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Media Release: Study demonstrates aged care staff need upskilling to improve resident access to health care

The skill level of residential aged care facility staff must be bolstered to ensure residents have access to better health care, an Austin Health led study has found.

Published in the Australasian Journal on Ageing, the study also revealed that residents have less-than-optimal access to medical care, especially GPs.

Lead author and Austin Health geriatrician Sanka Amadoru says both factors are contributing to avoidable transfers of residents to hospitals for conditions that might be better and more safely managed at their aged care facility.

“These conditions range from simple procedures such as changing of catheters, to acute illnesses,” Dr Amadoru says.

The research analysed factors affecting use of Austin Health’s Residential InReach (RIR) service. The geriatrician led service that offers more than fifty local residential aged care facilities assessments by a visiting geriatrician and/or senior nurse, acute interventions and telephone advice. The study’s objective was to investigate decision-making around hospital transfer and/or referral of residents to the service from the perspectives of residential aged care staff, GPs and registered nurses.

Dr Amadoru says the results show a new approach is urgently needed to improve healthcare delivery for a cohort of residents that are older, more frail and chronically ill than ever before.

 “Unfortunately we have a situation where there are greater numbers of increasingly frail people in residential care, with fewer registered nurses and an overall decrease in average facility staff skill sets, combined with inadequate access to timely GP care,” Dr Amadoru says.

 ”Residential InReach services have been introduced to try and plug the gap, with success within resourcing constraints. However, a more carefully-designed, comprehensive response is needed to tackle the growing needs of people living in residential care, now and in the future.”

Dr Amadoru says the quality of nursing care in facilities and access to timely and appropriate medical care, especially scheduled GP visits, seem to be key factors affecting patients being transferred to hospital emergency departments and inpatient wards, where they run the risk of significant distress and medical complications.

For interviews with Dr Amadoru contact Austin Health Deputy Director, Communications Julie McNamara: 0419 595 688.

 

 

Media Release: Calls for more allergy testing to restore patient access to first-line antibiotics

Dr. Jason Trubiano
Dr. Jason Trubiano

Monday June 18, 2018.

Incorrect antibiotic allergy labels pose a significant public health issue and more needs to be done to ensure Australia's most vulnerable patients are not incorrectly diverted to second-line drugs.

In a perspective article published in the Medical Journal of Australia today, Dr Jason Trubiano says incorrect antibiotic allergy labels frequently prevent the use of appropriate narrow spectrum penicillin and targeted antibiotic therapies and often it is the sickest patients who suffer.

Dr Trubiano - who is Austin Health's Director of Antimicrobial Stewardship and Drug and Antibiotic Allergy Services, as well as an Infectious Diseases Specialist at Peter MacCallum Cancer Centre - established Victoria's first dedicated antibiotic allergy clinic which is now operating at both sites.

"This clinic is now routinely testing patients to find those with antibiotic allergies wrongly listed on their record, so this does not unnecessarily limit the treatments they can receive," says Dr Trubiano.

"By removing these incorrect antibiotic allergy labels we can restore patients' access to first-line and preferred antibiotics - and this reduces the risk of treatment failure, post-surgical infection and an extended hospital stay."

The over-application of antibiotic allergy labels also increases reliance on other widely-acting antibiotics which can promote the rise of antimicrobial resistance and superbugs.

Dr. Trubiano recently published a study of Austin Health and Peter Mac patients which showed most (83%) had an antibiotic allergy label that was incorrect and should be erased from their medical record. Almost half (48%) of these patients were immunocompromised, with many receiving treatment for cancer or post organ or stem cell transplant.

Antibiotic allergy labels may not be confirmed at the time they are listed on a patient's medical record. They can carry-over from a childhood rash where a viral cause was possible, or patients may lose sensitivity over the years effectively growing out of their antibiotic allergy.

Another recent study, also cited in the MJA article, found 81% of Australians who were listed as allergic to penicillin could have this label removed after testing.

"We are calling for more awareness - patients with lowered immune systems need to be aware that many antibiotic allergy labels can be removed and thus open up their window of antibiotic choices," Dr Trubiano says.

"We also need multidisciplinary centralised testing services like those on offer at Austin Health and the Peter Mac that focus on our vulnerable patients, as well as simple point-of-care allergy testing programs in each hospital to remove low risk and unlikely allergies."

The antibiotic allergy testing at Peter Mac and Austin Health involves a skin-prick challenge under supervision. Dr Trubiano and the team from the National Centre for Infections in Cancer (NCIC), which is based at Peter Mac, are also collaborating to develop novel blood tests and testing programs so that vulnerable patients suspected of having severe allergies can also be safely tested.

The NCIC is a platform to address the critical need for informed strategies to improve the surveillance, prevention and management of infections in patient with cancer in Australia.

Contacts:
For more information contact the Peter Mac Communications team on 0417 123 048 or Austin Health on 0419 595 688.

About Peter Mac
Peter MacCallum Cancer Centre is one of the world's leading cancer research, education and treatment centres globally and is Australia's only public hospital solely dedicated to caring for people affected by cancer. We have over 2,500 staff, including more than 580 laboratory and clinical researchers, all focused on providing better treatments, better care and potential cures for cancer.

About Austin Health
Austin Health is a leading tertiary health service which is renowned for its specialist work in cancer, liver transplantation, spinal cord injuries, neurology, endocrinology, mental health and rehabilitation including a number of state-wide services. Austin Health is an internationally recognised leader in clinical teaching and training, affiliated with eight universities. It is the largest Victorian provider of training for specialist physicians and surgeons.

Media Release - World first test could predict risk of heart attack in coronary artery disease patients

Researchers have developed a world-first blood test which improves the prediction of the long-term risk of heart attack or death in those with severe coronary artery disease.

The Austin Health and University of Melbourne study published in PLOS ONE today, found patients with coronary artery disease who had a high level of an enzyme called ACE2 were more likely to die or suffer from a heart attack over the next 10 years.

Austin Health and University of Melbourne researcher Professor Louise Burrell says the study could change clinical practice for a disease that remains the leading cause of death in Australia.

“We have come a long way in treating coronary artery disease but certain patients continue to be at high risk of dying. This new blood test helped identify such patients who may derive benefit from more aggressive treatment,” Professor Burrell says.

“Future studies are planned to investigate if intensification of the medical treatment in those patients will reduce the risk of death. If this were the case, the ACE2 blood test could be offered to all patients with coronary artery disease as part of their risk assessment.’’

Professor Burrell says in healthy people, circulating ACE2 levels are low, but increase once cardiovascular disease or risk factors are present including heart failure, atrial fibrillation, kidney disease and diabetes. 

Researchers recruited 79 patients with coronary artery disease and followed them up long-term. Over the next 10 years, heart failure, heart attacks and death occurred in 46 per cent of patients, and this occurred more often in those with the highest ACE2 levels.

Coronary artery disease is a condition in which the heart’s own blood supply is narrowed or blocked due to build-up of plaque. It can lead to chest pain (angina), shortness of breath or a heart attack. As it progresses it may cause permanent heart damage leading to heart failure. High blood pressure, unhealthy cholesterol levels and diabetes increase the risk of it developing.

The study was funded in part by grants from the Heart Foundation, the National Health and Medical Research Council and the Cardiac Society of Australia and New Zealand.

To access the study click here:

For interviews with Professor Burrell contact Austin Health Deputy Director, Communications Julie McNamara: 0419 595 688.

Media Release - Cutting-edge treatment helping patients in the fight against cervical cancer

For Immediate Release May 25, 2018

Media Release - Cutting-edge treatment helping patients in the fight against cervical cancer

In a Victorian-first, cervical cancer patients at Austin Health's Olivia Newton-John (ONJ) Cancer Wellness and Research Centre are benefitting from a new treatment which allows radiation therapy to be administered at higher dosage while minimising damage to surrounding organs.

Austin Health Radiation Oncologist Dr Adeline Lim says the introduction of the state-of-the-art Venezia applicator will have enormous benefits for patients with advanced stage cervical cancer.

"It means that even large tumours can be targeted effectively with a very high dose of radiation, hence increasing the chance of cure," Dr Lim says.

"Not only does it enable a higher dose to be delivered to the cancer but it also allows us to reduce the dose delivered to normal organs, such as the bladder. This not only means a higher chance of tumour control but also a reduced risk of long-term side effects and an improved quality-of-life,'' Dr Lim explains.

Dr Lim says chemo-radiation is the standard line of treatment for locally advanced cervical cancer and the radiation component is a combination of external beam radiation therapy followed by a high dose of brachytherapy.

Brachytherapy is a form of radiotherapy which is delivered internally. It allows the cancer to be treated to a very high dose whilst enabling normal organs to receive a much lower dose compared to external beam radiotherapy - this increases the chance of cure and reduces the risk of side effects.

"The Venezia applicator is the latest gynaecological brachytherapy applicator on the market and Austin Health's ONJ Centre is the first site in the state to invest in this state-of-the-art equipment. We are very excited to be able to offer this service to Victorian patients" Dr Lim says.

Approximately 180 Victorian women are diagnosed with cervical cancer each year.

To donate to the ONJ Centre visit http://www.onjcancercentre.org/donate


For interviews with Dr Lim contact Austin Health Deputy Director, Communications Julie McNamara: 0419 595 688.

Media Release - Overdoses and misuse of the antipsychotic quetiapine on the rise

Jeff Robinson, manager of the Victorian Poisons Information Centre
Jeff Robinson, manager of the Victorian Poisons Information Centre

For Immediate Release May 25, 2018

New research reveals an alarming rise over the past decade of overdoses, misuse and mortality associated with the antipsychotic medicine quetiapine.

The Austin Health led research team analysed calls from Austin Health's Victorian Poisons Information Centre and coroners' and prescription data between 2006 and 2016 relating to quetiapine and found a six-fold rise in calls related to the drug from 126 in 2006 to 751 in 2016.

Fatalities related to quetiapine jumped from 21 in 2006 to 155 in 2016.

Quetiapine is a prescription medicine used for schizophrenia, bipolar disorder and acute mania. However, the Manager of Austin Health's Victorian Poisons Information Centre Jeff Robinson says it is being increasingly prescribed for ‘off-label' conditions such as insomnia. It is also being used by ice (methamphetamine) users to ‘come down' after an ice bender.

Mr Robinson, who co-authored the paper published in Drug and Alcohol Dependence says the increasing numbers are worrying.

"To give it some context, in 2015 almost 1 million prescriptions were dispensed for quetiapine across the Australian population of just 24 million people," Mr Robinson says.

"Even when prescriptions for quetiapine began to drop in 2013 the number of deaths and misuse did not reduce which suggests people may be accessing the drug by other means such as doctor-shopping or the black market.''

"Patients who overdose on this medicine often require admission to ICU for several days, at great cost to hospitals and the taxpayer.

"It is important that more research be is undertaken to find out how people are accessing quetiapine. Our study confirmed that quetiapine is a high-risk prescription medicine. It will be an appropriate inclusion in the SafeScript real time prescription monitoring system to be introduced in Victoria later in 2018."

(NOTE: SafeScript is computer software that will provide prescribers and pharmacists with access to their patients' prescription records for high-risk medicines during consultations, enabling safer clinical decisions. Prescription records for medicines that are causing the greatest harm to the community such as opioids, benzodiazepines, zolpidem, zopiclone and quetiapine, will be captured in SafeScript.)

Researchers from Austin Health, the University of Melbourne, Monash University and the Victorian Institute of Forensic Medicine carried out the research.

For interviews with Mr. Robinson contact Austin Health Deputy Director, Communications Julie McNamara: 0419 595 688.

Austin Health to receive Victorian-first technology to fight cancer

Assoc Prof Farshad Foroudi addresses media

Olivia Newton-John (ONJ) Cancer Wellness and Research patients will have access to the world's best ‘game-changing' cancer technology thanks to an $18 million State Government funding injection.

As part of the package, $8 million will go towards a new MRI-linear accelerator service for Austin Health - the first of its kind in Victoria and just the second in the Southern Hemisphere.

Austin Health director of Radiation Oncology, Associate Professor Farshad Foroudi says the new MRI linear accelator service, which will be introduced in 2019, will have enormous benefits.

Assoc Prof Foroudi says current radiation treatments rely on CT imaging to locate tumours whereas the new MRI-linac machine uses superior diagnostic quality MRI imaging to target the tumour with greater precision, and in real time.

"This ground breaking clinical technology will benefit patients with brain tumours, liver tumours, prostate, breast, head and neck cancers," Assoc Prof Foroudi says.

"It enables us to deliver radiation more accurately to tumours, limiting exposure of healthy tissue to radiation.

"By improving the accuracy of radiation treatment delivery we will be able to improve the control of cancer while sparing normal tissues from side effects."

Premier Daniel Andrews and Minister for Health, Jill Hennessy, joined Olivia Newton-John at Parliament House to announce the package which also includes $10 million for the Olivia Newton-John Cancer Research Institute to establish a Centre of Research Excellence with a focus on brain cancer. The funding will also assist with infrastructure and support researchers to continue current ground breaking work.

The words of a young father and cancer survivor sum up the significance of the funding announcement.

Flanked by his wife Jess and their children Darwin, 8, and Henry, 4, ONJ patient Ben Service, 32, says he has advances in cancer research to thank for being alive.

"Research means I've been able to see my little girl's first day at school. Without research I wouldn't be here," the Warrigal man says.

Ben was diagnosed with malignant melanoma two years ago. Shortly after diagnosis his cancer spread to his bones, liver and brain. Under normal circumstances this would be rapidly fatal, however he was able to receive life-saving immunotherapy treatment.

This was done using the liquid biopsy test developed by Professor Alexander Dobrovic at the ONJCRI.

He was also able to receive highly-targeted radiotherapy to control the tumours in his brain.

As a result of these treatments, he is now disease free.

"I honestly think it would be a different outcome if I wasn't at the ONJ," Ben says.

"To imagine in December 2016 that I thought it was my last Christmas and New Year with my family," he says.

Jess describes the results as "out of this world''.

"I thought I was going to lose him so many times. I am so grateful; from the bottom of my heart," she says.

Minister for Health Jill Hennessy says researchers at the ONJ Centre are leading the way in the fight against cancer.

"We're giving them the support they need to continue their work revolutionising patient care and one day find a cure,'' Minister Hennessy says.

 

 

 

 

Solving the challenges of valve replacement

Dr. Matias Yudi
Dr. Matias Yudi with a model of a heart with a replacement valve added

A life-saving Cardiology procedure has been such a phenomenal success that cardiologists now find themselves trapped in a cage - literally.

Austin Health interventional cardiologist, Dr. Matias Yudi, was published last month in the world's top Cardiology journal, the Journal of the American College of Cardiology, as lead author of one of the journal's ‘state-of-the-art reviews'. Dr. Yudi and co-authors looked into the issues following a procedure called transcatheter aortic valve replacement, or TAVR.

TAVR has been used with great success to treat aortic stenosis, a disease that causes people's aortic valve to narrow, limiting the amount of blood that can flow through it. It involves a metal mesh replacement valve deployed over the patient's own aortic valve to hold it open.

Dr. Yudi says that is has been so successful as a treatment that is being used with increasing frequency, including in patients who are younger, healthier - and more likely to live long enough to need other procedures in the Cardiac Cath Lab.

"The problem is that the replacement valve becomes like a cage that blocks access to the coronary arteries. It makes it hard to get a catheter in," says Dr. Yudi.

"Now that TAVR is generally used in younger people, there's a greater chance that they will go on to develop coronary artery disease in the future - and fixing it will be more difficult if there's effectively a cage around the artery," he says.

"There have been a couple of small reports from around the world where cardiologists have had trouble getting a stent in, and there have been complications," he says.

As part of their review, Dr. Yudi and his co-authors also discuss solutions to the problem. They have developed an algorithm to guide cardiologists to which catheter to use in each of the situations they are likely to encounter, but also make a suggestion on how cardiologists performing TAVR can orient the replacement valve as it's put in, in a way that makes it less likely that it interferes with access to the coronary arteries in future procedures.

"It's the first time a review of the problems surrounding TAVR has ever been published that incorporates both a comprehensive account of the technical problems, and provides guidance to practicing cardiologists," Dr. Yudi says.

As a result of this work, Dr. Yudi has now been invited to work with Medtronic in the United States to help develop a catheter that will solve some of the issues raised in the review.

Building culturally safe care

As both a Gunditjmara and Wotjobaluk woman and an occupational therapist, Tya Fry has a particular interest in making Austin Health's care and services feel culturally safe to indigenous patients.

"Research indicates very few Aboriginal and Torres Strait Islander patients access mainstream Occupational Therapy services," says Ms. Fry, who works as an OT on Ward 8 North.

After winning a scholarship to attend a recent National Indigenous Allied Health Conference, Ms. Fry presented ideas to the Occupational Therapy staff on how they may deliver better culturally safe services in all aspects of their work.

She recently won a scholarship to attend the biannual National Indigenous Allied Health Conference, which attracted more than 250 delegates from around Australia. Ms. Fry is the first person to represent Austin Health at the National Conference.

Ms. Fry says that she is often asked questions about Indigenous health by colleagues, and is excited to be formalising the role, by becoming one of the founding members of Austin Health's new Aboriginal Health Steering Committee.

She is looking forward to working with the committee to ensure the delivery of culturally safe and appropriate services and progressing Austin Health's goal of Closing the Health Gap between Aboriginal and Torres Strait Islander peoples and non Indigenous Australians.

World-first study links diabetes to poor surgical outcomes

A world-first Austin Health study has found people with diabetes are far more likely to have adverse outcomes following surgery than those without the disease.

Diabetes was associated with significantly higher six-month mortality, major complications, intensive care unit admission and mechanical ventilation as well as increased hospital length-of-stay in the study of 7565 patients.

Published in the world's leading diabetes journal, Diabetes Care, the study measured average concentration of glucose in the blood (HbA1c level) of surgical patients (excluding day surgery) aged 54 and above admitted to Austin Health between May 2013-January 2016. Of the patients, 30 per cent were found to have diabetes.

The other major findings were:

  • Patients with diabetes had a nine per cent incidence of death within six months of surgery compared to a six per cent incidence of death in those without diabetes.
  • A major complication was present in 21 per cent of patients with diabetes compared to in 14 per cent of those without the disease.
  • 27 per cent of diabetes patients were admitted to intensive care post surgery compared to 18 per cent of those without diabetes.
  • The median cost of treating a patient with diabetes was $20,440 compared to $17,439 for those without diabetes
  • 16 per cent of diabetes patients required mechanical ventilation compared to 10 per cent of patients without diabetes.

Principal investigator and Austin Health Director of Diabetes, Associate Professor Elif Ekinci said the findings are significant and provide strong evidence that future intervention is needed.

"While we previously already knew that people with diabetes had poorer outcomes following cardiac surgery, this is the first comprehensive study worldwide showing that these patients have poorer outcomes across all surgeries," Assoc Prof Ekinci said.

"A significant finding of the current study is that poor blood sugar control before surgery, as reflected by higher HbA1c levels, is an important risk factor for major complications and intensive care unit admission."

"Diabetes currently impacts 8.8 per cent of the world's population and its prevalence is rising. Therefore, it is imperative that we understand the risk of outcomes following surgery on people with diabetes.

"Now that we have a much deeper understanding of the adverse surgical outcomes in these patients, we can investigate the interventions that we need to plan in order to prevent these outcomes".

The study was possible thanks to Austin Health's Diabetes Discovery program - an Australian-first, the initiative measures the HbA1c of every patient admitted aged 54 and above. If their HbA1c is high they are seen more quickly, or if it is suboptimal, follow-up intervention is arranged.

 

Austin Health pioneers world-first treatment for patients with liver failure

Pic courtesy of ABC Liver transplant patient Devon Warren and his wife Chrissie Warren

 

Devon Warren used to have 10 litres of fluid drained from his abdomen through a needle as a result of his chronic liver disease.

But now Mr Warren is just one of 14 transplant recipients in Victoria who've benefited from a new treatment pioneered by Austin Health that could change the way people with liver disease are cared for.

In a world-first, Austin Health has reapplied how the drug Terlipressin is given to patients waiting for a liver transplant, reducing the length of hospital stays and improving their post-surgery recovery.

Austin Health Head of Intestinal Rehabilitation and Transplantation, Dr Adam Testro oversaw Mr Warren's treatment along with 21 other liver patients, 14 of whom have successfully received transplants since 2014.

Many patients like Mr Warren develop Hepatorenal syndrome, a pre-terminal condition with a life expectancy of 30 to 40 days, in which the kidneys fail before the patient succumbs to liver disease.

"We have a problem with a suspected survival of one month and waiting time for a transplant of nine months, so we desperately needed some intervention to enable these patients to access liver transplantation," Dr Testro said.

Terlipressin constricts blood vessels around the bowel, increasing the blood supply to the kidneys and improving how they function.

Typically liver patients with kidney issues have to be admitted to hospital to receive injections of the drug.
But Austin Health's Victorian Liver Transplant Unit has developed a continuous drip or infusion method of delivering Terlipressin over 24 hours, meaning patients can receive treatment at home, rather than being admitted to hospital for months at a time.

"We manage to save about $1,000 per patient, per day when they're on the infusion," Dr Testro said.
"We have quite a number of rural patients who end up having to come to Melbourne so to return them back to their communities and their family is an enormous benefit to them.

"They're having life-saving therapy but in their own homes."

Dr Testro said a flow-on benefit of the Terlipressin treatment was that it reduced demand for kidney transplants.

"There's a significant risk in patients with advanced kidney failure and who have liver failure of needing to have a combined liver and kidney transplant," he said.

"By using a medication that can either improve or in most cases normalise kidney function before a liver transplant, we would hope the need to have combined kidney-liver transplants would significantly decrease."

Dr Testro said the treatment had the potential to become a new standard of care for liver patients, with little to no negative side effects.

"We have had a number of enquiries from interstate and from New Zealand to share our protocols with them but to my knowledge we're still the only centre in the world doing this," he said.

Chrissie Warren says the Terlipressin treatment offered her husband a better quality of life.

"We went from weekly visits [to the hospital] to sometimes up to six weeks," she said.

"The volume of fluid drained decreased from what it was weekly, because before the Terlipressin it was an average of eight to 10 litres per week and then it went down to between five and six."

Devon recently received a liver transplant at Austin Health.

At his worst Mr Warren said he was "a skeleton wrapped in skin" and weighed less than 60 kilograms.
"When I was lying in the bed in ICU, I could feel this funny tingling sensation coming into my bones, my cheeks, through my whole body ... and when Chrissie saw me she said 'You just look so different already'," he said.

"It was the drugs I was on and the liver working, and my body adjusting to a new life."

 

 

New Drug and Antibiotic Allergy Service opens

Dr. Jason Trubiano
Dr. Jason Trubiano

Austin Health's new Drug and Antibiotic Allergy Service (DAAS) provides a fully-multidisciplinary and comprehensive service for the testing and diagnosis of drug and antibiotic allergies.

The clinic - which started operating last month - brings together a multidisciplinary team of doctors, nurses and pharmacists into a comprehensive service, to see patients with a wide range of drug allergies.

Dr. Jason Trubiano, who is director of DAAS, says that while each type of testing was available previously, patients sometimes needed to be referred to a number of different clinics - and even different hospitals - before they received the correct allergy label. In some cases, patients stopped attending appointments before they found out which drug they reacted to.

"If you have an operation on your hip, you might receive antibiotics, muscle relaxants, pain relief medication and anaesthetic drugs," Dr. Trubiano.

"If you then have an adverse drug reaction, we don't know which drug has caused it. Infectious Diseases has run an Antibiotic Allergy Service since 2015 that's been very successful in de-labelling patients who have been incorrectly labelled as having an antibiotic allergy," Dr. Trubiano says

"If we suspected that you had an allergy to the perioperative or anaesthetic drug, we'd then have to refer you elsewhere. Now, patients who come to clinic will leave with an answer by the end of the day."


The Clinic will also allow approximately 25 per cent more patients who are suspected to have an antibiotic allergy to be seen each year - which Dr. Trubiano says is a win for both antimicrobial stewardship, and the individual patient.

"There have been studies that have shown that having an antibiotic allergy label is associated with being more likely to have a resistant infection. Our data also says that these patients are more likely to receive an inappropriate antibiotic," Dr. Trubiano says. He says that clinic data has shown that up to 90 per cent of patients who believe they have an allergy to antibiotics have no such allergy at all.

When patients are labelled as allergic to a highly-effective drug, doctors are forced to prescribe a second-line antibiotic, increasing the likelihood of causing antibiotic resistance.

As well as opening the new service, Dr. Trubiano is principal investigator in a research project that will teach Austin Health's computer systems to identify patients who have had an adverse drug reaction, using a process called natural language processing (NLP).

The project has received $15,000 in funding from the Austin Medical Research Foundation, which will cover the cost of developing the NLP software, in collaboration with Department of Computing and Informatics at the University of Melbourne. Staff from Infectious Diseases and Pharmacy will then review patient records and flag key words that suggest a patient may have had a drug reaction - say ‘rash' and ‘amoxicillin', training the computer system to look for the same words automatically.

"It's basically training a computer to support the Adverse Drug Reaction pharmacist," says Dr. Trubiano, "and in real-time. If someone is in the Emergency Department and has a rash, by the time they're in the ward, they'll have been flagged."

Dr. Trubiano hopes that the project will improve the detection of adverse drug reactions.

"I estimate we'll pick up another 100 or 200 patients a year that are missed, or just get labelled as having a penicillin allergy, or are told they're allergic to lots of drugs," Dr. Trubiano says. He says that this will be on top of approximately 600 adverse drug reactions already picked up each year through a manual reporting system.

"Patients will be referred for allergy testing, leading to more appropriate allergy labels, and hopefully, safer drug and antiobiotic prescribing," Dr. Trubiano says.

The Drug and Antibiotic Allergy Service operates all day every Thursday from the Ambulatory Care Centre at Austin Hospital, and welcomes referrals from across Austin Health.

Emergency Department to begin cannabidiol trial

Dr. Bebee
Dr. Bebee

Doctors in Austin Health's Emergency Department (ED) will soon offer cannabidiol - a medicinal cannabis extract - in addition to standard treatment for back pain. The cannabidiol will be given as part of a small clinical trial that will recruit 100 people to investigate whether taking cannabidiol results in greater pain relief, than the standard treatment does alone.

"We are including individuals with mechanical low back pain, who are not pregnant and do not regularly use cannabis. They'll be admitted to the Emergency Department Short Stay Unit where, along with usual care, which might involve simple analgesia, physiotherapy and potentially opioids, they will receive a single oral dose of either 400mg cannabidiol oil or a placebo," says Dr. Bebee, who is chief investigator of the trial.

"Over the following two hours, we'll record their pain score and any side effects from the medication - with follow up after discharge, around 48 hours later, to make sure there were no other adverse effects."

Dr. Bebee emphasises that this is a small pilot study. Cannabidiol has been chosen because it is thought to have analgesic (pain-relieving) properties, without the psychoactive properties that are usually found in cannabis.

Should cannabidiol prove to be effective for chronic back pain, there are clear benefits to its use over other painkillers - particularly opioids.

"Opioids don't reduce the time course of back pain, and have well-known negative consequences, such as addiction, nausea and quite severe constipation. They are not the right drugs for us to be using for back pain," says Dr. Bebee.

"We use opioids in the ED for acute pain, which is likely to resolve in a short period. Opioids are not ideal for non-cancer, long term pain, such as chronic musculoskeletal pain, migraines or chronic abdominal pains."

"The ideal analgesic for back pain would not be addictive, and would allow individuals to carry on with life while using it - cannabidiol is both an analgesic and an anti-inflammatory," Dr. Bebee says.

"It has also been shown to reduce opioid-seeking behaviours, as it operates on the same pathways," Dr. Bebee says.

Dr. Bebee's professional interest in pain - before working in ED, she worked in Palliative Care and as the pain registrar in Anaesthetics - is also based on some very personal reasons.

"I have an autoimmune arthritis, and at 26 was dealing with quite bad chronic pain myself, on a daily basis. I had an 18 month-old at the time, and had trouble even changing her nappy because I couldn't use my right hand," Dr. Bebee says.

"No-one ever gave me an opioid - and I'm really grateful for that," she says.

"Pain doesn't matter as much as being able to function. If the goal is a pain score of zero, then we risk severe side effects and over-sedation, to the point of turning individuals into zombies. It's more important for people to be able to do all the things they enjoy in life despite chronic pain," she says.

If the trial is successful, the team will look at running the trial again with a larger cohort - and ideally, as a multi-centre trial.

"If a treatment effect is established, then we can look at comparing it to other treatments on its own. We could also look at its effectiveness in other types of pain, such as kidney stones, or procedural pain," Dr. Bebee says.

Although people have used cannabis for pain for centuries, "Home-grown cannabis contains different quantities of the various chemical compounds, and we can't pull any useful scientific data from that. It's really important that we do trials that stand up to scientific scrutiny," she says.

"If we can use a medicinal cannabis with one compound that's been refined down - and ours is over 98 percent pure cannabidiol - we can actually look at what the properties of that compound are. Once we find out what symptoms each of the compounds in cannabis can target, we will have the chance to really help people."

 

'The CANBACK trial: A randomised, double-blind, placebo-controlled, clinical trial assessing the usefulness of CANnabidiol for BACK pain in the emergency department' is just one of the major ongoing research projects listed in the latest Emergency Department Research Report, which has just been published online.

The trial has been funded thanks to a donation from the Robert C. Bulley Charitable Fund.

Artists add a splash of colour to Statewide Child Inpatient Unit

Statewide Inpatient Child Unit staff

A bright underwater-themed mural is bringing a splash of colour to the courtyard of Austin Health's Statewide Child Inpatient Unit, thanks to a team of local and interstate artists - and the creative energy of the unit's clinicians.

Acting Unit Manager Adam Blake (far left in the photo) has been working for 12 months on securing funding and organising the project, and says that "it's really good to have a project like this come to fruition."

The mural was painted by a team led by internationally-renowned Melbourne artist Mike Makatron (mike.makatron on Instagram), who brought in other artists from Melbourne and Byron Bay to contribute to the artwork. The four artists completed the work in just three days.

Although the piece was only finished over the weekend, Mr. Blake said that it is already attracting a lot of attention from children, families and staff.

"The feedback has been really positive, from everyone from the children to our Divisional Director. The first thing that people say is ‘ooh, it's very bright!' It's showing a fresh perspective for the Statewide Child Unit," Mr. Blake says.

"What we wanted was to provide a piece of art that represents how we work now; moving away from the white walls of a clinical space to thinking and doing things in a more creative way," says Mr. Blake.

"It's going to be a talking point for many years. A lot of children and families will look at this work and feel a sense of hope," he says.

Child Unit staff contributed ideas towards the artwork's theme, and Mr. Blake says that "it was really important to us to keep the Aboriginal flag, and continue to identify that we're on Wurundjeri land."

Taubman's donated the paint for the work, and construction firm Built., who are currently working on construction projects at Austin Hospital, provided staff to paint the undercoat, and replace the basketball ring and cubby house pro bono.

The Statewide Child Inpatient Unit works with children up to 12 years of age and their families who are seeking assistance for severe emotional, behavioural and relationship difficulties.

Mural artists Mike Makatron (front), with Gema, Austin and Ari.Mural artists (L-R): Gema, Austin, Mike Makatron and Ari.

Offering comfort and safety to Aboriginal patients

Jacob Nelson

Austin Health welcomes new Aboriginal Hospital Liaison Officer (AHLO) Jacob Nelson.

Mr Nelson joins Austin Health after five years living and working in Melbourne for a number of Aboriginal community controlled organisations. He will work across the three main hospital sites for 30 hours a week, and is looking forward to helping staff to improve their cultural awareness as well as "offering comfort and safety to Aboriginal patients."

He is a Bunjalung man, whose Country spans an area of north-east New South Wales and southern Queensland that covers the Gold Coast, Byron Bay, Ballina, Lismore and Lennox Head - a part of the world "I'd gladly debate is the most beautiful part of the planet but, I'm probably somewhat biased. I try and return to country once a year, with my older brother and mother. It's always an incredible, spiritual and humbling experience," Mr Nelson says.

By coincidence, his family totem is the goanna, an animal he was pleased to find represented in the Aboriginal artwork at Austin Hospital - and which he is pictured beside above.

"I am extremely passionate about the health and wellbeing of all Aboriginal and Torres Strait Islander people," Mr. Nelson says.

"I'm excited about my new role, working in a world class facility, alongside incredible staff. I cannot wait to bring my experiences and skill set to Austin Health, where I hope to also learn and grow, leading to the best care and experience of Aboriginal and Torres Strait Islander people that can be provided, in what can be very trying and difficult circumstances," he says.

Mr. Nelson emphasises that he cannot represent or speak for all Aboriginal peoples, and that he himself is still learning about the diverse peoples and cultures that make up indigenous Australia. However, he says "I want to be someone people feel that they can approach, to ask about Aboriginal culture."

He hopes too to help to close the still-significant gap in health outcomes between Aboriginal and non-Aboriginal Australians.

"It's 2018. I have a super computer in my pocket, but I still have relatives dying in their 50s. I think we can do better. I think we owe the traditional owners of this land a little bit more than what we've given them so far," Mr. Nelson says.

"I'm also quite happy to challenge stereotypes about Aboriginal people, as there's still prejudices and assumptions about Aboriginal people," he says.

Jacob is based In the Ngarra Jarra office, level 3 Harold Stokes Building, Austin Hospital and can be contacted on 03 9496 5834.

Steven Wells to guest present Gardening Australia

Steven Wells on Gardening Australia
Steven Wells on Gardening Australia. Photo courtesy of Gardening Australia.

Tune in to ABC's Gardening Australia at 7.30pm on Fridays from February 9 to see Austin Health's Gardens and Grounds Officer and horticultural therapist, Steven Wells, guest present.

The first episode presented by Mr. Wells will visit gardens at Royal Talbot Rehabilitation Centre, including the sensory garden. This episode includes interviews with staff members and recent patients about their use of the gardens.

"I'll be a guest presenter sharing some stories about horticultural therapy, therapeutic garden projects and the value that gardens and gardening programs can bring to different people in different situations," Mr. Wells says.

The Gardens and Grounds Project is on Facebook and Instagram.

Austin Health's horticultural therapy program relies entirely on community support. Find out more or make a donation.

ROCKet trial launches

Anaesthetist, Professor Philip Peyton
Prof Philip Peyton

An Austin Health led international trial that hopes to be a game-changer in the prevention of post-surgical pain has recruited its first patient.

The Reduction of Chronic post-surgical pain with Ketamine (ROCKet) trial is the world's first large-scale trial into post-surgical pain prevention.

Austin Health and The University of Melbourne received $4.8 million in NHMRC funding to run the trial - the biggest grant allocated for 2017. Just under 5000 patients who are undergoing major surgery will be recruited over the next five years to test whether ketamine given prior to and following surgery reduces the incidence of chronic post-surgical pain.

Principal Investigator Philip Peyton, who is Austin Health's Director of anaesthesia research, said the trial's scale had captured the attention of the pain research community. Prof Peyton said several small trials of ketamine have had mixed results and it was accepted that a large definitive trial was needed.

Prof Peyton said chronic pain after surgery is a widespread problem, especially after breast cancer, abdominal and thoracic surgeries and knee and hip operations. A large Australasian study found 12 per cent of patients still suffered pain 12 months following major surgery, with a third rating their pain as severe.

"This not only has a significant impact on quality of life but also a substantial economic impact,'' Prof Peyton said.

Those in the control group will receive standard anaesthesia and post-operative pain relief while the other half will also receive ketamine during surgery and for up to 72 hours after their procedure. They will be tracked for one year after surgery.

Prof Peyton said ketamine targets receptors in the pain pathways of the spinal cord which are thought to be responsible for the progression of acute pain to chronic pain.

"We think it's a drug that may be able to cut that progression," Prof Peyton said.

"This trial is an exercise in prevention. We are not trying to treat chronic pain once it is established - that is really difficult and we think an ounce of prevention might be worth a pound of cure.

"If it is proven to be effective it will be a game-changer because there will be a really strong argument for making ketamine a routine part of anaesthetic care rather than something we reach for when we have a problem with difficult pain," Prof Peyton said.

The five-year trial will recruit about 1000 patients per year, initially in Australia followed by centres in New Zealand, Hong Kong and other parts of Asia. Prof Peyton said there had also been significant interest from North America and the UK.

 

The doctors caring for doctors

Dr Joel Wight
Dr. Joel Wight

Dr. Joel Wight knows a thing or two about mentoring doctors - he wrote the book on it.

A Clinical Haematology Fellow and one of the doctors available to mentor junior doctors at Austin Health, Dr. Wight says "I became a mentor because I was mentored well myself and I know how big a difference it made to me, in terms of seeing my career path clearly, seeing the sort of doctor I wanted to be, and helping me get there."

Dr. Wight is also co-author of The intentional mentor in medicine, a book that he started working on while working at Townsville Hospital. He became an author, he says, a little less intentionally.

"I was in the right place at the right time. My co-author was the head of our Clinical Education Unit in Townsville, and she wanted someone with mentoring experience who was from a medical background to work with - I said yes and off we went," Dr. Wight says.

The book is one of the few resources out there to deal specifically with mentoring doctors.

"There was a need for it. People tend to know mentoring when they see it, but that doesn't necessarily mean that they know how to do it. There was a dearth of information in the medical space on how to do it properly," Dr. Wight says.

"As doctors, we're expected to teach, mentor and develop the next generation as part of our job, but we're never taught how to do that. We're just expected to pick it up along the way, but we could do a more effective job if we had more training and resources," he says.

This week, 62 new interns started at Austin Health. The beginning of a new year for junior medical staff has reignited conversations about what can be done to look after doctor's mental health, and prevent doctor suicide. It is timely to share information about the support available to doctors - which all doctors are encouraged to access if needed, whether they are junior or senior.

Dr. Wight's advice to new interns is to reach out for support.

"The sick feeling that you have in the pit of your stomach is universal - we've all been there, and we're here to help you," Dr. Wight says.
"If you're struggling, you're not alone in your struggles. Everyone struggles, and that's nothing to be ashamed of, because our job is hard. We're all here for each other."

The two key programs available to support doctors at Austin Health are the Mentor and Peer Support Programs. Dr. Wight says the two programs have a different focus.

"The Peer Support program is designed as support for the doctor who's having a really hard time, is potentially in crisis, and needs help getting through something difficult over a specific period of time," he says.

"Good mentoring might prevent people from getting to that point. Mentoring develops people when things are good, and when things are bad. I might be having a good time at work at the moment and not need to speak to a Peer Support person, but to get where I want to be in five years' time, I do need a mentor."

The doctors available to talk to via either program can be identified via the similar ‘M' and ‘P' stickers on their ID badge. A list of the doctors that can be contacted is accessible to Austin Health staff on the Caring for Doctors Hub page.

New workshops for doctors wanting to become mentors will be starting shortly. Any Austin Health doctors interested in being a mentor or locating a mentor can call Pauline Dib from the Clinical Education Unit, who manages the mentor program, on 9496 4407.

Victorian Poisons Information Centre releases 2017 figures

Jeff Robinson, manager of the Victorian Poisons Information Centre
Jeff Robinson, manager of the Victorian Poisons Information Centre

The Victorian Poisons Information Centre (VPIC) has published its 2017 Annual Report, revealing last year to be its busiest for 10 years.

"On average we got 113 calls a day, which translated into 41,410 calls during 2017," says VPIC manager Jeff Robinson.

The Report reveals that paracetamol continues to be the main medicine of concern, prompting 2,626 calls during the year. It was also the subject of six research publications and a conference presentation by staff.

"It's the number one medicine we get called about, either because of deliberate self-poisoning, people making mistakes with dosing, or what we term ‘paediatric exploratory digestion', where a kid might crawl up and put a dosing syringe into their mouth," Mr. Robinson says.

He also says that there is seasonal variation in the calls received.

"In the warmer months, we get a lot more calls about envenomation - for example, snake and spider bites and stings from bees, wasps, jelly fish and the like. In autumn and winter, we get a lot of calls about people ingesting wild mushrooms."

Mr. Robinson says that most of the 244 calls about mushrooms occurred during the cooler months of the year, suggesting that Victorians are managing to consume mushrooms that are poisonous - or suspected to be poisonous - at a rate of more than one a day during autumn and winter.

"It varies from kids swallowing mushrooms in the garden, to people finding wild mushrooms that they think look good to eat and finding that several hours later they're doubled up in pain and vomiting. Then of course there are those who go searching for hallucinogenic mushrooms. It's very difficult if you're not a mushroom expert and a lot of the time, they find they get very sick instead," Mr. Robinson says.

"We also get quite a few queries from people asking for advice on whether a mushroom they've found is ok to eat. We say no. It's a blanket no. There is no test for whether a mushroom is safe to eat."

Mushroom identification is such as expert art, in fact, that for some years VPIC has had an agreement with the senior mycologists (mushroom experts) at the Royal Botanic Gardens, who are available to help the team identify poisonous mushrooms. They even provide an overnight, on-call mycology service.

"If someone calls about a suspected mushroom poisoning, we get a description of the mushroom. If it meets certain physical characteristics - shape, colour, size, colour of the gills - then we ask them to email a photo of the mushroom taken from a few different angles next to a ruler or a 50-cent coin to us, and to the mycologists, and they identify the mushroom," Mr. Robinson says.

On occasion, a mushroom specimen is even couriered to the mycologists.

"They're very good - they know what sort of mushrooms are going to be growing from things like recent rainfall and recent temperature. It varies from year to year."

There are some interesting entries in the Report under ‘Exposures to non-medicine, non-drug products' - including 218 toys, 129 exposures to bubble mix, 28 slugs and snails and a number of art-and-craft mishaps, involving 24 crayons, 49 pieces of chalk, 12 pencils - and even 20 pieces of paper or cardboard.

Mr. Robinson says that this is "mostly accidental swallowing by small children", and - hearteningly for any parents reading the figures - assures that actual poisonings for small children remain very low.

"We live in a fairly safe society - you'll note that of the 11,840 calls we received about toddlers, our advice was that 88 per cent could be managed at home, and only three per cent needed to be sent to hospital. We have better packaging, better labelling and more restrictions on toxic chemicals than 20 or 30 years ago," he says.

"We play an important role keeping people away from doctors and hospitals when they don't need to be here, and in stopping unnecessary call outs of ambulances."

For Mr. Robinson, however, the most important parts of the Report are not in the call figures.

"The highlights for me this year are that we've had a record number of papers published this year by Poisons Centre and Austin Toxicology staff - 18 in total, and we've done a record number of outreach education hours, presenting lectures or at conferences for other health professionals. The really big deal for us this year has been having the Austin Toxicology Guidelines made available on the Clinicians' Health Channel, and thereby available to all clinicians in Victoria," Mr. Robinson says.

VPIC and the Austin Toxicology Service work very closely together to provide Victoria with an integrated poisons information and poisons management service of the highest professional standard.

You can call the Victorian Poisons Information Centre on 13 11 26  24 hours a day, seven days a week.

From plant to plate

An innovative idea from allied health assistant Anton Harrington has transformed an overgrown and unused space at Royal Talbot Rehabilitation Centre (RTRC) into a bustling social and therapeutic hub.

Starting with "a few reclaimed pots and some seeds", Mr Harrington - who has a background in horticulture - has created a kitchen garden in the courtyard outside the Occupational Therapy (OT) Department kitchen that is overflowing with rapidly growing pumpkin and tomato plants, strawberries, lettuces and bok choi. The plants are growing in garden beds, as well as a range of wheelchair-accessible raised planters, vertical gardens - and one amazing ‘Garden Tower', a combined worm farm/vertical garden donated to the project by Garden Tower Australia.

The accessible kitchen garden has won the praise of patients.

"I've had numerous patients say that it's just so nice to do something normal", Mr. Harrington says. "The space is now used daily by patients, and by people visiting relatives."

The garden also combines with the adjoining OT kitchen and Daily Living Skills space to create a unified space, with the garden and its home-grown produce complimenting the OT Department's weekly cooking retraining sessions. Participants from the Spinal Unit grow and harvest the plants that they then cook for shared meals with the group. Food waste from the cooking group is then composted back to the garden via the worm farm.

While he emphasises that the garden does not replace formal rehabilitation therapies, Mr. Harrington says that it "combines aspects of occupational therapy, physiotherapy and wheelchair skills in a meaningful and engaging activity."

The project has garnered support and collaboration from across RTRC and the community. Steven Wells - who runs both the Centre's official horticultural therapy program and the Austin Health Gardens and Grounds Project - allocated some donated funds to kick-start the project. The Woodwork Department built and donated the garden's first accessible planter boxes, which are raised on legs so that wheelchair uses can wheel under them, rather than having to turn sideways, to garden. Others have donated tools and equipment.

The Woodwork Department also worked with Mr. Harrington on a side project - to design and develop a chopping board with a pivot knife that helps spinal patients to work more independently in the kitchen.

His creative ideas are attracting recognition, with Mr. Harrington winning best poster award at the recent statewide Allied Health Assistant Day at Monash Medical Centre earlier this year, and Runner Up in Austin Health's Consumer Engagement Awards for his cutting board.

He has also been documenting the garden's progress on Instagram. You can follow him athttps://www.instagram.com/accessiblekitchengardening/

Record clot retrieval time saves Maria

A Reservoir grandmother can expect to return to a normal life despite suffering a severe stroke, thanks to the rapid response of our staff and the Mobile Stroke Unit ambulance.

Maria Argenzio was the first patient to be brought to Austin Health by the specially-equipped Mobile Stroke Unit ambulance on Monday. An Australian-first, the purpose-built MSU has an on-board CT scanner enabling a patient's brain to be imaged to detect the type of stroke they are having so assessment and treatment begins immediately, rather than at the hospital.

Austin Health Head of Stroke Medicine, Professor Vincent Thijs says this rapid assessment, combined with a perfectly-orchestrated team approach at Austin Health, saved Maria from a devastating outcome.

"The MSU had completed a brain scan and neurological assessment of Maria so we knew exactly what her problem was before she arrived and our team was able to give her treatment in the quickest time ever,'' Prof Thijs says.

Maria had a clot blocking a major artery in the brain, the left middle cerebral artery, causing a very severe stroke which left her unable to talk or move the right side of her body.

Prof Thijs says this kind of stroke is profoundly disabling if the artery is not unblocked very quickly.

And act quickly the team did.

"We were waiting in the Emergency Department and getting updates from the MSU. In the meantime we had organised our entire workflow to be ready. Some of the areas this included were ED staff, the anaesthesia support team and the cath lab.

"She was brought in at 4:40pm and by 4:53pm she had the catheter inserted in her groin. 21 minutes
later the blocked artery was open and she started talking and moving immediately,'' Prof Thijs explains.

"Our median door to start of procedure time is 70 minutes and this took 13 minutes," he says.

Prof Thijs says Maria, 78, is expected to make a full recovery.

"A few years ago, before the clot retrieval procedure was available, she probably would have been left severely disabled and probably would not go home from hospital.

"I think this is a result of a lot of hard work put in by the team and these outcomes can only be achieved with great collaboration across various units across the hospital."

Austin Health Head of Neurointervention, Associate Professor Mark Brooks agrees that strong teamwork was key to the great result.

He and his colleagues look forward to changing the lives of many other stroke sufferers going forward.

Maria and her daughters Teresa Crisafi and Elisa Argenzio caught up with some of the staff involved in Maria's care yesterday. An emotional Maria says she will be forever grateful for getting a second chance at life.

Her daughters wrote the following letter to express their gratitude:

Mum's life may have been very different today if not for the impressive coordination of paramedics, specialist doctors and nurses from the Mobile Stroke Unit, collaborating with the Austin Health medical team.

Sincere gratitude must be afforded to the gentle and considerate Emma Torzillo who explained the procedure required and the competent Doctor Asadi and Doctor Kruger who undertook the clot retrieval, with Prof Vincent Thijs overseeing.

We also wish to thank Austin Hospital for its extraordinary care of Mum, especially Doctor Paul Kopanidis, stroke nurse practitioner Bronwyn Coulton and the many wonderful nurses who assisted Mum's recovery on the sixth floor.

Words are hardly enough to express our gratitude to you all for giving Mum another lease on life.
Congratulations to the Mobile Stroke Unit Team for proving that this life-saving initiative works.

In gratitude,

Teresa Crisafi and Elisa Argenzio

 

Mad Grit: Thriving with a tracheostomy

Vietnam


Seven months ago, Daisy Xu was three months into a world trip and on top of the world.

Then, while motorbike riding across Vietnam with friends, she crashed and broke her spine, becoming quadriplegic.

Daisy's memories of those early days in the sweltering Vietnamese hospital are hazy. She remembers clearly the panic when she couldn't breathe anymore, and being rushed to the Intensive Care Unit (ICU) to be ventilated. She also remembers the pain and discomfort of being placed in a clunky metal halo - and the excruciating pain when she was taken off painkillers.

"I gave up the will to live... I was ready for death to take over me," she wrote later. "That was the scariest thing I have ever felt in my life, and to say that I have fallen to the lowest low is an understatement."

Daisy's breathing tube in Vietnam was put in incorrectly. Pushed in too far, the ventilator wasn't inflating her left lung at all, and was filling her right lung with twice the amount of air required. She developed severe pneumonia, and one of her lungs collapsed.

Ten days after the accident, on an emergency flight home organised by her travel insurer, Daisy's other lung collapsed and she had to undergo emergency treatment mid-flight.

The Austin Hospital


On arrival in Melbourne, Daisy was rushed to Austin Hospital.

Her luck had turned: Austin Health is a world leader and the statewide provider for respiratory and spinal care. It is also one of a handful of hospitals in the world that achieve the best outcomes for patients who require a tracheostomy - a breathing tube inserted into the windpipe (trachea) through a hole in the neck - thanks to the Tracheostomy Review and Management Service (TRAMS).

People with a tracheostomy treated at Austin Health are more likely to learn to speak earlier, wean from a ventilator earlier, have the tracheostomy tube out and leave the hospital earlier than patients from other hospitals. For patients who cannot have the tube removed, TRAMS and the Victorian Respiratory Support Service (VRSS) help patients live well and safely in the community.

Within a month of arriving at the Austin Hospital, Daisy was able to speak again and was out of ICU and in the Acute Spinal Unit. She learnt to swallow, eat, drink and has started a blog, which she authors using speech recognition software.

With the assistance of music therapist, Dr. Jeanette Tamplin, she has even learnt to sing while on ventilation. She has a wonderful voice.

Daisy Xu

Daisy singing at the Tracheostomy Patient, Family and Carer Festive Forum with music therapist, Dr. Jeanette Tamplin.
Thriving with a tracheostomy


Daisy's fast progress is in large part thanks to the close teamwork and collaborative excellence of TRAMS, VRSS and the Victorian Spinal Cord Service. Importantly, however, it is also due to her positivity and attitude toward recovery.

Last week, Daisy was awarded one of two ‘Thriving with a Tracheostomy' Awards at Austin Health's Tracheostomy Patient, Family and Carer Forum, alongside Steven Stewart.

TRAMS Clinical Nurse Consultant Kristy McMurray says that "Daisy and Steve have amazed us all with how they have not just got on with their lives, but thrived even in very difficult circumstances."

On why she thinks she received the award, Daisy says: "I try hard. I like to try everything. Because in the end, it's my life."

The Acute Spinal and Respiratory Wards also received an award - as did nurses Hallie Silver and Kim Boon.

Ms McMurray said that both nurses were "nominated by patients...They have gone above and beyond in times of need for their patients and this award recognises the appreciation their patients have for them."

"The patients that are cared for on these wards would in any other hospital be required to remain in ICU. This award ... recognises the excellent team work shown every day on every shift to support very complex patients with such compassion and dedication."

Other awards included the Carer's Award - which went to Daisy's dad, Geoffrey Xu, who has barely left her side, and the Consumer Advocacy Award, which was given to Kirby Littley.

TRAMS is a founding member and model service for the Global Tracheostomy Collaborative (GTC), which aims to improve the quality and safety of tracheostomy care for all patients. The GTC's patient and family committee creates change and improvement by teaching healthcare professionals about the experiences of people living with a tracheostomy.

Austin Health's own Patient and Family events give past and present tracheostomy patients and their families an opportunity to meet and share stories with other patients and their families, and hear news about tracheostomy care around the world. To find our more, visit www.globaltrach.org and http://tracheostomyteam.org/patients/

You can follow Daisy's blog, Mad Grit, at https://daizy4life.tumblr.com/

Tap into the Twitter conversations around tracheostomy news and care by following the hashtag #GTCbettertracheostomycareeverywhere

 

Could Melbourne's favourite beverage be the answer to one of our biggest health problems?

Woman drinking coffee
Austin Health researchers are investigating if coffee can reduce Fatty Liver Disease

December 5, 2017

Austin Health researchers think coffee could be a weapon in the fight against one of our biggest health problems - fatty liver disease (FLD).

Liver transplant physician Associate Professor Paul Gow, Senior Clinician (dietitian) Brooke Chapman and Hepatology Fellow Dr Zaid Ardalan are testing whether regular coffee consumption can treat fatty liver disease, which affects about one-in-three Australians.

FLD is as it sounds, a build-up of fat in the liver, largely caused by being overweight, a poor diet and inactivity.

Most people with the problem don't realise they have it which is a big concern as if left untreated it can cause liver cirrhosis, liver cancer and liver failure. It is also strongly predictive of future risk of heart disease and type 2 diabetes.

The Austin Health team are carrying out a proof-of-concept study which aims to test whether three cups of coffee a day can reduce liver fat.

All of the people in the randomised controlled trial currently have FLD and none of them were coffee drinkers before embarking on the trial. Half consume coffee while on the trial and the remaining half are told not to drink coffee.

MRIs are used to test whether liver fat is reduced.

Assoc Prof Paul Gow says the first evidence that coffee could improve liver function emerged 30 years ago, when a study into heart disease revealed that regular coffee drinkers had healthier livers.

"There have been observational studies showing that coffee drinkers have a lower risk of cirrhosis, of liver cancer , and they have a lower risk of fatty liver disease," Associate Prof Gow said.

"There haven't been interventional studies for fatty liver disease. We want to prove that cause and effect."

Assoc Prof Gow says it would be hugely exciting if coffee is found to be effective as there are no medications or surgical treatments available for FLD. Currently doctors advise their patients to try and lose weight through improved diet and exercise but Assoc Prof Gow says most people find this impossible.

Results of the trial are expected to be available in the first quarter of 2018.

For more information please contact Julie McNamara, Deputy Director of Communications, Austin Health: 0419 595 688.

 

 

Austin Health performs 1000 kidney transplants

Members of the surgery team hard at work during 1000th transplant recipient Vijaya Guduru's surgery.

 

Austin Health has performed its 1000th kidney transplant.

Clinical lead of renal transplantation, Dr John Whitlam says it is an exciting milestone that is a reflection of many things, most importantly, the extreme generosity of all living and deceased donors and their families.

Dr Whitlam says every transplant is a huge team effort.

"From the donor side, there is the donor family, donor doctors and nurses, DonateLife coordinators and retrieval team. From the recipient side there's the recipient family, recipient nurses and doctors, Victorian Transplant and Immunogenetics Service scientists, transplant surgeons, kidney pathologists and the full recipient allied health team. It is a testament to the health service that transplantation is possible,'' Dr Whitlam says.

He says achievement of the milestone would not have been possible without the Victorian Kidney Transplant Collaborative.

"The VKTC permits Victorians from the catchments of Eastern Health, Austin Health, Bendigo Health, Barwon Health and St Vincent's Health to access transplantation. We are very grateful for the goodwill and dedication of all in the VKTC team who care for recipients and living donors before, during and after transplantation,'' he says.

Austin Health's first kidney transplant was performed in 1974 and Dr Whitlam says despite significant advancements since then, the team continues to work hard to improve transplantation access and outcomes.

"Areas of transplantation research at Austin Health include development of transplant rejection biomarkers (in collaboration with Murdoch Children's Research Institute), acute transplant fluid management (in collaboration with the Anaesthetics Department), participation in national and international multicentre clinical trials and clinical studies of cardiovascular disease in kidney transplantation,'' Dr Whitlam says.

The milestone 1000th transplant was performed on northern suburbs father-of-one Vijaya Guduru, 40 who says he now has a second chance at life.

"The last three years were horrible. I was fully restricted with my life,'' Vijaya says.

"I was on dialysis for 10 hours per day. I couldn't perform my job as a mechanic and I couldn't play outside with my son."

A grateful Vijaya says he was overwhelmed by the support of the Renal Transplant Team right down to the thoughtfulness of staff giving his family regular updates throughout the transplant.

Channel 7 Melbourne reported on Austin Health's achievement. Watch the story here.

 

 

Raising awareness about diabetes

Dr Elif Ekinci is working hard to raise awareness about diabetes.

Did you know that 280 Australians develop diabetes every day? That's one person every five minutes!

Austin Health Diabetes Director Dr Elif Ekinci took time out from her busy clinical and research schedule this week to explain the disease to listeners of Dr Sally Cockburn's Talking Health program on 3AW.

Take some time to tune in and hear Dr Ekinci discuss the new drugs available in the treatment of type 2 diabetes and why women who have had gestational diabetes should ensure they are checked for type 2 diabetes.

Listen here: http://bit.ly/2muTg1J

World-first trial offers hope for epilepsy sufferers

 

A world-first trial taking place at Austin Health will deliver electrical pulses to the "master control centre" in the brain, aiming to halt seizures and restore clear thinking in those whose severe epilepsy doesn't respond to treatment.

The trial of deep brain stimulation therapy is for patients with Lennox-Gastaut syndrome, an aggressive type of daily epilepsy that typically appears in childhood and causes learning difficulty. The syndrome also causes "drop attacks" - seizures that send them randomly crashing to the ground or through walls, resulting in serious injuries such as broken bones, fractured skulls and chipped teeth.

Medication or surgery are ineffective for up to a quarter of epilepsy sufferers.

The study is being led by Austin Health and The University of Melbourne and has received $1 million in funding from the National Health and Medical Research Council.

Austin Health neurologist Dr John Archer is the trial's Lead Investigator.

"The major cognitive functions like attention are not located in one spot in the brain, but across a number of key nodes in the network," Dr Archer says.

"When epilepsy gets into these, it's a fundamental disruption to the brain.

"This led to the idea that's what's needed is a treatment that tackles the network of the brain."
Similar to deep brain stimulation to treat the tremors and stiffness of Parkinson's disease, the trial will involve placing a pair of electrodes in the brain, connected by internal wires to a pacemaker box on the chest.

The stimulation target is the thalamus, the "Flinders St railway station of the brain" as the relay station for electrical signalling controlling sensory and motor tasks.

Dr Archer says the double-blinded study will see 20 patients implanted in the next 18 months.

"My biggest hope is we can prove this significantly reduces seizures," Dr Archer said.

"If we can also show there is improvement in cognitive function, it would be a bonus."
South Morang woman Janina Freestone, 48, will be one of the first to take part in the trial.

Janina's seizures started at three, and she has trialled various medications as well as a different brain stimulation therapy but both have had limited success in controlling the drop attacks and absent seizures she experiences multiple times each day.

"I have no independence I can't drive, I can't leave the house on my own," Ms Freestone says.
Ms Freestone says her condition also forced her to give up her job as a retail assistant, something she misses dearly.

She and her family are optimistic that the trial may lead to improvement.

"I'm hoping for a better life. I feel like I'm in cotton wool at the moment and I just want to get out,'' Ms Freestone says.

Surgery in the first patients is expected to begin before the end of the year.

 

New MumSpace website to support new mums

mum and baby

The Parent Infant Research Institute (PIRI) at Austin Health is the lead agency behind a new government-backed website and app that will offer free access to evidence-based mental health support to pregnant women and new mums.

The new MumSpace website and MindMum mobile app can be used by any woman who needs a little extra help with their emotional wellbeing during the perinatal period, and includes PIRI's MumMoodBooster online tool, a self-directed cognitive behavioural therapy (CBT) treatment program that was developed for women with, or at risk of, perinatal depression. Research published by PIRI last year found it to be highly effective.

PIRI director, Professor Jeannette Milgrom - who is also Director of Clinical and Health Psychology at Austin Health - said that "MumMoodBooster is a perinatal depression treatment that PIRI has systematically developed, user-tested and rigorously evaluated over several years with NIH and NHMRC funding. It produces a high rate of remission from clinical depression. If depression in pregnancy can be caught early it can prevent the development of postnatal depression. Having a free, evidence-based resource like this helps to de-stigmatise perinatal depression and anxiety and encourages women to seek help and get support."

ResearchFest awards announced

Chris Rowe

October 19, 2017

The 2017 ResearchFest Awards were announced today, with the highest honour, the Distinguished Scientist Award, awarded to Professor Chris Rowe.

"It's a delight and an honour to be joining the list of previous recipients, which contains so many outstanding researchers," he said after today's awards ceremony.

Professor Rowe's Distinguished Scientist Award will be added to an office wall already filled with numerous honours, including one placing him on the 2016 Highly Cited Researcher list, of the top 1 per cent of neuroscience researchers world-wide. He is so highly cited because of his significant body of research looking at imaging neurodegenerative diseases, particularly Alzheimer's Disease. He lead research to develop imaging methods to detect beta-amyloid plaques in the brain using a technique known as positron emission tomography (PET), which found that Alzheimer's disease may be detected with scans up to 15 years before symptoms develop.

Although he has worked elsewhere - including for several years in the United States - Professor Rowe has a long history at Austin Health, commencing as an intern in 1980, where he was strongly encouraged by his supervisors and mentors to conduct research.

"Austin Health has, since my early days, always been a keen supporter of research and emphasised the need to undertake research to drive the practice of medicine forward," he said.

The AMRF's Young Investigator Award this year went to cancer researcher Riley Morrow, for his work ‘Manipulating Myc expression as a novel therapeutic strategy for gastric cancer', while nursing researcher Sarah Howe received two awards: the Nursing Research Award and the Clinical or Patient Care Nursing Quality Project Award, which were both for her project ‘Follow-Up Audit Results of the New Protocol for TR Band Removal Post Coronary Angiography.'

Other awards recipients include:

  • Charlene Holt - winner of the Allied Health Award for her work ‘Improving help-seeking for postnatal depression and anxiety: A cluster randomised controlled trial of Motivational Interviewing'
  • Madeleine Tancock - winner of the Austin LifeSciences University of Melbourne Prize for Basic Research for Drug treatments induce tumour and host cell changes enabling a fraction of tumour cells to survive and give rise to recurrence
  • Mardiana Lee - winner of the AMRF Research Higher Degree Award for her project ‘Inability to Increase Fatty Acid Oxidation Following Renal Injury Worsens Renal Fibrosis'
  • Remika Mito - winner of the Florey Prize for Neuroscience Research for ‘Fibre-specific white matter changes in Alzheimer's disease: novel insights from higher-order diffusion-weighted imaging.'
  • Teresa MacDonald - winner of the ONJCRI Scholarship for ‘Measuring PlGF and sFlt-1 at 36 weeks' gestation to predict small-for-gestational-age infants or late-onset preeclampsia' and
  • Jennifer Cori - winner of the RJ Pierce Memorial Award for ‘Hypocapnia has minimal effect on genioglossus muscle after-discharge elicited by arousal from sleep'

World-leading epilepsy expert Samuel Berkovic receives one of medicine's highest honours.

October 17, 2017

World-leading epilepsy expert Professor Samuel Berkovic today received one of medicine's highest honours when he was named as an international member of the National Academy of Medicine (NAM).

The NAM is an independent organisation of eminent professionals who advise the USA and the international community on critical issues in health, medicine and related policy and act to inspire positive action.

Membership is considered one of the highest honours in the fields of health and medicine and recognises individuals who have demonstrated outstanding professional achievements and commitment to service - just ten international members are elected membership each year.

The Director of Austin Health's Comprehensive Epilepsy Program and Laureate Professor in The University of Melbourne's Department of Medicine and Epilepsy Research Centre, Prof Berkovic AC described the appointment as humbling.

"I am humbled and delighted to join the small group of other Australian medical researchers who are members of the prestigious National Academy of Medicine of the USA," Prof Berkovic said.
"It is an amazing honour and one that is a tribute to our wonderful research team at the University of Melbourne and Austin Health," he said.

In 1995 Prof Berkovic and Austin Health director of paediatrics and University of Melbourne Chair of Paediatric Neurology Research, Professor Ingrid Scheffer AO and their collaborators discovered the first gene linked to epilepsy. This was a game-changer in the way the debilitating condition - which affects about 50 million people worldwide - is researched, diagnosed and treated. Until this point doctors tended to regard most forms of epilepsy as acquired rather than inherited - parents often felt responsible and carried considerable guilt.

Since then Prof Berkovic and Prof Scheffer have led the way in finding a genetic basis for many epilepsies and they and their colleagues have many of the known genes known to be directly linked with forms of epilepsy.

Austin Health Chief Executive Sue Shilbury said the organisation is extremely proud of Prof Berkovic.
"This achievement reflects the incredible contribution Prof Berkovic's research and treatment has made to global medicine and the lives of countless people with epilepsy and their families,'' Ms Shilbury said.

Professor Shitij Kapur, Dean of the Faculty of Medicine, Dentistry and Health Sciences and Vice-Chancellor (Health) said Professor Berkovic has been a passionate campaigner for advancing research into Epilepsy.

"With patience and perception, Professor Berkovic has worked resolutely to change the course of our understanding of epilepsy and in doing so has helped improve the lives of many people. This exceptional contribution is now also acknowledged by the NAM, and we congratulate him on this major award," Prof Kapur said.

To arrange an interview with Prof Berkovic contact Austin Health deputy director of communications, Julie McNamara on 0419 595 688.

 

Austin Health leads world-first trial to reduce brain injury in cardiac arrest patients

Assoc Prof Glenn Eastwood in ICU

October 17, 2017

A world-first trial being led by Austin Health will examine whether increasing carbon dioxide levels in cardiac arrest sufferers' blood will reduce brain injury post cardiac arrest.

The cost free intervention has improved quality of life in patients in a small study, but now it will be tested in a large multicentre worldwide trial.

If it is a success, the NHMRC and Irish Health Research Board funded-trial has the potential to revolutionise the way cardiac arrest patients are cared for.

Patients can suffer from long-term cognitive problems after cardiac arrest; reduced blood and oxygen flow to the brain after the heart has been restarted is thought to contribute to the brain damage.

Austin Health ICU research manager and study chief investigator, Associate Professor Glenn Eastwood said researchers are trying to understand if giving slightly higher than normal levels of carbon dioxide in the blood helps the brain to recover after cardiac arrest.

Half of the patients will receive the standard care, which maintains carbon dioxide levels in the blood at a normal level, and the others will have their levels kept 20 per cent higher.

A cardiac arrest patient admitted to ICU who survives to discharge costs the health system $120,000; their ongoing care in the community can be up to $34,000 a year.

The trial will enrol 1700 patients from Australia and multiple other countries world-wide who have an out-of-hospital cardiac arrest and require ventilation in ICU.

Results of a small trial published in the journal Resuscitation shows patients who had higher CO2 levels had lower brain injury biomarker levels, shorter ICU stays and improved quality of life function at six months.

To arrange an interview with Assoc Prof Eastwood please call Austin Health deputy director of Communications, Julie McNamara on 0419 595 688.

 

NHMRC funding boost for Austin Health

Dr Marie Sinclair. photo courtesy of Ned Meldrum

Austin Health has received six prestigious NHMRC 2017 Early Career Fellowships.

The purpose of the Early Career Fellowships are to provide opportunities for Australian researchers to undertake research that is both of major importance in its field and of benefit to Australian health.

Austin Health researchers who have been awarded fellowships are:

  • Medical oncologist and clinical lead in lymphoma, Dr Eliza Hawkes is looking at novel ways of giving immunotherapy to people with lymphoma,
  • Dr Jason Trubiano, director of Antibiotic Allergy Services and Antimicrobial Stewardship, is exploring novel diagnostics for patients with severe antibiotic allergy and develop translational testing programs that improve prescribing in vulnerable patients with reported antibiotic allergies,
  • Gastroenterologist Dr Marie Sinclair is looking at therapies to better nourish patients on the waiting list for a liver transplant to make them stronger and keep them out of hospital,
  • Peter de Cruz, director of Inflammatory Bowel Disease, is exploring new treatment therapy for severe inflammation of the large bowel,
  • Endocrinologist Dr Ada Cheung is exploring the effects of testosterone and oestrogen on body composition, and
  • Jason Kwong from Infectious Diseases is looking at developing clinical metagenomics to improve the healthcare of patients with infections

Dr Sinclair's study will trial, amongst other things, using therapy as a treatment to increase muscle mass in liver transplant waiting list patients. It will also at dietary approaches, including naso-gastric feeding and branch-chain amino acids.

"Malnutrition and muscle wasting is an extremely important area for research. We've found that at least 70 to 80 per cent of the patients on our liver transplant waiting list have malnutrition to begin with and they will only get worse while they're waiting. At the moment, we don't have any good ways to treat it." Dr Sinclair says.

Professor Jeff Zajac, Head of Medicine at Austin Health and The University of Melbourne says the fellowships are very important for people at the beginning of their research careers.

"It offers them the opportunity to pursue their own research, at a point in their career when funding is very difficult to get," Prof Zajac says.

"Austin Health's success strongly supports the research training programs available here. These fellowships are very difficult to get, and we congratulate all the recipients.

"A significant role of Austin Health is in medical research to help discover treatments for the future. Without research there are no new medical therapies."

"These fellowships are very important if Austin Health is to retain its primary position as a leading hospital for medical research."

Dr Hawkes received her fellowship through La Trobe University while the other four researchers received their fellowships through The University of Melbourne.

For more information or to arrange interviews with recipients, contact Julie McNamara, Deputy Director of Communications, Austin Health: 0419 595 688

 

Ballarat Austin Radiation Oncology Centre introduces cutting-edge treatment

Dr Simone Reeves

Cutting-edge radiotherapy treatment is now available for Western Victorian patients on their doorstep thanks to an Austin Health initiative.

Ballarat Austin Radiology Oncology Centre now offers Stereotactic Ablative Body Radiotherapy (SABR) - a type of treatment that is highly effective in treating small tumours with minimal side effects. It enables doctors to provide targeted high-dosage treatment to a tumour with very little to no radiation to neighbouring healthy tissue.

The high dosage means patients generally only need one to five treatments as opposed to up to 30 treatments for traditional radiotherapy.

The highly-specialised SABR equipment was able to be purchased thanks to a local philanthropic donation.

Ballarat Austin Radiation Oncology Centre (BAROC) campus director and consultant radiation oncologist, Dr Simone Reeves says BAROC is the first centre in Western Victoria to introduce the treatment.

"Access to this type of new radiotherapy technology in Ballarat is very exciting for patients. It means a large number of patients can stay at home avoiding travel to Melbourne for treatment,'' Dr Reeves says.

Dr Reeves says the treatment is currently available for patients with small lung tumours but the program will soon expand to include tumours in other areas of the body.

Austin Health Sciences Library ranked top in the country

Austin Health's librarians

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

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

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

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

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

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

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

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

Dr. Andrea Driscoll, Heart Failure Nurse Practitioner

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

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

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

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

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

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

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

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

Paediatric Short Stay Unit opens

Lenny and Jordan Wise

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

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

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

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

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

Leading the 3D printing revolution

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

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

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

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

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

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

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

Leading the charge against undiagnosed diabetes

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

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

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

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

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

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

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

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

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

For more information, visit the Diabetes Australia website.

Sleep-Smart Rosters Help Keep Doctors Sharper and Safer


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

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

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

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

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

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

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

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

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

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

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

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

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

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

About the CRC for Alertness, Safety and Productivity

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

For interviews with Assoc Prof Mark Howard contact:

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

 

Further enquiries:

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

Medicinal cannabis found to be effective in severe childhood epilepsy

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."