Get the latest news from across Northern Sydney Local Health District.
Research Annual Report 2020
Acknowledgement of Country Northern Sydney Local Health District acknowledges the Traditional Custodians of the lands on which our health services have been built, the Gaimariagal, Guringai and Dharug peoples, and we honour and pay our respects to their ancestors. We acknowledge and pay our respects to all Aboriginal and Torres Strait Islander peoples and to Elders past, present and emerging. We acknowledge that past, current and future Aboriginal and Torres Strait Islander peoples are the continuing custodians of this country upon which we live, work and meet and that it is from their blood, courage, pride and dignity that we are able to continue to live, work and meet on this ancient and sacred country.
Cover image (centre right) by the Mosman Daily
CONTENTS
CHRONIC AND COMPLEX MEDICINE
28 28 30 31 32 33 34 36 36 38 38 40 40 41
Message from the Chief Executive and Board Chair 4 Message from the Research Advisory Committee 6 Research Ethics and Governance 8 Sydney Health Partners 9 Clinical Trials 10 COVID-19 Clinical Research Group 11 The Kolling Institute 12 2020 Key Research Statistics at a glance 13 NURSING AND MIDWIFERY 14 ALLIED HEALTH 16 MENTAL HEALTH, DRUG AND ALCOHOL 18 Mental Health 18 Drug and Alcohol 19 ACUTE AND CRITICAL CARE 20 Emergency Medicine Research 20 Intensive Care Unit (ICU) Research 21 CANCER 22 Cancer Research 22 Radiation Oncology 24 CHILDREN AND YOUNG PEOPLE 26 Paediatric Endocrinology and Diabetes 27
Endocrinology
Cancer Genetics Laboratory
Diabetes Research
Renal Medicine
Pain Management
MATERNAL, NEONATAL & WOMEN’S HEALTH
MUSCULOSKELETAL HEALTH, INTEGUMENTARY AND TRAUMA
Musculoskeletal Dermatology Hand Surgery
NEUROSCIENCES
Neurology
Stroke
REHABILITATION AND AGED CARE
42 John Walsh Centre for Rehabilitation Research 42 Curran Ageing Research Unit 43 Penney Ageing Research Unit 43
SUPPORTIVE AND PALLIATIVE CARE
44 44 46
Palliative Care
SURGERY AND ANAESTHETICS
Surgical Education, Research and Training (SERT) Institute
46
Message from the
Chief Executive and Board Chair Research is thriving at Northern Sydney Local Health District (NSLHD) and we are proud that, despite a year of many challenges, the commitment to improve health outcomes and experiences for our patients through translational research remained a priority. While COVID-19 presented challenges to our healthcare system, it provided opportunities for our researchers to explore the virus and contribute to research on a global scale. Research plays such a vital role in health care and the health of patients, as we witnessed in the global race to find a vaccine. NSLHD promptly set up the COVID-19 Research Group whose work has been vital in our understanding of the virus. Our researchers are participating in or leading 41 COVID-19 studies which will help provide vital evidence on how to treat and prevent COVID-19, as well as study the disease epidemiology and its impact on non-COVID 19 activities. At the same time, our researchers continued to pursue other “bench to bed” clinical trials and research that will have long lasting effects on our community and beyond.
4
RESEARCH ANNUAL REPORT 2020
Despite the challenges that COVID brought, our district remained focussed on research. We have continued to build on the NSLHD Research Strategy 2019-2024, developed to support our research endeavours to continue to deliver excellent health research, as it adapts to emerging trends including genomics and precision medicine, convergence science and digital technologies. The Kolling Institute Research Strategy, 2021-2025, was finalised, which identified three priority research areas (PRAs): musculoskeletal, neuroscience and pain, cardiovascular and renal. The priority research areas are supported by research enablers; clinical trials and translation; data and informatics; research infrastructure and support services; and recruitment and retention. We look forward to supporting the delivery of this strategy. Cancer research goes from strength to strength, with the formulation of a Cancer Research Network. The Cancer Research Network will include a research manager specifically dedicated to the cancer group, a professorial level lead for the Bill Walsh Cancer Lab, and the addition of two exciting pieces of infrastructure to support cancer research, a total body PET scanner, and a dedicated multidisciplinary team meeting space. To highlight the magnificent work our clinicians and researchers are doing to transform the care and treatment we provide for our patients, we launched NSLHD Northern Lights. The NSLHD Northern Lights events bring together leading clinicians and researchers, to enable them to describe their work in their own words, to our community, to raise awareness of their key activities and the latest advancements.
Our strong partnerships with the University of Sydney, Sydney Health Partners and the Kolling Institute are creating opportunities for our researchers to collaborate on projects while also interacting with patients. These partnerships are set to flourish as the district looks towards the development of an education, health and research precinct, based at St Leonards. This will not only benefit our clinicians and researchers, but it will have a long lasting impact on our patients and the community. Our patients and consumers currently play a vital role in our research, participating in clinical research, and in reviewing our studies. We look forward, in 2021 and beyond, to further develop and embed our engagement with our consumers and our community, to collaboratively develop life changing research. This Research Annual Report is an overview of our some of our many significant research achievements in 2020. We thank our staff, research partners, community members and consumer representatives for their wonderful support of research and innovation in our district. We look forward to building on the outstanding health research that is transforming patient care.
Deb Willcox, Chief Executive Northern Sydney Local Health District
Trevor Danos AM, Chair Northern Sydney Local Health District Board
WWW.NSLHD.HEALTH.NSW.GOV.AU 5
Message from the Research Advisory Committee
The Research Advisory Committee (RAC) is responsible for overseeing the implementation of the NSLHD Research Strategy 2019-2024. We are delighted to report that almost a third of the initiatives identified by our stakeholders in the development of the strategy have been delivered, and we are on target to deliver the remaining initiatives within the five-year timeframe. The initiatives that have been delivered were predominately structural reviews and changes to the delivery of research support and infrastructure. Notable achievements to date include establishing a website presence for research, publishing an annual research highlights report, the development of a clinical trials reference group, maintaining ethics and governance review times within the Ministry of Health designated key performance metrics, and drafting a fundraising strategy, in conjunction with the NORTH Foundation. The initiatives that were not delivered are those that were halted or slowed due to the COVID-19 pandemic, such as hosting face to face research forums; these will be carried over to following years.
The inclusion of consumers in the strategy, from development to delivery, has been invaluable. In addition, with consumers sitting side-by side with our researchers and clinicians to provide feedback on their own experiences, as well as taking part in our trials and studies, has ensured we remain focused on delivering outcomes from research that will benefit our community in years to come. The district is now transitioning into delivery of the mid-term initiatives identified in the strategy; these are more strategic in nature and include, for example, the establishment of priority areas, the provision of support for early and mid-career researchers, and the further development of our district research culture. These initiatives are designed to embed research as a recognised and protected core business function, and to underpin our research as a strong and sustainable component of our core business. The Research Advisory Committee looks forward to partnering with our staff, our patients and our community to continue delivering our strategy, and to support our research throughout the remainder of 2021 and into 2022.
Rebeka Freckleton, Manager Research Strategy and Partnerships
6
RESEARCH ANNUAL REPORT 2020
WWW.NSLHD.HEALTH.NSW.GOV.AU 7
Research Ethics and Governance Our research ethics and governance team had a productive year in 2020, approving a total of 357 applications for research (141 ethics applications and 216 governance applications). This indicates a steady increase in research activity over the year and early trends in 2021 suggest that research at NSLHD continues to grow. However successful recruitment to a full team and a determined attitude led to significant improvements throughout the year, resulting in governance authorisations being under 15 days by mid-2020. Applications for COVID-19 research were reviewed with priority, and the team approved a total of 36 COVID-19 related projects. Twenty of these projects being conducted
across NSLHD remained active at the end of 2020. In 2020, the research ethics and governance team started regular communiques with researchers via email, webinars and in-service events, and contributed to a district research newsletter in an effort to build strong working relationships with key stakeholders. The year concluded on a high note with the Ministry of Health describing the ethics team as a “consistently strong performer throughout 2020” and commending the governance team for its “remarkable improvement” through the year.
The Ministry of Health key performance indicator (KPI) for ethics approval (45 days) was achieved for the whole of 2020. The KPI for governance authorisation (15 days) was negatively impacted in quarter one by staff turnover in 2019, which resulted in governance officers starting 2020 with a backlog.
HUMAN RESEARCH ETHICS COMMITTEE (average days to approval)
GOVERNANCE Average Metric Time (Days)
8
RESEARCH ANNUAL REPORT 2020
Sydney Health Partners
NSLHD is one of five founding partners of Sydney Health Partners, along with Western Sydney and Sydney local health districts, Sydney Children’s Hospital Network and the University of Sydney.
In 2019, Sydney Health Partners developed a three-year strategy, intensifying its commitment to translating research into better health outcomes. As part of the strategy, each of the founding partner members took leadership of a strategic platform of health and medical research translation. NSLHD is leading what is known as the “Platform Three” projects, a program of work designed to reduce the barriers to conducting research across the partner organisations. This has been an intensive program of work involving research support staff from across the different partner local health districts (LHDs).
Key achievements to date include: › The development of a combined ethics calendar, hosted on the Sydney Health Partners website, which enables researchers to search for the next available ethics meeting to submit their project for review › The development of a streamlined governance review process, which ensures that all governance requirements are based on policy and are consistent across partner LHDs › The development of a research passport that will allow researchers working in multiple LHDs to undergo the credentialling process just once in one LHD, and for that credentialling to be recognised across all partner LHDs › The development of a research support map for each LHD, to assist researchers in identifying the available support
The relationship between Sydney Health Partners and NSLHD is strong and positive, and we look forward to working together and further developing this relationship over the next year.
WWW.NSLHD.HEALTH.NSW.GOV.AU 9
Clinical Trials
Clinical trials are an integral component of health care delivery at NSLHD.
Most existing medical interventions for diseases and conditions — including cancer, heart disease, hypertension and asthma — have been developed as a results of rigorous clinical trials, and ongoing support of trials is essential to the development of new interventions. Our commitment to clinical trials is highlighted by both the widespread distribution of trials across the district – trials occur at all our sites and facilities – and in the breadth disciplines involved. We established the Clinical Trials Reference Group, which reports to the Research Advisory Committee, to facilitate and grow the number of high quality clinical trials across NSLHD, to foster capacity and capability and to grow our visibility and participation in clinical trials. In 2020, the Clinical Trials Reference Group, in conjunction with NSLHD research support staff, delivered a number of projects designed to support our trials, and reduce administrative delays and burden for participants and staff.
Proportion of clinical trials with governance approval within 15 days (Jul-Dec 2020)
100%
Proportion of clinical trials receiving ethics approval within 45 days (Jul-Dec 2020)
100%
A key initiative for 2021 will be the growth of consumers involved in clinical trials and the development of research. We are indebted to patients and their carers who take part in our trials and studies. To ensure more trials are available to the community, we are developing a clinical trials section on the NSLHD website. Another focus will be the planning and delivery of a clinical trials management system, with the support of the Ministry of Health, which will further enable trials capacity across the district.
10
RESEARCH ANNUAL REPORT 2020
COVID-19 Clinical Research Group
Like our local and international research colleagues, our focus turned to COVID-19 in 2020, when the severity of the pandemic became evident.
The NSLHD COVID-19 Clinical Research Group, chaired by infectious disease specialist Dr Bernie Hudson, includes members from several disciplines who came together to coordinate our approach to COVID-19 research. Co-chaired by Associate Professor Rory Clifton-Bligh, the rapid evolution of the COVID-19 crisis led to innovative approaches to conceiving and conducting clinical trials involving both COVID-19 patients and healthcare workers. By November 2020, NSLHDwas participating in or leading 41 COVID-19 studies across six broad areas of focus: › Emerging treatments for COVID-19 › Prevention (chemoprophylaxis) of COVID-19 in high risk groups (including healthcare workers) › Biomarker research for diagnosis and prognosis (including biobanking) › Epidemiology of disease outbreaks in NSLHD › Health services data collection and research › The impact on non-COVID-19 related activities (both in healthcare and in research) Significant grants were awarded to NSLHD researchers to undertake a range of important COVID-19 related projects and these are continuing alongside our broader program of health and medical research.
Could a common medication reduce COVID-19 symptoms?
Professor Carol Pollock
One exciting COVID study, involving researchers from across Australia and India, is investigating whether existing blood pressure medications can reduce the risk of severe COVID-19 disease, as well as the duration of severe symptoms. Professor Carol Pollock is leading the RNSH arm of the CLARITY trial, which will involve up to 600 patients over the next year. The trial will investigate whether a class of drugs, called angiotensin receptor blockers, can improve outcomes for COVID-19 patients, by interrupting the virus’ entry into the body’s cells. The trial received $1.4 million from the Australian Government’s Medical Research Future Fund. If the medications are found to be effective, it could represent a major breakthrough in the management of COVID-19 patients.
Publication highlights include: › Abayasingam A, Balachandran H, Agapiou D, et al. Long-term persistence of RBD+ memory B cells encoding neutralizing antibodies in SARS-CoV-2 infection. Cell Rep Med. 2021;2(4):100228. doi:10.1016/j. xcrm.2021.100228, 10.1016/j.xcrm.2021.100228 › Girgis CM, Clifton-Bligh RJ. Osteoporosis in the age of COVID-19. Osteoporos Int. 2020;31(7):1189-1191. doi:10.1007/s00198-020-05413-0, 10.1007/s00198-020-05413-0 › Tsang VH, Gild M, Glover A, Clifton-Bligh R, Robinson BG. Thyroid cancer in the age of COVID-19. Endocr Relat Cancer. 2020 Aug 1:ERC-20-0279.R1
WWW.NSLHD.HEALTH.NSW.GOV.AU 11
The Kolling Institute
Bridging Medical Research and Health
The last 12 months was an important time for the Kolling Institute, with the development of the Kolling Institute’s Research Strategy (2021-2025). The strategy provides a robust framework for the Kolling’s work, while broadening opportunities to achieve high-quality, translational research. Three priority research areas were identified in the strategy: musculoskeletal, neuroscience and pain, and cardiovascular and renal research. These areas of research investigate some of the biggest health challenges of our time, which result in significant health, personal and economic costs. By focusing on these important areas, the Kolling is strengthening its ability to achieve game-changing research that will ultimately improve the health of our community. It will position the Kolling as a centre of translational research excellence, with globally recognised expertise and strong local, national and international collaborations. A key component of the new strategy is the identified research enablers. These enablers are four specific areas of the organisation that support research teams
in their quest. The four enablers focus on clinical trials and translation, data and informatics, research infrastructure and support services, and recruitment and retention. A range of initiatives will deliver new opportunities for clinical trials and translational practice, building on existing strengths and expertise in this area. Kolling researchers work within NSLHD, with extensive access to patient groups and state-of-the-art facilities. This means researchers are embedded within a large health system, and directly able to incorporate scientific discoveries and evidenced-based improvements into patient care. This model also paves the way for strong collaborations between researchers, clinical teams and patients, and efficiently delivers improvements to patient care, patient experience and long term health outcomes. The last 12 months has already seen an increase in collaborative research efforts, a trend that is set to continue. The measures incorporated in the new Kolling Institute Research Strategy aim to assist teams to increase the impact of their research. They will deliver new opportunities, greater assistance, access to high quality facilities and new partnerships within and outside the organisation. The initiatives will help bolster research efforts within the Kolling and across NSLHD, ultimately improving the health of the broader community.
12
Key research statistics at a glance 2020 632 435 active clinical trials active research staff across NSLHD
1395
matters reviewed by research ethics and governance
221 governance applications
49 committee meetings across human, animal and institutional biosafety
1332
peer reviewed papers
WWW.NSLHD.HEALTH.NSW.GOV.AU 13
NURSING AND MIDWIFERY
The Nursing and Midwifery Directorate and the Nursing and Midwifery Research Centre work together to support the research activities of nurses and midwives across the district. In their pursuit of excellence in practice, our nurses and midwives continue to demonstrate improved outcomes for patients and the research the team undertakes is used to inform and shape clinical practice, education, research and healthcare policy. Nursing and midwifery is a multidisciplinary network that collaborates with many health professionals on targeted research priority areas. Together with medical colleagues, allied health and industry partners, nurses and midwives continue to showcase their leadership, expertise and contribution to applied healthcare research which is changing our workplace and narrowing the clinician-researcher theory-practice gap. Nursing and midwifery has partnerships with local universities that bring rigour, creativity and innovation to the health space and also helps to create meaningful practice change and support clinical innovation, integration and translation.
Major grants (Greater than $200,000) › Chappell L, Woodward M, Norton R, Hammond N, et al. Understanding the sex and gender dimensions on women’s health and wellbeing ($210,313.00). University of NSW COVID-19 Rapid Response Research Initiative; 2020 › Curtis K, Fry M, Considine J, Murphy M, Shaban R. Implementing evidence to improve access, equity and quality of emergency and trauma care and maximise patient and health service outcomes ($358,091.00). Thyne Reid Foundation; 2020 › Hammond N. Delineating the role of fludrocortisone and hydrocortisone in the management of patients with septic shock ($553,664.00). NHMRC Investigator Grant; 2020 Ongoing research studies led by NSLHD nurses and midwives include: › Oli™ pilot study – ensuring the Oli™ technology is developed to work best for all users in pregnancy and labour monitoring › Strengthening the safety culture of acute mental health in-patient units in NSW › Incorporating clinical informatics to describe the
electronic prescribing practices of nurse practitioners in NSLHD to enhance patient safety and quality of care
NURSING AND MIDWIFERY 2020 RESEARCH HIGHLIGHTS
Research Centre 25
$1.5m in grant funding (27 applications)
74 papers published in peer-reviewed journals
research education sessions provided by the Nursing and Midwifery
14
RESEARCH ANNUAL REPORT 2020
OlI gives new insights in pregnancy A landmark study into maternal and fetal monitoring is underway at Royal North Shore Hospital and has the potential to help change the way monitoring occurs for the first time in 55 years. As part of the Oli study, 120 pregnant women will be recruited to use new wireless monitoring that offers new measures, which it is hoped, if successful, could replace current invasive monitoring that can restrict the mother’s movements during labour. The Oli is a wireless patch that monitors key measures impacting mother and baby during pregnancy and labour. Providing details surrounding the quality of uterine activity, maternal and fetal wellbeing, movements and exertion, Oli is being developed to be used before birth, providing information on how a labour is presenting and progressing. Designed by Baymatob, a company founded by engineer and mother-of-three Dr Sarah McDonald after her second birth, the device is now entering its second human clinical study, where midwives at RNSH hope the data collected will shine a light on mother and baby monitoring. Michelle de Vroome, Network Manager Midwifery Practice, NSLHD, said the current cardiotocography (CTG) monitoring really hadn’t changed since 1965, measuring the same parameters. Women in labour are currently monitored via two devices strapped to thick bands wrapped around their torsos, one with a fetal heart rate sensor, the other to track the frequency of contractions. These are then either connected directly to a CTG machine, limiting movement, or wirelessly over a short distance to the CTG machine. The Oli has the potential to help cut the rates of unnecessary interventions, and where needed, intervene earlier to avoid complications. Following the results, a larger clinical trial across the state is expected to be conducted.
Publication highlights include: › Elliott R, Fry M. Psychological capital, well-being, and patient safety attitudes of nurses and midwives: A cross-sectional survey. Nurs Health Sci. 2020 Dec 31. doi: 10.1111/nhs.12808 › Fitzgerald E, Hammond N, Tian DH, Bradford C, Flower O, Harbor K, et al.. Functional outcomes at 12 months for patients with traumatic brain injury, intracerebral haemorrhage and subarachnoid haemorrhage treated in an Australian neurocritical care unit: A prospective cohort study. Aust Crit Care. 2020 33(6):497-503. doi: 10.1016/j.aucc.2020.03.006 › McKechnie D, Fisher MJ, Pryor J, McKechnie R. Predictors of unplanned readmission to acute care from inpatient brain injury rehabilitation. Journal of Clinical Nursing. 2020;29(3-4):593- 601.Doi: 10.1111/jocn.15118 › Tinker M, Elliott R, Roach V. Save our skin: A pressure injury reduction project targeting pressure injuries acquired in the intensive care unit. Wound Pract Res. 2020;28(3):106- 14. doi: 10.33235/wpr.28.3.106-114 › Yarad E, O’Connor A, Meyer J, Tinker M, Knowles S, Li Y, et al. Prevalence of pressure injuries and the management of support surfaces (mattresses) in adult intensive care patients: A multicentre point prevalence study in Australia and New Zealand. Aus Crit Care. 2020 34(1): 60- 66. doi:10.1016/j.aucc.2020.04.153
WWW.NSLHD.HEALTH.NSW.GOV.AU 15
ALLIED HEALTH
The Allied Health Network includes research within, across, and beyond NSLHD, focusing on the role of allied health professionals in patient care, from assessment and diagnosis to the informed and effective management of patients across the life-span. The NSHLD Allied Health Research team works to encourage the participation of allied health clinicians in research activities.
The Allied Health Research Committee (AHRC) assists in building research and promotes evidence-based practice and research within allied health disciplines. In 2020, the committee brought together key allied health clinicians, managers and research leaders from across the district to develop an allied health research action plan. Together the committee and research team will work with key partners to implement the research action plan. Our allied health team at NSLHD has important partnerships with Sydney Musculoskeletal, Bone and Joint Health Alliance (Sydney MSK), University of Sydney, CSIRO, Sydney Health Partners, the Kolling Institute and the NSW Health Agency for Clinical Innovation, as well as many important industry partners. Our early stage research is supported by Allied Health Kickstarter Research Grants, funded by NSLHD and the University of Sydney.
Key 2020 Allied Health Research Projects include: › Neuromuscular mechanisms underlying poor recovery from whiplash injuries › Supervised machine learning methods in the field of deep learning artificial intelligence, to solve complex clinical pattern recognition problems › A stress-diathesis model of chronic musculoskeletal conditions as a new framework to drive prevention and rehabilitation forward › MRI and machine learning to improve early prognosis and clinical management after spinal cord injury › Can changes in oropharyngeal morphometry explain self-reported dysphagia and dysphonia in patient with whiplash associated disorder? › What influences eating behaviours of consumers with chronic schizophrenia? › Diagnostic lung ultrasound in critical care: evaluation of the short-term effectiveness of physiotherapy treatment › Experiences of stigma and discrimination experienced by people from a culturally and linguistically diverse background while accessing mental health services and seeking care for musculoskeletal conditions › Mobile health technology solutions to expand pulmonary rehabilitation services for chronic obstructive pulmonary disease: The m-PR™ Implementation Project
16
RESEARCH ANNUAL REPORT 2020
Professor James Elliott
Case study Treatment of whiplash injuries could be modified following research which found even minor motor vehicle accidents can cause a long-term spinal cord injury. Researchers from the Northern Sydney Local Health District/University of Sydney along with scientists from Northwestern University, Stanford University and the University of Oklahoma conducted the longitudinal study involving participants who had been involved in a relatively simple motor vehicle collision. Using advanced MRI imaging, the research team identified profound changes in the health and integrity of spinal cord pathways of female participants who were still experiencing health issues one year after their crash. NSLHD Professor of Allied Health James Elliott said researchers believed the changes represent a more severe injury than what might be expected from a typical low speed car crash, and would not normally be detected with conventional imaging scans.
The research indicated these patients may have experienced an
incomplete spinal cord injury, which was linked to a range of associated health issues. “Whiplash-associated-disorders are the most common outcome for the 2.6 million Australians and four million Americans involved in a non-catastrophic motor vehicle collision every year,” he said. “Half of those injured recover rapidly, but the other half continue to experience long-term health issues, with neck pain the most common symptom. “Whiplash-associated-disorders are a leading cause of disability worldwide. They represent a considerable financial burden, costing the Australian economy around $1 billion a year, and the American economy more than $USD100 billion per annum.”
Selected publications › Elliott, J. M., Parrish, T. B., Walton, D. M., Vassallo, A. J., Fundaun, J., Wasielewski, M., & Courtney, D. M. (2020). Does overall cervical spine pathology relate to the clinical heterogeneity of chronic whiplash?. The American journal of emergency medicine , 38(5), 869-873. DOI: 10.1016/j.ajem.2019.06.052 › Kessler, R. C., Ressler, K. J., House, S. L., Beaudoin, F. L., An, X., Stevens, J. S., ... & McLean, S. A. (2020). Socio-demographic and trauma-related predictors of PTSD within 8 weeks of a motor vehicle collision in the AURORA study. Molecular psychiatry, 1-14. DOI: 10.1038/s41380-020-00911-3 › Milne, S. C., Corben, L. A., Roberts, M., Szmulewicz, D., Burns, J., Grobler, A. C., ... & Delatycki, M. B. (2020). Rehabilitation for ataxia study: protocol for a randomised controlled trial of an outpatient and supported home-based physiotherapy programme for people with hereditary cerebellar ataxia. BMJ open, 10(12), e040230. DOI: 10.1136/bmjopen-2020-040230 › Pagano, L., McKeough, Z., Wootton, S., Crone, S., Pallavicini, D., Chan, A. S., ... & Dennis, S. (2020). The feasibility of an innovative GP-physiotherapist partnership to identify and manage chronic obstructive pulmonary disease (INTEGRATED): study protocol. Pilot and feasibility studies, 6(1), 1-10. DOI: 10.1186/ s40814-020-00680-4 › Sinn, F. S., Charters, E., Stone, D., Janabi, M., & Bogaardt, H. (2020). Responsiveness of the EAT-10 to Clinical Change in Head and Neck Cancer Patients with Dysphagia. International journal of speech-language pathology, 22(1), 78-85. DOI: 10.1080/17549507.2019.1596312
WWW.NSLHD.HEALTH.NSW.GOV.AU 17
MENTAL HEALTH, DRUG AND ALCOHOL
Mental Health In psychiatry, research is integrated into clinical practice and involves a number of academic and clinical psychiatry groups. It spans mood disorders, consultation liaison psychiatry and drug and alcohol services.
CADE Clinic Publication highlights include: › Malhi GS, Bell E, Bassett D, et al. The 2020 Royal Australian and New Zealand
College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry. Jan 2021;55(1):7-117. doi:10.1177/0004867420979353
› Malhi GS, Bell E, Boyce P, et al. The 2020 Royal Australian and New Zealand College of psychiatrists clinical practice guidelines for mood disorders: Bipolar disorder summary. Bipolar Disord. Dec 2020;22(8):805-821. doi:10.1111/bdi.13036 › Malhi GS, Bell E, Singh AB, et al. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders: Major depression summary. Bipolar Disord . Dec 2020;22(8):788-804. doi:10.1111/bdi.13035 › Malhi GS, Das P, Outhred T, Bryant RA, Calhoun V. Role of self-focussed reappraisal of negative emotion in emergence of emotional symptoms in adolescent girls. Br J Psychiatry. Jul 2020;217(1):383-389. doi:10.1192/bjp.2019.255 › McIntyre RS, Berk M, Brietzke E, et al. Bipolar disorders. The Lancet. 2020/12/05/ 2020;396(10265):1841-1856. doi:https://doi. org/10.1016/S0140-6736(20)31544-0
The CADE Clinic A good example of how we integrate mental health research into clinical practice is the CADE Clinic, which is embedded within the Royal North Shore Hospital Department of Academic Psychiatry. The clinic is a statewide specialist service that acts as a hub for clinical education research and education for NSLHD, the University of Sydney and the Kolling Institute. The CADE team has developed strong national and international collaborations involving world-renowned experts. In addition to contributing directly to research, these international networks have been key in the development of national guidelines for the management of mood disorders – impacting policy-making nationally and internationally via the World Health Organization.
18
RESEARCH ANNUAL REPORT 2020
Drug and Alcohol The NSLHD Drug and Alcohol service has a strong focus on research. In 2020, the group delivered its first research strategy, which is aligned with the NSLHD Research Strategy 2019-2024, and demonstrates the value the group puts on supporting research. In the last three years, the number of research projects grew from one to 20 projects. The drug and alcohol group was also invited to join the NSW Ministry of Health-sponsored Drug and Alcohol Clinical Research and Improvement Network.
Publication highlights include: › Grebely J, Read P, Cunningham EB, et al. Elbasvir and grazoprevir for hepatitis C virus genotype 1 infection in people with recent injecting drug use (DARLO-C): An open-label, single-arm, phase 4, multicentre trial. Health Sci Rep. Jun 2020;3(2):e151. doi:10.1002/hsr2.151 › Kloft L, Otgaar H, Blokland A, et al. Cannabis increases susceptibility to false memory. Proc Natl Acad Sci U S A. Mar 3 2020;117(9):4585-4589. doi:10.1073/ pnas.1920162117 › Lintzeris N, Monds LA, Bravo M, et al. Designing, implementing and evaluating the overdose response with take-home naloxone model of care: An evaluation of client outcomes and perspectives. Drug Alcohol Rev. Jan 2020;39(1):55-65. doi:10.1111/dar.13015 › Mills L, Lintzeris N, Bruno R, et al. Validation of the Australian Treatment Outcomes Profile for use in clients with cannabis dependence. Drug Alcohol Rev. May 2020;39(4):356-364. doi:10.1111/dar.13050 › Valerio H, Alavi M, Silk D, et al. Progress towards elimination of hepatitis C infection among people who inject drugs in Australia: The ETHOS Engage Study. Clin Infect Dis. May 18 2020;doi:10.1093/cid/ciaa571
Key 2020 drug and alcohol research projects include: › Pilot study of an internet-based, simulated teachable moment for smoking cessation › Defining the clinical role of topiramate in the treatment of alcohol dependence in Australia › Real world efficacy of antiviral therapy in chronic hepatitis C (REACH-C) › An open-label, multicentre, single-arm trial of monthly injections of extended release buprenorphine in people with opioid dependence (CoLAB Extension Study) › Examining clinical outcomes and quality indicators for clients attending NSW AOD treatment services Amphetamine Type Substances (ATS) group (Clinical Outcomes and Quality Indicators Cohort Study) › Obtaining normative substance use data for clients attending NSW public drug and alcohol treatment services (Clinical Outcomes and Quality Indicators Cohort Study). › NSW dried blood spot self-sampling HIV and
hepatitis C testing pilot program › Australian longitudinal study of heroin dependence
WWW.NSLHD.HEALTH.NSW.GOV.AU 19
ACUTE AND CRITICAL CARE
Emergency Medicine research The emergency department (ED) at RNSH is one of the busiest EDs in NSW, seeing over 90,000 patients per year. The RNSH ED research unit has the task of undertaking medical research on the wide spectrum of patients who walk through its doors .
In 2020, the research team included a project support officer, 20 research volunteers and doctors, nurses, medical students, PhD students from the ED and many other disciplines at RNSH, as well as researchers from other hospitals, interstate and overseas. The ED is an area of medicine that demands high quality medical research so we can provide better treatment for patients, however it is a difficult area of the hospital in which to perform research due to the large patient numbers and their high medical acuity, and the need for research funding. Currently, the RNSH ED is conducting more than 20 research projects in areas including bicycle injuries; musculoskeletal injuries including back, neck and knee pain; pain relief in fractures and the use of diagnostic ultrasound in EDs. In the past three years, the research group has published more than 20 scientific journal papers.
Bicycle Injuries Study RNSH Emergency Department is undertaking one of the largest research projects on bicycle-related injuries. The study has been ongoing for the past two years and has already recruited over 400 participants. The study aims to provide an overview of the patterns of injuries to bicycle riders and look at associations of these injuries that may suggest changes to riding patterns, equipment and roadways which may help to improve health outcomes.
20
RESEARCH ANNUAL REPORT 2020
Intensive Care Unit (ICU) research
Key 2020 ED research projects include: › The creation of an Emergency Department Airway Registry: a multicentre observational trial into the procedure of ED intubation. This ongoing data collection into its sixth year and is now the world’s largest airway database › Use of High-Risk Influenza Stratification Test (HIST) in patients with suspected influenza infection: a multi-centre study that utilises a blood-based test to stratify patients with suspected influenza into low- and high-risk groups for developing severe disease › Nurse Initiated Fascial Iliacus Block (FIB) Study: is a prospective randomised control trial reviewing the implementation, timeliness and efficacy of early Nurse Initiated FIB compared to standard medically instigated FIB › Hypertensive emergencies: a systematic review that will generate an NSLHD guideline for hypertensive crises › A systematic review of emergency physician limited point compression ultrasound to diagnose proximal deep venous thrombosis › The PACE Study: an NHMRC-funded study reviewing the impact of an intensive multi-modal intervention program for patients presenting to ED with lower back, knee and neck pain Publication highlights include: › Groves CP, Butland BK, Atkinson RW, Delaney AP, Pilcher DV. Intensive care admissions and outcomes associated with short-term exposure to ambient air pollution: a time series analysis. Intensive Care Med . Jun 2020;46(6):1213-1221. doi:10.1007/ s00134-020-06052-z › Litton E, Bass F, Dickson C, et al. Prophylactic Intra-Aortic Balloon Counterpulsation in High Risk Cardiac Surgery: The PINBALL Pilot Multicentre, Registry-Linked, Randomised, Controlled Feasibility Trial. Heart Lung Circ . May 2020;29(5):710-718. doi:10.1016/j.hlc.2019.04.006
ICU research at NSLHD includes investigator-initiated, collaborative group, and industry-sponsored studies. Our ICU researchers have strong partnerships with many leading Australian and international research institutions, including The George Institute for Global Health (UNSW, Sydney), ANZCIS Research Centre (Monash University), Brain and Mind Centre (University of Sydney), Macquarie University, and the Canadian Critical Care Trials Group. The RNSH ICU research group has a strong history of supporting staff through higher degree research programs; several staff have been awarded research degrees by thesis as an extension of registrar research projects, and the group is currently supporting seven PhD candidates. At RNSH, ICU research is supported via a research education program with regular registrar teaching on evidence-based medicine, a monthly journal club, and the provision of a clinical research course. This provides an excellent support structure for trainees completing their professional college projects. › Luethi N, Bailey M, Higgins A, et al. Gender differences in mortality and quality of life after septic shock: A post-hoc analysis of the ARISE study. J Crit Care . Feb 2020;55:177-183. doi:10.1016/j.jcrc.2019.11.002 › Mackle D, Bellomo R, Bailey M, et al. Conservative Oxygen Therapy during Mechanical Ventilation in the ICU. N Engl J Med . Mar 12 2020;382(11):989- 998. doi:10.1056/NEJMoa1903297 › Narayan SW, Castelino R, Hammond N, Patanwala AE. Effect of mannitol plus hypertonic saline combination versus hypertonic saline monotherapy on acute kidney injury after traumatic brain injury. J Crit Care . Jun 2020;57:220-224. doi:10.1016/j. jcrc.2020.03.006
WWW.NSLHD.HEALTH.NSW.GOV.AU 21
CANCER
Cancer research For our broad cancer research program at NSLHD, 2020 presented an opportunity to rethink our research efforts, with the COVID-19 pandemic resulting in enforced changes on interactions, realigned priorities, and limits on many routine research activities such as experimental laboratory-based research. In response to these challenges, clinical and scientist cancer researchers developed a clinically focused, patient-centric theme for data generation, to implement real-time data capture and mining, and increase the available information, for example, from genome sequencing of biological samples. As well, NSLHD researchers played a leading role in providing national and global advice around COVID-19. Sydney Vital, a translational cancer research centre based at NSLHD, continued its translational and capacity-building activities in the district and was among the earliest research bodies to hold a face-to-face research symposium in November 2020 following the COVID-19 pandemic. In November 2020, Royal North Shore Hospital was announced as the preferred site for the National Imaging Facility’s “Total Body PET” (Positron Emission Tomography) scanner project. This is a $15 million collaboration between the Australian Government, University of Sydney and NSLHD, which will greatly enhance imaging access for cancer researchers in particular, as well as in a number of other areas such as cardiovascular, immunology, neurosciences and musculoskeletal disorders.
Key 2020 drug and alcohol research projects include: › 227 peer-reviewed publications for 2020, up 46 per cent on the previous year and a 30 per cent increase over the last five years › $5 million in funding from diverse sources, including NHMRC, Mark Hughes Foundation and Tour de Cure. › NSW Premier’s Outstanding Cancer Clinical Trials Unit 2019 award › Over 50 clinical cancer trials active in 2020 › The Bill Walsh Cancer Research Laboratory continued its work in investigating the relationship between the cancer microenvironment and inflammation and added a series of experimental radiobiological studies to try to understand how radionuclides can be better used to treat a range of cancers
22
RESEARCH ANNUAL REPORT 2020
Our research program is also providing opportunities for early career researchers to grow and advance their careers. Some examples include: › Dr David Chan, NHMRC emerging leader grant › Dr Wei Deng, CINSW Career Development grant and NHMRC ideas grant › Dr Yaser Gholami, University of Sydney Physics Grand Challenge award › Dr Angela Chou, a pathologist and cancer researcher at RNSH, was the winner of the 2020 NSW Premier’s Award for Outstanding Cancer Research Fellow - Early Career Fellow for her insights into pancreatic cancer in collaboration with the Australian Pancreatic Genome Initiative (APGI) at the Garvan Institute
WWW.NSLHD.HEALTH.NSW.GOV.AU 23
Radiation Oncology The radiation oncology multidisciplinary team is actively involved in cancer research and looks to improve patient outcomes through sophisticated radiotherapy. Translational research is a core focus of the group, and initiatives that were previously part of research projects conducted at NSLHD have been incorporated into standard care for patients. We strive to be patient-centric focus on individualised treatment pathways which is reflected in publications and research themes, and radiation oncology has strong collaborations with medical oncology, surgical oncology, allied health and nursing across NSLHD. Clinical trials are an important component of the radiation oncology research portfolio, and the group steers multiple phase I and II clinical trials for innovative treatment; for brain cancer, pancreas cancer and prostate cancer. This enables our patients to be involved in potentially life-saving treatment and access to treatments they may otherwise not have had. Our patients benefit directly through our research and involvement with clinical trials.
A key example of how radiation oncology research leads to better patient outcomes was the development of a streamlined palliative care pathway which removed the need for a simulation computed tomography (sCT) scan, meaning more prompt treatment delivery and fewer attendances for the patient. The radiotherapy unit is a collaborative research partner with Varian Medical Systems, participating an international consortium for adaptive radiotherapy and leading development for risk assessment, adaptive cervix radiotherapy, adaptive rectal cancer radiotherapy and simulation-free palliative radiotherapy. The district’s radiotherapy unit is a reference site for US-based radiation dosimetry software company, Sun Nuclear Corporation, and for Canadian-based 3D printing software company Adaptiiv. We have strong links with the University of Sydney, as a teaching and research partner.
Publications: › Back M, Jayamanne D, Brazier D, Newey A, Bailey D, Schembri G, Hsiao E, Khasraw M, Wong M, Kastelan M, Brown C, Wheeler H. Pattern of failure in anaplastic glioma patients with an IDH1/2 mutation. Strahlenther Onkol . 2020 Jan;196(1):31-39. English. doi: 10.1007/s00066-019-01467-0. Epub 2019 Apr 26. PMID: 31028406 › Booth J, Caillet V, Briggs A, et al. MLC tracking for lung SABR is feasible, efficient and delivers high-precision target dose and lower normal tissue dose. Radiother Oncol . Feb 2021;155:131-137. doi:10.1016/j. radonc.2020.10.036 › Horsley PJ, Back M, Lamoury G, Porter B, Booth J, Eade TN. Radiation oncology during COVID-19: Strategies to avoid compromised care. Asia Pac J Clin Oncol. Feb 2021;17(1):24-28. doi:10.1111/ajco.13456 › Itchins M, Chua TC, Arena J, et al. Evaluation of Fluorodeoxyglucose Positron Emission Tomography Scanning in the Neoadjuvant Therapy Paradigm in Pancreatic Ductal Adenocarcinoma. Pancreas. Feb 2020;49(2):224-229. doi:10.1097/mpa.0000000000001472 › Oar A, Lee M, Le H, et al. Australasian Gastrointestinal Trials Group (AGITG) and Trans-Tasman Radiation Oncology Group (TROG) Guidelines for Pancreatic Stereotactic Body Radiation Therapy (SBRT). Pract Radiat Oncol . May-Jun 2020;10(3):e136-e146. doi:10.1016/j.prro.2019.07.018
24
RESEARCH ANNUAL REPORT 2020
2020 RADIATION ONCOLOGY RESEARCH HIGHLIGHTS INCLUDE:
11
13
19
invitations for conference presentations
clinical trials in recruitment
publications
WWW.NSLHD.HEALTH.NSW.GOV.AU 25
CHILDREN AND YOUNG PEOPLE
The Children and Young People Clinical Network brings together multidisciplinary clinician-researchers from across NSLHD, including the acute and community health care services related to infants, children, young people and their families.
Research across the network focuses on improving the health and wellbeing of children and families; improving models of care to deliver the highest quality care; understanding and responding to workforce needs; best practice in respond to emerging health needs; COVID-19; the First 2000 days policy framework; and paediatric endocrinology and diabetes. The network has important research partnerships with the University of Sydney, University of Technology Sydney, Children’s Inpatient Research Collaboration of Australia and New Zealand (CIRCAN), University of Newcastle, NSW Ministry of Health, Sydney Children’s Hospitals Network (SCHN) and many other industry and academic groups. A key project for the network in 2020 was the Focus on New Fathers pilot, a study conducted in conjunction with Murrumbidgee, Western Sydney and Northern NSW local health districts. Publication highlights include: › Johnston R, Sunners J, Murphy E. Child and family health nursing: A workforce profile. J Nurs Manag . Apr 2020;28(3):532-539. doi:10.1111/jonm.12953 › Jones, C., Randall, S., & Fraser, J. (2020). Evaluation of nurse training using kirkpatrick’s model: A mixed-methods approach. In SAGE Research Methods Cases . https://www.doi. org/10.4135/9781529709681
Other key 2020 research projects included: › Simulation use in paediatric emergency nursing skills education (SUSPENSE) › Children’s Inpatient Research Collaboration of Australia and New Zealand (CIRCAN) study of the impact of the COVID-19 pandemic on general paediatric admissions in Australia › Impact of the immunomodulator OM85 on wheeze-associated hospitalisation in pre-schoolers: a multi-centre, randomised, double-blind, placebo-controlled trial Participation in these projects will continue into 2021.
Funding highlights include: › Translational Research Grants Scheme (TRGS) funded research with NSLHD, South Eastern Sydney and South Western Sydney local health districts: ‘First 2000 days care connect (FDCC) – a holistic first 2000 days model of care for migrant and refugee populations’ research to improve early childhood development and health › Grant funded research: ‘Improving emergency department safety through more consistent early detection and assessment of patient deterioration’
26
RESEARCH ANNUAL REPORT 2020
Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 38 Page 39 Page 40 Page 41 Page 42 Page 43 Page 44 Page 45 Page 46 Page 47 Page 48Made with FlippingBook - professional solution for displaying marketing and sales documents online