Annual Research Report | 2016 | Sunshine Coast Hospital and Health Service€¦ · Research day...

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AnnualResearch Report

Sunshine Coast Hospital and Health Service Annual Research Report 2016

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Table of contents .........................................................................................................................................2

Message from the Chair ...............................................................................................................................3

Introduction ................................................................................................................................................4

Research projects ........................................................................................................................................5

Research grant funding .............................................................................................................................6-7

Research day 2016 ...................................................................................................................................8-9

Research culture survey .............................................................................................................................10

Neuroscience and mental health clinical trials partnership .....................................................................10-11

Peer reviewed research articles .............................................................................................................12-13

Renal research report ...........................................................................................................................14-15

Reducing the Burden of Dialysis Catheter Complications ........................................................................16-17

Cardiac research report .........................................................................................................................18-20

Coronary Artery calcium score ...............................................................................................................21-22

Sunshine Coast Institute for Critical Care Research .................................................................................23-25

Jennifer Broom .....................................................................................................................................26-27

Implementation of Advance Care Planning through Participatory Action Research ...................................28-29

Embedding an enriched environment in an acute stroke unit increases activity in stroke patients .............30-31

An alliance with the University of the Sunshine Coast .............................................................................32-33

Surgical Services research report ...............................................................................................................34

Emergency Medicine research report ..........................................................................................................36

Clinical trials ........................................................................................................................................38-39

Clinical trials - Oncology .......................................................................................................................40-41

Journal articles and abstracts ................................................................................................................42-51

References ................................................................................................................................................52

Table of contents

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As I write the foreword to the 2016 Sunshine Coast Hospital and Health Service (SCHHS) Research Annual Report, the Sunshine Coast Health Institute (SCHI) has already opened and the Sunshine Coast University Hospital (SCUH) opening is only days away.

These facilities will aid the development of research across the SCHHS, but they are by no means the start of research. Indeed, research has been ongoing within SCHHS, and these facilities are just another step along the path. Both SCHI and SCUH are simply buildings; it is the people of the SCHHS who innovate and research. And so it is that this report recognises the work of our researchers over the year including grants, publications and presentations. Research is growing, collaborations are being formed, and the people of the Sunshine Coast and Gympie regions will be rewarded with the benefits.

This report provides an opportunity to pause and reflect. We should celebrate our successes and thank our supporters, foremost being Wishlist (the Sunshine Coast Health Foundation). I would like to thank the Research Committee for their support throughout the year.

Research has come a long way in the SCHHS. I am reminded of the poem The Road Not Taken, by Robert Frost, when considering the choices made over the years, “… and that has made all the difference”.

I commend the SCHHS Research Report 2016 to you.

Message from the Chair Research Committee

Associate Professor Nicholas GrayDirector Renal Services

Chair, SCHHS Research Committee



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Research capacity is an integral factor in developing new innovations in health care services leading to improvements in health outcomes and quality of care. (1, 2)

Building sustainable research capacity requires development of a strong research culture within clinical departments and the health service, effective research management, funding support, suitable research facilities and research collaborations (3 p12). For a tertiary teaching health facility conducting, supporting and supervising research are critical components in the delivery of evidence-based practice and translation into improved patient care. (5)

The SCHHS is just beginning this journey.

The planning for the SCUH afforded an opportunity to forward plan for the needs of researchers and the growth in research capacity. Key planning initiatives have included:

1. The appoingment of Executive Director Innovation, Quality, Research and Innovation and the subsection work stream, giving research a voice at the executive level within the SCHHS.

2. The recognition of the need for the appointment of a Director of Research to lead and develop research within the SCHHS. Recruitment is planned for late 2017.

3. The appointment of additional research staff in 2015/2016, in the areas of governance, financial management, grants management, training, education and administration.

Development of an understanding of the current research culture within the SCHHS was identified through the SCHHS Research Strategic Plan (2016-2021) and subsequently the staff of the SCHHS were surveyed in late 2016. The analysis of the results is pending.

The development of collaborations has begun both with the SCHI partners and in response to relationship building fostered by the community through the Sunshine Coast Council. Collaboration between the SCHHS and the University of the Sunshine Coast (USC) has seen the development of the Sunshine Coast Clinical Trials in 2016 (4), providing a single point of contact for clinical trials enquiries on the Sunshine Coast. Direct links have also been made with the Florey Institute of Neuroscience and Mental Health and USC to foster the development of clinical trials in neuroscience and mental health. These collaborations are a logical progression in the growth of an already existing clinical trial framework within the SCHHS, which has been expanding since the late 1980s.

The increase in research projects and commitment to research by clinicians, peer reviewed publications by SCHHS staff and additional research grant funding in the form of the strategic opportunity grants shows evidence that the SCHHS is building research capacity.

The aim of the SCHHS Research Report 2016 is to document and communicate to SCHHS staff, current and potential research partners, and the Sunshine Coast and Gympie communities the research activity and research capacity within the SCHHS and, to provide a baseline for assessing growth and changes over time.

Introduction


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Research projectsThe data reported is based on the research projects that have received SCHHS research governance approval that is, approval for the project to be conducted in the SCHHS.

A current research project is defined as a research project that was open as at the 1 March 2016, or received approval for conduct in the SCHHS in 2016. Where possible the data was distributed by SCHHS Research Themes. (6)

The total number of active research projects for 2016 was 254, which included 66 Clinical Trials. The percentage of active research projects per research theme for 2016 is shown in Figure 1. Of the 66 clinical trials, 35 were commercially sponsored, predominantly by pharmaceutical companies and 31 clinical trials were investigator led.

The total number of research projects receiving SCHHS approval in 2016 was 53, seven of which were clinical trials compared with the total number of research projects receiving SCHHS approval in 2015 of 45, eight of which were clinical trials (Table 1).

In 2016, the total number of SCHHS staff listed as investigators on one or more research projects were 239. This included 132 medical officers (55%), 50 allied health practitioners (21%), 49 nurses (21%) and eight non-clinical staff (3%).

Aged Care, cognitive impairment and stroke (7%)

Cardiovascular and renal disease (7%)

Health services research (28%)

Trauma, critical care and emergency care (8%)

Infectious disease (3%)

Mental health (2%)

Chronic disease (2%)

Oncology (6%)

Maternal and child health (7%)

Care of the surgical patient (4%)

Clinical trials (26%)

The percentage (%) of active research projects by Research Theme for 2016

Research theme 2015 2016

Aged care, cognitive impairment and stroke 7 2

Cardiovascular and renal disease 4 7

Health services research 5 22

Trauma, critical care and emergency care 7 2

Infectious disease 3 0

Mental health 1 0

Chronic disease 2 0

Oncology 3 2

Maternal and child health 4 7

Care of the surgical patient 1 4

Clinical Trials 8 7

Total new projects 45 53

Figure 1.


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Grants for SCHHS Research in 2016Figure 2.

Research grant fundingThe total value of grant funding awarded to SCHHS staff for research projects in 2016, from Strategic Funding Grants, Wishlist Sunshine Coast Health Foundation research grants and research higher degree scholarships and Study, Education and Research Trust Fund (SERTF) was $1,595,375.00.

The Strategic Funding Grants were provided by State Government funding for medical research and the SERTF is provided by SCHHS and distributed

by the SCHHS SERTF Committee. Figure 2 shows the distribution of grant funding including ‘other grants funding’ such as the Queensland Health Healthcare Improvement Unit, the George Institute for International Health, Heart Foundation Vanguard Grant and the National Health and Medical Research Council.

Wishlist is a strong supporter of research projects in the SCHHS providing a total of $474,576.00

SERT-(Research)

Other funding grants

Wishlist research grants x 15 and RHD scholarships x 4

Strategic funding opportunity grants x 5

$1,005,799

$115,000

$1,785,327

$424,576

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Wishlist research grants with value per category 2012-2016Figure 3.

in 2016. Figure 3 illustrates the financial support provided by Wishlist to SCHHS researchers since 2012 including research grants (by researcher category based on experience (novice – up to $10,000, early career – up to $20,000 and experienced – up to $50,000) and research higher degree scholarships (introduced in 2015). The graph further illustrates the increase in research being undertaken in the SCHHS since 2012.

20

18

16

14

12

10

8

6

4

2

0 $0.00

$50,000.00

$100,000.00

$150,000.00

$200,000.00

$250,000.00

$300,000.00

$350,000.00

$400,000.00

$450,000.00

$500,000.00

2012

$98,053

2013 2014 2015 2016

$17,300$38,919

$86,787

$45,500

$227,580$187,772

$50,000

$97,804

$89,000

$49,613

$69,491

$106,355

$39,210

$63,913

RHDExperiencedEarly careerNoviceTotal $ per year

No. of Grants

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Research Day 2016Over 150 registrants from Queensland Health, USC, Griffith University, Central Queensland University and the TAFE Queensland East Coast attended the Research Day 2016 held on the 15th October at Nambour General

Hospital. Staff based off-site at Gympie, Caloundra and Maleny Hospitals were also able to view the proceedings by videoconference.

Chair of the Research Committee, Associate Professor Nicholas Gray opened the day highlighting recent research capacity-building achievements including the $1 million in Strategic Research Funding grants and, the exciting path ahead with the opening of SCHI in 2017.

We were fortunate to attract two accomplished invited speakers to share their experiences. Dr David Hansen, Chief Executive Officer of the Australian e-Health Research Centre, returning to his childhood home of the Sunshine Coast, stepped the audience through the biomedical informatics, health informatics and health service research work of the Centre, highlighting the extraordinary potential for mobile apps and

sensor technology in health care. Professor of Health Economics at the University of Adelaide, Dr John Karnon, discussed the unharnessed potential of more widespread adoption of local quality improvement initiatives, highlighting results from investigations of cardiac healthcare processes in South Australian hospitals.

Sixteen insightful presentations from local researchers were very well received by the audience and ranged from a report on a double-blinded, randomised controlled trial of faecal microbiota transplantation for ulcerative colitis (Dr Johan van den Bogaerde), to a study to identify the risks which lead to post-partum bleeding


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(Ms Lisa Davenport), to the application of systems thinking to the improvement of clinical investigation by Dr Natassia Goode from USC who collaborates with Dr Piotr Swierkowski.

After a delicious Wishlist-sponsored lunch, the conference continued with presentations of innovative work including an evaluation of specialist community diabetes clinics (Dr Shyam Sunder), an assessment of the compatibility of combined multiple medication in an intensive care unit setting (Mr Paul Williams), to a study

insulin induced euglycemia on blood flow to the heart which was presented by Dr Michael Nam, recipient of the inaugural 2015 SCHHS/Wishlist (PhD) Research Higher Degree Bursary.

The day culminated in the 2016 Wishlist Research Grant Award ceremony where Wishlist CEO Ms Lisa Rowe

announced sixteen successful research grant recipients across three grant categories (Novice, Early Career and Experienced researcher) as well as four Research Higher Degree scholarships, to the total value of $474,576.00.



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In late 2016, a survey of allied health practitioners, medical officers and nurses was undertaken aimed at understanding the research culture within the SCHHS. Specifically the survey was aimed at answering the following research questions:

• Who is undertaking research?• Who would like to undertake research?• What is the level of knowledge to facilitate

research?• What is the attitude toward the conduct of

research?• What are the motivators to conduct research?• What are the enablers and barriers to the conduct

of research?

329 clinicians responded to the survey

compromising 84 males (25.5%) and 245 females (74.5%) including 107 allied health practitioners (32.5%), 72 medical officer (21.9%) and 150 nurses and midwives (45.6%).

Of the 329 respondents 130 (39.5%) were noted to be research active in the last 12 months, 76 (23.1%) active prior to the last 12 months and 123 (37.4%) responded that they had never been research active.

Full analysis of the results is yet to be completed however it is encouraging to note that of the total respondents 276 (83.9%) enjoyed research, given that only 62.6% of respondents have undertaken research previously the results support the opportunity for growth of research within the SCHHS through a workforce who are enthusiastic.

Neuroscience and mental health clinical trials partnership

Research culture survey

In October 2016 a Memorandum of Understanding between Sunshine Coast Hospital and Health Service and The Florey Institute of Neuroscience and University of the Sunshine Coast to establish a neuroscience and mental health clinical trials partnership.

The partnership is a unique opportunity for the SCHHS to undertake neuroscience and mental

health research with an internationally recognised research institute (The Florey) in collaboration with our SCHI partner the USC.

The SCHHS has had limited involvement in clinical trials in neuroscience and mental health to date, with the partnership offering the potential access to new treatments for the people of the Sunshine Coast. The SCHHS has established a Neuroscience


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Neuroscience and mental health clinical trials partnership

and Mental Health Research Sub-Committee (a sub-committee of the Research Committee). The sub-committee will be chaired by Dr Sanjay Gangadharan Department of Geriatric Medicine with multidisciplinary representation from allied health, nursing and medicine.

It is planned to have a face-to-face research planning day with representation from the partner organisations in early 2017.

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Peer reviewed

There were a total of 101 journal articles and abstracts published in peer reviewed journals authored by SCHHS staff in 2015 and 130 research articles and abstracts published for 2016 (Table 2), representing a 29% increase in publications from 2015 to 2016.

The Research Themes of ‘aged care, cognitive impairment & stroke and cardiovascular’, ‘renal disease’ and ‘trauma, critical care & emergency care’ continues to predominate. However increases in publications in the areas of ‘chronic care’ and ‘oncology’ are noted.

research articles


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Number of Peer Reviewed Publications by Research Theme

Research theme 2015 2016

Aged care, cognitive impairment and stroke 20 17

Cardiovascular and renal disease 28 33

Health services research 8 11

Trauma, critical care and emergency care 14 17

Infectious disease 9 9

Mental health 1 2

Chronic disease 8 13

Oncology 3 15

Maternal and child health 5 8

Care of the surgical patient 5 5

Total publications 101 130

Table 2.


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RenalResearch ReportThe Renal Unit has enjoyed a very successful 2016 with publications, but importantly, excellent grant success that will deliver results in future years. We have a strategic plan to grow research across all renal health streams and continue to be a research leader in the Health Service.There were two main highlights in 2016. Firstly,

Associate Professor Nicholas Gray was one of five Chief Investigators on the “Reducing the Burden of Dialysis Cather Complications: a National approach (REDUCCTION)” study which was awarded a NHMRC partnership grant of $1,192,237. The implementation research study aims to reduce haemodialysis catheter infection rates. This cluster step wedge trial will include

Introduction

approximately 35 renal units in Australia and implement a raft of measures to reduce infections. The project is being run by The George Institute.

The other major highlight is the research strategic funding grant awarded to Dr Rathika Krishnasamy. Dr Krishnasamy was recently awarded her Doctor of Philosophy and this strategic grant has enabled her to develop research locally and also become involved in a number of national initiatives that will bear fruit over

future years. The grant funds 12 hours per week for research time and runs until June 2017.

Both Associate Professor Gray and Dr Krishnasamy have roles with the Australasian Kidney Trials Network Haemodialysis workgroup, Australia and New Zealand Dialysis and Transplant Registry (steering committee and haemodialysis workgroup), and ongoing research collaborations with The George Institute for Global Health. Both are also members of national steering


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committees and/or investigators of investigator led trials including “REMOVAL-HD – The effect of Theranova dialyser on albumin and uraemic solutes in haemodialysis”, “RESOLVE – Randomised evaluation of sodium dialysate levels on vascular events”, “ENTICE - Evaluation if individualised telehealth intensive coaching to promote eating and lifestyle in Chronic Kidney Disease” and REDUCCTION.

The Renal Unit is taking steps to develop research in the allied health and nursing areas. We have collaborated with Hervey Bay to examine patient decision making processes when considering conservative renal management, the OPTIONS study, led by Annette Wilson. In the area of dietetics we have collaborated with the Princess Alexandra Hospital and Bond University to develop and lead research examining pre- and pro-biotics in chronic kidney disease (SYNERGY 2) and also

the impact of obesity on patient listing on the renal transplant waitlist. Associate Professor Gray has also arranged to supervise honours candidates from the University of the Sunshine Coast in 2017 from both dietetics and occupational therapy.

We continue to be regular contributors to local research initiatives such as the SCHHS Research Day and remain

a leader in research output in the Health Service. The enthusiasm and commitment of the entire team is responsible for our success.



Associate Professor Nicholas Gray, in collaboration with four other chief investigators across Australia, was awarded a National Health and Medical Research Council (NHMRC) partnership grant in 2016 to examine haemodialysis catheter infections.

Partners include Queensland Health ($200,000), Victoria Health ($90,000), Kidney Health Australia, Australia and New Zealand Dialysis and Transplant Registry, and several renal units across Australia.

The project is being run by the George Institute for Global Health over four years.

Healthcare associated infections (HAI) cause significant and life-threatening harm to patients and incur major additional costs. Patients with kidney disease are especially susceptible to HAI, due to the harm associated with central dialysis catheter use. These catheters, essential to the

delivery of life-sustaining dialysis treatment, are widely used and are a major driver of blood stream infection and increased mortality seen in patients receiving dialysis.

Despite this, our understanding of the burden of mortality and morbidity complicating dialysis catheter use in Australia is limited and the current scope for improvement is poor. Many renal units do not record data on dialysis catheter infections and definitions around infection are not standardised.

There are guideline recommendations and emerging international evidence around multifaceted strategies to reduce dialysis catheter complications but a systematic approach is required to define the burden of disease and test the application of interventions to improve patient outcomes.

Reducing the Burden of Dialysis Catheter Complications: a National approach (REDUCCTION) - $1,192,237

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The REDUCCTION Partnership aims to:

• define and standardise reporting of bacteraemia resulting from central venous dialysis catheters in Australia

• implement a multi-faceted intervention across participating units with a view to reducing catheter associated bacteraemia

• evaluate secondary outcomes of the partnership in reducing dialysis catheter exposure across participating units and economic impacts of the intervention.

The project team has already developed and implemented a web-based portal for the entry and recording of data at sites across Australia. Baseline data has been collected and work on process evaluation and data linkage is well underway. The suite of interventions to reduce catheter infections will be implemented in a cluster step-wedged design in late 2017 and the project will be complete by early 2020.

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CardiacResearch Report

Introduction

Photo: Professor Kim Greaves and Dr Rohan Poulter

Research within the cardiology department at SCHHS has grown significantly over the past few years. Led by Professor Kim Greaves (Director of Cardiac Research), the short-term research strategies are to expand in areas of existing strength such as microvascular function and heart failure, and the establishment of positive collaborative research networks.

The intermediate term strategy is to develop new niche areas of research expertise at the end of the translational spectrum that fit well within the local and state research environment. Such projects have already begun and include a workplace wellness strategy and the primary prevention of cardiovascular disease.

The recent recruitment of a new cardiologist, Professor Tony Stanton, with a strong research background and well-established collaborative links in heart failure and cardiac imaging, will help achieve these goals.

The department is committed to establishing a strong culture of research amongst all its staff that provides opportunities for all to participate if they wish.

The department has 14 active independent investigator research projects primarily carried out within SCHHS (listed below) amounting to a total of $665,000 in research funding. For the year 2016, the department had 18 peer-reviewed publications. The research team was also awarded ‘Best Paper of the Year in Heart Journal’ at the European Society of Cardiology 2016.

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Research Projects and collaborators, active within the cardiology department:

• The Effects Of Hyperinsulinemia On Myocardial Blood Flow. M Nam, T Stanton, C Askew, K Greaves

• Effects Of Exercise On Skeletal Muscle Blood Flow In Patients With Peripheral Vascular Disease. A. Meneses, M Nam, T Stanton, C Askew, K Greaves

• CRT-OPT—A randomized trial of benefit and cost-effectiveness of Cardiac Resynchronization Therapy (CRT) optimization in heart failure.

T Stanton.

• Effect Of Passive Heating Of Vascular Function. Bailey T, Greaves K, Askew C.

• Effect Of Omega 3 Fatty Acids On Abdominal Aortic Aneurysm And Inflammatory Markers. Greaves K, Russell F.

• A randomised-controlled trial investigating the effect of pre- and probiotic supplementation on left-ventricular function in Chronic Kidney Disease. Stanton T.

• Effect Of Exercise On Abdominal Aortic Aneurysm And Relation To Arterial Stiffness. Bailey T, Greaves K, Askew C

• Association Between Mild Cognitive Impairment And Future Development Of Dementia In Cardiac Patients. Stefanadis K, Greaves K, Summers M

• Electro-Encephalographic Markers And Other Markers That Predict Dementia In Patients With Coronary Artery Disease. Stefanadis K, Greaves K , Summers M

• Workplace Wellness Program. Collaborators: Health for Life, Wishlist, Thomson Brain Institute, USC Exercise and Sports Sciences and Nutrition Departments, Heart Foundation Australia; The National Centre for Epidemiology and Public Health, Australian National University.

• Coronary Artery calcium score: Use to Guide management of Hereditary Coronary Artery Disease (CAUGHT-CAD). Stanton T.

• Absolute Cardiovascular Risk (ACVD) Screening By GPs In The Community. Collaborators: Sunshine Coast PHN, Heart Foundation Australia, The National Centre for Epidemiology and Public Health, Australian National University.

• Primary And Secondary Care Data Integration And Linkage Program. Collaborators. SCHHS, Sunshine Coast PHN, Integrated Care Alliance, Preventative health Unit, Queensland Health, Brisbane.

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Editorial positions

Kim Greaves is an associate editor of Echo Research and Practice, UK Echocardiography journal. Tony Stanton is Cardiac Imaging Section Editor, Heart, Lung and Circulation Journal, Cardiac Imaging Section Editor, Heart, Lung and Circulation Journal. Tony is also NHMRC Project Grant Review Panel member 2016, a Heart Foundation Health Professional Scholarship Committee panel member 2014, 2015 and 2016 and an Editorial Advisory Panel member for Clinical Science.

Grants (principal recipient)1. Health Care Improvement Unit, 2017, $222,995. K

Greaves.

2. Heart Foundation Vanguard Grant 2016, $74,428. T Stanton

3. Wishlist (the Sunshine Coast Health Foundation) $50,000. T Stanton.

4. Wishlist PhD award 2016, $75,000. K Greaves

5. University of the Sunshine Coast PhD scholarship, 2016 $35,000. K Greaves.

6. West Moreton Hospital and Health Service Grant. $25,000Queensland Regional Grant Award Novonordisk, 2014, $15,000. K Greaves.

7. The University of Queensland New Academic Appointment Award, 2014 $18,000. K Greaves.

8. Wishlist for PhD scholarship, 2014, $75,000. K Greaves.

9. Private Practice Funding 2014, $75,000. K Greaves.

There are five current research students working within the department of cardiology

1. Tom Bailey post-graduate research fellow.

2. Dr Michael Nam The University of Queensland, PhD studentship (supervisor K Greaves, T Stanton).

3. Annelise Meneses University of the Sunshine Coast, PhD studentship (co-supervisor K. Greaves).

4. Kayala Stefanidis University of the Sunshine Coast PhD studentship (co-supervisor K Greaves).

5. Anita Smith, University of Western Australia, MD (co-supervisor K Greaves).

Kim Greaves (MSc Scholar in Applied Epidemiology, National Centre for Epidemiology and Public Health, Australian National University).

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In 2014 prior when working at Ipswich Hospital, Professor Tony Stanton was successful in obtaining a National Health and Research Council (NHMRC) Project Grant. Today Professor Stanton is a Staff Cardiologist at the SCUH and is undertaking this study from the SCHHS. Professor Stanton is one of the Chief Investigators of this multicentre study which is also being undertaken in Melbourne, Adelaide, Tasmania, Ipswich and Perth.

Coronary artery disease (CAD) remains a major cause of premature death and disability, and cost-effective primary prevention depends on accurately evaluating CAD risk. Although most new presentations with CAD involve new symptoms (eg. angina), >20% of initial presentations are with a sudden catastrophic event such as infarction, stroke or even sudden cardiac death. This spectre has motivated efforts to reduce the risk of individuals without defined disease.

The lifetime risk of CAD is doubled in people with a family history of premature CAD, yet this risk is not captured in most 5 or 10-year risk assessment algorithms. A promising marker of subclinical risk is coronary artery calcium scoring (CCS). This has been shown in observational studies to provide prognostic information that is incremental to the clinical assessment of CV risk, is relatively inexpensive and performed with a small radiation dose. However, use

Coronary Artery calcium score: Use to Guide management of Hereditary Coronary Artery Disease (CAUGHT-CAD) $ 2,652,448.15

of CCS in guiding prevention is not incorporated in Australian guidelines. Definitive evidence of the efficacy and cost-effectiveness of CCS is therefore of primary importance.

The proposed multicentre study will be the first randomized controlled trial (RCT) of the use of CCS, and will be targeted to 35-70 year old 1st degree relatives of patients with CAD onset <60 years old, or 2nd degree relatives of patients with onset <50 years old. Control patients will undergo standard risk scoring but have blinded CCS results. In the intervention arm, treatment will be initiated based on CCS, applying the new ACC/AHA prevention guidelines.

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At three years, the effectiveness of intervention will be assessed on change in plaque volume at CT coronary angiography (CTCA), the extent of which has been strongly linked to outcome. The results will provide high-level evidence to inform the guidelines regarding the place of CTCA in risk assessment, specifically in patients with a family history of premature CAD.

Professor Stanton has also received a Heart Foundation Vanguard Grant ($74,428.00) and a Wishlist Research Grant ($50,000.00) for the CRT-OPT Study and the SYNERGY II Study.

CRT-OPT StudyThe ageing of the population, together with improved life expectancy, has led to increasing numbers of cardiac patients with heart failure. A well-established treatment for this is cardiac resynchronization therapy (CRT) which has been shown to improve heart function and symptoms. A substantial investment (~$20M per year in Australia) is made in CRT pacemakers for these patients, but failure to properly fine tune ("optimize") these pacemakers may not allow them to deliver their full potential. Due to this more than 1 in 3 CRT patients receive little or no benefit from their pacemaker. Clinical guidelines are unclear as to whether optimization should be done in all patients or if it should be done at all. We therefore wish to answer 2 important questions:

1. Does CRT pacemaker optimization improve patients' functional performance and symptoms?

2. Is CRT pacemaker optimization a good use of patient time, doctor effort and public money?

This study will provide critical data which will assist clinicians in their decision as to who will benefit from CRT optimization. Whilst CRT optimization was included in many of the landmark trials this has not translated into routine clinical practice. The knowledge from this study is essential in providing optimal care for people with heart failure and making the most effective use of health-care funding.

SYNERGY II studyThis is a multi-centre (SCHHS and Princess Alexandra Hospital) double-blind, randomised controlled trial aiming to assess the effect of prebiotics (dietary fibre) and co-administration of probiotics (beneficial bacteria) on cardiovascular (CV) function in patients with chronic kidney disease (CKD). We hypothesise that left ventricular function, measured by myocardial strain, will improve with probiotic and prebiotic supplementation over 12 months, when compared with placebo. This application is to fund the conduct of the research in SCHHS and 50 participants (40%) with CKD stage 3-4 will be recruited from SCHHS Nephrology clinics.

Our pilot work has demonstrated that manipulation of the gut microbiota, through prebiotics and probiotics can inhibit the production of key gut-derived uraemic toxins. This multidisciplinary collaborative study will inform our understanding of the potential of prebiotics and probiotics on CV function and risk factors, and inform translation into practice.

If effective, a large-scale project will be proposed for Category I funding, utilising real foods and targeting endpoints including quality of life, cost-effectiveness, and CV morbidity and mortality. Such a study would make a significant impact on guidelines for clinical care and practice. Before this is possible further work, extending to surrogate clinical endpoints which we are proposing in this grant.

The aim of this study is to investigate the benefit of manipulation of the gut microbiota on patient level cardiovascular outcomes. If shown to be effective this low cost innocuous nutrition therapy will revolutionise the care and management of the growing number of CKD patients in the global community.

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Sunshine Coast Institute for Critical Care ResearchThe Intensive Care Unit (ICU) research department has a formal structure for research under the banner of the Sunshine Coast Institute for Critical Care Research (SCICCR) . The principal goals of SCICCR within the ICU include:

• Providing an environment capable of designing, conducting, and participating in local, national and international research;

• Facilitating and promoting investigator-initiated, collaborative clinical research;

• Advancing the Sunshine Coast University Hospital (SCUH) SCICCR as the lead site for national and internationally conducted studies;

• Providing a teaching environment advancing the education and understanding of research methods, and

• Promoting excellence in intensive care research that focuses on improving ICU patient care at the SCUH.

SCUH ICU is well placed to contribute to research projects across a wide spectrum of clinical questions with relevance for many residents in the Sunshine Coast and Gympie regions building on its research experience.

SCICCR participates in collaborative research studies which not only allows the development and analysis of new treatments but also provides a national and international benchmark for the quality of care delivery.

It has a proven track record in clinical research including both industry sponsored and international collaborative research run by the Australia New Zealand Intensive Care Society Clinical Trials Group (ANZICS-CTG). The ICU also works with the George Institute, and The University of Queensland (UQ), and is developing a growing association with the USC.

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The unit has four major research streams in which investigator driven research is developing:

• Aetiology of renal failure, identification of biomarkers and development of new therapies in collaboration with industry partners;

• Renal replacement therapy, anticoagulation, electrolytes and acid base balance;

• Shock resuscitation, microcirculation and metabolism with a focus on resuscitation strategies and phase of illness in collaboration with the Critical Care Research Group (CCRG) at The Prince Charles Hospital and the Bloomsbury Institute of intensive Care Medicine, University College London, and

• Medical Emergency Teams.

2016The significant growth and development of the research group, lead us to formalise our group structure under the banner of the SCICCR with the aim of providing a supportive structure for the development of local research activity across all disciplines interacting with Intensive Care. 2016 has been a busy year for the group, undertaking local investigator driven projects, collaborative investigator multi-centre studies and industry sponsored trials. We have maintained an excellent reputation as a recruiter for multi-centre studies performing within the top sites internationally for the ADRENAL and SPICE-III trials.

We have completed two local investigator driven studies BEARRS and All-SPICE-OPS. The BEARRS

study is the first local investigator driven trial to be published by the ICU and represents a milestone achievement for Dr Christopher Anstey and the ICU. All-SPICE and Accid-HF will mature into new projects in 2017.

All-SPICE is a multi-centre study run by our research group. It will recruit 100 patients enrolled in the ANZICS-CTG endorsed SPICE-III study and examine the effects of sedation on the central nervous system coordination of the physiological responses to critical illness and will conclude in 2017.

Assessment of the Concentration of Citrate during Haemofiltration Study (ACCid-HF) under the direction of Dr Anstey will investigate the monitoring of citrate levels in patients undergoing renal replacement therapy. Finally, Shock and the Oxygen Challenge Test (ShOCT) will explore the potential of a novel approach to the assessment of shock in critically ill patients.

These studies are vital for the group and represent broad collaborations with USC and The Prince Charles Hospital CCRG locally, as well as Imperial College London, University College London, ANZICS-CTG and the SPICE study management committee.

The group also commenced recruitment for three further ANZICS-CTG endorsed studies and other collaborative multi-centre studies this year including the now complete ETHICUS II under the guidance of Dr Peter Garrett, AMINO III with Paul Williams and Dr Vicki Campbell heading up STARRT-

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AKI. Along with the ongoing work of our nurse, dietician, pharmacy and medical researchers, 2017 promises to be both very busy and rewarding.

PresentationsDr John Moore presented his proposal for a multicentre ICU study on the effects of sedation on stress in critical illness (All-SPICE) at the Annual Meeting on Clinical Trials.

CollaborationsIn collaboration with the passionate team at Wishlist we have designed ICU research posters to be displayed in the relative’s waiting room and throughout the ICU.

These posters will give family members’ the opportunity to see we are an active research unit and also how to donate to Wishlist. We are very grateful to Wishlist for their support in this project.

We have joined with Wishlist (the Sunshine Coast Health Foundation) to host the inaugural Queensland Critical Care Research Forum which will bring together intensive care specialists and researchers from around the state to Sunshine Coast Health Institute (SCHI) in May 2017.

We are delighted to welcome one of the foremost critical care researchers in the world as our keynote speaker, Professor Rinaldo Bellomo. This is fantastic opportunity to place the SCHHS at the heart of critical care research in the state and to showcase the brand new SCUH.

Grants• Dr John Moore - Wishlist - $20,000:

All-SPICE study • Dr John Moore - SERTF $86,000: All-SPICE

study• Dr John Moore- Wishlist-$19,000: ShOCT

Study• Dr Chris Anstey & USC-$2000: Accid HF• SCICCR – Wishlist-$4500: Project Funding for

Research Forum• Lauren Murray-SERTF $27,500: Scholarship

funding for Master’s degree

PublicationsThe BEARRS studyA major achievement this year was the publication of our first double-blind randomised controlled trial. This represented a close collaboration with industry and the development of a bespoke dialysis fluid. This study had generated international interest and will pave the way to more nuanced renal replacement therapy in the critically ill.

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Jennifer BroomI was employed by the Sunshine Coast Hospital and Health Service in 2009 as the second Infectious Diseases Physician in the health service. Since that time, the SCHHS has gone through a rapid period of change and expansion, and research has had a significant focus as we transition toward the opening of SCUH in April March 2017.

This will fundamentally change the health service’s focus from a smaller regional hospital to that of a university hospital.

I came to Nambour in 2009 after finishing a Doctor of Philosophy (PhD) in Immunology. My interest was primarily to be a clinician. However, I found myself asking a lot of questions that I didn’t know the answers to. This has been particularly true in the past few years with regard to the overuse of antibiotics in Australian hospitals.

In a well-recognised era of escalating antimicrobial resistance, we still seem to use as many antibiotics as before. Why does this happen? Fortunately, I happen to be related to a Professor of Sociology at the University of New South Wales and to address this question, in 2012 Alex Broom and I started working together to combine a social science approach with a medical approach to examine the issue of why antibiotics are so overused.

From an initial small amount of seed funding from the Infectious Diseases Research Fund, we then received a Wishlist (Sunshine Coast Health Foundation) Grant, and subsequently a successful Australian Research Council (ARC) Linkage

Grant application in 2014 to start a qualitative research program exploring the social drivers of antimicrobial prescribing.

Since that time, we have collected data from different professional streams (medical, pharmacy, nursing, and executive) in multiple different institutional settings (regional, metropolitan, and remote, public and private) on their perspectives on the problem.

The insights from this program have been extremely novel and have been published widely in social science and medical journals. Essentially there are many social factors such as hospital hierarchy and significant inter-professional and intra-professional dynamics that have a significant influence on antibiotic prescribing, and which need to be taken into account if we are to change antibiotic use in hospitals in the longer term.

The balance between being a clinician and a researcher with an expanding research program has been challenging. In 2016 the health service supported this research program by awarding me a Strategic Research Funding Grant, which has allowed dedicated research time to pursue this expanding and fascinating research area.

2016 was a busy year. Data collection at four different centres (regional, metropolitan, remote, and private hospitals) has produced a large volume of data that is being analysed and published at a rapid pace. With eight publications accepted in 2016, this has been the highest output year

A personal perspective

Staff Specialist Infectious DiseasesSunshine Coast Hospital and Health Service and The University of Queensland

PO Box 547, Nambour, QLD 4560t: 07 5370 3739 f: 07 5470 6084e: [email protected]

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Associate Professor Jennifer Broom MBChB, FRACP, PhD

from this research program so far and is a direct translation of the support SCHHS has put into this work, including a cash contribution to the 2014 ARC Linkage Grant, and the funding for my time in 2016/17.

With recognition that a further body of work was required around governance of antibiotics, we are currently developing an ARC linkage grant application which involves a partnership between the University of New South Wales, SCHHS, the Prince of Wales Hospital (Sydney), Monash University, the Australasian Society for Infectious Diseases, the Australian Society for Antimicrobials and the Australian Commission on Safety and Quality in Healthcare.

“ The balance between being a clinician and a researcher with an expanding research program has been challenging.”

If successful, this grant will allow the continuation of this research program for three years and expansion of the program to a translational focus with future plans for National Health and Medical Research Council (NHMRC) applications testing interventions addressing the behavioural drivers of prescribing we have identified. Our research has been recognised at a national and international level, with conference presentations

nationally and internationally. In December 2016, I gave an invited presentation at the National Centre for Antimicrobial Stewardship workshop on “Behavioural change and drivers of antibiotic use” at the Asia Pacific Congress for Clinical Microbiology and Infection.

Presenting with the national leaders on antimicrobial stewardship (AMS) in Australia provides a national profile for the Sunshine Coast in this area of research and positions our research team with the research leaders in AMS in Australia.

This program of research has demonstrated to me the critical importance of health system/university partnerships, and the essential role of funding for clinician researchers so that research directions are both clinically relevant and translated into improved healthcare outcomes.

The SCHHS has shown a forward thinking approach in their willingness and significant financial commitment to support this research programme which has resulted in extensive collaboration and data that has changed the direction of antibiotic optimisation strategies both locally and internationally.

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Safe, high-quality and person-centred End of Life Care (EOLC) requires the availability of appropriately qualified, skilled and experienced multidisciplinary teams, effective communication, collaboration and teamwork. Patients must be empowered to direct their own care where possible, and have their care reviewed systematically as their needs, values, priorities, goals and wishes may change over time.

There is a critical need for the SCHHS to embed evidence-based Advance Care Planning (ACP) within daily clinical practice to better meet patients’ wishes for treatment, reducing anxiety for them and their family, reduce hospitalisations, and unwanted and often costly interventions that do not improve patient outcomes.

The greater acceptance of ACP in the wider community and focus on patient and family centred care at the end of life means preparedness of all staff needs to be a priority for the SCHHS.

Dr John Endacott and Wendy Pearse are leading a SCHHS team of researchers, including Dr Louise Welch, Dr Prem Ram, Sue Robson, Sarah Goodman and Clodagh Barwise-Smith, and drawing on the research expertise of Dr Florin Oprescu from the University of the Sunshine Coast (USC). The project aims to investigate how ACP is implemented across the district to support safe and high quality EOLC. This is in the context of a rapidly

growing proportion of the population over 80 years, and the need for health services to adapt to provide better coordinated care to patients with complex care needs and chronic, non-malignant disease.

This research project will be conducted using a Participatory Action Research method. This process generates new evidence and allows, through a collaborative process, its integration into practice, and can support culture change by embedding research into clinical care through the following:

• A better understanding of consumer needs for ACP integration into practice;

• Identification of the professional development needs of the health workforce within the SCHHS to implement ACP and provide safe and high quality EOLC; and

• Identification of collaborative, multidisciplinary service models for person-centred ACP in areas including aged, palliative, and critical care, including operational processes to record and communicate care preferences across the acute, residential aged care, primary care and community sectors.

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Implementation of Advance Care Planning through Participatory Action Research


Sunshine Coast Hospital and Health Service Annual Research Report 2016Sunshine Coast Hospital and Health Service Annual Research Report 2016

The data collection phase of this project will commence in 2017 on the following projects:

1. A retrospective chart audit of the chronology of ACP in relation to the Rapid Response team call, which will examine patient characteristics, ACP documents and discussions, and how RRT calls, may influence ACP in the acute care context.

2. Staff interviews to better understand staff roles in carrying out ACP with patients, the barriers and facilitators.

3. A staff survey of the education and training needs of medical, nursing and allied health staff to support the implementation of ACP.

Development of research capacityThis research aligns with the SCHHS Research Strategy and the opportunities provided by the SCUH for Community Integrated and Subacute Services (CISAS) to develop a research base over time, champion research as a core business activity, and work with external partners to conduct research that directly benefits the local community.

The involvement of the multidisciplinary team of researchers on his project is contributing to the development of research capabilities. Several staff has enrolled, or is enrolling in, Research Higher Degrees through USC. Further grant opportunities have been sought, with plans to expand upon this line of research beyond 2017.

Wendy PearseEnd of Life Care Project OfficerP: 07 5470 5306E: [email protected]

Dr John EndacottGeriatrician and Clinical Service DirectorCommunity Integrated and Subacute Services P: 07 5313 4279E: [email protected]

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One in six people in the world will suffer a stroke in their lifetime, and stroke is one of the leading causes of long-term disability. Over 500 stroke patients were admitted in the SCHHS in 2015 and these numbers are increasing yearly.

National Clinical Stroke Guidelines advocate that stroke patients engage in frequent activity early after stroke to promote recovery. However, evidence shows that stroke patients spend the majority of their time inactive and alone in acute stroke units.

An enriched environment is an innovative intervention designed to enhance activity in physical, social and cognitive activity domains within a stimulating and organized environment.

The enriched environment has shown to significantly improve functional recovery in animal models of stroke. The acute stroke unit in Nambour General Hospital translated the enriched environment to the acute setting to determine if our model of enrichment could safely increase activity levels in stroke patients.

We used a pre-post intervention study. We first exposed 30 stroke patients to a non-enriched acute stroke unit (usual care). We then embedded the enriched environment within the acute stroke unit and exposed 30 stroke patients to the enriched acute stroke unit.

Staffing levels were kept the same across both groups. We observed activity levels using a behavioral mapping method, which observed patients every 10 minutes from 7.30am till 7.30pm within the first 10 days after stroke.

The enriched environment was comprised of communal areas for eating and socialising and daily group activities focusing on early rehabilitation. Stimulating resources such as newspapers, books, magazines, iPads loaded with apps, music and self-management interventions were placed in the ward and at the patient bedside to stimulate activity outside therapy hours.

Staff focus towards enabling patient activity was reinforced through interdisciplinary workshops, monitoring of intervention fidelity and appointing nurse champions to promote activity on a day-to-day basis.

Results demonstrated that patients in the enriched acute stroke unit spent a significant higher proportion of their day engaged in activities compared to patients in a non-enriched acute stroke unit. Patients were more engaged in physical (33% vs 22%, p<0.001), social (40% vs 29%, p=0.007) and cognitive (59% vs 45%, p=0.002) activity and spent less of their day in bed (45% vs 68%, p<0.001).


Embedding an enriched environment in an acute stroke unit increases activity in stroke patients

Page 31Page 31

Fewer patients in the enriched acute stroke unit experienced adverse events (n=7 vs n=16) and serious adverse events (n=4 vs n=11) and length of stay was significantly shorter for the enriched group.In conclusion, we saw that our model of enrichment increased activity levels in stroke patients in all activity domains. This suggests that enriching acute stroke units may promote increased activity levels in stroke patients early after stroke which has been associated with improved functional outcomes in human populations after stroke.

Study results were presented in 2016 at the World Congress for Neuro Rehabilitation in Philadelphia (USA), the Asia Pacific Stroke Conference in Brisbane and at the SmartStrokes Conference in Canberra. In addition, Ingrid Rosbergen was awarded the Nursing and Allied Health Scientific Award 2016 from the Stroke Society of Australia for this study.

Stimulating resources such as newspapers, books, magazines, iPads loaded with apps, music and self-management interventions were placed in the ward and at the patient bedside to stimulate activity outside therapy hours.

We are currently analyzing how staff perceived working in the enriched stroke unit, and if activity levels were sustained in the enriched stroke unit three months post recruitment. Furthermore, we are exploring a multi-site phase II study ‘enriched environments in acute stroke units’.

The study would not have been successful without the support of many people. Research Team: Ingrid Rosbergen, Prof. Sandy Brauer (University of Queensland (UQ)), Dr. Rohan Grimley, Dr. Kathryn Hayward (UQ), Kate Walker, Donna Rowley, Janelle Trinder, Samantha Robertson, Alana Campbell, Suzanne McGufficke, Dr. Heidi Janssen (University of Newcastle (UON)), all staff working in 3FW, allied health colleagues who contributed to the study as blinded assessors and behavioral mapping staff for data collection.

Finally, we want to thank patients and families who participated in this research. They are our daily inspiration to strive for continuous innovation to reduce their burden from stroke.

BSc. Ingrid Rosbergen

Acting Clinical Lead Physiotherapist Acute Stroke/Geriatrics, Allied Health Medical Services

Sunshine Coast Hospital and Health Service

P: 07 53703018E: [email protected]

PhD candidate at The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane



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An alliance with the University of the Sunshine CoastIn late 2016, SCHHS developed a strategic partnership with the USC to form Sunshine Coast Clinical Trials (SCCT). The SCCT will provide a single point of entry for clinicians, researchers, pharmaceutical companies and trial participants in relation to clinical trials.

SCCT also provides oversight to all clinical trial opportunities to the region in the public and the private sector, presenting a single point of communication and transparency for the most appropriate site selection and patient recruitment.

SCCT is underpinned by a legal agreement and provides a clear governance framework for joint promotion, review and engagement in clinical trials by both SCHHS and USC.

Dr Bernadette Morris-Smith led consultations with clinical research organisations, sponsors, the health service and USC in May 2016. This revealed that clinical trials sites along the eastern seaboard are at maximum capacity and sponsors are exploring potential new sites.

The SCCT provides a single point of entry for clinicians, researchers, pharmaceutical companies and trial participants in relation to clinical trials.

With the opening of SCUH and SCHI, with our established SCHHS Clinical Trials Units, together with the USC Clinical Trial Centre in Ochre Health Medical Centre the region is well positioned to take advantage of the opportunity of the need for expansion of Australian sponsored clinical trial sites.

A new website has been established (http://www.sunshinecoastclinicaltrials.com.au/), presenting a single point of contact for sponsors, community members, doctors and investigators who have an interest in any aspect of clinical trials industry in the Sunshine Coast region.

The region is well positioned to take advantage of the opportunity of the need for expansion of Australian sponsored clinical trial sites.

Data collected from the single point provides a mechanism to track opportunities within the region, to assist with future areas of interest for expansion.

SCCT aims to proactively seek opportunities in areas of research following the SCHHS Research Themes 2016-2021 by expanding established relationships with the pharmaceutical industry.


Enquirers are able to learn more about the region, current clinical trial opportunities; a contact enquiry form is available for anyone requesting to know more. Incoming enquiries are monitored and answered promptly and a database is maintained to assist with forging and maintaining relationships with sponsors, health practitioners and community members. Future plans include, but are not limited to researcher profiles, articles, useful resource links and frequently asked questions.

SCCT has been jointly presented at a number of forums, including ARCS (Association of Regulatory and Clinical Scientists), Biomedical and Life Sciences (Queensland Department of State Development), Professor Ian Frazer of the Medical Research Future Fund (MRFF), with positive feedback received.

Dedicated resources will enable the vision of this SCUH Program deliverable to become a reality.

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Surgical ServicesResearch Report

Research activity continued to expand across the Surgical Service Group (SSG) in 2016. Toward the end of 2016 there were approximately 50 clinical trials or investigator-led research projects underway. SSG researchers were successful in obtaining several significant Wishlist grants in the annual funding round.

Currently, active research is conducted by individuals and teams in anaesthetics; colorectal, endocrine, general, orthopaedic, urology and vascular surgery; persistent pain management, trauma service and the Intensive Care Unit (SCICCR). Research activity amongst trainees remains consistent with increased collaboration between surgical and medical services clinicians.

Nursing staff undertaking post-graduate studies have contributed a developing interest in identifying potential research questions relating to clinical practice.

It is anticipated that significant expansion of research activity will occur across all Surgical Service Group departments following the move to the Sunshine Coast University Hospital. Much groundwork in establishing collaborative partnerships with external stakeholders has been underway during 2016.

Research staff• Nurse Manager Research: Suzanne Ryan 1.0 FTE• Trauma Registry Administrator: Denise

Beaudequin PhD 0.5 FTE• Clinical Nurse Research Coordinator ICU: Lauren

Murray 1.0 FTE• ICU Research CNs: Loretta Forbes, Anne Buckley,

Jane Brailsford 0.5 FTE + a/a leave backfill on loan for SSG research activity Anaesthetic RN: Sandra Allen 0.5 FTE

• PhD candidate: Gillian Puckeridge Clinical Nurse Consultant Orthopaedic Surgery 0.4 FTE

• Research Coordinator Anaesthetics and Perioperative Medicine 2016: Debbie Massey PhD 1.0 FTE

Departmental research portfolio holders• Surgery: Dr. Sandy Grieve – Trauma Director,

General Surgeon• Intensive Care (SCICCR Sunshine Coast Institute

of Critical Care Research):• Dr. Chris Anstey–Director ICU• Dr. John Moore–Staff Intensivist and Research

Lead• Anaesthetics and Perioperative Medicine–

Dr. Guy Godsall• Persistent Pain Unit–Dr. Tania Morris• Vascular Surgery–Drs. Rebecca Magee and

Pankaj Jha

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Emergency MedicineResearch Report

Emergency Medicine research is growing rapidly in Sunshine Coast Hospital and Health Service (SCHHS).

HighlightsThe successful grant application through the strategic funding opportunity allowed the appointment of 1.3 full time equivalent (FTE) staff and enabled the creation of the SCHHS Emergency Department (ED)Research Unit. This has led to a higher profile for ED research within our department as well as the Health Service. In this short period our unit has already been successful in two research grant applications for projects developed wholly within our unit.

Presentationsa. Johnston, A. N. B., Abraham, L., Thom, O.,

Wallis, M., & Crilly, J. (2016 ). Staff perception of the working environment in two Australian emergency departments. Paper presented at the 2nd Global Conference on Emergency Nursing & Trauma Care, Melia Sitges, Sitges, Spain, 22 - 24 September 2016.

b. Wallis, M. & Marsden, E. (2016). Care Coordination through Emergency Department, Residential Aged Care and Primary Health Collaboration: The CEDRiC Trial. Keynote Address at Preventing Unnecessary Hospital Emergency Department Transfers for Older People Conference, Melbourne, Australia, 5-6 May.

c. Marsden, E. and Taylor, A. (2016). The GEDI model. Presentation at Statewide Older Persons Acute Care Network Survey Forum, Brisbane, Australia, 7 June.

d. Marsden, E. & Taylor, A. (2016). Overcoming the Discombobulation. Presentation at Emergency Department Management Conference, Sydney, Australia, 20-21 July.

e. Marsden, E. & Taylor, A. (2017) GEDI Dissemination project. Presentation at the Queensland Emergency Department Strategic Advisory Panel Forum, Brisbane, Australia, 17 February.

f. Wallis, M., Marsden. E & Taylor, A. (2017) GEDI Model of Care Initiative. Presentation to Metro North Hospital and Health Service. Brisbane, Australia, 23 February.

Grants a. For geriatric patients presenting to the

Emergency Department, how much blood is used; why is blood used and can we reduce red cell use and improve outcomes? National Blood Authority, 2016. $46,820.09.

b. A proof of concept study assessing the safety and efficacy of sub-anaesthetic infusion dosing of intravenous propofol for the treatmentof refractory migraine like headaches in the emergency department setting. Redcliffe Hospital Private Practice Trust Fund, 2016. $10,544.60.

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Page 37


The SCHHS has been an active participant in national and international sponsored clinical trials since the mid-1990s. There has been a progressive increase in the number of clinical trials since 2000 with 71 clinical trials underway at the end of 2016.

Consistently oncology, renal and intensive care have been the most active clinical trials specialties with an increase in cardiology and stroke trials since 2014 and 2015 respectively. A marked increase in the number of oncology clinical trials was noted commencing in 2007 with the appointment of the Research Nurse for Oncology Trials. A staffing model mixing permanently appointed Clinical Nurses and Research Nurse as well as temporarily appointed staff recruited on a cost recovery basis has been implemented. This model ensures continuity in terms of clinical trials co-ordination and responsiveness to changes in demand based on the number and complexity of clinical trials being undertaken with the SCHHS. Research Governance and Development UnitIt has been a busy and fulfilling year for the Clinical Trials Team. Clinical trials supported by this team are coordinated by a small group of Research Nurses consisting of two Clinical Nurses and three Registered Nurses, a Clinical Nurse Educator and a Nurse Unit Manager.

Congratulations to Lorraine Thompson, Clinical Nurse Educator Research, for completing her Doctor of Philosophy (PhD) this year. Lorraine’s PhD focused on coaching for clinical nurse leaders. Lorraine is responsible for promoting evidence based practice, the translation of research evidence at the point of care, the provision of support and

education to researchers associated with research ethics and governance.

While the department is currently involved in conducting sponsored clinical trials on behalf of principal investigators, the team is also participating in investigator led studies both locally and nationally. This year has seen the completion of studies such as the Midkine Study, an investigator- led study evaluating midkine levels in patients with kidney disease. This is a great example of a home- grown study that received a Wishlist grant of$21,784.00. An impressive 225 patients were enrolled at Nambour General Hospital and another 44 patients from other regional sites with the work recently published in BMJ Open.

Another investigator led study that the Clinical Trials Unit has been participating in is the TEXTMEDS Trial. This is a large multicentre trial of 1400 patients with acute coronary syndrome aimed at evaluating a secondary prevention support program delivered via mobile phone text message. TEXTMEDS aims to improve medication adherence and serve as a reminder to patients to modify their diet, do regular exercise and quit smoking. Participants have provided feedback to our nurses that the nature of message delivery via text is highly appropriate in this day and age. This trial has complimented a range of pharmaceutical trials that the Cardiology Department has been participating in by encouraging patients to adhere to their medication regimes.

The department has also been involved in a government initiative research project, CHERISH, that is aiming to reduce the impact of a hospital

Clinical Trials


Page 38

stay on our elderly patients. Seventy-one patients have been recruited to participate in this study where they have been randomised to receive normal care or a regime of care of “Eat, Walk, Engage”. The investigators are looking at improving the model of care for elderly patients.

The departments that we work with include: cardiology, infectious diseases, renal, stroke, obstetrics and gynaecology. However, we are able to work with all departments as they require clinical trials support.

This year has seen the completion of studies such as the Midkine Study; an investigator-led study evaluating midkine levels in patients with kidney disease.

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Page 40

pre-

2000

*

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

Tota

l

Oncology 1 1 3 11 15 20 21 23 25 21 29 26 29 225

Haematology 1 1 1 1 1 4 4 4 17

ICU 2 1 1 3 3 4 4 2 4 5 4 6 39

Cardiac 10 1 2 4 4 6 6 4 2 1 2 3 4 4 3 5 8 9 78

Renal 0 0 1 1 1 3 5 5 6 5 6 6 5 7 9 9 7 7 83

Stroke/Geri 0 0 0 0 0 1 1 2 2 1 1 3 3 3 6 5 28

Infect Diseases 3 2 4 4 2 1 4 4 5 3 3 2 1 5 4 5 3 1 56

Gen Med-Other 1 0 0 1 1 1 2 2 2 2 1 1 2 3 3 3 3 3 31

Anaesthetics 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2 2 5

Surgery (incl Ortho) 1 1 1 1 1 2 2 2 2 2 2 2 2 2 4 5 32

Total Trials 14 3 8 11 9 13 22 22 31 34 38 41 42 52 50 66 67 71 594

Number of Clinical Trials undertaken in Sunshine Coast Hospital and Health Service


Clinical Trials

The Oncology Trials Unit has had a very busy year with an increase in staff supporting an increase in the number of clinical trials that the unit can undertake. Oncology trials equally represent sponsored pharmaceutical and investigator led studies. We currently have 12 trials open to

recruitment and/or with patients receiving study treatment. An additional seven trials have patients in follow up. The trials include: haematology, radiation oncology, prostate, lung, breast, colorectal, gastrointestinal and ovarian.


Page 41

Sunshine Coast Hospital and Health Service Clinical Trials - Oncology only

0 5 10 15 20 25 30

2016

2015

2014

2013

2012

2011

2010

2009

2008

2007

2006

2005

2004

29

26

29

21

25

23

21

20

15

11

3

1

1

Number of Clinical Trials

Nurse researcher - Oncology Trials appointed


Oncology Clincial Trials


Page 42

Journal articles and abstracts

1Andrew NE, Middleton S, Grimley R, Anderson CS, Donnan GA, Lannin NA, Salama E, Grabsch B, Cadilhac DA. The influence of organisational context on delivery of thrombolysis and stroke unit care. Cerebrovasc Dis 2016: 42(Suppl 1): 1-157 doi:10.1159/000447732

2Anstey C. Measurement of Pre- or Post-Filter-Ionised Calcium Concentration during Continuous Veno-Venous Haemofiltration. Blood Purification. 2016:123-4.

3Anstey C, Campbell V, Richardson A. A Comparison between Two Dilute Citrate Solutions (15 vs. 18 mmol/l) in Continuous Renal Replacement Therapy: The Base Excess and Renal Substitution Solution Study. Blood Purification. 2016;42(3):194-201.

4Appadurai V, Lakshmanan A, Zhang Z. An unusual cause for coronary bypass graft stenosis. Heart Lung and Circulation. 2016;25:S165.

5 Appadurai V, Law B, Zhang Z. A rare cause of angina. Heart Lung and Circulation. 2016;25:S164.

6

Azzopardi M, Thomas R, Muruganandan S, Lam DCL, Garske LA, Kwan BCH, Rashid AMR, Nguyen PT, Yap E, Horwood FC, Ritchie AJ, Bint M et al. Protocol of the Australasian Malignant Pleural Effusion-2 (AMPLE-2) trial: A multicentre randomised study of aggressive versus symptom-guided drainage via indwelling pleural catheters. BMJ Open. 2016;6(7).

7Baird T, Putt M, Dettrick A. A stonemason with accelerated silicosis in the setting of tumour necrosis factor alpha inhibitor therapy. Respirology Case Reports. 2016;4(5):e00171.

8Bajaj P, Houston K. Follow-up of indeterminate lung nodules on pet-ct scan in patient with lung cancer treated with curative intent: Retrospective study. Asia-Pacific Journal of Clinical Oncology. 2016;12:115.

9Beaton TJ, Krishnasamy R, Toussaint ND, Phoon RK, Gray NA. Nephrology Training in Australia and New Zealand: A Survey of Outcomes and Adequacy. Nephrology (Carlton, Vic). 2016.

10Beetham KS, Howden EJ, Krishnasamy R, Isbel NM, Coombes JS. Feasibility of higher intensity exercise in patients with chronic kidney disease. J Sport Med Phys Fitness 2016: 22(4707); 1827-1928

11Bellapart J, Roberts JA, Appadurai V, Wallis SC, Nuñez-Nuñez M, Boots RJ. Pharmacokinetics of a novel dosing regimen of oral melatonin in critically ill patients. Clinical Chemistry and Laboratory Medicine. 2016;54(3):467-72.

12Body R, Carlton E, Sperrin M, Lewis PS, Burrows G, Carley S, McDowell G, Buchan I, Greaves K, Mackway-Jones K. Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision aid: Single biomarker re-derivation and external validation in three cohorts. Emergency Medicine Journal. 2016.

13Branagan H, Hill K, Salama E, Dunstan L, Andrew N, Kilkenny M, Kelly L, Cadilhac D, Grimley R. An evaluation of the impact of the Strokelink Program in Queensland: Perceptions of participants. Cerebrovasc Di 2016: 42(Suppl 1): 1 -157 doi: 10.1159/000447732

14Broom A, Broom J. Fear, duty and the moralities of care: The Ebola 2014 threat. J Sociology 2016: 1440783316634215.

15Broom A, Broom J, Kirby E, Adams J. The social dynamics of antibiotic use in an Australian hospital. J Sociology 2016: 52(4): 824-839.

16Broom A, Broom J, Kirby E, Scambler G. Nurses as antibiotic brokers: Institutionalized Praxis in the hospital. Qualitative Health Research 2016: 1049732316679953

17Broom A, Gibson AF, Broom J, Kirby E, Yarwood T, Post JJ. Optimizing antibiotic usage in hospitals: a qualitative study of the perspectives of hospital managers. Journal of Hospital Infection. 2016;94(3):230-5.


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18Broom A, Plage S, Broom J, Kirby E, Adams J. A qualitative study of hospital pharmacists and antibiotic governance: negotiating interprofessional responsibilities, expertise and resource constraints. BMC Health Services Research. 2016;16:1-8.

19Broom J, Broom A, Adams K, Plage S. What prevents the intravenous to oral antibiotic switch? A qualitative study of hospital doctors’ accounts of what influences their clinical practice. Journal of Antimicrobial Chemotherapy. 2016;71(8):2295-9.

20

Broom J, Broom A, Plage S, Adams K, Post JJ. Barriers to uptake of antimicrobial advice in a UK hospital: a

qualitative study. Journal of Hospital Infection. 2016;93(4):418-22. Divithotawela C, Garrett P, Westall G, Bhaskar,B, Tol M and Chambers D C, 2016. Successful treatment of cytomegalovirus associated hemophagocytic lymphohistiocytosis with the interleukin 1 inhibitor–anakinra.Respirology Case Reports, 4(1), pp.4-6.

21 Brown J. Audit of clinical outcomes following induction of labour using balloon catheter and prostaglandin gel. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2016;56:32.

22Burmeister EA, Jordan SJ, O’Connell DL, Beesley VL, Goldstein D, Gooden HM, Janda M, Merrett ND, Wyld D, Neale RE. Using a Delphi process to determine optimal care for patients with pancreatic cancer. Asia-Pacific Journal of Clinical Oncology. 2016;12(2):105-14.

23

Byrne L, Diab S, Passmore M, Dunster K, Boon AC, Fauzi MH, Tung JP, Van Haren F, Obonyo N, Maitland K, et al. Septic shock does not impair cardiac, renal or cerebral oxidative metabolism but may impair splanchnic metabolism in an ovine model of supported endotoxemic shock. Anaesthesia and Intensive Care. 2016;44(2): 302-3.

24

Cadilhac DA, Andrew N, Kim J, Kilkenny M, Hill K, Grabsch B, Grimley R, Dewey H, Lannin N, Levi C, Faux S, Anderson C, Donnan G, Middleton S. Establishment of National Performance Benchmarks for Acute Stroke Care: New evidence from the Australian Stroke Clinical Registry. Cerbroasc Dis 2016: 42(Suppl 1): 1-157 doi: 1159/000447732

25Caesar R, Boyd RN, Colditz P, Cioni G, Ware RS, Salthouse K, et al. Early prediction of typical outcome and mild developmental delay for prioritisation of service delivery for very preterm and very low birthweight infants: A study protocol. BMJ Open. 2016;6(7).

26 Carlton E, Body R, Greaves K. External Validation of the Manchester Acute Coronary Syndromes Decision Rule. Academic Emergency Medicine. 2016;23(2):136-43.

27Carlton E, Greenslade J, Cullen L, Body R, Than M, Pickering JW, Aldous S, Carley S, Hammett C, Kendall J, Keevil B, Lord S, Parsonage W, Greaves K. Evaluation of High-Sensitivity Cardiac Troponin I Levels in Patients With Suspected Acute Coronary Syndrome. JAMA Cardiology. 2016;1(4):405-12.

28Carlton EW, Khattab A, Greaves K. Beyond triage: The diagnostic accuracy of emergency department nursing staff risk assessment in patients with suspected acute coronary syndromes. Emergency Medicine Journal. 2016;33(2):99-104.

29 Challen J. Athletic pubalgia. Journal of Medical Imaging and Radiation Oncology. 2016;60:142.

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52Fraser JF, Spooner AJ, Dunster KR, Anstey CM, Corley A. Nasal high flow oxygen therapy in patients with COPD reduces respiratory rate and tissue carbon dioxide while increasing tidal and end-expiratory lung volumes: A randomised crossover trial. Thorax. 2016.

53Furyk JS, Chu K, Banks C, Greenslade J, Keijzers G, Thom O, et al. Distal Ureteric Stones and Tamsulosin: A Double-Blind, Placebo-Controlled, Randomized, Multicenter Trial. Annals of Emergency Medicine. 2016;67(1):86-95.e2.

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73Koitka K, Nunan T, Marrinan M, Coverdale S, Stanton T. An audit of inpatient heart failure management-does cardiology care improve rates of evidence based therapy prescribing? Heart Lung and Circulation. 2016;25:S96-S7.

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