variome Project; Costa Brava;Spain.National:Ocular manifestations of inherited and chronic kidney disease;University Department of Medicine Seminar (Austin Health);Melbourne; Australia.Pathogenesis of autoimmune disease; Australian Association ofBiochemistry Annual Meeting; Melbourne; Australia.Ocular manifestations of inherited and chronic kidney disease;Department of Nephrology Seminar (Austin Health); Melbourne;Australia.Ocular manifestations of inherited renal and chronic kidneydisease; Royal Children’s Hospital Symposium on Inherited RenalDisease; Melbourne; Australia.A linear protein map of collagen type IV demonstrates majorligand binding sites and functional domains; Genome DisordersResearch Centre; Melbourne; Australia.Alport Syndrome Support Group; First Annual Meeting AlportSyndrome Support Group; Melbourne; Australia; 5 talks bymembers of our laboratory.CollaborationsProf James San Antonio, PhiladelphiaProf Tien Wong, CERA, University of SingaporeDr Ryo Kawasaki, CERAProf Billy Hudson, Vanderbilt UniversityDr Peter Barlis, Northern HealthDr Daniel Saddik, Northern HealthDr William van Gaal, Northern HealthDr Nagesh Anavekar, Northern HealthGastroenterology Unit, Northern HealthRenal Unit, Northern HealthOncology Unit, Northern HealthRespiratory Physicians, Northern Health

The University of MelbourneDepartment of Surgery(Northern Health)Researchers/staff:Dr Grace Chew – Principal ResearcherDr Chew was a clinician in breast and general surgery at theNorthern Hospital in 2009. She worked in a multidisciplinarysetting in breast oncology and regularly performed breastsurgery. She has a strong research background in breastoncology and biostatistics, having completed a Master ofEpidemiology and performed a meta-analysis on breast andovarian cancer incidences in high risk patients who undergoprophylactic surgery.In the course of her work, she noted changes in thepsychosocial function of breast cancer patients during theperioperative period. This was confirmed by a literature reviewshe presented at the surgeons Surgical Forum, which revealedsignificant psychosocial, sexual and functional disturbances inwomen undergoing surgery for breast cancer. Consequently, DrChew initiated the QOBS Study to explore the quality of lifeoutcomes after breast cancer surgery at the Northern Hospital.She proposed the study design, obtained ethics approval, andwas successful in an application for the Northern Hospital SmallResearch Grant in 2009. She has commenced recruitment ofstudy participants in early 2009 and expects to completerecruitment in mid-2010.Dr Chew is also in the process of preparing a prospective caseseries of patients with idiopathic granulomatous mastitis forpublication in a breast-specific peer-reviewed journal.Mr Pee Yau Tan – Principal InvestigatorMr Tan was a clinician in colorectal and general surgery at theNorthern Hospital in 2009. He has a strong interest in colorectaloncology surgery and research in collaboration with alliedhealth and nursing staff. He performed a literature review offast-track elective colorectal surgery, which he presented at thesurgeons Surgical Forum at Northern Health. He is the principalinvestigator for the Colorectal Fast-track Surgery Study, whichcommenced in 2009 at Northern Hospital. He proposed thestudy design, obtained ethics approval, recruited surgeonparticipation and performed initial statistical analysis. Hepresented interim findings at a second Surgical Forum, withplans for continuation of the fast-track program on electivecolorectal patients.Prof Hamish Ewing – Supervising-InvestigatorProfessor Ewing is a general and breast surgeon at the NorthernHospital, as well as the Head of Surgical Unit 2, Acute Services.He has a strong research and academic background, also takingup the position as Clinical Dean for the Northern HospitalClinical School, University of Melbourne in 2010.Prof Ewing has been instrumental in the commencements ofthe QOBS Study and Fast-track colorectal surgery study. He ismaintaining the ongoing administration of both studies. Hecurrently oversees the clinical aspects of the study and alsoadministers the research grant. He regularly performs breastoncology surgery on patients with operable breast cancer, whoare eligible for participation in the study.Mr David Butterfield, Ms Wanda Stelmach, Mr Boon Hong, MrDevan Gya – Associate ResearchersMr D. Butterfield, Ms W. Stelmach, Mr B. Hong, Mr D. Gya aregeneral and breast surgeons at the Northern Hospital. Theyregularly perform breast oncology surgery on patients withoperable breast cancer, who are eligible for participation in thestudy.Mr D. Butterfield, Ms W. Stelmach and Prof H. Ewing are alsoassociate researchers in the case series of patients withidiopathic granulomatous mastitis over the five years studyduration.Mr Neil Strugnell, Mr Andrew Bui – Participating generalsurgeonsMr N Strugnell, Mr A Bui and other general surgeons whoperform elective colorectal study are continuing to participatein the Fast-track colorectal surgery study.Ms. Tanya Gulliver – Associate ResearcherMs T. Gulliver is the dietitian for the general surgical patientsundergoing gastrointestinal surgery at the Northern Hospital.She is the Co-investigator for the Fast-track colorectal surgerystudy. She collated data regarding participating patients andmanaged their dietary management post-elective colorectalsurgery.Major achievements in 2009Quality of Life Outcomes after Breast Cancer Surgery (QOBS) StudyThe Quality of Life Outcomes after Breast Cancer Surgery (QOBS)Study is a prospective cohort study which aims to assess thequality of life outcomes after breast cancer surgery in patients atthe Northern Hospital. 100 patients after breast conservingtreatment or mastectomy and/or axillary dissection are beingrecruited into the study and their outcomes assessed byvalidated questionnaires at diagnosis, 3 months and 6 monthspost-operatively by the research team, with potential forongoing assessment in the longer term, at 1 and 2 years postsurgery. Post-operative outcomes recorded include aspects ofphysical well-being, social and emotional well-being andfunctional outcomes. Statistical analysis with Stata 7.0 will be37Northern Health Annual Research Report 2009

performed to determine if there is significant deterioration inspecific areas of quality of life after surgery, and if there is asignificant difference in outcomes between breast conservingand mastectomy patients.This study is important because it is the first prospective study inAustralasia that provides new information about the quality of lifeand functional outcomes in breast cancer patients undergoingsurgery in the Victorian community. Thus, Victorian clinicians mayhave improved knowledge regarding the post-operative physicaland psychosocial outcomes in this cohort, in order to providerelevant psychosocial support, and improve social and functionaloutcomes in the post-operative period.Idiopathic Granulomatous Mastitis: case series of a rare diseaseThe study aims to increase clinician awareness regarding a rarebreast disorder which mimics the presentation of breastmalignancy or infection. It has encouraged multidisciplinarymanagement of the condition.Fast-track colorectal surgeryThis study has increased clinician awareness and has promisingresults confirming the benefits of fast-track post-operativemanagement of elective colorectal surgery patients.Research projects in 2009Quality of Life Outcomes after Breast Cancer Surgery (QOBS) Study• a prospective cohort study on quality of life outcomes inpatients undergoing breast oncology surgery at theNorthern HospitalIdiopathic Granulomatous Mastitis: case series of a rare disease• a prospective series of women with a rare benign breastdisorder that mimics breast malignancy, and presents amanagement dilemmaFast-track colorectal surgery• a prospective cohort study on fast-track regime in electivecolorectal surgery patients, with early feeding, regularanalgesia and antiemetic regime and early mobilisationResearch grantsThe Northern Hospital Small Research Grant 2009 for the Qualityof Life Outcomes after Breast Cancer Surgery (QOBS) StudyResearch publicationsPlanned for publication in peer review journal in 2010 – 2011:• Quality of Life Outcomes after Breast Cancer Surgery (QOBS)Study• Idiopathic Granulomatous Mastitis: case series of a rarediseaseResearch presentations & abstractsQuality of Life Outcomes after Breast Cancer Surgery (QOBS)Study• Presentation at Surgeons Surgical Forum, The NorthernHospital 2009• In preparation for presentation at Annual General Scientificand Fellowship Meeting, Victoria, September 2010.CollaborationsThe development and implementation of both studies hasalready brought about a close collaboration between surgeons,junior medical staff, breast care nurses, and social workers; whilealso strengthening the relationship between surgeons and theirpatients. The surgical department has benefitted fromcollaboration with the Pathology department for informationregarding patients with idiopathic granulomatous mastitis.Collaboration with the infectious diseases physicians andrheumatologists has been ongoing in the multidisciplinarymanagement of mastitis patients.The research being performed at the Northern Hospital generalsurgery department will develop new skills amongst clinicalresearchers, including training in statistical and epidemiologicalstudy methods.38

Northern Health SmallResearch GrantsThe Northern Health Education and Research Committee iscommitted to the development of a dynamic, inter-professionalresearch environment at Northern Health. The Committee aimsto provide Northern Health staff and research groups with anopportunity to build their research activity and profile, andaccess support to build a strong research culture across theorganisation.Northern Health has provided money for research grants forNorthern Health employees. The research grant proposals willbe primarily judged on scientific merit and their potential toincrease the contribution of Northern Health Research to thewider research community.Seven rounds of The Small Research Grants program have beenheld resulting in 36 research projects being undertaken acrossNorthern Health.In 2009, rounds 6 & 7 were undertaken with a total of $43 674allocated to 11 successful applicants across Northern Health.Successful applicants in round 6‘Characteristics and outcomes of patients requiring transferfrom continuing to acute care’, Marie Mohr, Nursing (BHS),$4 921‘How much is enough? An exploratory study of the allied healthintervention received by people admitted to the GeriatricEvaluation & Management (GEM) Unit’, Robyn Smith, AlliedHealth, $4 953‘A 7 day per week physiotherapy service for inpatientrehabilitation patients at Northern Health: a feasibility study’, OfaStarman, Nursing (BHS), $5 000‘Reviewing the physiotherapy clinical education program atNorthern Health: a new model of the future Northern HealthPhysiotherapy Clinical School?’ Dr Natalie de Morton,Physiotherapy, $2 500‘What can be learned from hospital interpreters about culturalissues relevant to advance care planning?’ Dr Barbara Hayes,Medicine, $2 000‘Quality of Life Outcomes after Breast Cancer Surgery (QOBS)Study: A Prospective Cohort Study’, Dr Grace Chew, Surgery,$2 900‘Diversity of variation in genes potentially affected in diabeticnephropathy & progressive kidney failure in different racialgroups’, Dr Yanyan Wang, Senior Research Officer, Medicine,$4 989.75Successful applicants in round 7‘The use of optical coherence tomography to examine thedistribution of atherosclerotic plaque in the coronary arteries ofstatin-naive compared with statin-treated patients: A pilotstudy’, Dr Peter Barlis, Consultant Cardiologist, $5 000Evaluation of a rapidly deployed influenza clinic in response tothe 2009 human swine influenza pandemic’, Dr Samuel Hume,Infectious Diseases Physician, $3 800‘A Cochrane review: The effect of music facilitated exercisegroups for hospitalised older adults’, Ms Winifred Beevers, MusicTherapist, $5 000‘The use of guided imagery to alleviate pain in paediatricpatients (4-12 year olds) undergoing treatment in theEmergency Department’, Dr Kristine Gilbert, EmergencyRegistrar, $2 61039Northern Health Annual Research Report 2009

Northern HealthResearch Week 200940Research Week was held on the 16th – 20th November with 53abstracts being received, from across all Northern Healthcampuses.For the first time, broadcasting of speakers and presentations viaWebex (which allows simultaneous broadcasting and discussionbetween sites) to Craigieburn Health Service (CHS), BundooraExtended Care Centre (BECC) & Broadmeadows Health Service(BHS) was organised, allowing an extra 44 people to participate inResearch Week from remote sites.The Research Week Schedule included:• Poster displays at the Broadmeadows Health Service (BHS),Bundoora Extended Care (BECC), The Northern Hospital(TNH) and Craigieburn Health Service (CHS) from Monday –Friday.• Guest speaker, Dr Bill van Gaal, presented ‘Evidence BasedCardiology: Shaping the design of future clinical research’from registries, RCTs, mega-trials and metaanalysis to newtechnologies and the pursuit of the ultimate surrogateendpoint.’ Dr van Gaal proved to be a very engaging andinteresting presenter and was extremely well received.• Round 7 Small Grants certificates were presented by Mr GregPullen, CEO Northern Health, with all participants available toreceive their certificates.• Posters were manned by main authors, at most sites andattendance by Professor Judy Savige & Associate ProfessorHamish Ewing at TNH generated good discussion andnetworking opportunities for authors.• Internal speakers included:• Dr Peter Barlis - “First Australian experience with intracoronaryoptical coherence tomography”.• Jeanette Kamar - “Preventing pressure ulcers in acute care:does nurse experience affect accuracy of risk assessmentscoring and application of prevention strategies?”• Robyn Smith – “Supervision: A comprehensive approach tosupport retention and development.”• Posters were judged on a number of criteria includingoriginality of research question, significance to NorthernHealth, overall clarity and presentation. The poster winnerswere:1st prize‘Medication continuity for people in the transition from hospitalto Residential Aged Care’Harvey P, Cincotta M, Sivaraj R, Carter L, Jennings R2nd Prize‘Responding to the ageing profile of emergency departmentpatients’Keith Hill, Julie Considine, Robyn Smith, Tracey Weiland, JohnGannon, Marnie Graco, Christine Behm, Peita Wellington, SallyMcCarthy, Sam Corrie3rd Prize‘Comparative accuracy of two methods of predicting dischargedestination of hip & knee arthroplasty patients’Schofield C, Barker A4th Prize‘Out of site, out of mind: Assessment of insulin injection sites forlipohypertrophy’M. Wallace, D. Greig, J. Wallace, A.S. Cheung, F. Pyrlis, E. Premaratne,F. Lee, C. Lo, S. Varadarajan, S. Fourlanos.5th Prize‘Peripheral retinal drusen are increased in patients withinflammatory bowel disease’Ng D, Colville D, Glance S, Froomes P, Mariani A, Savige J,Highly Commended‘Impact of Troponin I on long term mortality after emergencyorthopaedic surgery in older patients’Carol P. Chong , Que T. Lam, Julie E. Ryan, Rabindra N. Sinnappuand Wen Kwang Lim‘A qualitative comparative evaluation of Northern Alliance HARPprogram’s electronic interRAI-HC trial’Gannon J, Hutchinson A, Shanahan-McKenna L, Graco M

Index of Poster Abstractsby AuthorAbstract 1Abstract 2RETURN TO HOSPITAL AND MEDICATIONCONTINUITY FOR PEOPLE IN RESIDENTIALAGED CAREAslan A, Harvey P, Tran T, Cincotta MFIRST AUSTRALIAN EXPERIENCE WITHINTRACORONARY OPTICAL COHERENCETOMOGRAPHYAbstract 9Abstract 10ELECTROCARDIOGRAPH CHANGES ANDCORRELATION TO TROPONIN LEVELS ANDCARDIAC COMPLICATIONS AFTERORTHOPAEDIC SURGERYCarol P. Chong , William Van Gaal , KonstantinosProfitis , Julie E. Ryan , Judy Savige , and WenKwang LimHELP! WHO WOULD INTERNS TURN TO?Abstract 3Asrar ul Haq M, Van Gaal W, Ramchand J,Ponnuthurai L, Mehta N, Barlis PLEFT VENTRICULAR TORSIONAL DYNAMICSDURING EXERCISE USING 2D STRAINIMAGING PREDICTS EXERCISE TOLERANCEBETTER THAN E/E’ ESTIMATIONAbstract 11Chong C, Sangas S, Fraser R, Bond F, Savige J.IMPACT OF TROPONIN I ON LONG TERMMORTALITY AFTER EMERGENCYORTHOPAEDIC SURGERY IN OLDER PATIENTSCarol P. Chong , Que T. Lam, Julie E. Ryan,Rabindra N. Sinnappu and Wen Kwang LimAbstract 4Asrar ul Haq M, Lin T, Anavekar N, Wong CPREVENTING PRESSURE ULCERS IN ACUTECARE: DOES NURSE EXPERIENCE AFFECTACCURACY OF RISK ASSESSMENT SCORINGAND APPLICATION OF PREVENTIONSTRATEGIES?Barker A, Kamar J, Tyndall T, White L,Hutchinson AAbstract 12Abstract 13DOES TYPE OF CLINICIAN INFLUENCE EDFAST TRACK PERFORMANCE?Considine J, Kropman M, Stergiou H.E.EMERGENCY DEPARTMENT MANAGEMENTOF EXACERBATION OF COPD: COMPLIANCEWITH BEST PRACTICE RECOMMENDATIONSConsidine J, Botti M, Thomas SAbstract 5WHY IT WORKS – ANALYSIS OF THE MUSICPROVIDED FOR AN EXERCISE GROUP ON THEG.E.M. UNIT – B.H.S.Beevers WAbstract 14PREVALENCE STUDY OF OVERWEIGHTCHILDREN IN EMERGENCY DEPARTMENTPOPULATIONSConsidine J, Craike M, Smit D, Stergiou HE,Hauser S, Waddell DAbstract 6H1N1 INFLUENZA AT CRAIGIEBURN HEALTHSERVICEBoase, L.Abstract 15USE OF INTENSIVE MULTISOURCECOMMUNICATION STRATEGIES ANDAPPROPRIATE STRUCTURAL SUPPORT TOIMPROVE PARTICIPATION IN CLINICALHANDOVERAbstract 7Abstract 8INTERDISCIPLINARY CHRONIC WOUND CARESERVICES INVOLVING PODIATRY – ASTRENGTHENED MODEL OF CARE?Butters Tim B Pod, Mannix Rebecca B Pod,Sandilands Dominic BAppSci (Pod)MICROVASCULAR ABNORMALITIES AREMORE PREVALENT IN CORONARY CAREPATIENTS UNDERGOING CORONARYANGIOGRAPHYCheng L, Colville D, Barlis P, van Gaal W, Savige JAbstract 16Abstract 17Dhulia Anjali, Baqar Sara and NAIDOO HumshaA QUALITATIVE COMPARATIVE EVALUATIONOF NORTHERN ALLIANCE HARP PROGRAM’SELECTRONIC INTERRAI-HC TRIALGannon J, Hutchinson A, Shanahan-McKenna L,Graco MMEDICATION CONTINUITY FOR PEOPLE INTHE TRANSITION FROM HOSPITAL TORESIDENTIAL AGED CAREHarvey P, Cincotta M, Sivaraj R, Carter L,Jennings R,41Northern Health Annual Research Report 2009

Abstract 18RESPONDING TO THE AGEING PROFILE OFEMERGENCY DEPARTMENT PATIENTSAbstract 28THE PROBLEM OF VISUAL MOTIONINTEGRATION IN SCHIZOPHRENIAKeith Hill, Julie Considine, Robyn Smith, TraceyWeiland, John Gannon, Marnie Graco, ChristineBehm, Peita Wellington, Sally McCarthy, SamCorrieAbstract 29Nash T J, Carter O L, Sundram SPERIPHERAL RETINAL DRUSEN AREINCREASED IN PATIENTS WITHINFLAMMATORY BOWEL DISEASEAbstract 19USE OF ANTI-EPILEPTIC MEDICATIONSASSOCIATED WITH BALANCE IMPAIRMENTNg D, Colville D, Glance S, Froomes P, Mariani A,Savige J,Abstract 20Hill K, Petty S, O’Brien T, El Haber N, Paton L,Lawrence K, Berkovic S, Wark JAN AUDIT ON THE COMPLICATIONSASSOCIATED WITH ARM PORTSAbstract 30RETINAL MICROVASCULAR ABNORMALITIESARE LESS COMMON AND LESS SEVERE INPATIENTS AFTER RENAL TRANSPLANTATIONTHAN BEFOREIywan R A, Probst K PNewk-Fon Hey Tow F K, Ooi Q, Colville D andSavige JAbstract 21Abstract 22RECRUITMENT AND RETENTION IN HEALTHJansen BEXHALED VERSUS ARTERIAL CARBON DIOXIDELEVELS: IMPROVING THE IDENTIFICATION OFHYPERCAPNIAAbstract 31CHRONIC KIDNEY DISEASE IS ASSOCIATEDWITH A DECREASE IN RETINAL ARTERIOLARCALIBREOoi Q, Alias M, Baharuddin N, Deva R, HutchinsonA, Kawasaki R, Newk-Fon Hey Tow F, Colville D,Savige JAbstract 23Abstract 24Abstract 25Elaine Killeen, Julie Considine, Judy CurreyMEASUREMENT OF RECOVERY IN SUB ACUTESTROKE PATIENTS WITH LATEROPULSIONMcDonald E, Hill K, Punt DARE NUTRITIONALLY AT RISK CANCERPATIENTS APPROPRIATELY REFERRED FORDIETETIC INTERVENTION IN A DAY ONCOLOGYSETTING AT THE NORTHERN HOSPITAL?McDonald T, Freeman KINTRODUCTION OF A DIABETES REFERRALFORM AND RISK STRATIFICATION PROCESS –RESPONSE OF GENERAL PRACTITIONERS ANDPRACTICE MANAGERS IN MELBOURNE’SNORTHMissing SAbstract 32Abstract 33Abstract 34A LINEAR PROTEIN MAP OF THE a1a1a2HETEROTRIMER OF TYPE IV COLLAGENDEMONSTRATES NOVEL FUNCTIONS ANDPOTENTIAL INTERACTIONSJ Des Parkin, J San Antonio, Vadim Pedchenko,Billy Hudson, Judy Savige,ANTIPSYCHOTIC DRUG MODULATION OFDOWNSTREAM TARGETS OF THE EGF-ERK CELLSIGNALING PATHWAY IN PREFRONTAL CORTEXAND STRIATUMPereira A, Zhang B, Malcolm P, Fink G andSundram SDO INPATIENT REHABILITATION PATIENTS ATBROADMEADOWS HEALTH SERVICE (BHS)WANT WEEKEND PHYSIOTHERAPY?Pow A, Lowe B & de Morton N42Abstract 26Abstract 27CLINICAL RISK MANAGEMENT: WHAT ARE THESOURCES OF RISK IN EMERGENCY CAREMs Belinda Mitchell, Dr Julie Considine, ProfessorMari BottiNPHS2 MUTATIONS IN PATIENTS WITHFAMILIAL RENAL DISEASE OF UNKNOWNCAUSE, FOCAL SEGMENTALGLOMERULOSCLEROSIS (FSGS), ALPORTSYNDROME AND CHRONIC KIDNEY DISEASEAbstract 35Abstract 36Abstract 37NORTHERN ALLIANCE HARP DIABETESSERVICE IMPACT ON HOSPITAL UTILISATIONRasekaba TM, Hutchinson ANORTHERN ALLIANCE HARP PROGRAMPATIENT SATISFACTION OCTOBER 2008 TOJANUARY 2009C.Risteski, A.Jasper, A.HutchinsonONE SIZE DOES NOT FIT ALL – HELPING IMGSLEARNMardhiah Mohammad, Nick Ho, Lin Rigby,Yan YanWang, Judy SavigeSangas S, Fu P, Chong C, Apswoude G, SomarajahG, Savige, J.

Abstract 38PAGER FREE EDUCATION – THE ‘PERFECT’TEACHING ARRANGEMENTAbstract 48NORTHERN PSYCHIATRIC UNIT, CLINICALOBSERVATION RESEARCH PROJECTSangas S, Chong C, Fraser R, Bond F, Savige, J.Sundram S, Harrington AAbstract 39THE PATHOGENESIS OF THE DOT AND FLECKRETINOPATHY IN ALPORT SYNDROMEAbstract 49PLASMA APOLIPOPROTEIN E IS ELEVATED INCLOZAPINE TREATED SCHIZOPHRENIAAbstract 40J Savige, J Liu, 1D Cabrera, J Handa, D Colville,COMPARATIVE ACCURACY OF TWOMETHODS OF PREDICTING DISCHARGEDESTINATION OF HIP AND KNEEARTHROPLASTY PATIENTSSchofield C, Barker AAbstract 50Sundram S, Bandara J, Sathiyamoorthy S. TaddeiK, Martins R, Cowie T, Lohdi R, Pereira A, MalcolmP, Wragg ABACK PAIN AND NEW ONSET BROWN-SÉQUARD SYNDROME IN A MIDDLE AGEDWOMANAbstract 41DIFFERENCES OF HEALTH SYSTEMS ININDONESIA AND AUSTRALIA: POPULATIONNUMBER AND ECONOMY ARE THECONTRIBUTING FACTORSAJ Sendjaja, CN Hutagalung, DA Loho, GGanabathi, H Alwainy, L Chandrahirawati, NHamid, N Zainal, N Halim, RS Fadli.Abstract 51Thuy MNT, Hume SCOUT OF SITE, OUT OF MIND: ASSESSMENTOF INSULIN INJECTION SITES FORLIPOHYPERTROPHYM. Wallace, D. Greig, J. Wallace, A.S. Cheung,F. Pyrlis, E. Premaratne, F. Lee, C. Lo, S.Varadarajan, S. Fourlanos.Abstract 42DEVELOPMENT OF A cDNA SCREENINGASSAY FOR COL4A3 AND COL4A4MUTATIONS IN AUTOSOMAL RECESSIVEALPORT SYNDROMESiva Kumar V, Wang YY, Tan R, Rigby L, Savige J.Abstract 43 ALLIED HEALTH GRADUATE PROGRAM –SUPPORTING NEW GRADUATES TO LEARNFROM EACH OTHER.Smith R, Pilling S, Champ PAbstract 44LEARNING TOGETHER TO WORK TOGETHER:FACILITATING COLLABORATION THROUGHINTERPROFESSIONAL CLINICAL EDUCATIONSmith Robyn, Dodd Karen, Davidson Megan,Smith Jenni, Schofield ClaireAbstract 52Abstract 53RETINAL ARTERIOLAR AND VENULARDILATATION IN CHRONIC OBSTRUCTIVEPULMONARY DISEASEWong A, Cheng L, Chew K, Colville D,Hutchinson A, Kawasaki R, Canty P, Savige JIMPACT OF THE NATIONAL INPATIENTMEDICATION CHART ON PRESCRIBING AT ASUBACUTE GERIATRIC HOSPITAL: ARETROSPECTIVE AUDITDr Paul Yates, Dr Penny Harvey, Dr Carol ChongAbstract 45Abstract 46Abstract 47SUPERVISION – A COMPREHENSIVEAPPROACH TO SUPPORT RETENTION ANDDEVELOPMENT.Smith R, Steel C, Champ P, Smith J, Spring A,Wilson KTO COMPARE THE EFFECT ON PEAKPLANTAR PRESSURES OF THE DH PRESSURERELIEF SHOE, STANDARD FOOTWEAR ANDCANVAS SHOES IN PATIENTS WITHPERIPHERAL NEUROPATHYStark M, Landorf K, Raspovic A, Gazarek JBENZODIAZAPINE AND APD USE IN APSYCHIATRIC INPATIENT UNIT IS NOTPREDICTED BY PRESENCE OR ABSENCE OFSUBSTANCE USE DISORDERSundram S, Matsudaira A, Sritharan P, Happell Band Swaminathan V43Northern Health Annual Research Report 2009

Abstract 1RETURN TO HOSPITAL AND MEDICATIONCONTINUITY FOR PEOPLE IN RESIDENTIALAGED CAREAslan A, Harvey P, Tran T, Cincotta MBackgroundPeople discharged from hospital to Residential Aged Care (RAC)can experience interruptions to medication therapy, and weexamined whether this contributes to hospital readmission.Methodology➢ Hospital electronic records of Northern and Austin Healthwere searched for people >60years age transferred to RAC➢ RAC Nurses were interviewed about continuity of medication➢ Records re-examined to identify people with unplannedhospital readmission within 7 and 28 days➢ An expert panel considered whether medication contributedto 7day readmissions.➢ Medication delays/missed doses at RAC were disclosed andconsidered for their contribution to readmissions.ResultsReadmission rates were 8% within 7days and 20% within 28days.Of 7 day readmissions, medication problems were:• potentially related in 74%;• dominant or partly contributing to 60%;• possibly preventable for 96%.Medication delay/missed dose at RAC occurred for 44% of 7dayreadmissions, and was the dominant cause of readmission for13%. Readmission was statistically associated with missed dosesat RAC, and number of prescribed medications (p

Abstract 3LEFT VENTRICULAR TORSIONAL DYNAMICSDURING EXERCISE USING 2D STRAINIMAGING PREDICTS EXERCISE TOLERANCEBETTER THAN E/E’ ESTIMATIONAsrar ul Haq M, Lin T, Anavekar N, Wong CDepartment of Cardiology, The Northern Hospital, Victoria,Australia.BackgroundLeft ventricular (LV) diastolic filling pressure as measured by E/E’during exercise is a marker of exercise capacity. We examined LVtorsional dynamic pre- and post-exercise using 2D strainechocardiography and compared to E/E’ post exercise, inpredicting exercise capacity.MethodologyWe evaluated LV torsion pre- and post-exercise in 40 patientsreferred for stress echocardiography. Patients with ischemiawere included. Treadmill exercise was performed using standardprotocols, and echo images acquired using GE Vivid 7, set athigh frame-rate and analysed using GE ECHOPAC software. LVtorsion was calculated as difference between clockwise rotationat the base and counter-clockwise rotation of the apex. Patientswere categorised into three groups according to % predictedexercise capacity (achieved metabolic equivalents [METS]),adjusted for age and gender. Correlation between exercisecapacity and LV torsion vs. E/E’ were determined.ResultsMean patient age 57, with normal resting LVEF.Group Predicted Mean Mean Meanexercise post total totalcapacity E/E’ torsion torsion(METS) at rest post exercise1 120% 11.97 9.8° 12°Post exercise E/E’ correlated with METS (r=0.48, p

Abstract 5WHY IT WORKS – ANALYSIS OF THE MUSICPROVIDED FOR AN EXERCISE GROUP ON THEG.E.M. UNIT – B.H.S.Beevers WBackgroundMusic therapists are often asked to provide music for exercises.Literature reviews show minimal details about the music, whochose it, or why, when used in exercise groups.Two Allied Health Assistants and the music therapist ran thegroup. This was a quality improvement project, and won the 2009NH quality award for clinical effectiveness.ObjectiveTo evaluate the music for rhythm, speed, tonality, genre and theeffect when a participant sang.MethodologyMusic was chosen by the music therapist to reflect the culturalbackgrounds and age of the participants. Participants wereconsulted and their choices used when possible. A database wascreated that linked the exercise to the music by title, rhythm andspeed. The only data kept was information about the music.Individual participants were not identified in any way.ResultsThe principle finding was that the time taken from the start -middle - end point of each repetition impacted most on therhythm and speed used. A long time could be filled with morebeats; a shorter time would fit fewer beats. The participantspreferred known music with a major tonality. There were severalgenres of music, from differing eras. Singing participants tendedto forget to exercise and concentrate on singing, but would workharder later in the session. They also helped motivate otherparticipants who derived great pleasure from seeing and hearingsomeone sing.Abstract 6H1N1 INFLUENZA AT CRAIGIEBURN HEALTHSERVICEBoase, L.BackgroundCraigieburn Health Service Minor Injury and Illness Service wasdesignated a ‘Fever Clinic’ during the H1N1 pandemic on 29thMay 2009. Over 600 presentations with Influenza Like Illness,Upper Respiratory Tract infections, or H1N1 enquiries occurred ina six-week period.Study AimsThis study aims to explore the performance of, and demands on,the Minor Injury and Illness Clinic and Craigieburn Health Serviceduring the H1N1 pandemic, including what types ofpresentations occurred. Recommendations on how to preparefor future pandemics in this setting will be made.MethodologyRetrospective medical record reviews using iPM and CPF.Total cases included in study – 608.Clinical case definitions were applied based on DHS definitions.ResultsIn the early stages of data analysis, most presentations to theMinor Injury and Illness Clinic involved patients who had not hadcontact with H1N1 influenza and did not have significant riskfactors.ConclusionThis study will evaluate the Craigieburn Health Service responseto the H1N1 Influenza pandemic, and provide recommendationsto enhance response to any future pandemics.ConclusionEach week the participants changed, as did their strength andfitness levels. Therefore the music played each week varied. It wasnot possible to link one exercise with one particular piece or eventype of music. Rather, it was necessary to have a range of musicwith differing rhythms and speeds for each exercise. The musichad to reflect the participants’ preferences. To find the best fit onthe day required the music therapist to assess the exercise as theparticipants started, then find and play music to suit.46

Abstract 7INTERDISCIPLINARY CHRONIC WOUNDCARE SERVICES INVOLVING PODIATRY –A STRENGTHENED MODEL OF CARE?Butters Tim B Pod, Mannix Rebecca B Pod, Sandilands DominicBAppSci (Pod)BackgroundThere is increasing literature regarding podiatrist’s involvementin managing “high risk” chronic foot wounds (Fitzgerald,Edwards & Tennant, 1997). Multi-disciplinary models of chronicwound management have predominantly been nurse ledservices with podiatrists referred to as deemed appropriate(Rayner, 2006). Recent literature states that an interdisciplinaryapproach provides capacity for genuine skills transfer throughlearning, implementing and refining skills across disciplines(Cowley 1994).Study AimThe aim of this study is to provide a preliminary evaluation ofthe outcomes and effectiveness of interdisciplinary model ofcare and to explore potential implications on the broadeningscope of podiatry.MethodologyA retrospective sample of clients presenting to the CHS ChronicWound Service (CWS) was reviewed from July 2007 to August2008. This data describes patient outcomes and compared withavailable published data to benchmark healing rates.The effectiveness of the interdisciplinary model was furtherevaluated through an independently completed satisfactionsurvey undertaken by all members of the CHS CWS.Results or outcomesSample data for 25 clients with leg ulcerations wasbenchmarked against published data from Gohel’s study (2005).Of the 25 clients, 72% were discharged following woundhealing, with an average episode of care of 12.1 weeks. Gohel’sstudy had a much larger sample size (1324 legs), howeverexcluded all clients with signs of arterial disease or lost tofollow-up (42% of participants). Gohel’s study found a healingrate of 76% in 24 weeks.Survey feedback from the podiatry, nursing and medical teammembers within the CHS CWS revealed increased workersatisfaction secondary to a broadened scope of practice withineach discipline.ConclusionBenchmarking against published data for a similar patientpopulation, the CWS clinic population appears to have adecreased time to heal. However, comparative studies areneeded to fully assess the effectiveness of the interdisciplinarymodel of care.ReferencesCowley, S ‘Collaboration in health care: the education link’, inHealth Visitor 67(1), 1994,pp.13-15.Fitzgerald, L, Edwards, F & Tennant, J, 1997, Establishing a highrisk foot care clinic, Primary Intentions, 5(2), pp 12-17Gohel M.S, Taylor J.J, Earnshaw, B.P Heather, KR. Poskitt, MR.Whyman: Risk Factors for Delayed Healing and Recurrence ofChronic Venous Leg Ulcers – An Analysis of 1324 Legs: Eur J VascEndovasc Surg 29, 74-77 (2005)Rayner, R The role of Nurse-led Clienics in the Management ofChronic Leg Wounds, Primary Intention (2006); 14(4): 150-167Abstract 8MICROVASCULAR ABNORMALITIES AREMORE PREVALENT IN CORONARY CAREPATIENTS UNDERGOING CORONARYANGIOGRAPHYCheng L, Colville D, Barlis P, van Gaal W, Savige JThe University of Melbourne Department of Medicine, NorthernHealthBackgroundCoronary heart disease (CHD) is the largest single cause ofdeath in Australia. A simple, non-invasive technique to identifythose with increased cardiovascular risk will be useful in theclinical setting. Already utilised as a prognostic indicator forhypertensive retinopathy in hypertensive people, retinalvascular integrity as observed during clinical examination mayprove to be a more sensitive alternative to more invasivetechniques for examining vasculature such as coronaryangiography. Microvascular abnormalities including arteriolarnarrowing, haemorrhages and exudates have been postulatedto relate to cardiovascular mortality. This study examined theretinas of patients in a coronary care unit for microvascularabnormalities, degenerative retinal changes and evidence ofdiabetic retinopathy to determine which abnormalities wereassociated with CHD.AimsTo document microvascular abnormalities, degenerativechanges and evidence of diabetic retinopathy in coronary carepatients undergoing coronary angiography, and to compare theprevalence of these abnormalities to those seen in age andgender matched hospital controls.Patients & MethodsTwenty one patients who underwent coronary angiographyand 21 age and gender matched hospital controls without CHDwere recruited from The Northern Hospital and Austin Hospitalas part of a pilot study investigating the link between retinalabnormalities and increased cardiac risk. A brief medical historywas obtained, and 45o digital retinal photographs were takenwith a KOWA 7 non-mydriatic camera. Retinal photos wereexamined and graded for the presence of microvascularabnormalities, degenerative changes and diabetic retinopathy.ResultsThe average age of patients was 59 (range 45 to 82). Theaverage age of controls was 59 (range 44 to 71). There were 17males in each cohort. There was a trend for microvascularabnormalities including arteriolar narrowing, arteriovenousnicking, opacity of retinal arteriolar walls, haemorrhages,microaneurysms and hard exudates to be present more often incoronary care patients (10 (48%) patients) compared with 5(24%) controls. In 4 (19%) patients, changes consistent with agerelated macular degeneration (drusen, pigment abnormalities,age related maculopathy) were present. There was a trend forthese changes to be more prevalent in controls (5 (24%)controls). In 3 (14%) patients, retinal abnormalities due todiabetic retinopathy (microaneurysms, retinal haemorrhages,exudates) were found. These abnormalities were found in 2(10%) controls. There was a trend for both microvascularabnormalities and diabetic retinopathy to be more prevalent inthis cohort of coronary care patients than in controls.Degenerative changes consistent with age related maculardegeneration were less prevalent in coronary care patients thancontrols.ConclusionsRetinal microvascular abnormalities are the most commonretinal finding in coronary care patients undergoing coronaryangiography. A further 150 patients will be recruited and retinalmicrovascular calibre compared to hospital controls withoutCHD to further investigate this link.47Northern Health Annual Research Report 2009

Abstract 9ELECTROCARDIOGRAPH CHANGES ANDCORRELATION TO TROPONIN LEVELS ANDCARDIAC COMPLICATIONS AFTERORTHOPAEDIC SURGERYCarol P. Chong *‡, William Van Gaal †, Konstantinos Profitis †, JulieE. Ryan §, Judy Savige ‡, and Wen Kwang Lim *‡From the Departments of *Aged Care, †Cardiology and§Biochemistry The Northern Hospital, Epping, Victoria, Australiaand the ‡Northern Clinical Research Centre, Northern Health andDepartment of Medicine, Austin and Northern Health, TheUniversity of Melbourne, Victoria, AustraliaAimTo determine the correlation between electrocardiograph (ECG)changes (ischaemia or arrhythmia) and troponin elevations afteremergency orthopaedic surgery which are not well characterised.Methods187 orthopaedic patients over 60 years of age were prospectivelytested for troponin I on the first three post-operative morningsfollowing emergency orthopaedic surgery and also hadelectrocardiographs performed. They received standard hospitalmanagement from the orthopaedic-geriatric unit peri-operatively.ResultsThe incidence of troponin elevation was 37.4% and the majoritywere asymptomatically detected. 72.9% (51/70) of patients whosustained a troponin rise did not have any concomitant ECGchanges. Post-operative ECG changes were noted in 18.4%(34/185) and of those with ECG changes 19/34 (55.9%) had atroponin elevation. 64.7% of ECG changes occurred on postoperativeday 1 and were non-ST elevation in type. ECG changesoccurred more frequently with higher troponin levels. Postoperativetroponin elevation (p=0.018) and not pre-operativetroponin level (p=0.060) was associated with ECG changes onunivariate analysis. Two pre-morbid factors were predictors ofpost-operative ECG changes using multivariate logisticalregression; age OR 1.04 (95% CI 1.001-1.096, p=0.047) and sex OR2.4 (1.035-5.405, p=0.041) adjusting for number of comorbiditiesand pre-morbid renal failure. Twenty patients 20/187 (10.70%)sustained post-operative cardiac complications, of which 9 (45%)were associated with ECG changes. Only post-operative troponinelevation was a predictor of cardiac complications includingadjustment for pre-operative ECG changes. 12/187 (6.4%)sustained an acute myocardial infarction and two of thesepatients died.Abstract 10HELP! WHO WOULD INTERNS TURN TO?Chong C, Sangas S, Fraser R, Bond F, Savige J.Medical Education Unit, The Northern HospitalBackgroundIntern year is often challenging and conflicts may arise. Internsmay need to turn to someone for help.AimWe surveyed our interns:(1) To identify which staff they would approach for help indifferent scenarios.(2) To evaluate our hospital support program.(3) To identify intern knowledge of external support services.Methodology14 interns were surveyed in May 2009, half way through theirsecond rotation. The survey asked interns to name which personin the hospital they would approach if they were bullied, had aheavy workload, rostering issues, or knew about an intern indifficulty etc. Additionally, they were asked about the hospitalsupport program and external services.ResultsResults showed that for many scenarios the interns would firstapproach another junior doctor for help rather than a seniorclinician or administrative staff. There was confusion about theroles of senior staff that have key intern responsibilities. Forexample, the Medical Education Officer was thought to also bethe HMO Manager. Seventy-nine percent (11/14) were aware ofthe Victorian Doctors’ Health Program and 59% (8/14) had theirown General Practitioner. Eighty nine percent of interns were notaware of the hospital’s formal support pathway.ConclusionInterns are more likely to approach junior doctors for help. Ourcurrent support program is being revised to include interntraining on how to support other interns and who to refer forfurther advice. There is more education about the roles of key staffand a support package is being produced so that interns havemore options for support.Conclusion48Electrocardiograph changes do not necessarily accompanytroponin elevations after emergency orthopaedic surgery but aremore likely with higher troponin levels. Troponin elevations occurcommonly and are usually asymptomatically sustained. The bestpredictor of post-operative cardiac complications is troponinelevation. Future research should look for causes of troponinelevations and treatment options to improve prognosis.

Abstract 11IMPACT OF TROPONIN I ON LONG TERMMORTALITY AFTER EMERGENCYORTHOPAEDIC SURGERY IN OLDERPATIENTSCarol P. Chong *‡, Que T. Lam†, Julie E. Ryan†, Rabindra N.Sinnappu* and Wen Kwang Lim*‡From the Departments of *Aged Care and †Biochemistry, TheNorthern Hospital, Epping, Victoria, Australia and the ‡NorthernClinical Research Centre, Northern Health and Department ofMedicine, Austin and Northern Health, The University ofMelbourne, Victoria, AustraliaObjectivesTo determine the association between post-operative troponinrises and longer term (2 year) mortality after emergencyorthopaedic surgery in patients over 60. It has previously beenfound that troponin I is a prognostic marker for mortality andcardiac events at 1 year in this patient population.MethodIn 2006, 102 patients were recruited prospectively and hadtroponin I measurements during their in-patient stay (one preoperativesample and three post-operative days) for emergencyorthopaedic surgery. These patients were followed up bytelephone call annually to determine if they had survived andwhether there were any cardiac events sustained. Cardiac eventwas defined as myocardial infarction, congestive cardiac failure,atrial fibrillation or major arrhythmia.ResultsAt two years, 29.4% (30/102) of patients had died. Twenty-fivepatients (25/54 or 49.3%) with a troponin rise were dead at twoyears, compared with five patients without a troponin rise (5/48or 10.4%) which was significantly different p0.1mcg/L) were more likely to bedead at 2 years compared with those with lower level troponinsor no troponin rise. However, when adjusted for othercomorbidities the association between troponin elevation anddeath at 2 years did not persist. Using multivariate analysis, onlyone factor, sustaining an in-hospital cardiac event, wasassociated with 2 year all-cause mortality OR 6.4 (95% CI 1.8-22.2, p=0.003). Furthermore, patients who sustained asymptomatic troponin rise (p

Abstract 13EMERGENCY DEPARTMENT MANAGEMENT OFEXACERBATION OF COPD: COMPLIANCE WITHBEST PRACTICE RECOMMENDATIONSConsidine J, 1,2 Botti M, 2,3 Thomas S41Deakin University-Northern Health Clinical Partnership2School of Nursing, Deakin University3Epworth-Deakin Centre for Clinical Nursing Research, Victoria,Australia4Primary Health Care Research Unit, Monash UniversityAbstract 14PREVALENCE STUDY OF OVERWEIGHTCHILDREN IN EMERGENCY DEPARTMENTPOPULATIONSConsidine J, 1 Craike M, 2 Smit D, 3 Stergiou HE, 3 Hauser S, 4Waddell D 31Deakin University-Northern Health Clinical Partnership,2Deakin University – Eastern Health Nursing Research Unit3Emergency Department, The Northern Hospital, Northern Health4Department of Paediatrics, Northern Health50BackgroundThe growing burden of COPD is increasing the need forEmergency Departments (EDs) to manage acute exacerbations ofthis debilitating disease. Analysis of evidence-based guidelines formanagement of acute exacerbation of COPD showed clearguidelines related to pharmacotherapy, oxygen therapy and noninvasivepositive pressure ventilation (NIPPV).Study AimThe aim of this study was to examine evidence-basedrecommendations for the management of exacerbation of COPDduring the first four hours of ED care.MethodologyA retrospective chart review was conducted at five MelbourneEDs. Participants were adults with COPD who attended ED fromJuly 2006 to July 2007 with a primary complaint of shortness ofbreath. Outcomes measured were compliance with evidencebasedrecommendations for use of bronchodilators,methylxanthines, steroids, oxygen therapy and NIPPV.ResultsOf 273 patients in this study, 72.4% received short acting betaagonistbronchodilators, 37.8% received an inhaled short actinganticholinergic, and 56.6% received systemic steroid therapy.Oxygen therapy was commenced in arrival in ED for 55.7% ofpatients: face masks were used in 52.9% of patients with SpO2 >95% on arrival to ED with median oxygen flow rate of 8L/min.NIPPV was used in 21 patients, 15 of whom had documentation ofacidosis and / or hypercapnia)ConclusionThere was variation in the uptake of high level evidence for theED management of acute exacerbation of COPD. Further researchis needed to better understand the barriers to evidence-basedemergency care for exacerbation of COPD.BackgroundChildhood obesity is a major and increasing public health issue.Weight management initiatives for children are often focussed inschools, community health and primary care settings. The role ofEmergency Departments (EDs) in detection and referral ofoverweight children is still unknown.Study AimsThe aims of this study were to: i) estimate the prevalence ofoverweight children who presented to two metropolitan EDs and,ii) examine the feasibility of using EDs to detect and referoverweight children to weight management interventionprograms.MethodologyA prospective, exploratory approach was used. The study siteswere EDs at The Northern Hospital, Northern Health andMaroondah Hospital, Eastern Health. A convenience sample of122 ED patients aged 2 to 16 years were recruited. Demographicdata, primary diagnosis, weight, height and body mass index(BMI) were collected during the child’s ED episode of care.Overweight was defined as BMI greater than the 85th percentileand obesity was a BMI greater than the 95th percentile.ResultsOf 122 children recruited to this study, 21.8% (n = 19) wereoverweight or obese: 5.7% had a BMI greater than 95th percentile(obese) and 16.1% had BMI greater than the 85th percentile(overweight).ConclusionThe prevalence of overweight children in EDs is similar to that ofpopulation norms. Further research is needed to understand ifoverweight / obese children have a different illness profile tochildren in the healthy weight range. Given that 21.8% of childrenin this pilot study were overweight / obese, the ED does have arole in detection and referral. Further consideration of effectivereferral systems and intervention studies testing the uptake ofreferrals is warranted.

Abstract 15USE OF INTENSIVE MULTISOURCECOMMUNICATION STRATEGIES ANDAPPROPRIATE STRUCTURAL SUPPORT TOIMPROVE PARTICIPATION IN CLINICALHANDOVERDHULIA Anjali 1 , Baqar Sara 1 and NAIDOO Humsha 11The Northern HospitalBackgroundIn 2007, The Northern Hospital participated in the VQCsponsored Clinical Handover Project where an observationalaudit was conducted. This highlighted that in geographicallyconfined units like ICU, a regular and effective handover processoccurs. However, in General Medicine clinical handover wasperformed poorly. Reasons identified were lack of directcommunication from executive and senior clinical staff to juniormedical staff (JMS) and there was no dedicated time or place forhandover. Inadequate handover was identified as an area ofhigh risk and improving general medical handover became ahospital priority.ResultsA significant improvement was observed in handover. Itoccurred at the dedicated time and place with animprovement of 50% over baseline. All required attendees werepresent showing an improvement of 83% over baseline. Therewere no interruptions in the form of pages or phone calls.However, whilst most information was communicatedadequately, there was no standardized format to the handoverprocess.ConclusionAdequate structural support and an intense multi-sourcecommunication strategy resulted in significant improvement inthe handover process. Direct observational audit was found tobe an efficient evaluation technique. Further improvements inthe structure and content of the handover are the next keysteps to further improve this process.AimTo improve the process of night handover between JMS byproviding adequate structural support and using an intensivemulti source communication strategy.MethodsManagement support: Sponsorship from Executive and Clinicaldepartments endorsed the continuation of the clinicalhandover project. Operational support was provided by theDirector of Nursing. The Senior Medical Registrar and theMedical Administration Fellow provided the operational lead forthe project.Structural Support: A dedicated time and place was identifiedfor handover. Rosters were adjusted to ensure remunerated,overlapping shifts. Nursing staff were informed about the timeof handover to minimise interruptions to medical staff.Intensive multi-source communication strategy: Memo fromthe clinical sponsor highlighted that handover was mandatoryand clearly outlined the expectations of JMS. Furtherinformation was put in JMS Handbook, electronic Learningpackages. Reminders were made at grand rounds and teachingsessions for 4 weeks. Automatic pages were sent to relevantdoctors 10 minutes prior to handover.Using the VQC observational audit tool, a single observerobserved the night handover on five occasions, six weeks afterimplementation of the new strategies.51Northern Health Annual Research Report 2009

52Abstract 16A QUALITATIVE COMPARATIVE EVALUATIONOF NORTHERN ALLIANCE HARP PROGRAM’SELECTRONIC INTERRAI-HC TRIALGannon, J 1 ; Hutchinson, A 1 , Shanahan-McKenna, L 2 ; Graco, M 11Northern Clinical Research Centre, Northern Health, Melbourne,Victoria, Australia2Northern Alliance HARP Program, Northern Health, Melbourne,Victoria, AustraliaIntroductionThis study primarily investigates the future applicability of ahome-based comprehensive assessment tool; the computerbased “interRAI-HC” in two Northern Alliance HARP services. Thestudy secondarily investigates the potential applicability of theinterRAI suite for Northern Alliance HARP’s other twelve services.The study also considers the nature of interRAI and the contextsurrounding its trialling.AimThe primary purpose for conducting this study was to investigatethe future applicability of the computer based interRAI and itspotential use by Northern Alliance HARP services.MethodologyThe study explores clinicians’ perceptions of the “usability” of theinterRAI-HC. This was investigated by the use of qualitativemethods including interviews with clinicians, participantobservation of the interRAI-HC in practice and a review of relevantliterature. Data from these investigations was then compared andcontrasted in order to understand and explain differences inclinicians’ perceptions of the interRAI-HC.ResultsThis investigation revealed marked differences in both the natureof the two services involved and in the relevant clinicians’perceptions of the “usability” of the interRAI-HC. Clinicians fromone service found that the interRAI-HC was valuable whileclinicians from the other service found that the interRAI-HC was aburden. These differences were fairly consistent across a numberof qualitative dimensions including the interRAI-HC: ergonomics,interface user friendliness, usefulness of outputs, ease of learning,perceived client user friendliness and sustainability. The twoservices differed in relation to their length of association with theinterRAI-HC, the degree of the services’ integration with generalpractitioners and in regards to the average length of time theservice has contact with clients.ConclusionAlthough not conclusive the evidence suggests that clinicians’interpretation of interRAI-HC’s usability is most likely determinedby the nature of the relevant service. In particular services thatmonitor clients over relatively long periods and who haveintegrated relationships with GPs are optimised to derive benefitfrom interRAI-HC. For services that do not possess thesecharacteristics it is probably the case that successful adoption ofinterRAI-HC requires relevant restructuring. Alternatively theinterRAI-CA may be better suited to HARP services that havecontact with clients for shorter periods and who do not have wellintegrated relationships with GPs. In any case the successfuladoption of interRAI by HARP services requires careful planning,monitoring and evaluation.Abstract 17MEDICATION CONTINUITY FOR PEOPLE INTHE TRANSITION FROM HOSPITAL TORESIDENTIAL AGED CAREHarvey P, Cincotta M, Sivaraj R, Carter L, Jennings R,BackgroundPeople in Residential Aged Care (RAC) who have recently beenhospitalised have complex health needs and complicatedmedication regimens. They are uniquely sensitive and susceptibleto failures in medication management at the hospital/RACinterface.ObjectivesTo explore the causes and extent of missed or delayed medicationadministration following the patient’s arrival at the RAC.Methodology• Audit and follow-up of 185 discharges to RAC from BundooraExtended Care Centre and the Northern Hospital;• Structured phone interview with RAC Nurse on the dayfollowing patients’ transfer;• Did the person receive their first medication dose and atwhat time?• Has the facility medication chart been re-written and bywhom?• Were extra measures taken to ensure medication continuityand what were these?Results• In the day following transfer, 31 (17%) of patients leavingNorthern Health for RAC missed a medication dose;• Of the people who missed doses, 90% lacked medicationand 71% lacked a current medication administration chart;• Lack of medications and a current chart were significantlyassociated with missed doses (both p

Abstract 18RESPONDING TO THE AGEING PROFILE OFEMERGENCY DEPARTMENT PATIENTSKeith Hill 1,2, Julie Considine 1,3 , Robyn Smith 1 , Tracey Weiland 4,5,John Gannon 6 , Marnie Graco 6 , Christine Behm 5 , PeitaWellington 1 , Sally McCarthy 7 , Sam Corrie 5 .1Northern Health, Melbourne, Victoria, Australia2La Trobe University, Melbourne, Victoria, Australia3Deakin University, Melbourne, Victoria, Australia4St Vincent’s Hospital, Melbourne, Victoria, Australia5University of Melbourne, Melbourne, Victoria, Australia6Northern Clinical Research Centre, Melbourne, Victoria,Australia7Bendigo Health Care Group, Bendigo, Victoria, AustraliaBackgroundAs the population ages and the burden of chronic disease rises,ED use by older people is likely to increase.Study AimsThis study explored the ED experience from the perspective ofolder patients and their carers.MethodologyA total of 30 patients and 12 carers were recruited from twometropolitan EDs and one regional ED in Victoria, Australia. Datawere collected using observation of ED care and interviewwithin one week of ED presentation. Data were integrated andthematically analysed by two independent investigators.ResultsThe average age of patients was 77.1 years, 59% were female,and 74% were triage category 1-3. Half the study participantswere discharged home (50%), 43% were admitted and 7% weredischarged to residential care/hospice. The average ED length ofstay was 7 hours and 47 minutes. Themes related to access toemergency care and the triage process included: i) variation inED use by older people, ii) reluctance to access ED care, iii)mixed experiences of waiting, and iv) perceived influences onaccess to emergency care.ConclusionsResults of this study highlight important issues around theaccess and triage elements of the ED experience for olderpeople and their carers. The study findings provide anopportunity to reflect on the appropriateness of current EDsystems for older ED users. The study results can inform ageappropriate triage and waiting processes to improve outcomesfor older ED users.Funded by the Victorian Government Department of HumanServicesAbstract 19USE OF ANTI-EPILEPTIC MEDICATIONSASSOCIATED WITH BALANCE IMPAIRMENTHill K, 1,2,7 Petty S, 3 O’Brien T, 3,6 El Haber N, 3 Paton L, 3 Lawrence K, 4Berkovic S, 4 Wark J 3,51Northern Health, Bundoora, VIC2Faculty of Health Sciences, La Trobe University3The University of Melbourne, Parkville, VIC4Epilepsy Research Centre, The University of Melbourne, AustinHealth, VIC5The Royal Melbourne Hospital Bone and Mineral Service,Parkville, VIC6The Royal Melbourne Hospital Department of Neurology,Parkville, VIC7National Ageing Research Institute, Parkville, VICBackgroundAnti-epileptic drugs (AEDs) are used for a range of commonhealth problems including epilepsy, migraine, trigeminalneuralgia, neuropathic pain syndromes and psychiatricdisorders, all of which increase in prevalence with age. Patientstaking AEDs have increased fracture risk. The contribution ofbalance impairment to this increased fracture risk with AED useremains poorly explored.AimTo investigate the effect of AEDs on balance and related falls riskfactors using AED-discordant twin/sibling pairs.MethodParticipants were people taking AEDs (n=29, 12 male, mean age45 years), and their twin (5 monozygous and 5 dizygous twins),or same gender sibling (+/-3 years, n=19). Balance and relatedmeasures were assessed using a detailed laboratory and clinicalassessment battery, including the Chattecx Balance Platform,Lord’s Balance test, KinCom, manual muscle tester, Step Test,Coordinated Stability Test, activity and gait measures.Questionnaires were completed regarding falls, fractures andmedical history. Paired t-tests were used to compare meanwithin-pair differences; independent t-tests were used tocompare mean within-pair differences for subgroups.ResultsSignificant mean within-pair differences were seen betweenAED users and non-users in the Adjusted Activity Score, andseveral static and dynamic balance measures, with AED usershaving poorer performance (p

Abstract 20AN AUDIT ON THE COMPLICATIONSASSOCIATED WITH ARM PORTSIywan R A, Probst K PDay Oncology, The Northern HospitalBackgroundThe insertion of implantable arm ports are a relatively newintervention, and commenced at the Northern Hospital in July2008 for the delivery of long-term and infusional chemotherapyto cancer patients. This study is a review of the complicationsassociated with the use of implantable arm ports at The NorthernHospital.Study AimTo conduct an audit on the incidence and types of complicationsof arm port insertions over a period from July 2008 to July 2009,using evidence from patient’s medical history.MethodologyA retrospective audit of medical histories of patient’s attendingthe Day Oncology unit was conducted. The types of incidencesencountered with the arm ports were analysed.These were then placed into separate groups and expressed as a% of the total reviewed.Results/OutcomesA total of 33 arm ports were inserted into oncology patientsduring the above timeframe. The problems encountered wereDeep Vein Thrombosis, Infection, Access Difficulties and Flippingof the port.5 (15.2%) of the patients developed Deep Vein Thrombosis.Infection was only seen in 1- (3.0%) of patients during the wholeperiod.3 (9.1%) of patients had problems with accessing their ports.1 (3.0%) patient had their port flip over.5 (15.2%) had their arm ports removed post completion oftreatment with no complications.Abstract 21RECRUITMENT AND RETENTION IN HEALTHJansen BBackgroundTo understand the literature on generational cohorts and how thisinformation could improve recruitment and retention in a nursingcontext. This forms part of a PHD in recruitment and retention inmental health.Study AimTo understand which retention strategies keep the differentgenerational cohorts engaged with an organization and whichstrategies could be used to recruit a person to the organizationusing current strategic human resource management literature.MethodologyReview of current literature using multiple databases looking atboth the nursing aspect and strategic human resourcemanagement in large non-health organisations.OutcomesThere is a lot of literature about the generational cohorts and howthe information should be used by astute managers to help retaintheir staff however there is some literature emerging suggestingthat it is not the information about the generation rather the agegroup that managers should be aware of. The age groupinformation suggests that each generation at a particular age hassimilar aspirations such as most 18 year olds want a car whetheryou are born in 1942, 1962 or 1982.ConclusionGenerational and age cohorts research literature should be ofknowledge to managers to guide rather than direct the way staffare supported and retained within the organization. Otherinfluences which may direct an employees engagement with theorganization is their cultural background and their values andgoals at the time as to their willingness to remain engaged withthe organization.ConclusionThis study reveals a low incidence of complications as a result ofarm port insertions, especially in the setting of patient’s with acancer diagnosis who have increased risk of deep vein thrombosisand infection.54The findings in this study provide the clinician with confidence tounderstand the complications that may arise with the use of armports in the clinical setting.Further study is needed to compare the incidence ofcomplications within other facilities.

Abstract 22EXHALED VERSUS ARTERIAL CARBONDIOXIDE LEVELS: IMPROVING THEIDENTIFICATION OF HYPERCAPNIAElaine Killeen 1 Julie Considine, 2 Judy Currey 31Quality, Safety & Risk Unit, The Northern Hospital, NorthernHealth, 185 Cooper St, Epping, Victoria, Australia 3076. Masterof Nursing Practice Candidate , Deakin University, 221Burwood Hwy, Burwood, Victoria, Australia 3125.Elaine.Killeen@nh.org,au2Deakin University-Northern Health Clinical Partnership, c/-School of Nursing, Deakin University, 221 Burwood Hwy,Burwood, Victoria, Australia 3125.Julie.Considine@deakin.edu.au3School of Nursing and The Alfred/Deakin Nursing ResearchCentre, Deakin University, 221 Burwood Hwy, Burwood,Victoria, Australia 3125. Judy.Currey@deakin.edu.auBackgroundHypercapnia is an often insidious and clinically significantcomplication for patients with respiratory dysfunction.Although arterial blood gas (ABG) analysis is often used forcarbon dioxide monitoring, arterial blood sampling is painful,invasive, and carries inherent risk of trauma. The invasive natureof ABGs may also contribute to suboptimal carbon dioxidemonitoring. Non-invasive methods of carbon dioxidemonitoring are available; however, there is little evidence tosupport their accuracy in the detection of hypercapnia.Study AimsMinimise clinical risk associated with hypercapnia, and ABGsampling.Identify a feasible and safe alternative for carbon dioxidemonitoring.MethodologyA prospective correlational study is underway in the Emergencyand Critical Care Departments at Northern Health. Participantsare spontaneously breathing adult patients who require arterialblood gas sampling as part of their clinical care. The correlationbetween end-tidal carbon dioxide (ETCO2) levels and partialpressure of arterial carbon dioxide (PaCO2) levels will beexamined using Pearson r. Ethics approval for this study wasgranted by Northern Health and Deakin University HumanResearch and Ethics Committees.ResultsPreliminary analysis of data from the first 34 participants showsa correlation coefficient of r=+0.833 (p2)and recovery measured on the 17 point BLS and 36 point PASS.The Standardized Response Mean (SRM) was used to calculatethe scales’ sensitivity to change.ResultsOver 7 months, 17 stroke patients (23%) of 74 displayedsymptoms of lateropulsion measured on the BLS. The medianadmission score was 6.0 points [3.0-9.0] and on discharge was3.0 points [1.0-5.0]. The lateropulsion group had an averagelength of stay of 63 days [42.2-83.8]. The BLS and PASS had highlevels of measurement responsiveness (SRM >1.0).ConclusionsCurrently lateropulsion diagnostic scales are not used in routineclinical practice, suggesting lateropulsion, especially milderforms, may be under diagnosed. Given that lateropulsion leadsto slower progress in rehabilitation and longer length of stay ,there is a need for improved recognition and management oflateropulsion in stroke patients.1Davies P. (1985) Steps to Follow: a guide to the treatment of adulthemiplegia. Springer-Verlag, Berlin, pp.266.2Babyar S. et al. (2008) Outcomes with stroke and lateropulsion:a case-matched controlled study. Neurorehabil neural repaironline, pp. 1-9. 55Northern Health Annual Research Report 2009

56Abstract 24ARE NUTRITIONALLY AT RISK CANCERPATIENTS APPROPRIATELY REFERRED FORDIETETIC INTERVENTION IN A DAYONCOLOGY SETTING AT THE NORTHERNHOSPITAL?McDonald, T and Freeman, KBackgroundIt has been well documented that patients undergoingchemotherapy treatment are at nutritional risk. Due to the lowreferral rate from the day oncology unit at The Northern Hospital(TNH), it was hypothesized that patients at nutritional risk may nothave been referred to the dietitian.Study Aims• To determine the number of patients at nutritional risk withinthe Day Oncology Unit• To establish the number of patients referred to the dietitianfor interventionMethodologyA retrospective audit was conducted over a two-week period ofall patients attending TNH day oncology unit, to assess thenumber of patients at nutritional risk based on anthropometric,biochemical and clinical data.ResultsThe audit revealed that 39 patients attended the day oncologyunit at TNH, with some patients attending on more than oneoccasion (totaling 53 visits). Five (12%) out of the 39 patients wereunderweight according to BMI classification.24 patients experienced side effects, with 71% experiencingmultiple symptoms. Only 1 patient had been seen by a dietitianwithin this period and 2 other patients had been seen previouslyby a dietitian outside the day oncology unit.ConclusionIt is apparent that patients at nutritional risk are not being referredfor dietetic intervention. Recommendations include establishingan appropriate referral process including implementation andevaluation of a screening tool, while also increasing awarenessabout the importance and benefits of dietetic intervention andneed for appropriate referrals through education of medical andnursing staff.This abstract was submitted and accepted by the DAA (DietitiansAssociation of Australia Conference, Brisbane, 2009).Abstract 25INTRODUCTION OF A DIABETES REFERRALFORM AND RISK STRATIFICATION PROCESS –RESPONSE OF GENERAL PRACTITIONERS ANDPRACTICE MANAGERS IN MELBOURNE’SNORTHMissing SBackgroundThere are a number of publicly funded diabetes programs in theNorthern Health catchment, which cater to differing levels ofpatient acuity, have different referral criteria and service models.A number of agencies and services within Northern Health’scatchment agreed to a common diabetes referral form and riskstratification process that identified key criteria for entry into localprograms and enabled triaging of clients. The purpose of theproject was to ensure that patients referred into services receivedthe most appropriate package of care for their level of acuity andto simplify referral for General Practitioners by ensuring that areferral to any of the partner agencies would be forwarded to themost appropriate service.AimThe aim of the survey was to assess the response of GeneralPractitioners and Practice Managers to the referral process andidentify opportunities for improvement.MethodMembers of two local General Practice Divisions surveyedeighteen General Practitioners and Practice Managers, face to faceor on the phone. A range of quantitative and qualitativequestions were asked.ResultsMost of the respondents had seen the new form and all of therespondents that had seen the form had used it. The majority ofrespondents (16) found the form easy (12) or very easy (4) to read,and the information requirements were perceived by most (16) tobe reasonable (11) or very reasonable.ConclusionThe respondents indicated a high level of satisfaction with thereferral process. There was universal support for the form to beavailable as a template in their clinical software. A number ofGeneral Practitioners indicated a desire for improvedcommunication from services about their client’s care, indicatingthe need for further work in this area.

Abstract 26CLINICAL RISK MANAGEMENT: WHAT ARETHE SOURCES OF RISK IN EMERGENCY CAREMs Belinda Mitchell, 1,2 Dr Julie Considine, 2 Professor Mari Botti 31Quality, Safety & Risk Unit, Northern Health, 2 Deakin University-Northern Health Clinical Partnership, 3 Epworth – DeakinUniversity Clinical PartnershipBackgroundAdverse events and clinical risk are common in healthcare andare associated with increased morbidity and mortality. TheAustralian Quality & Safety in Healthcare study showed that16.6% of patients will suffer an adverse event during theirhospital stay: 13.7% of these patients will be permanentlydisabled and 5% will die.1, 2 A group at significant risk ofadverse events in health care are Emergency Department (ED)patients. EDs have the highest incidence of preventable andnegligence-related adverse events.1, 2 It may also be arguedthat EDs have specific sources of clinical risk, for example, highcognitive load, little or unreliable information, fragmented care,poor continuity of care and diagnostic uncertainty.1-10Study AimThe aim of this study is to provide a detailed analysis of thesources of clinical risk in Emergency care, particularlyemergency nursing.MethodologyThe sources of risk in emergency care will be examined using adescriptive exploratory approach.Data will be collected using i) incident reports submitted by EDclinicians during 2008 to identify patient, human & systemfactors which are present in adverse events and ii) structuredobservation in order to identify the prevalence of medicationerrors, critical instability and documentation errors at specificpoints in time and (iii) a critical appraisal of the literature.ResultsPreliminary data analysis indicates that there are a wide varietyof adverse events reported by ED staff; however the mostcommon incident reports related to patient behaviour (67%),patient management (23.6%), medication (6.1%) anddiagnostics (3.1%). It is anticipated that data collection will becompleted in mid 2009.References1. Wilson R, Runciman W, Gibberd R, Harrison B, Newby L,Hamilton J. The Quality in Australian Health Care study.Medical Journal of Australia 1995;163:458-71.2. Leape LL, Brennan T, Laird N, et al. The Nature of AdverseEvents in Hospitalized Patients: Results of the HarvardMedical Practice Study II. The New England Journal ofMedicine 1991;324(6):377-84.3. Considine J, Botti M. Who, when and where? Identificationof patients at risk of an in-hospital adverse event:Implications for nursing practicedoi:10.1111/j.1440-172X.2003.00452.x. International Journal of NursingPractice 2004;10(1):21-31.4. Croskerry P, Sinclair D. Emergency Medicine: A practiceprone to error? Journal of the Canadian Association ofEmergency Physicians 2001;3(4):271.5. Johnstone M-J. Patient safety ethics and human errormanagement in ED contexts: Part I: Development of theglobal patient safety movement. Australasian EmergencyNursing Journal 2007;10(1):13-20.6. Kohn L, Corrigan J, Donaldson M. To err is human: buildinga safer health system. Washington, DC: National AcademyPress; 2000.7. Leape LL. Error in Medicine. JAMA 1994;23(272):1851-7.8. Reason J. Human Error. Cambridge: Cambridge UniversityPress; 1990.9. Reason J. Understanding Adverse Events: the human factor.In: Vincent C, ed. Clinical Risk Management - EnhancingPatient Safety. London: BMJ Publishing; 2001:9-30.10. Vincent C. Patient Safety. London: Elsevier Limited; 2006.57Northern Health Annual Research Report 2009

58Abstract 27NPHS2 MUTATIONS IN PATIENTS WITHFAMILIAL RENAL DISEASE OF UNKNOWNCAUSE, FOCAL SEGMENTALGLOMERULOSCLEROSIS (FSGS), ALPORTSYNDROME AND CHRONIC KIDNEY DISEASEMardhiah Mohammad, Nick Ho, Lin Rigby,Yan Yan Wang, JudySavigeDepartment of Medicine (NH), University of Melbourne, NorthernHealth, EppingBackgroundThe genetic basis of many forms of inherited renal disease isunknown. Mutations in the gene for podocin (NPHS2) account for20-30% of cases of familial focal segmental glomerulosclerosis(FSGS) and also occur in sporadic disease. The R229Q variant inNPHS2 is possibly implicated in the development of proteinuria inThin basement membrane nephropathy but is also present in 3%of non-proteinuric Caucasians.AimThe aim of this study was to determine how often NPHS2mutations occurred in patients with: familial adult-onset renalfailure where X-linked Alport syndrome was excluded by theabsence of COL4A5 mutations in DNA or skin fibroblast mRNA(n=9); sporadic FSGS (n=14); Alport syndrome (n=27); chronickidney disease (CKD 3-5, n=145); and non-proteinuric normals(n=50).MethodDNA was examined for mutations in all 8 exons of the NPHS2gene using sequencing (in the Alport patients) or thermal meltingcurve analysis in the others. All NPHS2 variants were confirmed bysequencing in both directions, and tested in DNA from 50 normalindividuals.ResultsHeterozygous R229Q was present in 3 of the 9 (33%) patients withfamilial non-Alport renal failure; one (6%) patients with sporadicFSGS; 5 of the 27 (19%) patients with Alport syndrome; 7 of the145 (5%) with chronic kidney disease, and 4 of the 50 (8%)normals. R229Q in Alport patients was not necessarily associatedwith early onset renal failure. No other pathogenic mutationswere identified, but 3 novel non-pathogenic variants were found(IVS 7+7C>A, IVS7+22A>G and 678T>A).ConclusionThe R229Q mutation in the NPHS2 gene is common in patientswith familial non-Alport renal failure. Although it also occurred inpatients with Alport syndrome these individuals did notnecessarily develop early onset renal failure.R229Q was notincreased in patients with chronic kidney disease 3-5.Abstract 28THE PROBLEM OF VISUAL MOTIONINTEGRATION IN SCHIZOPHRENIANash T J, Carter O L, Sundram SBackgroundPerceptual disturbances, including hallucinations, are one of themost prominent symptoms of schizophrenia but may occur in anypsychotic disorder. Hallucinations may result from impairments inintegrating perceptual information. Previously deficits in globaldirection of motion in schizophrenia have been noted whereaslocal motion processing is unimpaired. However stimuluspresentation times in studies of global motion may have beeninsufficient to reach maximum performance1. This projectexamined perceptual information integration in visual motionprocessing in people with a range of psychiatric disorders andhealthy controls.Study Aims• To determine if impairments in global motion processing inschizophrenia are true deficits or due to reduced processingspeed.• To determine any relationship between global motionprocessing deficits and level of perceptual disturbances.MethodologyParticipants completed tests of global and local visual motionprocessing, with extended stimulus presentation times of up to8000ms for global and 1000ms for local processing. Perceptualdisturbances were rated using the Positive and NegativeSyndrome Scale.Results48 inpatients were recruited from the Northern Psychiatric Unit.30 formed a schizophrenia/schizoaffective disorder group while18 formed a psychiatric control group. Eight healthy controls werealso recruited. There was no significant difference between thegroups for local motion processing. However there was asignificant difference in global motion processing. While thehealthy control subjects had greater global processing levels thanboth patient groups at all stimulus presentation time points, therewas no difference between the two patient groups. Significantnegative correlations were found between global motionprocessing and hallucinations at the 5000ms and 8000ms timepoints in the schizophrenia/schizoaffective group only.ConclusionResults suggest that the deficits in global motion processing inschizophrenia are true deficits and not due to reduced processingspeed. However the deficits observed were not specific toschizophrenia. Further analysis using symptom ratings rather thandiagnosis to cluster participants may reveal differences in thepatient groups.1. Burr, D. C., & Santoro, L. (2001). Temporal integration of opticflow, measured by contrast and coherence thresholds. VisionResearch, 41, 1891-1899.

Abstract 29PERIPHERAL RETINAL DRUSEN AREINCREASED IN PATIENTS WITHINFLAMMATORY BOWEL DISEASENg D, Colville D, Glance S, Froomes P, Mariani A, Savige J,The University of Melbourne Department of Medicine, NorthernHealthBackgroundDrusen are yellow accumulation of extracellular materialbetween the retinal pigment epithelium and Bruch’smembrane. Bruch’s membrane regulates the transport ofnutrients, fluid, oxygen and waste products between the retinaand general circulation. Thickening and reduced permeability ofBruch’s membrane has been correlated with age, genetics,disease state and increased drusen. Macula centred drusen arean early sign of severe vision loss from age-related maculardegeneration. Peripheral drusen have been associated withsome conditions however, their significance is unclear.Inflammation has been proposed to play a role in drusenformation with inflammatory proteins being one of itsconstituents. Inflammatory bowel disease (IBD) results inincreased systemic inflammatory mediators. Retinal imaging willbe used to determine whether patients with IBD have increaseddrusen and at greater risk of age related macular degeneration.Other retinal changes reflect coincidental ocular pathology.AimsTo document retinal abnormalities in patients with IBD.Patients & MethodsPatients with inflammatory bowel disease and controls wererecruited from Northern Hospital, Epping. Participants’ medicalhistory were documented with a questionnaire. Retinal imageswere taken using a KOWA 7 or CANON 45 non-mydriatic retinalcameras. Photographs were examined for the presence ofretinal haemorrhage, exudates and drusen. Age-related maculardegeneration grading was performed.ResultsTwenty six patients have been recruited including 14 males and12 females with a mean age of 48 years (range 28 – 79 years ofage). Average duration of disease ranged from 3 weeks to 28years. Peripheral drusen were noted in 9 (34.6%) patients and 2(7.7%) with drusen around the optic disc. These abnormalitieswere seen in only 7 (26.9%) controls. Haemorrhage was noted in2 (7.7%) patients and 1 ( 3.8%) with exudates compared with 5(19.2%) and 2 (3.8%) respectively in hospital controls. Agerelated macular degeneration changes (macula drusen,hypopigmentation) were found in 3 (11.5%) patients of which 2(7.7%) were grade 2a and 1 of grade 2b (3.8%). Eleven (42.3%)hospital controls were noted to have age related maculardegeneration changes ranging from grade 1-5. Uveitis, a notedextraintestinal manifestation of inflammatory bowel disease,was noted in 2 (3.8%) patients.ConclusionPeripheral drusen are common in IBD and may be aconsequence of the severity of the underlying inflammatoryprocess.Abstract 30RETINAL MICROVASCULAR ABNORMALITIESARE LESS COMMON AND LESS SEVERE INPATIENTS AFTER RENAL TRANSPLANTATIONTHAN BEFORENewk-Fon Hey Tow F K, Ooi Q, Colville D and Savige JThe University of Melbourne Department of Medicine AustinHealth/Northern Health, AUSTRALIABackgroundApproximately 16% of the Australian adult population haskidney damage. The number of patients receiving treatment forend-stage renal disease (dialysis or renal transplantation) hasincreased steadily, reaching 16,751 in 2007. Renaltransplantation reverses some of the changes associated withrenal disease. This study was designed to determine if there arefewer retinal microvascular abnormalities after renaltransplantation and whether these mirror the changesassociated with a higher risk of heart disease. Themicrovasculature structure in the eye resemble those in thekidney and we want to see if improved kidney function inpatients with a renal transplantation will be accompanied byfewer retinal microvascular abnormalities.AimsTo characterise the retinal microvascular abnormalities inpatients before and after a renal transplantation.Patients & MethodsA total of 19 patients who had undergone renal transplantation,with a mean age of 55, were recruited at Austin Health renaltransplant clinic. Another 19 patients still on dialysis waiting fora renal transplantation, with a mean age of 57, were alsorecruited. All patients were interviewed for a medical historythrough a questionnaire, and had retinal images taken witha non-mydriatic Canon CR6-45NM digital camera. Red freeimages were also taken. The pictures were then graded by anophthalmologist for microvascular abnormalities using theClassification of Hypertensive Retinopathy by Wong andMitchell.ResultsMost patients post transplant had mild microvascular changes(generalised arteriolar narrowing, arteriovenous nicking orcopper wiring of arteriolar walls) whereas the majority of pretransplant patients had moderate microvascular changes(haemorrhage, microaneurysm, cotton-wool spot or hardexudate) (p = 0.0072).Hypertensive Pre transplant (n=18) Post transplant (n=18)RetinopathyNone 4 (22%) 8 (44%)Mild 5 (28%) 9 (50%)Moderateand Severe 9 (50%) 1 (6%)ConclusionRetinal abnormalities are less common and less severe inpatients after a renal transplantation than in those patients withend stage renal failure. Retinal microvascular calibre will also beexamined to determine whether there are any changes in thecalibres before and after transplantation.59Northern Health Annual Research Report 2009

60Abstract 31CHRONIC KIDNEY DISEASE IS ASSOCIATEDWITH A DECREASE IN RETINAL ARTERIOLARCALIBREOoi Q, Alias M, Baharuddin N, Deva R, Hutchinson A, Kawasaki R,Newk-Fon Hey Tow F, Colville D, Savige JBackgroundMany studies have measured the effects of chronic kidney disease(CKD) on the retinal circulation. The retina and kidneys sharemicrovascular features. Microvascular damage is one of theearliest pathological changes and a key mechanism in thedevelopment of kidney disease. Thus, retinal imaging wasexamined as a biomarker for pathogenesis of microvascularproblems in the kidney.AimsTo document retinal vascular calibre in individuals with andwithout CKD and to correlate this with the severity of CKD.Patients & MethodsA total of 126 patients with CKD and 144 controls were recruitedfor this cross sectional cohort study. CKD was defined as anestimated glomerular filtration rate (eGFR) of

Abstract 33ANTIPSYCHOTIC DRUG MODULATION OFDOWNSTREAM TARGETS OF THE EGF-ERKCELL SIGNALING PATHWAY IN PREFRONTALCORTEX AND STRIATUMPereira A, Zhang B, Malcolm P, Fink G and Sundram SMental Health Research Institute of Victoria; Centre forNeuroscience and Department of Psychiatry, The University ofMelbourne; Northern Psychiatry Research Centre, The NorthernHospitalBackgroundAntipsychotic drugs (APD) exert variable efficacy and areineffective in about one third of patients with schizophrenia.For a proportion of these resistant cases, the atypical APDclozapine is an effective treatment option. The reason forclozapine’s superior efficacy although unknown may involvemodulation of the mitogen activated protein kinaseextracellularsignal regulated kinase (MAPK-ERK) cascade thatlinks GPCRs and ErbB growth factor signaling systems. We haveobserved that whilst APD initially inhibit ERK phosphorylation,clozapine causes subsequent activation of the cortical andstriatal ERK response, mediated by the epidermal growth factor(EGF) receptor (ErbB1).Study aimsTo determine if modulation of the EGF-ERK1/2 pathway by APDaffects expression of the ERK substrates p90RSK and c-Fos,factors that regulate gene transcription.Methodologyp90RSK and c-Fos signaling in PFC and striatum of C57Bl/6 micefollowing acute APD treatment was examined byimmunoelectrophoresis.ResultsIn cortex and striatum, clozapine-induced p90RSKphosphorylation paralleled ERK phosphorylation. However,increase in striatal p90RSK at 8 hrs was not attenuated by theEGF receptor inhibitor, AG1478. Moreover, c-Fos expressionfollowing clozapine treatment was initially inhibited for up to 2hrs and significantly increased 24 hrs later (PFC 24 hrs clozapine155±17% vs vehicle 100±11%, p

Abstract 35NORTHERN ALLIANCE HARP DIABETESSERVICE IMPACT ON HOSPITAL UTILISATIONRasekaba TM, Hutchinson ABackgroundIntegrated multi-disciplinary diabetes management is one of theservices that are offered by the Northern Alliance HospitalAdmission Program (NA-HARP) or patients with poorly controlledblood sugar (HbA1c > 8.0%), diabetic complications or werehospitalised for diabetes in the previous 12months. One of theservice aims is to reduce hospital utilisation, with changeexpected after attending a minimum 3 service contacts.AimTo evaluate the impact of the NA-HARP Diabetes Services onhospital utilisation (ED presentations and inpatient admissions)following HARP intervention between September 2007 and May2008.MethodsThe study evaluated hospital utilisation 12 months pre and 12months post intervention in NA-HARP for the diabetes patientpopulation. Patients who had 1-2 service contacts werecompared with those who had ≥3 service contacts. Statisticaltests were the Wilcoxon Signed Ranks Test for within groupcomparisons and the Mann-Whitney U Test for between groupcomparisons.ResultsIntervention was provided to 357 patients; 28% had a previoushospital attendance at Northern Hospital, 55% had ≥3 contactsand 45% 1-2 contacts. The two groups were similar in age andHbA1c at baseline. The proportion of patients who presented toED pre and post were: 1-2 contacts 14% vs. 23%; ≥3 contacts 25%vs. 23%. Trends were similar for inpatient admissions. LOS: 8 vs. 5days (p0.05) for the≥3 contacts. Bed days: 7 vs. 10 (p = 0.273) for 1-2 contacts and wasunchanged (4 days) for the ≥3 contacts. Combined groups datafor discharge diagnoses indicated diabetes mellitus and disordersof glucose regulation decreased from 7% to 4% (p

Abstract 37ONE SIZE DOES NOT FIT ALL – HELPINGIMGs LEARNSangas S, Fu P, Chong C, Apswoude G, Somarajah G, Savige, J.Medical Education Unit, The Northern HospitalBackgroundInternational Medical Graduates (IMGs) are at different phases intheir career and need individual support. A ‘one-size fits all’package does not apply.MethodologyA series of progress meetings were held over a 3-month periodbetween IMGs and staff with IMG responsibilities. The aim wasto determine what education and support programs can beimplemented to ensure a smoother transition.Results(1) IMGs are a diverse group in different phases in career. Somemay have just arrived in Australia and are adjusting to theAustralian way of life and healthcare system whilst othersmay be sitting for the AMC exam.(2) There was significant angst from IMGs about the AMCprocess and exams. Recent changes were not wellunderstood and there was disagreement from passedapplicants about the difficulty of the exam.(3) Mentors are significant for: career advice, exampreparation, as potential referees, to resolvecommunication problems, for cross-cultural training and toprovide assistance with visa and registration applications.(4) Employment paperwork seems voluminous particularlywhen English is not the first language.(5) Education programs specifically for IMGs are difficult giventhe diversity of the group.As a result of these findings, a pool of support staff/mentors wasput together and contact details provided in an ‘IMG SupportNetwork’ Brochure. The weekly HMO Education program wascombined with the IMG program. A series of IMG Workshopswere developed to improve/enhance clinical skills such as EDprocedures, history taking and exam, reading ECGs.ConclusionOne size does not fit all as every IMG has individual learningneeds that need to be addressed. An appropriate supportprogram needs to take this into account.Abstract 38PAGER FREE EDUCATION – THE ‘PERFECT’TEACHING ARRANGEMENTSangas S, Chong C, Fraser R, Bond F, Savige, J.Medical Education Unit, The Northern HospitalBackgroundFor years, interns in Victoria have campaigned heavily forprotected teaching time. Despite attending one-hour weeklyeducation sessions, pagers were interrupting their supposedly‘protected’ time.MethodologyIn November 2008 the Medical Education Unit introducedpager free education. Intern feedback from this innovation hasbeen overwhelmingly positive as they are able to concentrateand learn during the session without interruption.OutcomeThis presentation details how weekly pager free education wassuccessfully implemented to support our interns. The pagersare held by medical education staff during education hour andthere is a protocol on how to respond to pagers appropriately.We propose that this initiative be taken up by other hospitals.We also analysed components of our education program thatwere successful; the PERFECT teaching initiative. Education isPager free and Protected, Educational, practical and Relevant.Feedback from interns is essential and good Food is a necessity.Engaging speakers and interactive sessions are important.Cover shift topics and Clinical risk issues are important topics tointerns, as well as addressing the Curriculum framework.Timing of topics is important, for example, cover shift topics and‘skills you need to survive on the wards’ are priorities at thebeginning of the intern year. Our interns have embraced thisprogram, with attendance and feedback improved, particularlywith the introduction of pager free time.ConclusionThe PERFECT teaching initiative works well for our hospitalinterns and in particular, pager free education has beenpositively received. Pager free education is not difficult toimplement and we urge other hospitals to consider thisinnovation.63Northern Health Annual Research Report 2009

Abstract 39THE PATHOGENESIS OF THE DOT AND FLECKRETINOPATHY IN ALPORT SYNDROMEJ Savige, J Liu, 1 D Cabrera, 2 J Handa, D ColvilleThe University of Melbourne Dept Medicine (Northern Health),Melbourne, VIC, Australia; 1 Bascom Palmer Eye Institute, Universityof Miami Miller School of Medicine, Miami, FL, USA; 2 Wilmer EyeInstitute, Johns Hopkins Medical Institutes, Baltimore, MD, USA;and 3Launceston General Hospital, Launceston TAS, Australia.PurposeTo determine the effects of X-linked and autosomal recessiveAlport syndrome on retinal basement membranes and how theseresult in the characteristic perimacular dot and fleck retinopathy,retinal lozenge, and macular hole.MethodThe type IV collagen chains present in the normal retina weredetermined immunohistochemically. Ten patients with Alportsyndrome underwent retinal photography and optical coherencetomography (OCT, Topcon OCT-1000, Topcon, Tokyo; and CirrusHD-OCT and Stratus OCT, Carl Zeiss Meditec, CA) to determinethe thickness of the internal limiting membrane (ILM) bysegmentation analysis, the layers affected by the retinopathy andany correlates of the lozenge and macular hole.ResultsThe alpha3alpha4alpha5 type IV collagen network was present inthe normal ILM as well as the retinal pigment epitheliummembrane of Bruch’s membrane. In Alport syndrome theILM/nerve fibre layer and Bruch’s membrane were both thinned.The dot and fleck retinopathy corresponded to hyperreflectivity ofthe ILM/ nerve fibre layer in the distribution of the nerve fibrelayer. The lozenge and macular hole corresponded to temporalmacular thinning. Overall retinal thinning was due principally tothinning of the ILM/nerve fibre layer and inner nuclear layer.ConclusionThe Alport perimacular dot and fleck retinopathy results primarilyfrom abnormalities in the ILM/nerve fibre layer rather than Bruch’smembrane. Thinning of the ILM/nerve fibre layer contributes tothe retinopathy, lozenge and macular hole possibly throughinterfering with nutrition of the overlying retina or the clearanceof metabolic by-products.Abstract 40COMPARATIVE ACCURACY OF TWO METHODSOF PREDICTING DISCHARGE DESTINATION OFHIP AND KNEE ARTHROPLASTY PATIENTSSchofield C, Barker ABackgroundDischarge prediction tools provide an objective pre-operativemeasure of a patient’s likelihood of achieving discharge to eitherhome or rehabilitation. The use of such tools is recommended inorder to streamline care. The Risk Assessment and Prediction Tool(RAPT) is used widely for predicting discharge destination forelective hip and knee arthroplasty patients, however itsperformance in comparison to the current method of predictingdischarge destination (nursing staff prediction) is unknown.AimTo investigate the comparative accuracy of pre-admission nursingstaff prediction and the RAPT in predicting acute care dischargedestination for elective hip and knee arthroplasty patients.MethodologyA retrospective audit was conducted of the histories of 249patients admitted for elective hip or knee arthroplasty between1st June 2005 and 31st May 2008. Fifty-three patients wereexcluded from the study, yielding a sample of 196. The RAPT wascompleted by a physiotherapist at the time of audit. Nursing staffprediction was documented during the routine pre-admissionclinic assessment. The proportion of patients classified wascompared and the area under the receiver operative characteristiccurve (AUC) was calculated to establish the accuracy of eachmethod.ResultsThe overall accuracy of the RAPT (AUC=0.74) was significantlyhigher (p=0.001) than nursing staff prediction (AUC=0.60). Whilstboth tools left a large number of patients unclassified, the RAPTprovided a definite discharge prediction for a higher proportion ofpatients than nursing staff.ConclusionThe Risk Assessment and Prediction Tool provides a significantlymore accurate prediction of discharge than nursing staffjudgement.64

Abstract 41DIFFERENCES OF HEALTH SYSTEMS ININDONESIA AND AUSTRALIA: POPULATIONNUMBER AND ECONOMY ARE THECONTRIBUTING FACTORSAJ Sendjaja, CN Hutagalung, DA Loho, G Ganabathi, H Alwainy, LChandrahirawati, N Hamid, N Zainal, N Halim, RS Fadli.Universitas Indonesia and The University of Melbourne,Northern HealthBackgroundIndonesia is one of Australia’s closest neighbors but it is verydifferent in many aspects. It is one of the world’s most heavilypopulated countries with a total population of more than 250million people with a median age of 27 years. The health systemis similar to that of other developing countries where thegovernment provides basic health care with emphasise onvulnerable groups such as those from a lower socioeconomicgroup. In contrast, Australia is a developed country with apopulation of 21 million with a median age of 37 years. Itshealth system is very different where health care is universallygovernment-provided. With their many differences, especially indemographics and health status, the challenges faced by thehealth care system are also very different.AimTo compare the stresses on the health systems in the twocountries.MethodsDemographic data were obtained for Indonesia and Australiafrom the internet (WHO website and CIA world fact book) andPubmed using search words ‘health care’ AND ‘Indonesia’ OR‘Australia’, starting from 2002 until 2008.ResultsIn Indonesia 29% of the population is under the age of 14 yearsand 5% is more than 65 years. The numbers for Australia are 18%and 14% respectively. Infant mortality in Indonesia is 34/1000live births and 6 – 10 in Australia. Maternal mortality rate is 307/100,000 live births in Indonesia, a big difference from that ofAustralia’s, which is 8,4/100,000 live births. Life expectancy inIndonesia is 72 years at birth compared with that of Australia’swhich is 79 years. Food, water, and vector-borne infections aremore common in Indonesia compared to Australia, but diseasestypical of developing countries such as ischemic heart diseaseand diabetes are on the rise too. Ischemic heart diseaserepresents the major cause of death in both countries. HIVaffects one in 1000 individuals in Indonesia which is similar tothe rate in Australia. Indonesia spends less than 3% of its GNPon health care whereas Australia spends 9.7%.Statistics showthat the number of registered medical practitioners in Indonesiais approximately 25,000 and is almost three times lower incomparison with 61,261 registered medical practitioners inAustralia. Indonesia has 62 hospital beds per 100,000 of thepopulation compared to 7400 per 100,000 in Australia.ConclusionsHealth care in Indonesia is improving but some major factorslimit health care provision in Indonesia such as its rapidlyexpanding population and its economic instability. Besides that,there is also an increase in lifestyle diseases such as ischemicheart disease and diabetes which is identical to the situation inAustralia. In both countries these diseases further stress thehealth system.Abstract 42DEVELOPMENT OF A cDNA SCREENINGASSAY FOR COL4A3 AND COL4A4MUTATIONS IN AUTOSOMAL RECESSIVEALPORT SYNDROMESiva Kumar V, Wang YY, Tan R, Rigby L, Savige J.Department of Medicine, University of Melbourne, NorthernHealth, The Northern Hospital, Epping VIC 3076BackgroundAutosomal recessive Alport syndrome (ARAS) is a conditionaffecting 1 in 40,000 of the general population. The clinicalfeatures include haematuria, proteinuria, renal failure, hearingloss, lenticonus and retinopathy. A lamellated and thickenedglomerular membrane is observed upon renal biopsy. Thegenes affected are COL4A3 and COL4A4. Parents and offspringare carriers with haematuria only and of thin basementmembrane nephropathy. Mutation screening would providefast diagnosis and help to study the cause of ARAS widely.AimTo detect mutations through cDNA screening and to establish ascreening assay for autosomal recessive Alport syndrome.MethodSkin biopsy and blood samples were obtained from patientswith ARAS to establish fibroblast and lymphoblast cell lines.mRNA was extracted from the cell lines and cDNA sequencedto look for nucleotide changes in both COL4A3 and COL4A4.Changes were screened against 50 controls to confirmpathogenic variants.ResultsSome novel and previously described variants were identified,notably insGGTT at nucleotide 1927 of COL4A3 is pathogenic asthis results in a stop codon mid transcript. Anotherheterozygous change, 1934G>C, R645S is probably alsopathogenic.ConclusionThe cDNA analysis is a fast and sensitive detection method forARAS. The cell lines from the individuals will be used to examinehow these mutations cause disease.65Northern Health Annual Research Report 2009

Abstract 43ALLIED HEALTH GRADUATE PROGRAM –SUPPORTING NEW GRADUATES TO LEARNFROM EACH OTHER.Smith R, Pilling S, Champ PBackgroundThere is evidence to indicate that the time of transition fromstudent to professional is challenging and potentially stressful.Programs that actively support this transition process areuncommon in allied health. In 2004, our health servicedeveloped and implemented a support program specifically forallied health graduates. The interdisciplinary program aims to:• Smooth the transition from graduate to professional• Capitalise on peer support and build collaborative teamwork• Foster interprofessional practice• Provide orientation and induction of graduates into the alliedhealth workforce and organisation – complementing thediscipline specific experience.OutcomesThe program has evolved over time, to now comprise 8 x 2 hoursessions held 3 – 4 weeks apart during the first half of the year,with a follow-up session in late November. The program employsreflective practice and group based learning. Graduate numbershave ranged from10-28 depending on the intake of graduates in aparticular year. More than 90 graduates will complete theprogram by the end of 2009.This paper will describe the evolution of the program; outline therefined model and present summary data on graduatedemographics – including retention rates – and programoutcomes. Issues regarding program sustainability, flexibility andperceived value will also be detailed.Submitted and accepted for National Allied Health Conference,Canberrra, October, 2009Abstract 44LEARNING TOGETHER TO WORK TOGETHER:FACILITATING COLLABORATION THROUGHINTERPROFESSIONAL CLINICAL EDUCATIONSmith, Robyn 1 , Dodd, Karen 2 , Davidson, Megan 2 , Smith, Jenni 1 ,Schofield, Claire 1(1)Northern Health Allied Health, (2) Faculty of Health Sciences,LaTrobe UniversityIntroductionInterprofessional teamwork is essential to achieve good patientoutcomes. Whilst models of health professional education areevolving to reflect this, we continue to train our students indiscipline specific models with few opportunities to learn with,from or about the rest of the team.In Victoria, the Department of Health has funded a collaborationbetween an outer metropolitan hospital and a major university torefine, implement and evaluate an existing model ofinterprofessional clinical education.The main objective is to produce a model that can be appliedwith a broad cross-section of health professional students duringtheir clinical education/professional placements at a range ofagencies in a geographic region.The intention is to develop a model that could be applied statewide.MethodsThe project takes an iterative approach, with guidance from aninterdisciplinary advisory group. Students in their final orpenultimate year, from nursing, allied health, and medicinedisciplines are eligible to participate. Facilitated workshopsessions, which focus on person centred care andinterprofessional collaboration, run during a professional orclinical placement. Where feasible, opportunities for students tocollaborate in patient care are provided. Program outcomes willbe evaluated using the Interdisciplinary Education PerceptionScale (IEPS) and feedback from participants, placementsupervisors and IPCE session facilitators.ResultsThe program ran in May/June 2009 and August 2009.Preliminary results demonstrate a statistically significant change inthe IEPS demonstrating a positive shift in professional perceptions(paired t-test p

Abstract 45SUPERVISION – A COMPREHENSIVEAPPROACH TO SUPPORT RETENTION ANDDEVELOPMENTSmith, R., Steel, C., Champ, P., Smith, J., Spring, A., Wilson, K.Robyn Smith; Robyn.Smith@nh.org.au Ph: (03) 9495 3333.Key words: professional supervision, professional development,supervision frameworkBackground“Supervision” has a spectrum of meanings across allied healthdisciplines. The word may provoke thoughts of studentsupervision, or of the regular checking on workload foraccountability purposes, or of more in-depth debriefingsupport to clinicians involved in counseling roles.ProcessAt our outer metropolitan public health service, the allied healthexecutive identified a need to improve the approach,consistency and availability of supervision for all allied healthstaff and implemented a program aimed to address these. Weembarked on a process of developing an evidence informedframework to underpin supervision. This included guidelinesabout supervision model, frequency and documentation. Thesupervision framework and guidelines have been implementedacross 8 allied health disciplines and all grade levels across 5campuses. This comprises approximately 240 allied health staff(195 EFT).A targeted training program was developed and implementedfor supervisors, with a supporting “how to use supervision”inservice for all allied health staff. The training program hasundergone continuous evaluation and refinement. Anevaluation of the implemented supervision process andoutcomes will be completed in mid-2009.This paper will present an overview of the supervisionframework and supporting resources. The outcomes of the2009 allied health wide review of supervision will be presented,with implications for future development discussed.ConclusionFeedback to date indicates that the supervision framework hasbeen feasible and appropriate for application across a range ofallied health disciplines.Submitted and accepted for the National Allied HealthConference, Canberra, October, 2009Abstract 46TO COMPARE THE EFFECT ON PEAKPLANTAR PRESSURES OF THE DH PRESSURERELIEF SHOE, STANDARD FOOTWEAR ANDCANVAS SHOES IN PATIENTS WITHPERIPHERAL NEUROPATHYStark M, Landorf K, Raspovic A, Gazarek JBackgroundWorldwide, Diabetes Mellitus (DM) is reaching epidemicproportions, those affected is on the rise. One of the seriouslong-term complications associated with DM is neuropathiculceration, which is also the highest predictor for lowerextremity amputation (Armstrong and Lavery 1998). Off-loadingof plantar pressure is a key strategy adopted to prevent theformation or to heal existing ulcers (Lavery and Vela et al 1997).There are a number of studies which report on peak plantarpressure reduction with currently used off-loading modalities.However alternative methods for off-loading that are effective,economical, easy to use and have little impact on lifestyle arecontinually being sought.Study AimThe aim of this study is to evaluate the effectiveness of the DHPressure- Relief Shoe in off-loading diabetic foot ulceration.This is a collaborative project between the Northern Health andLa Trobe University Podiatry departments and has beensupported by a Northern Health small research grant.MethodologyA repeated measures trial was conducted to assess theeffectiveness of the DH Shoe in off-loading diabetic footulceration. 7 participants* were recruited and three footwearconditions were evaluated; a canvas shoe (the control),participants’ standard footwear and the DH Shoe. The primaryoutcome was differences in peak plantar pressure measuredusing the PedarX® mobile in-shoe system between the 3footwear conditions.ResultsStatistically significant differences in peak plantar pressure werefound between each of the 3 footwear conditions. The greatestmean difference was between the canvas (control) shoe andthe DH Shoe, however a significant difference was also foundbetween standard footwear and the DH Shoe; with the DH shoebeing lower in all instances. Peak pressure reduction wasgreatest (from control) by the DH Shoe (52%), compared to theparticipant’s standard footwear (25%).ConclusionThe DH Pressure-Relief Shoe may be a useful alternative tocurrent off-loading modalities used in clinical management ofdiabetic foot ulceration. As no previous research on theeffectiveness of the DH Shoe exists, it is difficult to ascertainwhether the 52% reduction would be significant enough toreduce pressure below the ‘threshold pressure’ for ulcerating.Future research is indicated into the effectiveness of the DHShoe in comparison to methods currently utilised for the offloadingof neuropathic ulceration.* This study is currently unfinished, therefore data has only beenanalysed for 7 participants. Overall, 16 participants data will beanalysed.ReferencesArmstrong, D.G. and Lavery L.A (1998). “Diabetic Foot Ulcers:Prevention, Diagnosis and Classification”. American FamilyPhysician MarchLavery, L.A., Vela S.A., et al. (1997). “Reducing plantar pressure inthe Neuropathic Foot: A comparison of footwear”. Diabetes Care20 (11): 1706-171067Northern Health Annual Research Report 2009

68Abstract 47BENZODIAZAPINE AND APD USE IN APSYCHIATRIC INPATIENT UNIT IS NOTPREDICTED BY PRESENCE OR ABSENCE OFSUBSTANCE USE DISORDERSundram S, Matsudaira A, Sritharan P, Happell B andSwaminathan VBackgroundThe comorbidity of substance use disorders (SUD) and otherpsychiatric disorders ranges up to 70% and is associated withsignificantly worse clinical, social and functional outcomes. Wepreviously reported that within an acute psychiatric inpatient unitclinicians failed to recognise a high proportion of SUD diagnosesin patients admitted with other psychiatric disorders. This nonrecognitionhas the potential to lead to increased agitation andbehavioural disturbance requiring additional medicationadministration. To assess the consequences, if any, of this nonrecognitionwe prospectively examined the use of antipsychoticsand benzodiazepines in admitted inpatients.Study AimsTo compare the amount of benzodiazepines and antipsychoticdrugs used in a consecutive sample of patients admitted to anacute general adult psychiatric inpatient unit between those withidentified SUD and those with unrecognised SUD.MethodologyProspectively 93 admitted patients were assessed using astandardized interview questionnaire, the Tobacco and SubstanceUse components of CIDI-Auto (Version 2). Data forbenzodiazepine and antipsychotic drug use was available for 71patients and was calculated as total diazepam andchlorpromazine equivalents for the first two weeks of admission.Clinical file review determined identification of SUD. Unpaired ttests and ANOVA were used to compare between groups usingSPSS 17.0.ResultsAntipsychotic and benzodiazepine drug use did not significantlydiffer between those with any SUD (Mean Diazepam Equivalentdose 240.7 mgs {σ=577.62}, Mean Chlorpromazine Equivalent5159.5 mgs {σ=4878.1}) and patients without a SUD. Furthermore,failure to clinically identify a SUD diagnosis did not result in asignificantly higher cumulative dose of benzodiazepines orantipsychotic drugs.ConclusionPatients with SUD did not require more antipsychotic orbenzodiazepine treatment and clinical failure to recognise SUDdiagnoses also did not result in increased drug use. Theseunexpected findings raise questions about the utility of strategiesaimed solely at identifying SUD and about the clinical impact ofSUD during the early phase of hospitalisation for other comorbidpsychiatric disorders.Abstract 48NORTHERN PSYCHIATRIC UNIT, CLINICALOBSERVATION RESEARCH PROJECTSundram, S., Harrington, A.Background‘Functional’ or ‘Clinical Observations’ have been utilised as apractice to ‘monitor’ patients at risk in acute inpatient psychiatricunits throughout Victoria for an indefinable period. Acomprehensive literature search failed to locate an evidence basefor this practice. Clinical observations evolved in a reactionarymanner to address the question of managing risk in the acuteinpatient setting. No systematic review has been done regardingthe development, implementation or long term outcomes of thisclinical practice.Study AimsThis project aimed to review the practice/s of managing risk in theacute psychiatric inpatient unit (IPU) setting; develop andimplement a new model of patient risk management andevaluate its effectiveness.MethodologyAction research was utilised as the research framework for theproject. Qualitative data included thematic analysis of pre andpost pilot focus groups. Quantitative data included analysis of;reported adverse events during the pilot and for correspondingperiods in the previous 2 years, and pre and post pilot satisfactionsurveys.Results1. Staff dissatisfaction with current model.2. New model of risk management was developed.3. New model significantly reduced; the number of episodes ofpatients absconding (RR 0.51, 95%CI 0.32-0.80, p

Abstract 49PLASMA APOLIPOPROTEIN E IS ELEVATED INCLOZAPINE TREATED SCHIZOPHRENIASundram S, Bandara J, Sathiyamoorthy S. Taddei K, Martins R,Cowie T, Lohdi R, Pereira A, Malcolm P, Wragg ABackgroundPeople with schizophrenia and related disorders have a reducedlife expectancy principally due to increased cardiovascular (CV)mortality. We previously demonstrated that the prevalence ofdyslipidaemias is higher in people with schizophreniacompared to the general population. Low apolipoprotein E(apoE) protein levels have been associated with elevated LDLand triglyceride levels(1) and also with schizophrenia(2) andtherefore may mediate this relationship. We previouslydemonstrated that antipsychotic drugs (APD) do not, as a class,alter apoE levels(3), however it is not known if APD associatedwith weight gain more specifically altered apoE.Study AimsTo measure cross-sectionally in stably treated people withschizophrenia plasma apoE levels and genotype and todetermine if clozapine lowered apoE levels more than otherAPD.MethodologyConsented patients from a psychiatric rehabilitation servicewith a diagnosis of schizophrenia or related disorder weremeasured for demographic and clinical data, BMI, BP, abdominalgirth, fasting blood glucose, fasting serum insulin, lipids andplasma apoE levels and genotype. Analysis of variance,Student’s t test and correlational measures were undertaken tocompare effects of treatment type on the above variablesResults74 participants were recruited of which n=43 receivedclozapine. The clozapine treated group had significantly higherplasma apoE levels (52.03±2.27µg/ml vs 44.31±3.32µg/ml;t=2.01, df=50 p

70Abstract 51OUT OF SITE, OUT OF MIND: ASSESSMENTOF INSULIN INJECTION SITES FORLIPOHYPERTROPHYM. Wallace, D. Greig, J. Wallace, A.S. Cheung, F. Pyrlis, E. Premaratne,F. Lee, C. Lo, S. Varadarajan, S. Fourlanos.Department of Endocrinology, The Northern Hospital, Epping,Victoria, Australia.BackgroundLipohypertrophy is a recognised complication of subcutaneousinsulin therapy and can adversely affect glycaemic control. Thediabetes team at our hospital were prompted to investigate thisproblem after detecting lipohypertrophy in several patients withpreviously unexplained recurrent hypoglycaemia andhyperglycaemia.Aims1) To identify the prevalence of lipohypertrophy at insulininjection sites in patients with type 1 and type 2 diabetesmellitus.2) To establish the frequency of insulin injection siteexamination by treating physicians.3) To assess patients’ insulin administration technique anddetermine whether patient education can improve glycaemiccontrol.MethodIn 2009, a survey was undertaken aiming to assess 200 patients(ambulatory care and inpatient) at The Northern Hospital.The assessment consisted of:1. Physical examination of insulin injection sites by anEndocrinologist and documentation of location and size ofareas with lipohypertrophy.2. Performing an insulin injection survey by a Diabetes NurseEducator to evaluate prior education and application ofinjection technique.3. Documenting a contemporary HbA1c.Following assessment, all patients were educated regarding theimportance of rotating insulin injection sites and to avoidinjecting in areas of lipohypertrophy.ResultsSurveys have been completed and the prevalence oflipohypertrophy was 45%. Of these, 73% were not changing theneedle with each injection and 76% did not have insulin injectionsites checked previously by a physician.ConclusionFindings show that lipohypertrophy affects a significantproportion of patients treated with insulin. Examination ofinjection sites is frequently overlooked by treating physicians andshould be recommended as a part of annual screening. Patienteducation on avoidance of lipohypertrophy is paramount.Abstract 52RETINAL ARTERIOLAR AND VENULARDILATATION IN CHRONIC OBSTRUCTIVEPULMONARY DISEASEWong A, Cheng L, Chew K, Colville D, Hutchinson A, Kawasaki R,Canty P, Savige JThe Northern HospitalBackgroundChronic obstructive pulmonary disease (COPD) affectsapproximately 20% of Australians aged over 40. Many die fromcardiovascular events. Traditional risk factors may not identify all atrisk patients in a clinical setting. Retinal photography takesadvantage of similarities in the coronary and retinal vasculature toprovide a non-invasive means to assess cardiovascular health. Thisstudy examines retinal vessel calibre in patients with COPD.AimTo determine the association between retinal vessel calibre andCOPD.Patients & MethodsNinety eight patients who met spirometry criteria for COPD(forced expiratory ratio

Abstract 53IMPACT OF THE NATIONAL INPATIENTMEDICATION CHART ON PRESCRIBING ATA SUBACUTE GERIATRIC HOSPITAL:A RETROSPECTIVE AUDITDr Paul Yates, Dr Penny Harvey, Dr Carol ChongIntroductionIn April 2004, Australian Health Ministers proposed a NationalInpatient Medication Chart (NIMC) in public hospitals to reducepatient harm from medication errors.This chart was introduced at Northern Health’s acute hospital inJune 2006 and was rolled out at one of its subacute sites onDecember 4th 2006. It included several novel initiatives aimedto improve standards of documentation of medicationprescribing, dispensing and administration. It has met a variedreception, with some criticism of certain design elements, andindeed, even the rationale for its implementation.In 2007, we reviewed the incidence of medication errors duringthe months preceding and post the rollout phase of the NIMC,and reported our findings to our campus Drug AdvisoryCommittee and the Quality and Risk Management team.Recently, we performed a follow-up audit of the NIMC with asuccessive cohort of prescribers to assess compliance with itsrequirements and whether changes in prescribing safety haveoccurred.Objectives• To compare medication prescribing, dispensing andadministration before and after the NIMC rollout.• To review standards of medication documentation andimprove awareness of common prescribing errors.• To examine performance of the NIMC with a subsequentcohort of practitioners.MethodA retrospective audit of a random sample of in-patient files overa three-month period immediately prior to, post- and two yearsafter implementation of the NIMC, using the NIMC Audit Tool.Compliance with individual audit criteria was calculated, as wellas overall compliance with all audit criteria (as a percentage)was measured for each sample. Overall compliance with “novel”NIMC items was calculated for the 2006-7 and 2008-9 groups.Audit results were reported back to the campus Drug AdvisoryCommittee and the Quality and Risk Management team.SettingThree wards of a subacute geriatric and rehabilitation hospital(72 beds), in Northern Melbourne, Australia.Results125 charts (1253 medication orders) were audited, sampledrandomly from each of the three wards.Total drug orders decreased across the three groups (468, 404,381, p=0.08).The total number of charts in use, average days chart in use andaverage charts in use/patient also all decreased (p

Northern HealthEthics Committee ReportNH is appreciative of the commitment of both our communityand staff members who give generously of their time whichresults in this critical work progressing.Members of the NH HREC Acute and Continuing Care Divisions:Chairs:Members:A/Prof Phillip Ebrall, Chairperson, Acute DivisionDr Richard McClelland, Chairperson, ContinuingCare DivisionSecretariat: Ms Cheryle Williams, JP (MinuteSecretary)Ms. Maree Cuddihy, Dr Graeme Duke, Dr Shane White, Mr RussellPeterson, Ms Christine Lamotte, Ms Jane Petryszyn, Ms Kate Eve,Dr William van Gaal, Dr. Michael El Moussalli, Dr Ken Eckersall, MrRoss Falcone, Dr Barbara Hayes, Mr Bob Milstein, Prof. Keith Hill, DrChristine Thompson, Fr Mark West, Mrs Geraldine Chambers, DrDeidre FetherstonhaughResearch at Northern Health has developed significantly over thelast few years. There is a marked interest and enthusiasm inconsolidating and promoting greater research endeavour withinthe Health Service, and this is seen in the number of submissionsmade to the Research and Ethics Committee. In 2009, five ClinicalTrials were reviewed that were mainly in the areas of Cardiologyand Oncology, and 48 applications were submitted from NHacross a variety of areas. While we are proud of building a strongfoundation there is much to bring about in the future, and thiswill be advanced by the building of the Academic and Researchprecinct.The following report shows the projects that were overseen bythe Northern Health HREC in 2009.Project Project Title Approved Researcher Organisation EstimatedNumber or Ratified CompletionCC01/09 The Role of Medical Emergency Feb-09 Dr Andrew Casamento, ICU, TNH ICU, TNH 2009Team in end of life care :A multicentre prospectiveobservational study72CCO3/09 Randomised controlled trial of Approved Mr M. Spink, LATROBE UNI Musculoskeletal 2009a multifaceted podiatry intervention April 09Research Centre,to improve balance and preventLATROBE UNIfalls in older peopleCC04/09 Preparing for clinical education – Feb-09 MS R. Smith. Allied Health, NH Allied Health 2009what do allied health cliniciansADMIN, BECCdo in preparation for teachingstudents in the clinical setting?CC05/09 Preoperative and postoperative Feb-09 MS S. Trelfall, Physio, TNH PHYSIOTHERAPY, TNH 2011physiotherapy versus postoperativephysiotherapy alone followingelective upper abdominal surgery –a random trial.CC06/09 Evaluation of the experience of Feb-09 Dr. Marilyn Richardson-Tench, School of Nursing 2010the preadmission care in day School of Nursing Victoria & Midwifery,surgery patients undergoing University VICTORIA UNIVERSITYcataract surgery and insertionof intraocular lensA08/09 Analysis of gender validity of Mar-09 Dr J. Considine, ED TNH Emergency 2010the Australasian Triage Scale (ATS)Department, TNHand Adaptive Process Triage(ADAPT)A10/09 Strengthening Care Outcomes Mar-09 Prof. R. Nay, ACEBAC, BUNDOORA ACEBAC, Bundoora 2010for Residents with Evidence (SCORE)

Project Project Title Approved Researcher Organisation EstimatedNumber or Ratified CompletionA11/09 Australian NGAL Evaluation in Mar-09 Prof. Henry Krum Alfred Hospital 2010Heart Failure Study (Utility of NGALin predicting renal impairment,further decompensation andrehospitalisation in acutelydecompensated and chronicheart failure patients.A12/09 What can be learned from Mar-09 Dr. B. Hayes, BECC, BUNDOORA BECC, Bundoora 2010hospital interpreters about culturalissues relevant to advance careplanning?CC13/09 Exploring how Hospital social Apr-09 Dr David Nilsson, Latrobe University La Trobe University 2009workers support aged patientsand their families or carers duringthe transition from hospital toresidential aged careCC14/09 Evaluation of providing acupuncture Jun-09 Drs. Xue, Zhang, DeVilliers RMIT University 2010for acute pain management in anand Taylor, RMIT UniversityEmergency Department at a majormetropolitan hospitalCC15/09 Early intervention for Amnestic Mild Apr-09 Prof. Glynda Kinsella, La Tobe University 2011Cognitive Impairment: A randomisedLatrobe Universitytrial of memory managementCC16/O9 Randomised Controlled Trials of Apr-09 Dr P. de Villiers Smit, ED, TNH TNH 2011Acupuncture vs Pharmacotherapyfor Acute Pain Relieve in EmergencyDepartmentsCC17/09 Clinical Outcomes, staff and carer Apr-09 Dr K. Lim, Clinical Services Director, TNH 2011perceptions of acute hospitalisationServices Director, TNHof older peopleA18/09 Northern - Perioperative Epidural May-09 Dr Juris Briedis, Dept of AnaesthesiaAnalgesia for Major Abdominal Anaesthesia Department, TNH and PerioperativeSurgery and Incidence of LateMedicineCancer Recurrence.A19/09 Quality of Life outcomes after May-09 Dr Grace Chew, Surgeon, TNH TNH 2012Breast Cancer Surgery – a Prospectivecohort studyA20/09 Responding to medical May-09 Prof. Tracey Bucknall, Deakin University 2010Emergencies: System characteristicsDeakin Universityunder examination (RESCUE):A point prevalence studyA21/09 ANZICS CTG POINT May-09 Dr G. Duke, ICU, TNH TNH 2011PREVALENCE STUDY.A22/09 Characteristics & Outcomes of Jul-09 Ms Marie Mohr, DON BHS 2010patients requiring transfer fromcontinuing to acute careA23/09 A new model of care to reduce Jul-09 Dr Penny Harvey BHS 2010the risk of medication-relatedproblems at the hospital-residentialaged care interface.A24/09 Focus Groups with Northern Health Jul-09 Dr Natalie de Morton, Physio BHS 2010Physiotherapy Clinical Educators.A25/09 Evaluation of the Winter Bed Jul-09 Dr Liza MY Lau Aged Care Dept Austin/NH 2009strategy - hospital treatment inresidential care73Northern Health Annual Research Report 2009

Project Project Title Approved Researcher Organisation EstimatedNumber or Ratified CompletionA26/09 Evaluation of advanced practice Jul-09 Dr Julie Considine ED TNH 2010emergency nursing practice rolesin ED at the The Northern Hospital.A27/09 A qualitative exploration of the Jul-09 Mr John Gannon RN NCRC 2011reality and ideal of HARP complexneeds services assisting generalpractitioners in providing patientcentred care to their elderly clientswith significant health care needs74A28/09 Outcomes of mid-shaft humeral Jul-09 Mr Dirk Van Bevel NHfractures treated surgicallyOrthopaedic Surgeonby plating.A29/09 Outcomes of Proximal Humeral Jul-09 Mr Dirk Van Bavel NH 2010Fractures Treated At Australian Othopaedic Surgeon (9monthTrauma Centres.project)A30/09 Iinfinite 2009 Study - Impact Jul-09 Dr Graeme Duke ICU TNH 2009and risk factors associated withinfluenza H1N1 in the AustralianHospital System, Epidemic 2009.A31/09 The impact of the Intensive Jul-09 Dr Graeme Duke ICU TNH 2009Care Discharge Process on PatientsOutcome Study (DARE)A33/09 BioGrid Australia - Australian Jul-09 Prof. Judy Savige, TNH 2011Cancer Grid (ACG).NH Research CommitteeA34/09 A multicentre, Double-Blind, 1/07/2009 Dr Niall Tebbutt TNH 20103-Arm, Phase 1b/2 Study in Approval Medical OncologySubjects with Unresectable grantedLocally Advanced or Metastatic Sept 10Gastric or Esophagogastric2009 afterJunction Adenocarcinoma to requestedEvaluate the Safety and Efficacy amendmentsof First-line Treatment with to lawyersEpirubicin, Cisplatin, andand HRECCapecitabine (ECX) plus AMG 102 received.A35/09 Life Threatening respiratory Jul-09 Dr Melissa Kaufman/G.Duke, ICU TNH 2009failure from novel 2009/H1N1(Swine) Influenza (Expeditedapproval granted)CC36/09 Reducing disability in older Aug-09 Dr Jacques Joubert, Neurologist Royal Melbourne 2011Australians through secondaryHospitalstroke prevention.CC37/09 Beating the Blues before Birth - Aug-09 Professor Jeannette Milgrom, University of 2013Evaluating an Antenatal Depression Director, CEO, Melbourne,Treatment Program: A RandomisedAustin HealthControlled TrialCC38/09 Thrombotic Thrombocytopenic Aug-09 Dr Erica Wood, National Australian Red Cross 2012Purpura (TTP) Registry. Transfusion medicine Blood ServicesServices ManagerCC39/09 H1Ni1 (Swine) influenza: Aug-09 Dr Craig Aboltins, Physician, TNH 2010development of a clinical caseInfectious Diseasesdefinition and review ofepidemiology and antiviralresistance patterns.CC40/09 Evaluation of a rapidly deployed Aug-09 Dr Samual Hume, TNH 2010influenza clinic in response toDepartment of Medicine, TNHthe 2009 Human Research andEthics Committee.

Project Project Title Approved Researcher Organisation EstimatedNumber or Ratified CompletionCC41/09 A 7 day per week Aug-09 Dr Ofa Starman, RN BHS 2010physiotherapy service Nurse Unit Manager -for inpatient rehabilitationBHS Rehabilitation Unitpatients at BHS, NorthernHealth: A feasibility study.A42/09 Loss of position after Sept-09 Dr Jacqueline Hang, TNH 2009manipulation of wrist fracture.Surgical resident, TNHA43/09 The effectiveness of specific Sept-09 Dr Jon Ford, La Trobe University, 2011physiotherapy and advice Musculoskeletal Research Centre Bundooracompared to advice aloneCentre La Trobe Universityin people with sub acutelow back pain or sciatica.A44/09 Shared orthogeriatric care for Sept-09 Dr Elizabeth Dapiran, TNH 2010elderly patients with hip fractures –Aged Care Registrar, xa comparison of outcomes withTNH & Austin Healtha traditional orthopaedic unit.A45/09 Management of Chronic Sept-09 Dr Colleen Doyle, Craigieburn Health 2010Obstructive Pulmonary Disease Senior Research Fellow, TNH 2010in Pulmonary RehabilitationCentre for Health Policyclinics in Victoria.Programs and Economics,School of Population Health,University of MelbourneA46/09 Crystalloid versus Hydroxyethyl Sept-09 Dr Michael Reade, TNH 2012Starch Trial (C.H.E.S.T). A multi-Consultant Intensivecentre randomised controlledCare Physician, TNHtrial of fluid resuscitation withstarch (6% hydroxyethyl starch130/0.4) compared to saline(0.9% sodium chloride) inintensive care patients on mortality.A47/09 Associations between the adjuvant Sept-09 Dr Shane White Austin Hospital 2010chemotherapy regimen received,Medical Oncologistexpression of biological markersAustin Hospitaland prognosis in early stagetriple negative breast cancer.A48/09 Capsule endoscopy compared Sep-09 Dr Paul Froomes The Northern 2011with video endoscopy in diagnosing Visiting Gastroenterologist Hospitalpatients with acute gastrointestinalbleeding.CC49/09 Five year mortality results for Oct-09 Dr Vivek Kumar Shidhar The Northernfractured neck of femurs. Dept. of Orthopaedic Surgery Hospital 2010CC50/09 Measuring mobility of healthy Oct-09 Dr Natalie de Morton The Northern 20102010community dwelling older Physiotherapy Hospitaladults using the DEMMICC51/09 Exploring the carer's experience Oct-09 Ms Pauline Donaldson Bundoora 2010travelling the journey from Nurse consultant, Extended Carecommunity support for thoseDementia Consultancywith dementia to residential careService HARPCC52/09 How much is enough? An Oct-09 Robyn Smith Bundoora 2010exploratory study of the therapy Health Service Manager Extended Carereceived by people admitted toAllied Healththe Geriatric Evaluation andManagement Unit.A 53/09 Understanding the willingness of Nov-09 Dr Julie Considine ED The Northern Hospital 2010emergency nurses to respondHospitalto a health care disaster.75Northern Health Annual Research Report 2009

Project Project Title Approved Researcher Organisation EstimatedNumber or Ratified CompletionA 54/09 Perceived Risk of Ischaemia Nov-09 Dr William Van Gaal Cardiology The Northern 2010and Bleeding in AcuteHospitalCoronary Syndrome Patients(PREDICT)A 55/09 Mean door to needle time for Nov-09 Dr William Van Gaal Cardiology The Northern Hospital 2011thrombolysis before primaryPCI compared to mean doorto balloon time in the first12 months of the primaryPCI in a young cardiaccatheterization laboratoryin the Melbourne metropolitancentre.A56/09 Retention of post graduate year: Nov-09 Katia Forbes Acting Coordinator The NorthernAre we doing enough? Graduate Nurse Program - Hospital Acutecare and Midwifery2010A57/09 A prospective study examining Nov-09 Dr Edwina Holbeach The Northern 2011functional and quality of life Aged Care Hospitaloutcomes of elderly patients6 months post dischargefrom intensive care unit.A58/09 Prosthetic Joint Infection Nov-09 Dr Craig Aboltins TNH 2013Treatment OutcomesInfectious Dieseases Physician76

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Northern Health Corporate Office185 Cooper Street Epping Vic 3076Telephone (03) 8405 2900 Facsimile (03) 8405 2930Broadmeadows Health Service35 Johnstone Street Broadmeadows Vic 3074Telephone (03) 8345 5000 Facsimile (03) 8345 5655Bundoora Extended Care Centre1231 Plenty Road Bundoora Vic 3083Telephone (03) 9495 3100 Facsimile (03) 9467 4365Panch Health Service300 Bell Street Preston Vic 3072Telephone (03) 9485 9000 Facsimile (03) 9485 9010The Northern Hospital185 Cooper Street Epping Vic 3076Telephone (03) 8405 8000 Facsimile (03) 8405 8524Craigieburn Health ServiceCraigieburn Road West Craigieburn Vic 3064Telephone (03) 8338 3000 Facsimile (03) 8338 3110www.nh.org.au