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Multi-organ transplant a world first

Steph Dundas during surgery
Steph Dundas undergoing the 24-hour surgery that saved her life

Yarck woman Steph Dundas is the world's first person with cystic fibrosis to undergo a quintuple transplant after a life-saving operation at Austin Health.

Due to problems associated with her cystic fibrosis, Steph, 27, began suffering major damage to her liver at 11. By age 19 she was critically ill and was fortunate to receive a liver transplant at Austin Health.

Several years after her liver transplant, Steph suffered from widespread blood clots within the major veins of the abdomen, in particular the veins draining blood from her bowel to her liver. This resulted in intestinal and kidney failure, necessitating the need for kidney dialysis and nutrition delivered directly into her veins. The combination of malnutrition and kidney failure led to a decline in her lung function. In recent years her health had deteriorated significantly and she was in desperate need of a new intestine, duodenum, liver, kidney and pancreas.

Unfortunately, the antibodies her body had acquired as a result of her first liver transplant and multiple blood transfusions over many years made it almost impossible to find a match for Steph and time was running out.

"Steph had a vast number of antibodies that make cross-matching new organs incredibly challenging," Austin Health Head of Intestinal Rehabilitation and Transplantation, Dr Adam Testro says.

"In fact Steph was incompatible with over 98 per cent of Australian organ donors. Given the relatively low rate of organ donation in Australia, we were acutely aware that a perfect match for Steph was almost impossible, and that time was running out. Much to our amazement, we were offered organs for Steph that were absolutely ideal, and whilst we knew the procedure was high risk, we knew there was no other option but to proceed with the transplant," Dr Testro says.

Steph's operation, from the donor to completion of surgery, took exactly 24 hours. However, that was only the beginning.

"More than 15 departments across Austin Health were involved in Steph's care in her first week post transplant,'' Dr Testro says.

"Transplanting the intestine is highly complex, largely because unlike the liver, the intestine is so unforgiving. On top of that, over 70% of our immune cells reside within the bowel, so rejection of the intestine is very common. High doses of immune suppressing medication are required to combat this, and this in turn brings a significant chance of serious infections. This problem is multiplied in patients with cystic fibrosis, who often suffer from recurrent chest infections".

The transplant means that Steph will no longer have to endure hours of dialysis and intravenous nutrition feeding and her diabetes has been cured.

"Words can't describe how grateful I am to be able to live some sort of normal life," Steph says.

"I can't wait to get home to be with my family and friends and my animals."

Something else Steph is looking forward to doing is indulging her passion for good food - thanks to the transplant she is no longer gluten, fructose or lactose intolerant and she has compiled a wish list of restaurants she can't wait to try.

The Australian Intestinal Transplant Service, a collaboration between Austin Health and The Royal Children's Hospital, is the only unit in Australia which carries out intestinal transplants and Steph is just the sixth person in Australia to receive a new intestine, since the first transplant was performed in 2010.

"In earlier years a small number of Australians were sent overseas to access this service, usually at a massive financial cost to the health budget, so it's important that we are now able to provide this service within Australia," Dr Testro says.

Steph is now receiving further care for her cystic fibrosis at Monash Health.

Our statement on Olivia Newton-John

Olivia Newton-John visits patients on one of her recent visits to Austin Health
Olivia Newton-John takes time to visit and support cancer 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

Colin Gray walks his daughter Robyn down the aisle on her wedding day.
Colin Gray walks his daughter Robyn down the aisle on her wedding day.

"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

Rachel Brown is the first patient to The Surgery Centre's new expanded satellite.
Rachel Brown is the first patient to The Surgery Centre's new expanded satellite.

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

Professor Jonathan Cebon
Professor Jonathan Cebon

"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

14072016_Jay Ramchand_newsroom.jpg
Jay Ramchand

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

20160517_AH_Minister_TransitLounge_newsroom.jpg
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.

 

From carer to patient and back – how the patient experience helped Lisa Power to be a better carer

Lisa Power and staff from 7 North
Lisa Power (centre) with staff who cared for her from Ward 7 North

"You never really understand a person until...you climb inside of his skin and walk around in it," Atticus Finch said famously in To Kill a Mockingbird. It's advice that Lisa Power understands well.

The health assistant, who usually works on Austin Hospital's Ward 8 East, was herself admitted to Austin Hospital after a recent kidney and pancreas transplant.

"Being in hospital, it changes you," she says. "You have a greater understanding of what people are experiencing. Some people...are scared and don't know what is happening."

"If you say, ‘I've been in hospital a few times and I know how scary it is and how you're out of your comfort zone', they know that someone knows exactly how they feel and they don't feel so alone."

"Sometimes I duck down and buy them a smiley-face balloon to cheer them up. If you can make someone happy at their weakest and most vulnerable time, that's amazing," she said.

Frequent appointments at Austin since the age of 16 mean Ms Power has "always loved the Austin; it feels like home." But even she was blown away by the care she received recently on Ward 7 North.

"They make me feel safe - that's what I love about them. They make everyone feel like they're a high priority," she said.

After a worrying blood test result, Ms Power said that Renal Transplant Unit deputy director, Assoc Prof Frank Ierino and his team had her admitted to hospital and receiving treatment before she'd even had time to take in that she was experiencing a problem.

On another occasion, after bursting into tears, one of the nurses "gave me a massive hug and said: ‘It's alright; that's what we're here for', and I thought, ‘Yeah, I'm in good hands'."

"They're are all so amazing, so reassuring. I know they've got my back," she says. "No words can describe that kind of feeling. That's not someone doing their job; that's someone who really cares."

Lisa Power was interviewed in the Heidelberg Leader - read her story at: http://bit.ly/1NUAHeO

 

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.

50 years of incredible commitment and service for Rob

"It's my job and it's my hobby'', Rob Winther reflects on 50 years of service.

A tragic accident when he was 13 sparked an extraordinary lifetime of commitment for Rob Winther.

Having survived World War 2, Rob's Dad Paul, a member of the 39th battalion, died in a motor vehicle accident. As well as dealing with their grief, things were tight financially for the family. Legacy stepped into help and their enduring support over the years left a lasting impression on Rob, steering him to a career in Veterans Affairs.

The Veteran Liaison Officer has just notched up 50 years of service at the Heidelberg Repatriation Hospital and his contribution to Austin Health continues to be extraordinary.

As well as helping countless patients and families through difficult times, Austin Health CEO Brendan Murphy describes Rob as the "custodian'' of our heritage who keeps alive memories for so many in our community.

"Rob's unique and hugely valuable to Austin Health. He is tireless in his work for the whole organisation but particularly for the Repat campus and the welfare of Veterans.

"He is loved and respected by all of us and we can't begin to contemplate that one day he might retire,'' Dr Murphy says.

Rob, 68, can't contemplate retirement either.

"I love my job, it's my job and my hobby,'' Rob says.

"I have a great group of people I work with and we want to be here until we drop.

"This hospital has such a feel about it, it rubs off on you. You only need to look around to know why we're here supporting patients,'' he says.

The influence of Rob's passion for the Repat is on display right across the campus - from the Remembrance Garden and the Anzac memorial chapel which he played a pivotal role in establishing, to the iconic signage and, of course, the groups of Veterans sharing coffee and chats at the café.

Diabetes experts warns Paleo diet is dangerous and increases weight gain

Austin Health and University of Melbourne diabetes expert Sof Andrikopoulos. pic courtesy of University of Melbourne

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.''

 

 

Meet Nicholas Johnson.

Nicholas Johnson
He's 14, and struggles every day with the seizures caused by his epilepsy. He's also set to be the first patient in Australia to participate in a medicinal cannabis trial, thanks to a change in legislation and funding from the Victorian Government.

The trial will investigate whether a synthetic cannabidiol will be effective at treating certain types of childhood epilepsy.

For the Johnson family, the Austin Health trial provides a new treatment option that they hope will help to control Nicholas' seizures, after exhausting seven or eight other medicines that have failed.

Nicholas - who often experiences seizures during the night - hopes for something unsurprising for a teenage boy: to "sleep more!"

Mum D'Lene says that Nicolas is "attending school so tired that his potential probably isn't being reached. We want him to achieve the best he can. We're really hopeful that [this trial] means that we can have a seizure-free life."

The trial in Australia will be led by Austin Health's director of Paediatrics and world-leading epilepsy researcher, Professor Ingrid Scheffer. Professor Scheffer and her team "are very excited about this trial as it will establish if cannabidiol is an effective treatment for severe childhood epilepsy."

The trial has been made possible by research funding from the State Government, as well as new laws introduced into the Victorian Parliament in December that provide a legal framework for the cultivation, manufacturing, supply, patient eligibility and support ongoing research into medicinal cannabis.

Anyone interested in the trial can contact the Medicinal Cannabis Taskforce on 03 9096 7768 or medicinal.cannabis@dhhs.vic.gov.au 

You can support our epilepsy research by donating to the Austin Medical Research Foundation.

Ego Seeman recognised in Australia-day honours

Professor Ego Seeman
Prof Ego Seeman appointed a Member of the Order of Australia

 

Professor Ego Seeman has been appointed a Member of the Order of Australia for his ground-breaking contributions to research into osteoporosis and endocrinology.

Prof Seeman has twice shifted the direction of thinking in osteoporosis research worldwide but it is mentoring up-and-coming talent that gives him the greatest career satisfaction now.

 

In 1989 he was the first to demonstrate a childhood link to osteoporosis, by showing that daughters of women with osteoporosis have reduced bone mass. This led researchers to change their focus from studying ageing bones towards bone growth and development in young people.

 

Two decades later Prof Seeman, along with his then student, Roger Zebaze, shook things up again. The pair had been trying to understand why bones become brittle and break. Contrary to prevailing beliefs, they discovered that 70% of bone loss occurs in the cortical shell of the bone - a momentous discovery because up until then it was thought that most bone loss occurred within the honeycomb-like trabecular bone which dissolves more rapidly with ageing. Their finding led to a method of analysis of bones scans that remains unique to Austin Health and the University of Melbourne.

 

Prof Seeman said his Australia Day honour reflected the work of many past and present staff members.

 

"It's a very satisfying award to get at this late stage of my career and I'm very humbled by it. I don't believe the award belongs just to me a lot of people have helped me,'' Prof Seeman said.

 

One of those people is former Austin Health staff member and Head of Endocrinology, George Jerums, the person who taught him it is okay to ask questions.

 

Prof Seeman thinks the ability to ask questions is pivotal to success in both patient care and research and it is something he goes to pains to emphasise to the many young endocrinologist he mentors.

 

It is nurturing emerging talent that he derives the greatest career satisfaction from now.

 

"Jeff Zajac has built a wonderful endocrinology department which gives people like me a wonderful opportunity to mentor our young people and help young people find their own voice," Prof Seeman said

 Austin Health CEO Brendan Murphy said Prof Seeman's award was recognition of a fantastic contribution.

"Ego epitomises the great academic tradition of Austin Health, with his enormously productive research career and the training and mentoring of many clinicians and researchers. Ego is one of Australia's most internationally recognised bone researchers and has made seminal contributions to bone research," Dr Murphy said.

Michael Woodward receives Australia Day honour

Professor Michael Woodward
Assoc Prof Michael Woodward has been appointed a Member of the Order of Australia.

Michael Woodward has been appointed a Member of the Order of Australia.

Associate Professor Woodward's has worked at Austin Health for 28 years and is current director of our Memory Clinic, Director of Austin Health's Aged Care Research and director of our Wound Management Clinic.

Associate Professor Woodward established Austin Health's Medical and Cognitive Research Unit which is the largest dementia clinical trials site in the Southern Hemisphere and currently has 27 trials underway with patients at various stages of Alzheimer's Disease.

He also oversaw a large expansion of aged care in the hospital and played a key role in helping set up a range of clinics/services to better serve older people in the hospital.

Assoc Prof Woodward described the award as "a privilege'' and said he was delighted to be honoured.

Assoc Prof Woodward has produced over 100 peer-reviewed publications and delivered almost 400 scholarly addresses throughout his career. He said his greatest research achievement was defining the frontal variant of Alzheimer's Disease.

"This variant of Alzheimer's Disease is characterised by rapid spread of pathology to the frontal regions of the brain, and causes early frontal clinical features such as behavioural and personality changes,'' Assoc Prof Woodward said.

Austin Health CEO Brendan Murphy said Assoc Prof Woodward was a tremendous asset to Austin Health and a deserving recipient of the award.

"Austin Health is delighted that Prof Woodward's long and distinguished contribution, especially to dementia research, has been recognised by this award."

A record-breaking year for our renal transplant unit

Austin Health's involvement in an Australian-first seven-way paired kidney swap capped off a record-breaking year for our renal transplant unit.

As well as taking part in the exchange, our unit carried out a record 50 kidney transplants in 2015 - an almost five-fold increase from a decade ago.

Hundreds of staff across Austin Health, Monash Medical Centre, the Royal Melbourne and NSW's Westmead, Prince of Wales and John Hunter hospitals was involved in the exchange which has given seven transplant recipients a new lease of life.

On November 19 simultaneous operations were carried out across the seven hospitals to remove the kidneys from their donors before the precious organs were either couriered across town or flown interstate to be transplanted into recipients.

Austin Health had one transplant-donor pair. Forest Hill mother Veronica Reid received a kidney while her sister Eleanor Canning donated one of her kidneys.

Veronica was suffering from end-stage renal disease.

"I am so grateful. If the transplant didn't happen I would probably be on dialysis by now," Veronica said.
"I used to feel like there was cement in my body. I always felt heavy and tired. All of the symptoms have totally gone now which is great,'' she said.

Austin Health Renal Transplant Unit deputy director, Assoc Prof Frank Ierino said he felt fortunate and proud to be part of the exchange.

"To see the health system working in such a collaborative way is just fantastic,'' Assoc Prof Ierino said.
"It's a great thing to see patients having the opportunity to have a renal transplant where they would otherwise be on a transplant list for long periods of time."

The Australian Paired Kidney Exchange organises organ transplants when a person in urgent need of a kidney has a loved one willing to donate but their organ has an incompatible blood or tissue type. The recipient-donor pair's details are placed into a pool and are matched with other donor-recipient pairs until each is matched with a suitable swap.

A special computer system is used to scan all those needing a kidney, as well as a donor they can offer, to find any potential donor-recipient chains.

The seven-way exchange was kick-started by an altruistic donor, Paul Bannen. Paul had originally offered his matching kidney to a friend with renal failure but when a deceased donor organ became available for his mate, Paul decided to donate his organ anyway to help a stranger.

Assoc Prof Ierino said thanks to initiatives such as the Australian Paired Kidney Exchange and the work of the Organ and Tissue Authority he was confident that Austin Health's renal transplant program would only continue to grow.

Gifts from the community help us to purchase new equipment helping us to better support people in need of our care. If you wish to donate to Austin Health's renal transplant program please click here.

Austin Health performs Australian-first combined transplant

Tim and Robyn surrounded by many of the Austin Health team involved in Tim's lifesaving care and operation.

Austin Health has performed Australia's first combined small bowel and kidney transplant, giving Melbourne businessman Tim Boyle a second chance at life.

 Our Victorian Liver Transplantation Unit team is the only unit in Australia which carries out intestinal transplants and Tim is just the fourth person to receive a small bowel.

Tim, 47, had been gravely ill with intestinal failure for 12 years after a twisted bowel meant 90% of his small intestine had to be removed in emergency surgery. While the average length of a small intestine is between 3-8 metres, Tim was left with a small intestine of just 25 centimetres.

The father-of-two had to spend more than 40 hours a week hooked up to intravenous nutrition to survive because his body could only absorb a small amount of nutrients from the food he ate. When the condition caused his kidneys to also fail 18 months ago, hope seemed to be running out for Tim.

"He had deteriorated so badly that I would be sitting there in church planning his funeral,'' Tim's wife, Robyn Laurie, said.

Austin Health gastroenterologist Adam Testro said just a handful of combined small bowel and kidney transplants are completed around the world each year.

"I've looked after him for five years and there has been a very obvious deterioration in his health in that time. It's so satisfying for us to be able to give him the opportunity to return to the normal life of a young father," Dr Testro said.

A surgical team of 13 took 15 hours to carry out the delicate operation on Tim.

"We knew it was very risky for Tim and we were very anxious about the outcome,'' Liver Transplant Unit director Professor Bob Jones said.

Tim, 47, spent 36 days in hospital recovering from the operation and was released just in time to celebrate his youngest daughter's 7th birthday at home.

"To say it is life changing is an understatement - it is a new life, not life changing," Tim said.

"I've got a whole new opportunity to redesign life which is so exciting,'' he said.

"To be there as a dad and a husband, and to be able to support the loved ones around me is a big thing. In the past few years as my health has continued to deteriorate, and being able to move from a burden to a contributor is great."

Tim and Robyn said they were incredibly grateful to the donor and their family and that they were "constantly in their thoughts and prayers".

Visit donatelife.gov.au to register for organ and tissue donation.

 

Discovering the power of creative therapy

Music therapy patient Annette Lade performed on the harmonica at the Garden Affair event. Photo courtesy of Progress Leader

Annette Lade always loved her music but she never guessed it would help in her recovery from a horrific road accident.

Mrs Lade was left a quadriplegic after a car accident in Traralgon last year.

She has spent the past few months living at the Royal Talbot Rehabilitation Centre in Kew.

"I broke my neck in the accident, which left me a quadriplegic," Mrs Lade said.

"It's been a lengthy road to this point and I'm slowly getting some movement back in my arms, but I doubt I'll ever walk again." Mrs Lade said the work of the Royal Talbot therapists with their range of techniques and programs had made given her a new outlook on life.

"I've been doing music therapy since October," she said. "I love music, I play music and obviously I don't have the method I once did, but I play the harmonica and I'm playing some basic chords now.

"It's all about pushing the boundaries and doing what you can do.

"You should never take life for granted, because anything can happen." At the weekend, Austin Health said thank-you to all supporters of its creative therapies with a garden affair.

The event was hosted by Austin Health's employee Steve Wells, who was ABC Gardening Australia's Gardener of the Year in 2012.

Liver disease expert recognised with lifetime achievement award

Prof Peter Angus has been recognised with a lifetime achievement award from the Gastroenterological Society of Australia.

An Austin Health professor's decades of influential research into liver disease have been celebrated with a lifetime achievement award.

Professor Peter Angus received the 2015 Distinguished Research Prize from the Gastroenterological Society of Australia.

The medical director of Austin Health's liver transplant unit and director of gastroenterology and hepatology, Prof Angus played a key role in establishing highly successful adult and paediatric liver transplantation programs which have resulted in over 1000 life-saving operations since 1988.

Prof Angus has been principal investigator for many clinical trials, including local and international studies in viral hepatitis, transplantation medicine and chronic liver disease.

Prof Angus' laboratory research program is carrying out world-leading work in its study of possible new treatments for preventing liver scarring in patients with chronic liver disease and ways of controlling the complications of severe liver damage.

"If we could stop the scarring it is highly likely that you would stop people going onto develop end-stage liver disease,'' Prof Angus said.

"We are the pioneers in this area and now we are collaborating with international groups to advance these possible new treatments. It's very exciting.

He is delighted to receive the award.

"It's recognition for research achieved by my wonderful team of clinicians and researchers here at Austin Health. We have been at the forefront of so many new therapies for our patients. I'm really very proud of the work that they and the many phD students I've supervised over the decades have done,'' Prof Angus said.

 

 

 

 

 

Austin Health's Physiotherapy team wins Premier's Prize!

Austin Health's Physiotherapy Department has won the Premier's Award for excellence in supporting the health workforce at the 2015 Victorian Public Healthcare Awards.

The Physiotherapy Department designed and implemented an innovative new workforce model of care this year to ensure patients get the right care at the right time by the right physiotherapist. New streams of physiotherapy care were developed to better match patient need across the acute health service. This unique workforce model was so successfully implemented that it has attracted widespread interest from other health services. The leadership demonstrated by the local management team in leading this change was outsanding. 

Austin Health also picked up a silver award (second place) in the 'Innovative models of care' category in partnership with the Royal District Nursing Service for the assisted home peritoneal dialysis program. Congratulations to Allyson Manley and the team behind this project!

Austin Health reaches finals of the Premier's Sustainability awards

Sustainability unit's Lauren Poulton, Karen Hames and Madeline Dorman pictured with gardens officer Steven Wells

Austin Health is a finalist in the Health category for this year's Premier's Sustainability awards.

Sustainability Victoria CEO Stan Krpan congratulated Austin Health staff for their creative and influential work towards building a more sustainable environment for Victorians.

"These awards represent Victoria's highest recognition for sustainability, and acknowledge leadership, innovation and achievement,'' Mr Krpan said.

Mr Krpan said Austin Health has a long-standing dedication to sustainability, showing whole-of-business commitment over seven years which has resulted in remarkable achievements.

Austin Health Sustainability Unit manager (acting) Karen Hames said these achievements include becoming the first Melbourne healthcare facility to recruit a dedicated sustainability officer in 2008 and establishing a sustainability network with metropolitan healthcare facilities, the Victorian Green Health Round Table group, in 2009. The group of 15 private and public healthcare organisations continues to meet bimonthly sharing and discussing sustainability ideas and benchmarking waste data.

Ms Hames said Austin Health is also the only Australian health organisation which recruits a gardens officer, Steven Wells, to develop green spaces for the therapeutic benefit of patients and staff.

"We are proud and excited to celebrate our achievements. Not only for 2014 but since our achievements began in 2008 and we are excited to celebrate with all of the people who have been part of the journey - from nurses and PSAs all the way through to board members,'' Ms Hames said.

Winners will be announced at an awards ceremony on Thursday 29 October at Melbourne's Plaza Ballroom.

 

 

 

 

World-first trial could be the game-changer in the fight against Alzheimer's disease

Laura Sides undergoes a PET scan as part of her participation in the world's first prevention trial for families of Autosomal Dominant Alzheimer's Disease.

 

He was the “most doting and loving Dad” a daughter could ask for which is why Laura Sides knew something was awry when her father Jeremy failed to show up on a date to celebrate her 21st birthday.

Laura would soon discover that her 52-year-old father had just been diagnosed with Autosomal Dominant Alzheimer’s Disease (ADAD). He had first started displaying subtle symptoms of the disease when he was 47 and passed away as a result of ADAD aged 60.

It was devastating for Laura to watch her father, once a successful and well-loved doctor, succumb to the disease. It was terrifying to learn she had a one-in-two chance of suffering the same fate.

Approximately 200 Australians suffer from ADAD. Families with the disease have a dominantly-inherited gene mutation meaning that if one parent has ADAD there’s a 50% chance offspring will get Alzheimer’s at the same age their parent did. Genetic testing can identify if the person is afflicted with the mutation.

Laura, 32, spoke to genetic counsellors at Austin Health about having the testing in 2014 but subsequently decided it wasn’t something she was ready to find out.

“It’s not something I feel I want to do at the moment. I think it’s a really big decision to make and you could potentially, I guess, find out your own fate and I’m just not sure how I feel about that as yet,’’ Laura said.

“I think maybe I was waiting for a right time to do it and I think I’m understanding now that maybe there’s not a right time and it’s something I think a lot more about doing that I have done in the past.’’

It was a result of the meeting with the genetic counselling team that Laura discovered Austin Health, in conjunction with the Florey, is one of three Australian sites taking part in a world-first prevention trial for ADAD families.

The Dominantly Inherited Alzheimer’s Network Trial (DIAN-TU) focuses on drugs it is thought could prevent, delay, or possibly even reverse, Alzheimer’s changes in the brain.The medication is an antibody that works by targeting the build-up of a damaging protein, amyloid, in the brain. Amyloid build-ups form plaques which are thought to cause the damage that ultimately leads to Alzheimer’s.  It is hoped the drugs will bind to the amyloid and flush it from the brain.

Like all of the trial participants, Laura does not know if she is receiving the medication or a placebo. She does know that she felt a moral responsibility to take part in the trial. In researching her family history she discovered her Great-great grandfather had 8 children and 5 died of ADAD. She is worried not only for herself but future generations.

“It’s given me a sense of involvement within something that I’m obviously very interested in and is very important to me. I also wanted to try and find a positive out of what potentially is a negative situation and to help in any way I could,’’ Laura said.“Being involved has made me feel better for a lot of reasons. It has put me in contact with experts in the field and to have as much knowledge as you can gives you a sense of power’’.

Positron Emission Tomography (PET) scanning is integral to the DIAN-TU study and into the research and treatment of Alzheimer’s disease as a whole. The technique uses small amounts of radioactive material to highlight any amyloid plaque build-up in the brain, enabling detection of Alzheimer’s disease 15-20 years before people experience symptoms.

Austin Health’s Prof Chris Rowe is one of the world’s pioneers in PET scanning and has dedicated much of his career to dementia research. He says the DIAN-TU study provides a unique insight because it is one of the first trials to attempt treatment in people who don’t have dementia to prevent them from progressing to the disease.

“It will tell us more about whether amyloid is the true cause of Alzheimer’s disease because if the treatments show that we are clearing the amyloid but the disease is progressing then obviously something else critical is being missed and we will have to look again to find out what’s really driving the development of Alzheimer’s dementia,” Prof Rowe said.

“It will hopefully prove what has been hypotheses - that amyloid causes Alzheimer’s disease – but also, that amyloid is potentially a way to diagnose dementia early so we can stop people from getting it.

“If this works, we’ll have an effective treatment for Alzheimer’s disease, not only for these people with this rare young-onset form, but for Alzheimer’s disease in general, and that will have an enormous benefit to society, reducing suffering of patients and their care givers and also economically, reducing health care expenditure.

Trial results should be known in two years.

Austin Health is home to the biggest dementia clinical trials site in the Southern Hemisphere. Led by Assoc Prof Michael Woodward, our Medical and Cognitive Research Unit currently has 27 trials underway for patients at various stages of Alzheimer’s disease. To find out more about these trials visit: http://www.austin.org.au/cognitiveresearch.

Check out ABC's coverage of the trial here:

New procedure puts a spring back into Peter's step.

Austin Health Cardiology Director Assoc Prof Omar Farouque shows patient Peter Kingsley how his TAVI was inserted. Picture courtesy of Heidelberg Leader

Peter Kingsley used to be a marathon runner. In a typical training week he would clock up 100 kilometres and not even torrential rain would stop him lacing his shoes.

Sadly, a series of cardiac problems ended Peter's athletics career and this time last year he couldn't even walk 200 metres without becoming breathless. Thanks to a new procedure at Austin Health, the 79-year-old is back enjoying an active life.

Peter was one of the first patients at Austin Health to undergo a Transcatheter Aortic Valve Implantation or TAVI. The TAVI is for patients who suffer from aortic stenosis. Aortic stenosis is the narrowing of the left ventricle of the heart. This narrowing results in high blood pressure, prevents the heart from pumping blood efficiently and can lead to heart failure. It's a problem which becomes increasingly common as people age.

Traditionally patients who had this problem would have had to have undergone open heart surgery to fix it. However, open heart surgery is not a viable option for some patients, including Peter who has had multiple heart attacks.

Austin Health Cardiology Director Associate Professor Omar Farouque said the TAVI was a wonderful alternative for people like Peter as it is far less invasive and has a far quicker recovery time.

Rather than opening the patient's chest, an insertion is made through their leg and a fully collapsible replacement valve is delivered to the heart through a catheter. The old, damaged valve remains and the replacement aortic valve is wedged into its place.

Mr Kingsley said the procedure has given him a second chance at life.

"It's brilliant. I had the procedure on the Wednesday and was home on the Sunday," Mr Kingsley enthused. "Within three weeks I was back walking two kilometres without any problem.''

 

 

Olivia's lifesaving procedure marks 1000 for Liver Transplantation Unit

Olivia and her husband Matthew surrounded by some of the Liver Transplant Unit's key staff. From L-R: Michael Fink, Greg Przbylowski, Julie Lokan, Bob Jones, Caroline Miller, Paul Gow, Graeme Hart, Larry McNicol, Angela Vago, Graham Starkey, Cath Devine.

Every liver transplant that is carried out is incredible, but Olivia Sanders' transplant will forever carry extra significance for her and Austin Health.

Olivia's successful surgery marked the 1000th transplant that Austin Health's Victorian Liver Transplantation Unit has carried out.

The transplant is a second chance and a new beginning for Olivia, 40, and her husband, Matthew.
An elated Olivia explained she will now celebrate her transplant date as her new birthday as the transplant has provided a new beginning for her.

The Melbourne woman was given a year to live in April. Primary biliary cirrhosis - an autoimmune disease of the liver - had resulted in advanced organ failure and her only hope of survival was a liver transplant.
"It feels like a dream...It's an absolute miracle, it's a chance for a new beginning. It's like having a new birthday,'' Olivia said.

Olivia had spent every day in hospital or housebound since marrying her husband Matthew in October 2014. The pair will now plan a long-awaited honeymoon to Olivia's homeland of El Salvador.

Matthew said they will feel forever grateful to the liver transplantion team and the donor's family.
"It means the absolute world to us. It's just been incredible seeing my wife look so healthy,'' Matthew said.
Unit director Professor Bob Jones said the safety of the procedure had greatly improved since he performed the state's first in 1988.

"We now know when to do it and who we're likely to get better results with," Prof Jones said.

If you would like to make a donation to help purchase vital equipment for the liver transplantation unit please visit: https://secure.donman.net.au/client/austin/austindonate.asp.

For details on becoming an organ donor go to donatelife.gov.au.

 

 

Naz stands tall

Naz taking his first steps with the aid of the REX exoskeleton.

 

Paralympics gold medal winner Naz Erdem recently took his first steps in more than twenty years.
Naz was the first Australian patient to trial a pair of robotic legs at Austin Health.

The experience left Naz elated and Austin Health Victorian Spinal Cord Services Director, Andrew Nunn excited about future opportunities for patients with high-level quadriplegia.

Naz said it was an amazing experience to be able to stand straight without worrying about falling backwards and to be at his full height again.

"I've been 4 foot 2 for the past few years and now I'm 6 foot again. It feels great,'' he enthused.

The trial provided a break from a busy schedule for Naz - he currently juggles a demanding schedule of training for the 2016 Rio Paralympics wheelchair rugby competition with fulltime work for Aspire, formerly known as Australian Quadriplegic Association, Victoria. His role at Aspire is to help support and motivate people rehabilitating from spinal cord injury.

Dr Nunn said Austin Health plans to conduct Australia's first clinical trial of the REX robotic exoskeleton. The trial will form part of a research project being undertaken by the robot's creator Rexbionics.

Dr Nunn said although a number of mobility robots have been developed over the past decade or so, this is the first that allows people with high-level quadriplegia to walk. Previous technology has required too much upper body strength meaning they are only suitable for people with paraplegia.

"The robot like Rex can provide our spinal patients with the opportunity to stand, to be mobile and exercise," Dr Nunn said.

"This has physiological benefits with the bladder, the bowel, sexual function, reduction in pain, reduction in spasticity, improvement in posture and quite interestingly, body awareness.

Dr Nunn said the huge benefit the robot provided was allowing people to spend part of their day standing, enabling them to carry out everyday tasks - both at home and in the workplace - much more easily.

Rex Bionics spokesman Malcolm Hebblewhite said the company was started by two Scottish immigrants to New Zealand, one of whom had been diagnosed with multiple sclerosis and both of whom had mothers in wheelchairs.

"They decided to do something about this by inventing a robot. They started in their garage and developed a number of prototypes. They faced enormous challenges to be able to put together something so technically sophisticated from an early prototype that literally looked like Wallace and Gromit's wrong trousers."

Victorian-first clinic delivers benefits to some of our most vulnerable patients

Patients at high risk of infection could soon be able to use more powerful and effective drugs, following the opening of Victoria's first antibiotic allergy testing centre at Austin Health.

Clinic coordinator Dr Jason Trubiano said of the 20 per cent of people who came to hospital believing they had an allergy to antibiotics; up to 90 per cent of them did not.

Dr Trubiano said people would sometimes have had a strange reaction in childhood that was mislabelled as an allergy.

"This can be very limiting if, for example, they think they are allergic to penicillin and they have cancer or need a liver transplant, if you're allergic to penicillin it potentially excludes many drugs," Dr Trubiano said.
"When people are labelled as allergic we often have to use second-line drugs.

"Any infection in a patient that has a lowered immune system is a risk and in that situation we want to give them the best antibiotics, so if we can remove a penicillin allergy label and give them the penicillin antibiotic to a bug that's going to work against it, then we want to do that at all opportunities."

Austin Health's clinic is only the second of its kind in Australia. Patients with recurrent infections or a high risk of developing one - such as cancer and organ transplant patients - undergo a detailed consultation of their medical history, then a skin-prick test using a few drops of the antibiotic.

If there is no allergic response, patients are given a small amount of the drug under the skin and if the results are still negative, they are carefully monitored after being given an antibiotic tablet.

If all the tests are completed with no reaction, the patient is given the all-clear. Of the 60 patients tested to date, only one has had a positive response.

Chrissie Hopper, 63, was "over the moon'' when she was told she could use penicillin again, more than five decades after being told she was allergic because of a childhood reaction.

She has suffered from recurring pneumonia and recently was hospitalised for eight days after having to be treated with second-line drugs because of her penicillin "allergy".

"To suddenly be able to know that I could have penicillin was almost life-changing," she said.
"I think it's absolutely brilliant and I was just so fortunate that I got referred here."

Austin Health's head of infectious diseases, Professor Lindsay Grayson said removing incorrect allergy labels, and therefore the need to administer second-line drugs, was also important in the fight against the growing problem of bacteria resistance to antibiotics.

Prof Grayson said first-line drugs were quicker, safer and more effective than second-line drugs. He said the higher rates of side effects and toxicities associated with second-line drugs meant patients were less likely to take them effectively and therefore antibiotic resistance could emerge.

Dr Trubiano said it was just as critical to determine if a person's allergy label was correct as 50 per cent of very severe and rare adverse drug reactions that needed hospitalisation were caused by antibiotics. Of those, he said one in five patients would die from their reaction.

He is also in the early stages of developing a simpler test for antibiotic allergies.

"We'd like to make it as easy as possible in the future and one way would be able to diagnose this in a test tube and we're looking at trying to measure a patient's white blood cell response or immune response to antibiotics in a test tube," he said.