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Austin Health Sciences Library ranked top in the country

Austin Health's librarians
Austin Health's librarians

These are our friendly librarians. They are so good at what they do that they have helped catapult the Austin Health Sciences Library to become the highest ranking academic health library in Australia! The ranking is according to Insync Library Client Survey, which benchmarks some of the country's largest libraries, including two of the top 100 ranked universities globally.

Chief Librarian Michele Gaca says that the Library team are excited by the results. "We've scored highly before, but to reach this benchmark high - and to be top in three of the four categories surveyed - represents a great team achievement," she said. "I just really want to thank everyone for supporting us through the survey. Compared to the large universities, it's much harder for us to get 500 responses, so we are very thankful to all our staff and students who participated."

The Library serves clinicians, researchers and students from across Austin Health and the Mercy Hospital for Women.

While the Library's success came from performing strongly across all categories, Ms Gaca said a key theme was the friendliness of the Library staff.

"A number of people commented ‘the staff are really accessible and approachable, ‘they're warm and welcoming', ‘they always go above and beyond' and so on," Ms. Gaca said.

The Library received consistently positive feedback from across Austin Health sites and Mercy Hospital for Women, from students, and from both new and long-standing staff.

As well as quality service, responses indicated that the Library team are highly knowledgeable in evidence based practice, and that the Library itself is valued as a rare quiet space where people can study and work.

Nurse Practitioner role a success in keeping heart failure patients out of hospital

Dr. Andrea Driscoll, Heart Failure Nurse Practitioner

After just three years in their role, Austin Health's Heart Failure Nurse Practitioners, Professor Andrea Driscoll and Tina Asker, have reduced the number of heart failure patients being readmitted to hospital within 90 days by 16 per cent.

Prof Driscoll attributes the success of Austin Health's program to "a combination of improved patient education about self-management techniques, and the fact that patients are being seen by the HIP Heart Failure Service quite rapidly after discharge. By linking people in with the right services we've been able to reduce the readmission rate, and reduce that instability in people's health."

"Unfortunately, there's nothing we can do to cure heart failure but we can certainly improve pumping of the heart. It's about what we can do to reduce people's symptoms and improve quality of life," Prof Driscoll says.

Heart Failure is a term for when your heart muscle isn't strong enough to pump your blood effectively. It causes the body to hold onto fluid, and this fluid build-up can cause you to feel symptoms such as weakness and shortness of breath, and puts even more pressure on your heart.

Without education about how to monitor and manage fluid balance, it can be a difficult condition to control. Before the Nurse Practitioner role was introduced, 25 per cent of heart failure patients were back in hospital within the month.

Now, inpatients seen by Prof Driscoll and Ms Asker have their medications reviewed (and frequently changed) and receive education about their medications and condition. They are taught how to monitor for early signs of fluid build-up such as weight gain or swollen ankles, so that these can be addressed well before a hospital admission is required. They are also more likely to be referred to Austin Health's Health Independence Program (HIP) Heart Failure service, which involves a home visit from a nurse shortly after leaving hospital.

Prof Driscoll and Ms Asker have been so successful in their role that it is now being introduced in at least four other hospitals. "We've been so effective at what we've done that it's now being developed as a statewide model," Prof Driscoll says.

Austin Health is recognised as a national leader in advanced nursing roles, and has introduced the first nurse practitioner and nurse practitioner candidate roles in a number of fields. The Victorian Department of Health and Human Services (DHHS) Victorian Cardiac Clinical Network funded the three-year pilot of the Heart Failure NP role, as well as the research into the program’s outcomes, which Dr. Driscoll and colleagues have recently published in the July/August edition of the Journal of Nurse Practitioners.

Paediatric Short Stay Unit opens

Lenny and Jordan Wise
Lenny Wise, 15 months, with dad Jordan.

Austin Health's Paediatric Short Stay Unit (SSU) opened to patients for the first time today. And while first patient, 15 month-old Lenny Wise, didn't seem at all happy to be here, dad Jordan said "It's been really good! As the one and only patient he's getting lots of attention."

Lenny came to the Emergency Department due to asthma complications, which unit director Dr. Simon Bolch says is typical of the cases that will be seen in the Paediatric SSU: children who won't need to be admitted to the paediatric ward, but who may need more than four hours of observation and care in Emergency. He says that children may be admitted to the unit for up to 24 hours.

"They're going to go home, but just need a bit more care from us," says Dr. Bolch. "They will still be under the care of emergency doctors, but with more time to follow the response to treatment and the support of a paediatrician if needed."

Before the arrival of our photographer, Lenny had been sitting calmly on the bed in his own room with his dad, more than happy to allow a doctor to listen to his chest with a stethoscope. Outside the four single-bed rooms, a communal space has brightly-coloured cushioned stools and toys.

Today's opening means the Short Stay Unit is now fully open. In full, the unit incorporates a 16-bed adult short stay, four-bed Psychiatric Assessment and Planning Unit (PAPU), which provides acute mental health care in a calm environment for up to 72 hours - and now, a four-bed Paediatric Unit. It expands the Emergency Department's overall capacity by 10 beds, and paediatric capacity by four beds.

Leading the 3D printing revolution

Dr Jasamine Coles-Black

Dr Jasamine Coles-Black may only be in her intern year, but today she published her eighth medical journal article; ‘Three-dimensional printing in medicine', in the Medical Journal of Australia.

"What we found was quite exciting, which is why we decided to push forward with the work of the 3D print lab at Austin Health," says Dr. Coles-Black. "The number of applications of 3D printing in medicine is extraordinary: prosthesis development; patient training, education and simulation; surgical planning; and its beginning to expand into other types of planning too - for example, in Radiation Oncology," she says.

As well as aiming to establish the state of play in medical 3D printing, Dr. Coles-Black and her senior colleagues, Director of Vascular Surgery Mr. Jason Chuen and anaesthetist Dr Ian Chao, were seeking to see how Austin Health's 3D Med Lab compares to other players.

"In terms moving on from 2D CT scans to using 3D models when planning surgery, we're on par with anyone else in the world. We don't print metals here, but have really good relationships with the University of Melbourne and the CSIRO. What sets us apart is that we freely show other people what we're doing and what we've learnt, rather than holding onto our knowledge," Dr. Coles-Black says.

On being published so many times while still an intern, she says "it's a combination of being in the right place at the right time, and that people here have been really supportive. The fact that they would even support and encourage an intern to go for the MJA speaks volumes about the culture here."

"I started the research during my scholarly selective subject here through the University of Melbourne, and it just went from there."

For those interested in learning more, Austin Health's 3D Med Lab are holding a 3D Med Symposium on Friday August 25. Book through Eventbrite.

Leading the charge against undiagnosed diabetes

"Diabetes Discovery is a world-first program. It has led to system wide change ... detecting undiagnosed diabetes in patients admitted to Austin Health," says Dr Elif Ekinci, Director of Diabetes at Austin Health and Sir Edward Dunlop Medical Research Foundation Senior Fellow at the University of Melbourne.

Dr. Ekinci's Diabetes Discovery program automatically provides a blood test to every patient over the age of 54 to check their blood sugar levels and likelihood of having diabetes.

"When people get admitted to hospital there is no way of knowing if they have diabetes, apart from asking them. There are a lot of people who don't know they have diabetes or high blood sugar. What we have learnt is that one-third of people over the age of 54 who are admitted to Austin Health have diabetes. And a further one-third have pre-diabetes. Only one-third are in the normal range for blood sugar levels."

"Anybody who has a high reading is seen directly by a specialist within 24-48 hours," says Dr Ekinci. "We ... identify patients earlier, see them earlier and we are also actively educating junior hospital doctors and general practitioners in the local area to increase awareness of diabetes."

It is National Diabetes Week, which this year aims to raise awareness about the importance of early detection and treatment for all types of diabetes. Many people live with type 2 diabetes for up to seven years before being diagnosed: in fact, Diabetes Australia estimate that there are 500,000 Australians with undiagnosed type 2 diabetes.

This article is adapted from the most recent addition of our Fundraising magazine, Vitality. You can read it, subscribe or make a donation via our website.

Dr. Ekinci is a speaker at our Diabetes Grand Round this Wednesday 12 July, on Living with Type 1 Diabetes, from 12.25pm in the John Lindell Lecture Theatre. To participate in the conversation on Twitter, follow the hashtag #GRAustin

If you have any of the following symptoms of type 2 diabetes, visit your GP:

  • Being excessively thirsty
  • Passing more urine
  • Feeling tired and lethargic
  • Always feeling hungry
  • Having cuts that heal slowly
  • Itching, skin infections
  • Blurred vision
  • Gradually putting on weight
  • Mood swings
  • Headaches
  • Feeling dizzy
  • Leg cramps

For more information, visit the Diabetes Australia website.

Sleep-Smart Rosters Help Keep Doctors Sharper and Safer


An Australian-first body clock rostering system trial underway at two leading Victorian hospitals aims to improve doctors' performance and wellbeing and enhance patient safety.

The country's best sleep researchers have joined forces to create a staff rostering schedule for shift work that best mitigates fatigue, based on the latest sleep and circadian rhythm research.

Austin Health and Monash Health intensive care unit doctors are taking part in the trial which is being led by the Cooperative Research Centre for Alertness, Productivity and Safety (Alertness CRC) as part of an ongoing effort to further improve workplace alertness, safety and health for staff and patients.

Extensive research has shown sleepiness at work can lead to poor concentration, absenteeism, accidents, errors and even fatalities, says Associate Professor Mark Howard, a sleep and respiratory specialist at Austin Health and Institute for Breathing and Sleep.

"What is more concerning is that shift workers are often employed in the most critical jobs - including the 30,000 plus doctors who work in Australian hospitals," Associate Professor Howard says. "Our new scheduling practices are based on fundamental principles in sleep and circadian medicine and are the result of an extensive review of published literature in the field, undertaken by a reference group of experts.

Research shows reducing the number of consecutive nights worked helps to minimise fatigue and drowsiness, because when you work an evening shift you are less likely to get the optimal hours of sleep required. On top of that, there's a circadian rhythm affect that promotes sleepiness at night.

The trial puts these findings to the test, ensuring that the intensive care doctors work no more than three consecutive night shifts, have a minimum of 11 hours' rest between rostered shifts and that they work no longer than 13 hours straight. Shift patterns that run against the 24-hour body clock are also removed

Associate Professor Howard anticipates enrolled staff will feel fresher and more alert on the job. "We're hopeful these changes will result in improved vigilance and alertness, reduced errors and improved safety for both staff and patients," he says. "That would be a great result for all concerned."

He praised the organisations for getting on board. "This type of trial requires great willingness to change and we are proud that Austin Health staff and hospital management have embraced the opportunity to be innovative.''
Professor Yahya Shehabi, Director Research, Critical Care and Perioperative Medicine, Monash Medical Centre, said the trial will likely deliver long-term benefits too. "In addition to the immediate improvement in workplace effectiveness, the safety of staff and patients, we expect a positive impact on the long-term wellbeing and health of doctors and nursing. It is a rich area for future research".

The initiative was welcomed by the Sleep Health Foundation, which this week launched Sleep Awareness Week calling for a greater focus on the sleep needs of Australia's tens of thousands of shift workers. Prof Dorothy Bruck, Chair, Sleep Health Foundation said, "As we mark Sleep Awareness Week, it's exciting to see a project catering specifically to the needs of this often sleep-troubled population."

Monash Health is using a product developed by Melbourne-based optimisation software company Opturion Pty Ltd, an Alertness CRC industry partner, as part of its trial. The product is thought to be the first of its kind, combining logistics modelling software and workplace sleepiness software into a single tool. It incorporates scheduling guidelines designed by leading sleep researchers at Monash University, Austin Health and the Institute for Breathing and Sleep.

Alan Dormer, CEO of Opturion stated, "Opturion is unique in its ability to build rosters that ensure complex service levels and compliance requirements are met at minimum cost. Alert safety is a further level of compliance sophistication, so it was a natural extension. We see this as a major opportunity for the health sector to improve performance and control costs, and we now have the software to deliver those outcomes," Mr Dormer says.

Professor Steven Lockley, the Alertness CRC Program Leader for Safety and Productivity Improvements and Professor at Monash University, says until now it has been difficult to incorporate knowledge of factors causing sleepiness into the rostering process. "The great advantage of this new tool is that those factors are automatically included when the schedule is generated, and, we hope, therefore minimising preventable medical errors due to poorly designed work shifts," Professor Lockley says.

The system is not only for medical personnel. "Alertness-safe staff rostering is particularly relevant for overnight workers, shift workers or people starting early in the morning", Professor Lockley said. "Our system could potentially benefit those working in many professions; not just in healthcare, but also mining, police, firefighters, ambulance service, pilots, ships' captains, long-distance trucking and others."

About the CRC for Alertness, Safety and Productivity

The Alertness CRC is an industry focused research program committed to maximising alertness in the workplace. The mission of the Alertness CRC is to 1) Promote the prevention and control of sleep loss and sleep disorders, and 2) Develop new tools and products for individuals and organisations to improve alertness, productivity and safety. http://www.alertnesscrc.com/

For interviews with Assoc Prof Mark Howard contact:

Julie McNamara, Deputy Director, Communications, Austin Health
T: 0419 595 688

 

Further enquiries:

Susan Waterer, Communications Manager
T: 0423 194 593, E: swaterer@alertnesscrc.com

Our statement on Olivia Newton-John

Olivia Newton-John visits patients on one of her recent visits to Austin Health

The Austin Health Board, management, staff and patients send support and best wishes to our good friend, Olivia Newton-John as she commences treatment for the relapse of breast cancer.

Olivia is well-loved at Austin Health not only for her ongoing commitment and dedication to the Olivia Newton-John Cancer Wellness & Research Centre but also for the hope and inspiration she has brought to so many cancer patients.

We wish Olivia strength and positivity on her journey to recovery.

For more information see the Olivia Newton-John Cancer, Wellness and Research Centre website.

 

Medicinal cannabis found to be effective in severe childhood epilepsy

Professor Ingrid Scheffer

In children with the Dravet syndrome - a severe form of epilepsy - those given cannabidiol saw the median frequency of convulsive seizures drop from 12.4 to 5.9 per month - and 5 per cent of the children became entirely seizure free, a study in the New England Journal of Medicine has found.

"This is a major scientific breakthrough", says Professor Ingrid Scheffer, who is our Director of Paediatrics, one of the world's top epileptologists, and a contributing author of the study. "It's the first scientific evidence that cannabidiol works. There have been anecdotal reports in the past, and people with firm beliefs that it works in epilepsy, but this is the first time it's been proven."

Known as CBD, cannabidiol is a natural compound found in cannabis seeds, stalks and flowers. Studies have shown it does not have the psychoactive properties of THC.

Conducted for the Cannabidiol in Dravet Syndrome Study Group, the randomised, double-blind, placebo-controlled trial involved 120 children and young adults across the US and Europe. They received cannabidiol oral solution or a placebo, in addition to standard antiepileptic treatment.

Seizure frequency was measured over a 14-week treatment period. The median frequency of convulsive seizures per month decreased from 12.4 to 5.9 with cannabidiol, compared with a decrease from 14.9 to 14.1 with placebo.

There was no significant reduction in nonconvulsive seizures. Five per cent of patients taking cannabidiol became seizure-free, compared with none of the placebo group.

Side effects were more frequent in the cannabidiol group and included diarrhoea, vomiting, fatigue, increased body temperature, drowsiness and abnormal liver-function tests.

Professor Scheffer welcomed the findings. "I am delighted that we finally have high level evidence that cannabidiol is effective for uncontrolled seizures in Dravet syndrome," she says.

"Until now, there has only been anecdotal evidence but now we have scientific evidence proving that cannabidiol is definitely effective in epilepsy.

"The next question is whether cannabidiol is effective in other forms of epilepsy and it is great that there are trials already underway of cannabidiol in other groups of patients with epilepsy."

Scientific breakthrough boosts gastrointestinal cancer hopes

Scientists at the Olivia Newton-John Cancer Research Institute have made a groundbreaking discovery that could progress the fight against gastrointestinal cancers, revealing a novel way to suppress the growth of tumours.

Gastrointestinal cancers - those that affect the stomach and bowel - are among the most common causes of cancer death, affecting more than 15,000 Australians each year.

The researchers have shown, in preclinical studies, that inhibiting a protein called HCK (hematopoietic cell kinase) can suppress the growth of established gastrointestinal tumours and reduce the emergence of new cancers.

Professor Matthias Ernst said HCK had a powerful role in cancer development because of the effect it has on macrophages, a critical part of the immune system. "We have known for a long time that in non-cancer situations macrophages have two major roles;" Professor Ernst said. "These cells can behave like ‘garbage collectors' when they remove unwanted debris or damaged cells, or they can behave like ‘nurses' to help at sites of injury and wounding.

"What we've now discovered is the more HCK activity a macrophage has, the more it nurtures cancer cell growth and survival. The macrophage becomes a wound healer rather than a garbage collector that cleans up the cancer cells."

Professor Ernst's team found that inhibiting HCK using a small drug-like molecule reduced the growth of bowel and gastric cancers. Their work is published in the current issue of the international journal Cancer Cell.

Dr Niall Tebbutt, Head of Medical Oncology at the Olivia Newton-John Cancer Wellness & Research Centre said the research presented important insight into future treatment approaches for gastrointestinal cancers. "Unfortunately, bowel cancer is generally resistant to conventional immunotherapy treatment," Dr Tebbutt said. "This research may help us to understand why bowel cancer is so resistant to immunotherapy but, more importantly, it provides a new approach to possibly overcome this resistance through inhibition of HCK. Future clinical trials of this approach in patients with advanced bowel cancer are worth pursuing."

Recognising knowledge and wisdom

A/Prof Gwynne Thomas
A/Prof Gwynne Thomas (right) is presented the Emeritus Clinician award by Austin Health Board Chair The Hon Judith Troeth AM

Associate Professor Gwynne Thomas is Austin Health's first ever Emeritus Clinician.

This is a new award created to recognise service that is truly extraordinary. In his 40th year at Austin Health, "Gwynne was the first person to come to mind for many, and universally endorsed as an appropriate choice for the Emeritus role," says Austin Health's Chief Medical Officer, Dr Fergus Kerr.

He worked as a Senior Renal and General Medical Physician for 39 years, and was the Head of General Medical Unit 1 for 25 years. He was the Director, then Medical Director of the Medical and Emergency Clinical Service Unit during its first 13 years, and was heavily involved in hospital management.

A/Prof Thomas lists among his achievements establishing the Infectious Diseases department and the Endocrine Centre of Excellence - departments that contribute significantly to Austin Health's international reputation. In the case of the Endocrine Centre of Excellence, when A/Prof Thomas was told by the chief executive officer that there wasn't enough funding to create the Centre, he went on to raise a million dollars through private donations. He followed that achievement by raising $400,000 to establish the Renal Pancreatic Islet Cell Programme.

He unified the separate Renal Units from Austin Hospital and Heidelberg Repatriation into a single entity.

The mentoring and development of junior medical staff is a passion of A/Prof Thomas'. He set up informal mentoring for junior medical staff in the nephrology and general medicine, something which has more recently been formalised into an official hospital-wide programme to support junior doctors, and developed many people in clinical leadership positions.

A/Prof Thomas is also the inaugural President of Austin Health Medical Alumni Association.

As well as giving recognition, Emeritus Status offers recipients an avenue to continue to contribute through teaching, research and mentoring roles, as well as committees and associations - something that is of significant benefit to Austin Health.

"Thank-you for this Award," said A/Prof Thomas. "I have had the most wonderful time in all my years at Austin Health, and have enjoyed the camaraderie, but I decided it was time to stand down from paid hospital work to give the young doctors a chance to develop their careers."

‘Emeritus' is an honorary title given to a person of outstanding merit, especially by universities. A/Prof Thomas was presented the inaugural Emeritus Clinician award by the Board on March 30 2017.

World-leading project is the 'best new weapon' against superbugs

Dr. Norelle Sherry with a superbug
Austin Health's Dr Norelle Sherry examines a superbag strain.

A world-leading study which aims to improve control of superbugs is one of five new cross-institution genomic sequencing projects announced by Health Minister Jill Hennessy at Austin Health.

Austin Health is co-leading the Controlling Superbugs project with the Microbiological Diagnostic Unit Public Health Laboratory. The project will assess whether genomic sequencing can track the transmission of antibiotic-resistant bacteria in real-time across multiple hospitals, improving control of superbugs and preventing further spread.

Austin Health is involved in all five disease areas in which selected patients will receive genomic sequencing through the Melbourne Genomics Health Alliance during 2017 to 2019. Genomic sequencing enables the examination of a person's, or a bacteria's, complete genetic information to identify gene changes that may impact health or, in the case of superbugs, enable more accurate characterisation.

Controlling Superbugs project co-clinical lead and Austin Health clinician-researcher, Dr Norelle Sherry says superbugs are a rapidly escalating global problem and genomic sequencing is our "best new weapon" in the fight against them.

"Genomic sequencing of antibiotic-resistant bacteria can more accurately identify these bacteria and their antibiotic resistance. It can also provide information to map how superbugs are spreading,'' Dr Sherry says.

Controlling Superbugs is the first project internationally to investigate the impact of rapid genomic sequencing of superbugs on individual patient care and hospital-wide infection control strategies.
"Rapid genomic sequencing of superbugs means that results can be reported in a matter of days, enabling real-time action on reducing infection risk.

"We are building a world-leading model for a real-time, state-wide, genomics based superbug tracking system that will improve protection for all Victorians." Dr Sherry says.

Dr Sherry says sequencing may also help identify the best treatment for a patient's superbug infection, which ultimately reduces the risk of bacteria developing further antibiotic resistance.

Patients at particular risk from superbugs include those in intensive-care units, those being treated for cancers or particular blood disorders and transplant recipients.

Experts at Austin Health, The Royal Melbourne Hospital, Monash Health and the Peter MacCallum Cancer Centre, together with the specialist genomics laboratory at the Microbiological Diagnostic Unit Public Health Laboratory, will test bacterial isolates from 1700 patients over the next 18 months.

Austin Health is also leading a genomic sequencing project aimed at improved diagnosis and care of patients with complex neurological and neurodegenerative disease. Along with our project partners we are also involved in the other projects which are:

• Better understanding the cause of a patient's bone marrow failure, enabling more personalised medical care and improved identification of relatives at risk.
• Better understanding of the cause of multiple abnormalities of babies who die in utero or in early infancy.
• More accurate diagnosis and improved patient care for genetic kidney disease.
For more information visit melbournegenomics.org.au.

New patient and family network for those living with a tracheostomy

"I wanted a life! So I just woke up one morning when they come around and said: I'm going home with a trachy," says Colin Gray. 

The dairy farmer and CFA volunteer became quadriplegic in a farming accident in 2011, and repeat admissions to intensive care due to chest infections left him flat on his back.

Colin informed his treating team that he wanted to go home with a permanent tracheostomy tube - a breathing tube inserted into his windpipe (trachea) through a hole in his neck. He wanted to carry on with his life, his business and one important goal: to walk his daughter Robyn down the aisle on her wedding day.

"It was a pretty proud day to be honest. It was just fantastic," says Colin.

It was the first of many life goals that Colin has achieved since with the assistance of Austin Health's Tracheostomy Review and Management Service (TRAMS), one of the leading tracheostomy services in the world.

People with a tracheostomy treated at Austin Health are more likely to learn to speak earlier, wean earlier from a ventilator and be able to live in the community than those treated in most other hospitals.
TRAMS is a founding member and model service for the Global Tracheostomy Collective (GTC), which aims to make the outcomes achieved for patients by Austin Health standard across the world.

Colin, who is used to running a business, values that he has always been able to set the agenda for his care. He works with TRAMS to tailor his program to his specific tracheostomy needs. He also shares his experiences with his clinicians to benefit other patients.

For example, he recently developed an infection in his stoma; the hole in his neck where his tracheostomy tube is inserted TRAMS helped him to access additional nursing care and in consultation with TRAMS, Colin has come up with a new process for stoma care that reduces his risk of developing another infection: "Instead of one dressing under the trachy, we now use two. With two dressings, a carer can slip one out and you still have a dry one underneath," he explains.

The GTC now has over 100 patient and family members, who can join for free. The GTC's patient and family committee plays a critical role, teaching healthcare professionals about the experiences of people living with a tracheostomy, to lead to improved care.

TRAMS nurse consultant Kristy McMurray, who is also the GTC's Patient & Family Committee Officer, says that setting up the committee is also "about creating a support network that doesn't currently exist for adult tracheostomy patients, where people can share their experiences, network with other patients, and where we can hear the patient's perspective."

Austin Health is hosting a Patient and Family event for past and present tracheostomy patients and their families on April 4th. The event provides an opportunity to meet and share stories with other patients and their families who have had or have a tracheostomy - including Colin Gray, and hear news about tracheostomy care around the world. To find our more, visit http://tracheostomyteam.org/patients/


See more on Colin Gray's story:

Telehealth connects people with nerve transfer surgeons who may be able to give them back use of their hands

Austin Health's nerve transfer surgery program is an Australian first, providing life-changing surgery to give people with quadriplegia use of their hands. Now a new telehealth program is helping surgeons connect with people around Australia to assess them for suitability - saving them from having to travel to Melbourne.

Hear about the program from plastic and reconstructive surgeon Natasha van Zyl and young dad Rob, who became quadriplegic in a surfing accident:


We need your help to raise $12,000 to purchase new equipment for the program, including a 42-inch LCD monitor, camera and audio.

This will vastly improve the amount of information we can learn from remote and regional patients without the need for them to travel to Melbourne. The only trip they need to make is for the surgery itself.

Find out more about the campaign.

Make a donation.

Nancy urges others to be aware of delirium

When her husband John started complaining of mysterious itching and getting up at strange times of the night, Nancy Panettieri couldn't work out what was going on.

"Then this particular Saturday morning, he was in a very bad way. By the evening, he said he could hear people having a party downstairs and things going on in the neighbourhood, but we live in a very quiet street. We made the decision together and rang the doctor, and they rang an ambulance," Mrs. Panettieri said.

John was admitted to Austin Health and diagnosed with a urinary tract infection.

"We didn't know. The paramedics found he had a temperature - and that week he'd had a lot of medication," Mrs. Panettieri said.

But it was another week before John received a second diagnosis that is often missed in the elderly: delirium.

For Nancy, in particular, the diagnosis was a relief. Things that had really frightened her finally made sense.

"I've spoken to my friends about this, and none of them have heard about it - apart from a few, who said they'd had a similar experience," she said.

"I really want people to know more about it, to be aware that it might happen to their relatives," she said.

Victoria Clague - who is the acting nurse unit manager of Ward 10 at Austin Health as well as the treasurer for the Australasian Delirium Society - says that sometimes delirium takes time to diagnose in elderly patients.

"If hospital staff don't know a patient, they need to determine if some degree of confusion is normal for them. The unfamiliar, noisy, hospital environment can cause a further layer of confusion to an elderly patient who is already unwell and it can take time for the patient to settle," she said.

Ms Clague said that one in four elderly patients in hospital develop delirium - and while it is usually brief and reversible, that some patients never fully recover. She too wants more people to know and recognise the signs of delirium, so that it can be caught earlier.

"With some forms of delirium - called hypo-delirium - the person just appears to be asleep for most of the time, and we need to be careful to wake those people up. They could slip into death if their delirium is not recognised," she said.

"With the more agitated states of delirium, some families leave shocked and in tears because they're so confronted and frightened by their family member's behaviour," she said.

"But the good news is if we can recognise it, we can treat it," says Ms. Clague.

This Wednesday 14 March was the first World Delirium Day. The aim for the first year is simply to increase the awareness of delirium amongst both the general public and health practitioners.

For family members, Ms. Clague says "if an elderly family member has significant and unexplained changes in behaviour, it may be a delirium. It's a particular risk in people with dementia or who've experienced delirium before, but anyone can experience it, even younger people."

For healthcare workers, there is a delirium awareness quiz and information sheet about how to recognise delirium at http://www.idelirium.org/

Sleep research could hold key to reducing road toll

Lead researcher Associate Professor Mark Howard

Ground-breaking Austin Health-led research means police could soon be able to test drivers for drowsiness, in a move experts believe will dramatically reduce fatigue-related road death.

Fatigue is a factor in up to a third of serious traffic accidents in Victoria, killing about 50 people and seriously injuring a further 300 in Victoria annually.

Experts believe the technology could hold the key to changing driver behaviour toward getting behind-the-wheel while tired in the way that alcohol testing has changed attitudes to drink driving.

Research lead, Austin Health and Institute for Breathing and Sleep, sleep and respiratory specialist Associate Professor Mark Howard and his team have successfully tested the technology, which involves using "smart glasses" to track eye movements, including the duration of blinks and how eyes scan the road, to accurately measure driver fatigue levels in both laboratories and off-road driving simulations.

Researchers studied drowsiness in night-shift workers during driving tests and found a tenfold increase in ‘microsleeps' and double the number of lane crossings.

They also found drivers struggled to keep their eyes open and had more trouble staying in the middle of a lane.

Prof Howard says they are now working on translating technology calibrated for each driver to a one-size-fits-all-test that police could use to scientifically determine in a roadside test if someone is too tired to drive.

Assoc Prof Howard says a big part of the problem is a low awareness of what it means to be too tired to drive.

"Usually there has been simple messaging for this; if you feel fatigued stop driving. But that means different things to different people," he said.

"I have clinical examples where people have run off the road, hit a tree, and nearly killed themselves," Assoc Prof Howard says.

"You'll ask them: ‘Were you tired? They'll say ‘no'.

"Then you'll ask: ‘Did you wind the window down?'

"They'll say: ‘Yeah and I also turned the radio up to help keep me alert - but I wasn't tired," Assoc Prof Howard says.

He says raising awareness of what it means to be tired will be key to reducing deaths.

"With drug and alcohol testing, you're trying to change driver behaviour. You don't need to detect everyone - just the tip of the iceberg people who are very impaired.''

"Education, with measurement and enforcement, creates the behaviour change''.

"We are really at the start of the journey for drowsy driving - people still see it as a badge of honour to drive while tired".

Assoc Prof Howard says a key to progress the research will be the establishment of a Centre of Excellence in Respiratory and Sleep Medicine at Austin Health. A collaboration between Austin Health and the Institute for Breathing and Sleep, the Centre will provide a world-class research and specialist clinical care hub under the one roof. For more information visit: http://centreofexcellence.austin.org.au/.

Back on your bike! Can bicycle riding in your hospital bed help recovery after a hip fracture?

A/Prof Cathy Said
Director of Physiotherapy Research A/Prof Cathy Said (right) is leading a team of researchers that includes physiotherapist Marissa Delahunt and Physiotherapy manager A/Prof Sue Berney to investigate whether recumbent bike riding while still in bed can improve the outcomes for people with a fractured hip.

Imagine this: your Nan is getting very old and frail, but is still living independently and doing well. Until she falls, fractures her hip and ends up in hospital. She has surgery and pain-relief drugs, but ends up confused and delirious, and can't get out of bed. Then she gets a pressure wound and a urinary tract infection from lying in bed... and ultimately, never returns to the level of health and mobility she had before the injury.

Unfortunately, it's not an uncommon scenario - but it's one that Austin Health's Director of Physiotherapy Research A/Professor Cathy Said and her research team hope to change for the better.

They've received the Austin Medical Research Foundation's largest 2017 grant - $30,000 - to investigate whether recumbent bike riding while still in bed can improve the outcomes for people with a fractured neck of femur, the most common type of hip fracture in elderly people.

"We know that people do better if we can get them up and walking within a day or two of their surgery, but that's not always possible," says Dr Said. "Some are too confused, or there might be physical or medical reasons that make it difficult to get them out of bed, like low blood pressure.

"If we can get people exercising while they're still in bed, we're hoping that it will result in better mobility as well as a reduction in some of the adverse events related to surgery and being in bed for a long time, such as delirium and confusion, respiratory problems, pressure injuries and urinary tract infections. It may also be safer way for staff to exercise patients.

"We know that some people have a lot of trouble regaining mobility after a hip fracture and some never get back to the level of function that they had before, and we know that people who are old and frail don't do well lying around in a hospital bed - which is why it's important to get them up and moving sooner rather than later," says A/Prof Said.

The research team, which includes A/Prof Said, Physiotherapy manager A/Prof Sue Berney, physiotherapist Marissa Delahunt and director of Orthopaedic Surgery, Mr Andrew Hardidge, will spend the $30,000 to purchase a new recumbent bike like the one pictured to use at Heidelberg Repatriation Hospital and for research staff to carry out the intervention.

They build on a body of research coming out of Austin Health's Physiotherapy Department demonstrating that the earlier you can get patients moving again after injury or illness, the better they recover - including a world-first trial in which unconscious patients in the intensive care unit were strapped to a similar style of bike, which found that exercise while still in ICU may improve patients' function and reduce delirium.

The AMRF funds research undertaken at Austin Health that aims to improve the care we deliver to patients, and recently allocated over $320,000 in grants for 20 new research projects. Support the great research done here at Austin Health or see the full list of grant recipients for 2017.

The Surgery Centre to see more patients sooner

When Rachel Brown was referred to The Surgery Centre (TSC) for a knee operation, she wasn't expecting to be the very first person to sit in the recliner that she was allocated - or to wait only three weeks for surgery.

"It's very nice! It's very open here now and must be much nicer for the staff to have all this space and be able to move around. You can see that a lot of thought's gone into the design," she said admiringly. 

Rachel was one of the first patients to be treated in the expanded ‘satellite' to the TSC, which is seven spaces bigger from this Wednesday - with an additional four beds to open on the ward within weeks.

The additional capacity is expected to supercharge the surgical output of The Surgery Centre. Last financial year, TSC treated more than 10,000 patients - and this latest capacity boost should see them treat around 15 per cent more patients each week. These renovations will see TSC functioning with two discrete areas - a 32-bed ward for patients who need overnight care, and a 21-space satellite especially for same-day surgery patients.

When TSC first opened at the Heidelberg Repatriation Hospital in 2008, it brought a new way of doing surgery to Austin Health. Protected from the Austin Hospital's growing emergency surgery demands, TSC could offer a near-guarantee that people would get their surgery on the day that it was booked. By focussing on simple, non-urgent procedures, TSC began completing 6,000 surgeries a year.

Local waiting times for category three and four procedures (those considered non-urgent) began to plummet, and several expansions later, TSC is now open 7 days a week, runs with eight operating theatres, and completes increasingly complex procedures.

While very happy with the speed of service, for Rachel, it's the care she and her family have received that's left the greatest impression. After years of working in the disability sector and teaching dance, this is the second time in a year that she has needed an arthroscope to tidy up and repair damaged tissue in her knees - and she was last at TSC only a week ago when her 9 year old son needed surgery after injuring his foot.

"The care has been amazing. Even the guy who puts you in the wheelchair to take you to surgery is so lovely. And my son's care was amazing too. That's so important for those who come in feeling anxious," she says.

"You feel like a person, not a number. We're so blessed to have a hospital with facilities like this so close to home," she said.

Media Release: The 'eHarmony approach' to improving liver transplant outcomes

12th January, 2017


The concept used by global matchmaking giant eHarmony to pair lonely hearts may hold the key to improving liver transplant outcomes and reducing the number of viable livers which are unused.

In an Australian-first, an Austin Health led study recently published in Transplantation journal found using artificial intelligence to predict the outcome of future transplants can greatly improve the accuracy in matching donors and recipients - leading to less graft failures and deaths post-transplant. The Chief Investigator, Austin Health's research fellow Dr Lawrence Lau said the study used machine-learning - a type of artificial intelligence that provides computers with the ability to learn without being explicitly programmed.

"Machine-learning algorithms can be trained to predict the outcome of a new event, based on multiple interactive factors observed in previous events where the outcome is known," Dr Lau said.

"This approach not only considers the influence of each variable, but also looks at how the variables interact with each other in complex, interdependent ways.

"This is the same concept eHarmony uses to match those looking for love with potential partners. eHarmony considers hundreds of variables in deciding the ideal match for prospective partners. Similarly, long-term organ/recipient compatibility is our ultimate aim and this is dependent on many different interactive donor and recipient factors."

The study, which was in collaboration with University of Melbourne Department of Computing and Information Systems PhD candidate, Yamuna Kankinage, used Austin Health liver transplant data from 2010-2013. The top 15 donor, recipient and transplant factors influencing the outcome of graft failure within 30 days were selected using a machine-learning methodology and an algorithm predicting the outcome of graft failure or primary non-function was developed based on those factors.

Dr Lawrence Lau said the study found the method had an accuracy rating of 84% at predicting graft failure 30 days post-transplant compared to 68% with current methods.

"At the moment there's really no method to determine the safest and most effective way to use the scarce donor livers. It largely comes down to a surgeon's judgement call of who we should give a particular organ to," Dr Lau said.

"This study is a proof-of-concept that machine-learning algorithms can be an invaluable tool, supporting the decision-making process for liver transplant organ allocation.

"The benefits of being able to assess the suitability of organs in a quantitative way, and to assess how well they match a particular recipient, are huge.

"Currently about 10% of Australian patients in need of a liver transplant die on the waiting list. Because our current donor liver assessment method is subjective, sometimes probably viable organs are discarded. This technique would minimise this.

"It could also reduce patient mortality post transplant and the need to re-transplant, both of which continue to be big problems in liver transplantation.

"The idea to use machine-learning algorithms came from a desire to replicate the experience of some of our most senior clinicians, like Austin Health's Professor Bob Jones, who has over 30 years liver transplantation experience and performed Victoria's first liver transplant in 1988, in a quantifiable way. This tool can then be used by transplant surgeons to make better calculated decisions in the future."

Dr Lau said the concept could be successfully applied to many other areas of medicine such as in cancer detection, prognostication and treatment planning to enhance clinical decision-making.

"Machine-learning algorithms are already used across a wide range of fields including search engines, agriculture, financial markets and match-making. There is so much untapped potential to apply this in medicine," Dr Lau said.

The next step is to perform a randomised prospective trial, pitting liver transplant decisions aided by specially designed machine-learning algorithms against unaided clinician-made decisions.

Chronic viral hepatitis is the leading reason for liver transplantation. Each year, approximately 2500 Australians die from Hepatitis C while over 7000 die from chronic liver disease overall.

For interviews with Dr Lau please contact Julie McNamara, Austin Health Corporate Communications on: 0419 595 688

Fellowship to support research into transgender health

Austin Health endocrinologist Dr Ada Cheung is set to begin 2017 as the new Bernie Sweet Clinical Research Fellow. Dr Cheung will use the $25,000 grant to investigate the bone effects of hormone therapy in people who are transgender - the first time that the fellowship has ever been used to support transgender health research.

Dr Cheung, from the new Transgender Research Group, is seeing an increasing number of transgender patients. She says that people who are transgender or gender diverse can experience distress because their physical appearance does not match their inner identity, contributing to alarming rates of depression and suicide.

"Cross-sex hormone therapy can relieve that distress," Dr Cheung says. "But there is much we don't understand about hormone therapy. Which hormonal treatments work best? One drug or two? How fast? What are the side effects? And is this safe? Our research seeks to answer these questions," she says.

"We know that sex hormones are critical for bone health and when we treat transgender individuals, we usually reduce their natural levels to nearly zero. This must have some sort of effect on their bones and we want to study this. It will help inform transgender individuals and their treating doctors about potential risks and allow us to monitor for or prevent any possible side effects on their bone."

"There is a profound lack of good quality medical research in the trans and gender diverse area and as such clinical care is not evidence based. Traditionally there has been a lack of awareness and sensitivity in health care that has perhaps led to inadequate access to health care and disparities in the health system for this population, and lack of medical research in this area. I want to change this," Dr Cheung says.

To undertake the research, Dr Cheung will collaborate with the Bone Research Group, which is also based at Austin Health's Endocrine Centre of Excellence. Researchers will use the group's state-of-the-art high resolution 3D bone scanner to compare the 3D structure of bone in people starting cross-sex hormone therapy with people the same age who are not undertaking the therapy.

Dr Cheung will begin looking for participants once approval from the Austin Health Human Research Ethics Committee has been finalised.

She has also founded a not-for-profit organisation called the True Colours Medical Research Fund, to crowdfund medical research to advance healthcare for trans and gender diverse people. It will have a presence at Midsumma Festival on January 15 and is supported by Austin Health, The University of Melbourne and TransGender Victoria.

The Bernie Sweet Clinical Research Fellowship is the flagship grant awarded each year by the Austin Medical Research Foundation (AMRF). The AMRF supports research undertaken at Austin Health, and recently allocated over $320,000 in grants, for 20 new research projects to begin in 2017.

If you'd like to support the great research done here at Austin Health, visit http://austinmrf.org.au/support-amrf

Austin Health receives $4.8 million NHMRC grant for study into chronic pain post surgery.

Ketamine infusion

Austin Health will lead a $4.8 million study which may be a game-changer in preventing chronic pain after major surgery.

Chief Investigator, Austin Health’s Professor Philip Peyton has received the largest Australian National Health and Medical Research Council Project grant for 2017 to carry out the ROCKET (Reduction of Chronic Post-Surgical Pain with Ketamine) trial.

Assoc Prof Peyton said a recent large study showed 12% of patients who have major surgery – particularly abdominal, thoracic or orthopaedic surgery – developed long-term pain as a result of their surgical wound.

 “This funding is an affirmation that this condition is a major health problem,” Assoc Prof Peyton said.

“The trial will answer one of the most important clinical questions in our field,’’ Assoc Prof Peyton said.

“Chronic pain not only has a major detrimental impact on patients’ quality of life but it also is likely to cost the Australian economy billions of dollars annually in lost productivity and additional medical costs.”

Data from a number of small studies indicates ketamine might make a difference to chronic pain post surgery but a large trial is needed to provide a reliable answer.

The international study will involve almost 5000 patients who will be followed for 12 months post their surgery.

All patients on the trial will receive standard anaesthesia and post-operative pain relief while half of the patients will also receive ketamine as part of their anaesthesia and then for post-operative pain relief for up to three days post-surgery.

“Ketamine is a powerful analgesic that targets specific pain receptors in the nervous system that we think might be involved in the development of chronic pain,” Assoc Prof Peyton said.

“Ketamine might influence the development of processes in the central nervous system that lead to this.’’

The study will also focus on patients’ well being and quality-of-life post surgery.

The trial will begin in mid-2017.

Over $12 million in research funding will flow to Austin Health from the December round of NHMRC funding.

Perinatal mental illness continuing to go unrecognised, undiagnosed and untreated, say Austin Health-based research team

mum and baby

Mental illness during pregnancy is going unrecognised, undiagnosed and untreated, according to researchers from the Parent-Infant Research Institute (PIRI) at Austin Health.

And as Perinatal Depression and Anxiety Awareness Week draws to a close, there is still much to do to increase awareness of perinatal mental health conditions other than depression. These include anxiety - which is nearly as common as depression, as well as postnatal psychosis, obsessive-compulsive disorder and post-traumatic stress disorder, says PIRI director, Professor Jeannette Milgrom.

"Under recognition is a serious problem that reduces women's likelihood of seeking help."

"Even with post-natal depression, which is better recognised, few women are treated at all and even fewer are treated adequately," Professor Milgrom says.

This is despite research showing that treatment can be effective: in fact, recent research from PIRI into an Internet-based CBT program for postnatal depression found that 79% of women who received the treatment no longer had depression.

A similar trial is now investigating whether the program is effective for pregnant women too.

The need to improve understanding and treatment of perinatal mental health is an epic one, and to undertake this task, a new Global Alliance for Maternal Mental Health (GAMMH) was recently launched in Melbourne, with PIRI as one of the founding members..

"The Alliance is based on a successful model from the UK, which saw over 60 organisations from different sectors form an alliance, which significantly improved understanding of perinatal mental health and accelerated the availability of care," Professor Milgrom says.

When left untreated, perinatal depression and anxiety may lead to complications for unborn babies, including preterm birth and low birth weight. For conditions that continue into the postnatal period, children are at increased risk of worse emotional, behavioural and cognitive outcomes. There is also increased risk of infanticide in the most severe cases.

"At PIRI and in the Mother-Baby Unit at Austin Health, we've observed the impact on children and have actually pioneered treatment that focuses on the mother-baby relationship and on dads, rather than just the mother herself."

"There's a need to transfer what we know from research into identification and treatment programs that provide help to all women and children affected by perinatal mental health conditions," Professor Milgrom said.

Some facts:
  • For approximately 20% of women, depression and anxiety can begin during pregnancy.
  • Many women are concerned about seeking treatment while pregnant or breastfeeding. However, timely access to treatment is likely to benefit your unborn and new baby.
  • Online treatments can be effective and are easy to access - visit MumMoodBooster.com to find out more.
  • Perinatal mental illness comes in many forms - if you don't feel depressed but still feel like you're not okay, speak to your GP.

To support great research done right here at Austin Health, make a donation to the Austin Medical Research Foundation.

Austin Health leads a revolutionary approach to reduce coronary heart disease

We all have one. The annoying friend who spends five minutes getting the perfect shot of their café breakfast before the rest of the table is allowed to take a bite. Down-to-earth Gary McQuiggan doesn't strike you as the type of bloke who would fit this category but since April he's whipped out his smartphone to take shots of almost every meal that's passed his lips.

Gary isn't taking photos to gain ‘likes' on social media though, he's taking them to save his life.

Taking food ‘selfies' is an integral part of an Austin Health led smartphone based rehabilitation trial Gary joined after suffering a heart attack in April.

Austin Health Interventional Fellow, Dr Matias Yudi is the brains behind the CardiacMate trial which aims to reduce the recurrence of cardiac problems for people who have suffered heart attacks by providing them with ongoing support and guidance when they return home from hospital.

Funded by the Heart Foundation and the Victorian Government, the innovative trial has just finished recruiting patients across six Melbourne hospitals. Dr Yudi was recently named the Heart Foundation's Victorian top-ranked Health Professional Scholar for his work. With the rising popularity of smartphones, Dr Yudi says it makes sense to harness the latest technology to try and reduce coronary heart disease - the world's leading cause of death.

"We know heart attacks are preventable through simple lifestyle modifications and better medical therapy," Dr Yudi explains.

"In an era where prevention is better than cure I think we need to take responsibility and start looking after the patients more holistically and for longer periods of time.''

Dr Yudi says most patients start off with good intentions but, unfortunately, for many, life gets in the way and they slip back to their old unhealthy habits.

"The trial means we can follow patients wherever they are. It makes them more accountable and we can provide them with targeted support and advice''.

Patients are encouraged to upload photographs of every meal they eat so medical staff can provide dietary feedback. The program also tracks physical activity levels through the smartphone's accelerometer and provides interactive feedback and goal setting while a dynamic dashboard is used to review and optimise cardiovascular risk factors.Medical staff send regular health education messages, provide pharmacotherapy review and offer words of encouragement via the app while patients can send staff questions through a built-in messaging service.

Gary lost 11kgs on the program, returning to a healthy weight and also dramatically lowered his cholesterol and improved other risk factors in the process.

"It has absolutely changed my life,'' the father-of-two enthuses. "I knew that I had to change my habits but it was a matter of doing something about it. I never ate a lot of junk food but I ate too much - one of the things the program really helped me do was reduce my portion sizes.Knowing that someone is going to be analysing the food you put on your plate definitely influences what you choose to eat."

The app also spurred the Lower Plenty man to adopt an active lifestyle.

"I used to play a lot of sport when I was younger but as I got older I became less active. Now I'm walking 75kms a week and I feel guilty if I don't get out there.''

Gary lives alone and says another benefit of the app is it helped him feel less isolated post the emotional trauma of his heart attack.

Preliminary results of the trial will be available in February 2017.

Arthritis drug Celebrex creates no greater heart attack risk than similar drugs, discovers game-changing international trial

medication

The widely-prescribed arthritis drug celecoxib (marketed as Celebrex) presents no greater risk of heart attack or stroke than comparable NSAIDs naproxen or ibuprofen, according to a 10-year, Cleveland Clinic-led trial published today in the New England Journal of Medicine.

The result "is a real game-changer" for patients, according to the only Australian author on the study, Austin Health's Professor Emeritus Neville Yeomans, because celecoxib is also around 50 per cent less likely to create dangerous stomach ulcers than more traditional NSAIDs (non-steroidal anti-inflammatory drugs). It has also been found to be protective against the recurrence of pre-cancerous polyps in the bowel.

Other NSAIDs in the same class as Celecoxib/Celebrex - known as COX-2-selective NSAIDs - were taken off the market after two large clinical trials into these drugs were abandoned in 2004 due to concerns about the heart attack risk that they presented.

Since then, Celebrex has come with warnings about its potential cardiovascular risk, and arthritis patients who are thought to be at risk of developing heart disease are usually advised to take one of the more traditional NSAIDs, despite the higher risk of stomach ulcers and gastrointestinal bleeding.

"Most of the consensus guidelines given to doctors ask them to weigh up their patients' potential gastrointestinal and cardiovascular risks and choose an NSAID accordingly, but these are based on evidence that's scanty and fragmentary at best. These results are striking and clear cut, and have bucked what the consensus guidelines have been advising for the last 10 years at least," Prof Yeomans says.

"What was a real surprise was that, in some of the analyses, Celebrex actually caused significantly less cardiovascular events than the traditional NSAIDs. I think this will see the guidelines being rewritten," he says.

NSAIDs work by inhibiting the release of pain and inflammation-causing prostaglandins, but in doing so, also inhibit the useful prostaglandins in the stomach that protect the lining of the stomach from being damaged from the strong acids in the stomach.

NSAIDs prevent the release of these prostaglandins by inhibiting an enzyme called cyclooxygenase (COX).

The discovery that there are in fact two types of COX; COX-1, which is responsible for producing stomach-protective prostaglandins, and COX-2, responsible for the pain-producing ones, sparked a pharmacological treasure hunt for NSAIDs that that only inhibit COX-2.

Following the abandonment of the 2004 trials, Celecoxib/Celebrex is now the only COX-2-selective NSAID available in Australia.

"It's possible these results will reignite the hunt for effective COX-2-selective NSAIDs that have fewer of those side effects like stomach ulcers, bleeding and nausea," Prof Yeomans says.

The research was published in the New England Journal of Medicine today, at http://www.nejm.org/doi/pdf/10.1056/NEJMoa1611593

The original Cleveland Clinic media release is available at http://cle.clinic/2fPuVPH

Professor Yeomans is Director of Research at Austin Health.

To support great research at Austin Health, donate to the Austin Medical Research Foundation.

Immunotherapy trial successes provide new hope in the battle against cancer

"It may sound a bit rough, but this is a really good time to have cancer. I'm really lucky to have got cancer at this time when these treatments are available" says Andrew Howard, 29.

While part of a six-month immunotherapy trial at the Olivia Newton-John Cancer Wellness & Research Centre, Andrew's tumours shrank at a "great rate" and nearly 3 years later, he is cancer free. For all the hope that immunotherapy provides, however, the fact remains that not everyone benefits from the treatments.

"There's a real task to try to identify the patients who are going to benefit from treatment, and to understand why others don't," his oncologist and medical director of the ONJ Centre, Professor Jonathan Cebon says.

Support us to do more research like this. Join Olivia Newton-John and Steve Moneghetti at the Wellness Walk and Research Run this Sunday! Register now at http://fundraisingoliviaappeal.com/event/WWRR16

Read more of Andrew Howard and Professor Jonathan Cebon's story in the South China Morning Post.

 

Buruli ulcer in the media

Professor Paul Johnson is the country's leading expert on Buruli ulcer (Mycobacterium ulcerans), and has been in the media recently due to an increase in cases in Victoria, and the discover of cases in suburban Melbourne for the first time. The number of cases in Victoria has increased from 32 in 2010 to 106 in 2015.

If you are concerned that you may have an ulcer, please visit your GP. Buruli ulcers are treatable. If diagnosed accurately early, they often remain no larger than a pimple.

GPs can find the latest clinical guidelines in the Medical Journal of Australia

Professor Johnson, who is deputy director of the Infectious Diseases Department at Austin Health and director of the World Health Organization Collaborating Centre for Mycobacterium ulcerans, also maintains a website on Buruli ulcer in Australia.

Recent media coverage has included the Age and ABC Online.

The Surgery Centre treats 10,000 this year

"I've only waited a month and a half for surgery - I'm very pleased! My hip's been giving me a bit of pain at night when I lie horizontal, and I've had to take painkillers morning and night. It's just a blessing to get it done so quickly," says 73 year-old John Connor, who last week became The Surgery Centre's 10,000th patient for the financial year.

It's the first time that The Surgery Centre (TSC) has ever clocked such a high number of patients, and TSC has now doubled the number of patients it treats per year since its first year of operation, 2008/09, when it treated 5008 patients.

Its work has had particular impact for orthopaedic surgery patients like John, who waited just 48 days for his hip replacement.

Since four new operating theatres were opened at TSC in late 2013, which allowed it to increase its capacity and perform a greater variety of surgeries, Austin Health's elective orthopaedic surgery waiting list has nearly halved from 1030 people, to 590.

TSC is about to expand again due to new funding for additional beds in the inpatient ward (which is going to expand from 28 to 32 beds Monday to Friday), and additional chairs in the satellite ward (which will rise from 14 to 21 chairs, Monday to Friday).

Surgery at TSC is completely separated from the emergency surgery that occurs at the Austin Hospital, meaning that elective procedures that are planned there never need to be cancelled because of emergency surgery that needs to take priority.

We're aiming to raise $42,350 by 30 June to buy new equipment for the operating theatres at TSC. With new equipment available to staff, we can perform more elective surgeries and shorten waiting times even more. If you're interested in helping, visit Support Us

 

Cutting-edge project aims to improve detection of cardiac disease

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Identifying life-threatening cardiac conditions earlier is the key aim of an innovative project being led by Austin Health.

Dilated cardiomyopathy (DCM) enlarges the heart and reduces the organ's pumping function - in severe cases it results in heart failure and death.

Austin Health consultant cardiologist and project lead, Jay Ramchand says although the cause of DCM often isn't known, as many as one-third of those who have the disease inherit it from their parents.

"The project will test patients who we know already have DCM,'' Dr Ramchand said.

There are different genetic abnormalities that can cause DCM. The project is aimed at finding a specific genetic abnormality in an affected individual. If the testing comes back positive, doctors will then go on to test the same gene in this person's immediate family members.

"We will use a blood test to test the section of the person's genetic information that is relevant to the disease.''

"Usually, if there's a family history of the disease, family members need to undergo cardiac testing every five years. Being able to undergo a single genetic test would remove that stress and burden of life-long assessments and, importantly, may allow earlier intervention.

"We can start medications that may prevent progression of heart disease while the person is still healthy and fit,'' Dr Ramchand said.

"This may reduce the severity and delay the onset and hopefully, may even prevent it all together''.

The project is part of a suite of projects being delivered by the Melbourne Genomics Health Alliance, a partnership of ten leading hospitals and research organisations devoted to finding the best way to bring the benefits of genomics - testing of a person's entire genetic sequence - to everyday healthcare.

The disease areas were selected by experts as those where genomic sequencing is most likely to benefit patients and their care, in comparison with current approaches.

The DCM project is looking to recruit people under the age of 40 who has already been diagnosed with DCM or anyone who has a family member with DCM.

Patients will be recruited through Austin Health, Monash Medical Centre, The Royal Melbourne Hospital and The Royal Children's Hospital.

For further information contact Dr Ramchand on: 0421 047 607.

For more information about the Melbourne Genomics Health Alliance visit: http://www.melbournegenomics.org.au/

To learn more about the DCM project read this Q and A with Dr Ramchand: http://www.melbournegenomics.org.au/news/take-heart

Prof Proietto honoured for lifetime of service

Prof Joe Proeitto_Newsroom.jpg

World-renowned investigator into obesity management, Professor Joseph Proietto has been appointed a Member in the General Division of the Order of Australia for his ground-breaking research and work as a clinician, teacher and mentor.

Prof Proietto heads Austin Health's Weight Control Clinic and was recently appointed to the executive of the World Obesity Federation which is tasked with educating health care professionals from across the globe on how to treat obesity.

The Sicilian-born Professor is delighted his work has been acknowledged.

"It's a great honour for me especially given my origins. I came to Australia aged 8 and not speaking a word of English. I was from a non-academic family and I guess this shows that society appreciates the work we have done in diabetes and obesity,'' Prof Proietto says.

In 2011 Prof Proietto and his team discovered the reason most people regain weight after weight loss. They showed that following weight-loss, the 10 circulating blood hormones that regulate hunger change their levels in a direction to make the person more hungry and that these changes persist for at least one year. Prof Proietto says this explains why most people struggle to maintain weight loss and justifies the use of appetite suppressants for weight maintenance.

In 2014 he spearheaded research which disproved the myth that the quicker you lose weight, the quicker you will regain it. In this study he and his team also found that rapid weight loss is easier and more successful than gradual weight loss and that the hormone changes that occur during weight loss are still evident three years later.

He loves putting his research into practice at Austin Health's Weight Control Clinic.

"It's very satisfying helping people to lose weight and improving their diabetes control. It's incredibly satisfying because they can see the changes in themselves and feel so much better after some weight loss,'' Prof Proietto says.

 

Victorian-first radiotherapy machine to treat more cancer patients, sooner

Rebecca Davies, a 33-year-old mother of three who is one of the first patients in the state to benefit from the targeted imaging.

A Victorian-first radiotherapy machine which will be able to more accurately target tumours in cancer patients has been unveiled at the Olivia Newton-John Cancer Wellness & Research Centre (ONJ Centre).

Victorian Health Minister Jill Hennessy officially launched the $3 million linear accelerator which enables more precise imaging and radiotherapy treatment to tumours, therefore minimising damage to surrounding tissue and reducing possible side-effects.

The ElektaTM linear accelerator provides a unique 4D imaging technique on the treatment machine, a first for Victoria. The technique allows for real time video to show precisely where the tumour lies, and how it may be affected by a patient's breathing. By providing a precise location, doctors are able to target radiotherapy treatment to the tumour area and avoid surrounding normal organs or tissue and reduce possible side effects.

This is great news for patients like Rebecca Davies, a 33-year-old mother of three who is one of the first patients in the state to benefit from the targeted imaging.

Mrs Davies will attend the ONJ Centre for six weeks to receive treatment including radiotherapy, chemotherapy and possible surgery in order to tackle her stage 3 lung cancer diagnosis.
Her recent diagnosis has given Mrs Davies an insight into the way the ONJ Centre offers support to patients and their families.

"It's a comfort to know that I'm able to access the newest technology in a world-class facility. The machine's targeting will help not only treating the cancer but also look after my long term health by being so targeted," Mrs Davies said.

"I'm feeling really positive; the team is looking after me and it's great to see them working together not just on my cancer but on looking after me and my family, being really clear and allowing me to participate in my treatment by making sure we are as informed as we want to be."

The ONJ Centre's director of Radiation Oncology, Associate Professor Farshad Foroudi, says treatments can be adapted daily to allow for even slight changes in patient and organ movements, improving precision and giving patients a better treatment experience.

"For some patients the new technology will also mean that they will need far less treatments than previously to see significant results,'' Assoc Prof Foroudi said. "This means fewer visits to the hospital, a reduction in side effects and - because fewer treatments are required - we will have more availability to treat more patients."

State Government funding boost

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Health Minister Jill Hennessy, CEO Dr Brendan Murphy and Mr Agnostopoulo

Austin Health will be able to treat emergency and surgical patients more quickly thanks to a State Government funding boost.

Our ambulatory care centre is set to undergo a $500,000 upgrade meaning that more acute beds will be available for the sickest patients and there will be a better flow of patients through surgery and emergency.

The expansion is also good news for the day patients who use the Ambulatory Care Centre regularly - like John Agnostopoulo, 81, - as it means they will be treated more quickly and will be able to return home sooner.

Health Minister Jill Hennessy met Mr Agnostopoulo and his wife Kolliopi while touring the current centre.

A great-grandfather and retired small business owner, Mr Agnostopoulo attends the centre every three weeks for treatment to drain fluid that accumulates in his stomach as a result of a liver condition.

The funding will create an additional ambulatory care treatment spaces and will also mean the centre's transit lounge will be able to treat 50% more patients each day.

The transit lounge is used by inpatients who are medically ready for discharge but need to wait for something like discharge medications, a final consultation from physiotherapy or dietetics, or because the person coming to collect them is unable to make it until later in the day. Moving well patients to the transit lounge frees up ward beds for seriously ill patients who need to be admitted to a ward from the Emergency Department and also frees up surgical ward beds so the hospital can increase surgical activity.

 

New Austin Health research finds many antibiotic allergy labels are incorrect

Dr Jason Trubiano
Dr Jason Trubiano

Do you think you have an allergy to a ‘first-line' antibiotic, such as penicillin? You could be wrong, new research from Austin Health doctor Dr Jason Trubiano indicates - and may be being treated with more restricted antibiotics that are less effective and more likely to drive antibiotic resistance.

"We need to remove those unnecessary antibiotic allergies from people's drug charts," Dr Trubiano said.

"Not all allergies are the same, and some people who had a reaction a long time ago might not find that their allergy label is relevant anymore. They should talk it over with their GP and if needed, get a referral to the Antibiotic Allergy Clinic at the Austin Hospital."

Hear more about Dr Trubiano's research from his interview with Norman Swan on ABC Radio National's ‘Health Report' on Monday 18 April 2016.

You can also read the original research published in last Monday's Medical Journal of Australia (MJA), or:

New funding to mean patients get surgery sooner

Minister Charles Woods and Shakala
Health Minister Jill Hennessy meets knee replacement surgery patient Charles Woods and his granddaughter, Shakala

Charles Woods had been counting down the days until his knee replacement surgery at Austin Health last week. Each day took him one day closer to getting back to activities he loves, like going for a walk.

He and 9 year-old granddaughter Shakala - who used the experience to practice her nursing skills on her granddad - were amongst those thrilled to hear Health Minister Jill Hennessy announce a $335 million funding package to reduce elective surgery waiting lists in Victoria.

The $335 million includes funding over four years for nearly 200,000 additional elective procedures and a $20 million capital works injection.

"We want Victorians happy and healthy. The sooner they can get their surgeries, the sooner they can recover and get back to their normal lives and families," Minister Hennessy said. She said the additional funding this year would provide the equivalent of 3100 coronary artery bypass grafts, or 6700 hip replacements.

Austin Health will receive money to expand the Austin Hospital's Transit Lounge and Ambulatory Care Centre. At the Heidelberg Repatriation Hospital, this funding will provide four new surgery beds, an expansion of the specialist clinical capacity and a new allied health treatment space.

Launch of Genetics in the North East

Tracey Hamilton and her daughters Chelsea, 17 and Destiny, 15 have all had their thyroids removed after genetic testing revealed a mutation that increases their risk of thyroid cancer.

Identical scars on their necks will forever remind the Hamiltons of the life-saving care their family has received.

Genetic testing revealed Tracey Hamilton, 39, and her four children all have genetic mutations that increase their risk of thyroid cancer.

Unfortunately Tracey has already developed thyroid cancer but the testing has meant that her two eldest children Chelsea, 17 and Destiny, 15 were able to have their thyroids removed before cancer developed while their siblings London, 3 and Riley, 2 will have the same operations as soon as they are old enough.

The Sunbury family was one of the first to benefit from the launch of Genetics in the North East (GENE) - Victoria's clinical genetic service hub encompassing Austin Health and Mercy Health in Heidelberg and Mercy Health in Epping.

Parliamentary Secretary for Medical Research, Frank McGuire launched the service and said it will mean more families in the north-east can access genetic testing so they can get the diagnosis and treatment they need sooner.


"Our genes play an important role in the health of Victorians and their families - that's why we're investing to grow our public genetic services," Mr McGuire said.


Austin Health director of Clinical Genetics and co-director of GENE, Professor Martin Delatycki said the hub provides public clinical genetic services such as medical diagnosis of genetic conditions and genetic counselling, as well as genetic testing for patients and their families in north-east Victoria. This includes regular clinics in Ballarat, Shepparton and Wodonga meaning rural patients no longer need to travel to the city for public genetics services.

Prof Delatycki said genetics underpins many adult medical conditions including breast cancer, cardiac issues and diseases of the nervous system as well as rare childhood disorders.

Testing is vital for the prevention, diagnosis and management of inherited conditions as people with specific genetic mutations are more at risk of that disease than the general population. This knowledge enables people to make informed decisions about how best to manage the higher risk.


Tracey said the service had been ‘life-saving' for her family.


"Without a doubt it has changed our lives. Without these guys we would be in a world of trouble and every day I thank my lucky stars for the genetic counselling team," Tracey said.


‘We are so very lucky because now my girls won't pass it onto their kids. The genetics clinic will be involved if they want to have children, they will have IVF and be safe.

Prof Delatycki said the launch of GENE meant a big expansion of services.

"Not many years ago there was no genetic service in the area and we now have a complete service at two sites - Epping and Heidelberg.

"We have gone from five staff to 21 staff across the sites," Prof Delatycki said.

 

 

New beds boost for elective surgery

Victorian Health Minister Jill Hennessy meets knee replacement patient Franceska Buljanovic

Austin Health's elective surgery centre will treat an additional 750 patients annually thanks to a State Government funding boost.

Minister for Health, Jill Hennessy has officially opened six new beds in the centre which were funded as part of the $200 million Beds Rescue Fund.

The fund paid for a total of 101 new beds across the state and means a total of 19,800 patients will be able to be treated annually.

Minister Hennessy also toured our new satellite ward where 14 chair bays have been installed, meaning there is more room to treat day patients and freeing up the new beds for more surgeries.

Minister Hennessy met patient Franceska Buljanovic who is recovering from a total knee replacement.
Franceksa said she is delighted her surgery is complete and is looking forward to improved mobility going forward.

Austin Health CEO Brendan Murphy said the additional beds are a great boost to our surgery centre, meaning patients like Franceska will spend less time waiting for treatment.

Minister Hennessy, was also joined by former AMA President, Dr Douglas Travis, to launch a new independent body, Better Care Victoria, to drive innovation across the Victorian health care system.

"We know we need to do things differently to ensure our health system is able to cope with increasing demand as a result of our ageing and growing population - and Better Care Victoria will help us do just that,'' Minister Hennessy said.

Better Care Victoria was a key recommendation from the Travis review, the most comprehensive audit ever undertaken in the capacity of Victoria's hospitals, and will help drive improvements by identifying and funding innovative projects that can be scaled up across our health care system.

The independent Better Care Victoria Board is chaired by surgeon and former AMA President Dr Douglas Travis and will advise the Minister on the most effective ways to invest the Better Care Victoria Innovation Fund.

Diabetes experts warns Paleo diet is dangerous and increases weight gain

Following a low carbohydrate, high-fat diet for just two months can lead to rapid weight gain and health complications, research led by Austin Health and University of Melbourne diabetes expert Sof Andrikopolous has revealed.

The surprise finding, detailed in a paper in Nature journal Nutrition and diabetes, has prompted Assoc Prof Andrikopolous to warn people about putting faith in fad diets which have little or no scientific evidence.

Assoc Prof Andrikopolous says this type of diet, exemplified in many forms of the popular Paleo diet, is not recommended - particularly for people who are already overweight and lead sedentary lifestyles.

"The low-carb, high-fat diet is particularly risky for people with diabetes or pre-diabetes.

"These diets are becoming more popular but there is no scientific evidence that these diets work. In fact, if you put an inactive individual on this type of diet, the chances are that person will gain weight,'' Assoc Prof Andrikopolous said.

In a study carried out at Austin Health's University of Melbourne, Department of Medicine, researchers took two groups of overweight mice with pre-diabetes symptoms and put one group on the LCHF diet. The mice were switched from a three per cent fat diet to a 60 per cent fat diet. Their carbohydrates were reduced to only 20 per cent. The other group ate their normal diet.

After eight weeks, the group on the LCHF diet gained more weight, their glucose intolerance worsened and their insulin levels rose. The paleo diet gained 15 per cent of their body weight and their fat mass doubled from 2 per cent to almost 4 per cent.

"To put this in perspective, for a 100 kilogram person, that's the equivalent of 15 kilograms in two months. That's extreme weight gain,'' Assoc Prof Andrikopoulos said.

"This level of weight gain will increase blood pressure and increase your risk of anxiety and depressions and may cause bone issues and arthritis.

"For someone who is already overweight, this diet would only further increase blood sugar and insulin levels and could actually pre-dispose them to diabetes.

"We are told to eat zero carbs and lots of fat on the Paleo diet. Our model tried to mimic that, but we did not see any improvements in weight or symptoms. In fact, they got worse. The bottom line is it's not good to eat too much fat."

Prof Andrikopoulos says the Mediterranean diet is the best for people with pre-diabetes or diabetes.

"It's backed by evidence and is a low-refined sugar diet with healthy oils and fats from fish and extra virgin olive oil, legumes and protein.''