Get the latest news from across Northern Sydney Local Health District.
Researchers question value of plasma injections for knee osteoarthritis
Study confirms deadly risk of COVID-19 for those with heart failure and other chronic conditions
Talented, young researcher takes out prestigious national award
Discovery into reality
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MESSAGE FROM THE ACTING EXECUTIVE DIRECTOR
2021 has been another extraordinary year. It’s been a year defined by the COVID-19 pandemic and the significant changes to our work and personal lives. We have again been asked to demonstrate considerable flexibility and resilience, and I’ve been tremendously impressed by the efforts and commitment of our team throughout the year. Despite the changes over the last 12 months, it’s been a remarkable year for the Kolling. We kicked off the year with the launch of the institute’s strategy, a blueprint to strengthen our ability to achieve ground breaking research. The strategy involves a host of initiatives to increase the impact of our research and shape the future of the institute. I would like to thank the large number of people who have been involved in the development of the strategic framework this year, as well as the many members of the priority research area and research enabler committees. Thank you for sharing your time and expertise to help us achieve substantial progress this year and help secure our long- term success.
2021 has seen members of our team drive nationally and internationally significant research and directly influence patient outcomes. Importantly this progress has been made across all our priority research areas of neuroscience and pain, musculoskeletal, and cardiovascular and renal research. We are influencing patient treatments, health policy, and crucially, raising the level of care our community receives. Our efforts have been recognised with a range of prestigious honours and significant funding including National Health and Medical Research Council grants – some of which are featured in this newsletter – state government funds and philanthropic support. There is tremendous expertise and experience across the Kolling and it’s encouraging to see our track record consistently recognised. As we reflect on the achievements this year and plan for 2022, we expect to see a greater focus on strengthening our existing partnerships and establishing new ones. We anticipate there will be further collaborations across our priority research areas, as well as with industry, government
and a growing body of consumer partners. All of these partnerships hold the key to large-scale, multidisciplinary research success and substantial improvements in patient care, and further efforts will be invested in fostering these relationships. I would like to commend everyone for their contribution this year and wish you all a wonderful break over the holiday period. I would also like to welcome back Executive Director Professor Carolyn Sue who will be returning from leave in the new year. We look forward to your return.
Warm regards
Jim Professor Jim Elliott Acting Executive Director
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KOLLINGNEWS | DECEMBER 2021
Researchers reject the use of plasma injections for knee joint osteoarthritis
In what will be disappointing news for many, a large-scale clinical trial has found platelet-rich plasma injections for osteoarthritis knee pain are no better than a placebo. This type of injection has become an increasingly popular form of treatment for knee joint arthritis, despite its prohibitive cost at around $2,000 per injection. Plasma from a patient’s own blood is injected directly into the joint in the hope it will reduce pain and improve joint cartilage. But a trial conducted by researchers from the universities of Sydney and Melbourne and Monash University has found that while participants who had the plasma injections did have a significant improvement in their knee pain over 12 months, the level of improvement was the same as for those in the placebo group.
There were also no differences in the MRI scans across both groups. Kolling Institute and University of Sydney researcher, and RNSH clinician Professor David Hunter concedes the findings will disappoint some people who had hoped these injections would offer long-term relief. “With more than two million Australians affected by knee joint arthritis, there is clearly a need for new therapies to reduce symptoms and improve the structure of the knee,” he said. “Unfortunately, the particular treatment trialled in this study, whilst widely used and typically expensive, appears to be ineffective. “Our research however has added to our understanding of this type of treatment and will ensure the latest recommendations are backed by high-quality evidence.
“Our current advice encourages people with knee osteoarthritis to adopt a consistent exercise program and lose weight if they are above a healthy weight range. “We know that by reducing your body weight by just 10 per cent, you can reduce your knee pain by a remarkable 50 per cent.” The research paper has been published in one of the world’s leading medical journals, the Journal of the American Medical Association.
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Study confirms deadly risk of COVID-19 for those with heart failure and other chronic conditions
The largest study of its kind in Australia has found patients with a history of heart failure are three times more likely to die from COVID-19. Launched last year at the outset of the pandemic, the AUS-COVID trial is investigating those who are most at risk from COVID-19 in Australia. To date, it has assessed hundreds of patients in 21 hospitals across the country. The study confirmed earlier concerns by clinicians and demonstrated that patients with pre-existing heart failure are three times more likely to die from COVID-19. Over 100,000 Australians live with heart failure according to data from the Australian Bureau of Statistics. The study found that patients with chronic kidney disease are twice are likely to die from COVID-19, while patients with chronic lung disease such as emphysema or chronic bronchitis are also approximately twice as likely to die from the virus.
Kolling researcher and Head of Cardiology at Royal North Shore Hospital Professor Ravinay Bhindi said the findings have provided valuable data to assist in the treatment of new cases of COVID-19. “The research is providing timely advice for clinicians, helping them identify the patients most likely to deteriorate and therefore in need of a higher level of care,” he said. “These patient outcomes and emerging trends are also underpinning the importance of vaccination. “It’s critical that all patients with heart failure and other chronic conditions are vaccinated against COVID-19. We now have the data to show that if you have one of these chronic conditions and you’re not vaccinated when you get COVID-19, you are much more likely to die.
“Our research is based on hundreds of cases across Australia, many with tragic outcomes. It’s important that we use this information to inform the care we provide for patients, and address any vaccine hesitancy with real-life experience.”
Professor Ravinay Bhindi
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KOLLINGNEWS | DECEMBER 2021
Dr Tom Lynch and Dr Lara Bereza-Malcolm
Blueprint to strengthen research and improve the care we receive
The Kolling’s new research plan has been confirmed marking an important milestone for the institute. The plan details the implementation of the institute’s five-year strategy, and will ensure the Kolling is in the best position to deliver game-changing research. Acting Executive Director Professor Jim Elliott has welcomed the development of the plan, saying a robust strategic framework will help shape the future of the institute and secure its long term success. “This important roadmap will have a crucial role in increasing the impact of our research and improving health outcomes across our community,” he said. “A large number of people have shared their time and expertise to bring us to where we are today, and
I’d like to thank them for their commitment to the Kolling and its talented research teams.” The research plan focuses on a range of key goals, including new collaborations, additional large-scale funding and improved research outputs. There will be an emphasis too on positively impacting patient care, building on our world-class science, training tomorrow’s leaders, and ensuring a collaborative working culture is day to day core business. The blueprint details a large collection of initiatives including closer ties with government, industry and consumers, and stronger collaborations across the priority research areas to attract large-scale funding for multidisciplinary research projects and infrastructure programs. “These steps will see an increase in research translation, with clearer
pipeline pathways from basic science to clinical care. There will also be a focus on a strong education program, new fellowship opportunities, measures to attract top students and broader access to equipment and support. “Importantly, the new framework aligns with the strategic direction of both the University of Sydney and the Northern Sydney Local Health District, increasing opportunities for research impact and better patient outcomes. It will see researchers benefit from unprecedented support and targeted assistance from the partners. “We have a large and impressive team of researchers at the Kolling, including many who are world leaders in their fields. I’m confident this new strategic framework will offer crucial support to our team as they continue their life-changing work.”
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John Walsh Centre for Rehabilitation Research team
Kolling centre guiding gold standard rehabilitation care
The John Walsh Centre for Rehabilitation Research has been awarded close to $10 million to help improve the lives of those living with injury-related disability. The funding has been granted by the state’s compensation agencies icare NSW and the State Insurance Regulatory Authority, continuing a 20 year research partnership. icare NSW Managing Director and CEO Richard Harding said the research was invaluable in supporting people with injuries. “Getting the right care and support for injured people is paramount. This investment will ensure NSW stays at the forefront of treatments and recovery pathways for severely-injured people,” he said. Chief Executive of the State Insurance Regulatory Authority Adam Dent said
the ongoing investment will ensure this specialised research continues over the next five years. “The John Walsh Centre for Rehabilitation Research has played a key role providing evidence-based advice, and informing policy and legislative changes to make personal injury schemes in NSW sustainable and meet the needs of scheme claimants,” Mr Dent said. Head of the centre Professor Ian Cameron has welcomed the substantial funding, saying it will allow them to expand their activities and increase the impact of their research. “While the emphasis of the funding is to support people injured in NSW workplaces and on NSW roads, the expanded work will directly impact on the health of people in the NSLHD who have experienced injury or illness causing disability,” he said.
“Our research aims to improve rehabilitation services for people with severe injury, particularly traumatic brain injury and spinal cord injury, and also people with musculoskeletal and psychological injuries. “Our focus is on applying our research progress to clinical practice, so that we are directly improving the lives of people living with disabilities. “Importantly, a key part of our success will rely on our collaborations within the NSLHD and the Kolling Institute to broaden our research and educational activities.”
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KOLLINGNEWS | DECEMBER 2021
Professor Lyn March and team
Kolling teams driving world-leading research into arthritis care
A Centre for Research Excellence to improve care for inflammatory arthritis will be based at the Kolling following an exciting announcement by Health Minister Greg Hunt. The minister revealed the latest round of National Health and Medical Research Council funding, which will see $2.5 million invested in the centre over the next five years. Professor Lyn March will lead the research efforts, backed by a large team within the Kolling as well as leading national collaborators from universities across the country. Researchers from the A3BC, the Institute of Bone and Joint Research and the Sutton Arthritis Laboratory will have a key role. Professor March said the Centre for Research Excellence represents a tremendous achievement and follows many years of work developing a national registry and biospecimens collection to improve health outcomes
for those living with inflammatory arthritis and autoimmune conditions. “We’re delighted to launch this nationally significant program which aims to identify the best treatment pathways for men, women and children living with inflammatory arthritis. Importantly, we’ll be working to confirm the best options for symptom relief, with the least risk of side effects,” she said. “As the lead national site, we will be looking to expand our national registry and biospecimens collection and our rheumatology research community. This will put us in the best position to broaden our understanding of the complex condition and improve health outcomes through prevention, prediction and precision medicine. And to one day find a cure.” “I would like to congratulate and extend my thanks to the local team who has developed this wonderful
initiative including A/Professor Meilang Xue, Dr Craig Willers, Dr Marita Cross, Dr Tom Lynch, Dr Lara Bereza-Malcolm, Dr Rani Sinnathurai, Haiyan Lin, Helen Martin, A/Professor Sean ONeill and Professor Chris Jackson. “A key part of our project will see us partner with leading cardiologist Professor Gemma Figtree and her research team to explore the links between inflammation, microbiome, the heart and the joints.” “This is an exciting opportunity for collaboration between two unique longitudinal collections combining patient outcomes with biospecimens, being led out of the Kolling Institute and Northern Sydney Health, the BioHEART and the A3BC (Australian Arthritis and Autoimmune Biobank Collaborative).”
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Kolling researchers to lead national project for better back pain care
Professor Manuela Ferreira
Researchers from the Kolling Institute will strengthen their expertise in the management of low back pain following further Federal Government funding. More than $2.5 million will be directed to a five-year program of research led by Professor Manuela Ferreira to improve care for low back pain. Professor Ferreira has welcomed the funding to focus on a condition which causes more disability than any other health challenge. This will allow me to continue working towards improving knowledge and care of low back pain in Australia and overseas,” she said. “Nearly 570 million people in the world suffer from debilitating low back pain, while in Australia the condition affects a quarter of the population,
and costs more than $8 billion a year in healthcare expenses and lost work opportunities. “We know that low back pain is often poorly managed, with many current treatments causing more harm than good. “Many people turn to common pain medications which offer limited relief, and have a high risk of adverse events. “When patients fail to improve, they tend to seek more complex treatments such as surgery, but this option is not always supported by scientific evidence. “We are seeing a fragmented and inefficient approach which delays access to the right care for low back pain and delivers treatments which are not backed by robust evidence.”
This important program of research will work towards improving care by broadening knowledge around the efficacy and safety of the most common surgical procedures, and by developing innovative digital approaches to bring high value care to patients with low back pain. “Part of the project will involve designing and conducting clinical trials that include placebo surgery, while we will also assess the use of technology to support the uptake of evidence-based care. “Ultimately, we’ll be working to deliver an approach will offers the right care, to the right patient, at the right time, while truly making an impact on the leading cause of disability in our community.”
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KOLLINGNEWS | DECEMBER 2021
Researchers confirm extreme heat increases the risk of premature births
Researchers have found that women are more likely to have a spontaneous preterm birth when exposed to extreme heat and those with pre- existing conditions may have an even higher risk. Preterm or premature birth, when a baby is born before 37 weeks of pregnancy, is the leading cause of infant death worldwide and many children born early deal with ongoing health problems for the remainder of their lives. The research team from the Sydney School of Public Health at the University of Sydney and Women and Babies Research at the Kolling Institute examined over 918,000 births in NSW over a ten-year period. Their research assessed data on the daily incidence of spontaneous preterm birth and maternal risk factors from the NSW Perinatal Data Collection and the Admitted Patient Data Collection.
The data was then modelled with the daily temperatures from the Australian Bureau of Meteorology over the study period. The study found about 29,000 or 3.2 per cent of babies were born as a result of spontaneous preterm birth. Importantly, researchers found that when it was hotter, the risk of spontaneous preterm birth increased for all women and particularly for women with diabetes, hypertension, chronic illness and those who smoke. On days where it was hotter than 33 degrees the risk of spontaneous preterm birth increased by 12 per cent compared with a 20 degree day. This increase in risk was potentially higher for women with diabetes (29%), hypertension (29%), chronic illness (17%) and those who smoked during pregnancy (19%).
Lead study author Edward Jegasothy PhD said it was the first study to link effects of extreme weather and spontaneous preterm birth in the temperate climate of New South Wales. “We now have a better understanding of the relationship between extreme heat and preterm births. Our study adds to the growing body of evidence regarding the health impacts of climate change-related exposures. This is particularly important given the increasing temperatures and heatwave events not just in Australia, but globally,” he said. “These findings are also important given the long term and significant implications of preterm births and the potentially exacerbated risk in mothers with underlying health conditions.” The findings encourage pregnant women to stay well hydrated and reduce their exposure to extreme heat.
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High profile appointment The Kolling Institute’s Executive Director Professor Carolyn Sue will join a dynamic group of Australian leaders on the new National Health and Medical Research Council.
Professor Sue has been appointed to the high profile body for a three-year term until June 2024. A record number of women are represented on the new council, including chair and internationally-renowned researcher Professor Caroline Homer. The council brings together expertise in biomedical science, clinical and public health, nursing, health care training and the medical profession, as well as business and consumer perspectives, and expertise in the
health needs of Aboriginal and Torres Strait Islander people.
Professor Sue will join the chief health officers from across the country on the influential council, which is charged with supporting the best research and researchers in Australia to improve health outcomes. It also helps set the agenda for future funding. A broad range of health and medical professionals have been appointed to the advisory body, with Professor Sue’s knowledge and world-leading research experience in rare diseases set to be called upon. Professor Sue said she is honoured to be appointed to the NHMRC council during such an important and exciting time for medical research. “Throughout the pandemic, we have really seen the transformative impact that medical research can have on healthcare and the broader community,” she said.
Professor Carolyn Sue
“I’m delighted that I’ll be able to share my experience with rare diseases and that this important area of research will be represented on the council. “By broadening our knowledge of rare diseases and their processes, we develop a better understanding of the basic fundamentals of disease, giving us a much clearer insight into the bigger picture.”
Minister Hunt thanked the former Chair of the NHMRC Council and Kolling Institute clinician/researcher Professor Bruce Robinson for his contribution to the NHMRC from 2018-2021.
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KOLLINGNEWS | DECEMBER 2021
New test for high blood pressure to save lives
Kolling researchers and clinicians have welcomed funding to improve the diagnosis and treatment of high blood pressure. The condition affects around 1 in 3 people in Australia, significantly increasing the risk of stroke, coronary heart disease, heart failure and chronic kidney disease. Men are more likely to have uncontrolled high blood pressure, with 1 in 4 men suffering untreated high blood pressure, compared to 1 in 5 women. Many people don’t experience any symptoms and don’t realise they have the condition, raising their chances of serious illness.
The community will now have greater access to ambulatory blood pressure monitoring, regarded as the best available test to confirm the diagnosis of hypertension. It involves wearing a device which can monitor blood pressure continuously over 24 hours, rather than the snapshot generally provided by GP blood pressure monitoring. Senior hospital scientist within the Department of Cardiology and Kolling researcher Dr Anastasia Mihailidou has welcomed the announcement. As one of the initiating members of a select committee of the High Blood Pressure Research Council of Australia, Dr Mihailidou advocated for greater access to ambulatory blood pressure monitoring.
She has backed the listing of the test on the Medicare Benefits Schedule, saying it’s an important milestone in tackling the silent killer of high blood pressure and hypertension. “Ambulatory blood pressure monitoring is the gold standard diagnostic test for improving the diagnosis of hypertension and much better than in-clinic blood pressure measurement,” she said. “I am delighted this important step has been taken and grateful that Health Minister Greg Hunt has recognised our work on the committee.” It’s anticipated more than 400,000 people will benefit from the improved testing over the next 12 months.
Dr Anastasia Mihailidou
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Dr Jillian Eyles
Kolling researcher takes out coveted award Congratulations to Kolling researcher Dr Jillian Eyles who’s been named one of the inaugural research translation fellows by Sydney Health Partners.
“We’re very pleased to be able to support such able clinicians and researchers through Sydney Health Partners. The standard of applications was very high and we are disappointed not to be in a position to support several other worthy applicants,” he said. Dr Eyles will now be able to direct her research focus to strategies to enhance the adoption of the Osteoarthritis Chronic Care Program (OACCP) across NSW public hospitals. Jillian has welcomed the fellowship saying it will provide an opportunity to extend this important program focusing on evidenced-based, patient centred care to improve outcomes for people living with osteoarthritis. “While it is a great program, the clinicians who lead the OACCP have
identified important aspects that could be improved to make it even more successful. I’m looking forward to collaborating with clinicians from Northern Sydney, Western Sydney and Sydney local health districts to help make this happen.” Kolling Institute Acting Executive Director has commended Jillian on her fellowship, saying it’s a testament to her talent and impressive track record. “This additional support from Sydney Health Partners is welcome as the Kolling steps up its focus on research translation,” he said. “By investing in projects like this, we can speed the implementation of best practice, and ensure our hospital- based care is informed by the very latest developments and research.”
Facing tremendous competition from a large group of researchers, Jillian is one of just five people to have been awarded a fellowship. Sydney Health Partners says the fellowships are aimed at building research translation capability in the workforce by supporting researchers to improve their translational skills while remaining in their substantive position. Sydney Health Partners Executive Director Professor Don Nutbeam says the new fellows were successful in a highly competitive process.
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KOLLINGNEWS | DECEMBER 2021
Researchers informing new evidenced-based program to reduce medication burden
A team from the Kolling Institute led by Professor Sarah Hilmer has helped develop a valuable, new national program to reduce the adverse impacts of taking multiple medicines. Medicines with an anticholinergic effect can successfully treat many conditions such as depression, dementia and chronic non-cancer pain. Cumulatively however, they can cause serious adverse effects such as falls, confusion, cognitive decline, dry mouth, constipation and urinary retention. They are linked to a 60 per cent increase in fall-related hospitalisations, a 50 per cent increased risk of dementia and a 30 per cent increase in mortality. Now a new program has been produced by NPS MedicineWise to encourage the safe and effective use of these medicines with anticholinergic effects by older people in the community and residential aged care. The program involves a collection of practical resources to support conversations with patients about anticholinergics, deprescribing and medicine reviews.
One of the key resources includes the Goal-directed Medication review Electronic Decision Support System which has been developed within NSLHD, and informed by the expertise of a group of Kolling researchers, including Professor Sarah Hilmer, Dr Lisa Kouladjian O’Donnell and Associate Professor Danijela Gnjidic. The team helped develop a report for GPs to reduce the burden of multiple medications, particularly for patients who are exposed to high anticholinergic burden. Dr Lisa Kouladjian O’Donnell has welcomed the opportunity to contribute to this important initiative. “This collaboration with NPS MedicineWise has led to the development of important and easy-to-use tools that clinicians can adopt within their practice,” she said. “It is great to see the Goal-directed Medication Review Electronic Decision Support System rolled out nation- wide and broadly adopted.”
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Talented, young researcher takes out prestigious national award
Despite a tremendously competitive field, Kolling Institute researcher Dylan Ashton has won the 2021 Cooperative Research Australia Early Career Research competition. Dylan is part of the team investigating the effectiveness of kangaroo tendons to treat ACL injuries. He has worked on the project for several years and has welcomed the announcement. “I’m extremely thankful for Cooperative Research Australia’s efforts to link universities and industry to drive innovation and stimulate research and development,” he said. “I have always been passionate about translatable research, and I think universities and industry have a lot to offer each other.
“This prestigious award is a great opportunity to recognise the research achievements of our rising stars and to highlight the fantastic, industry-linked, translational musculoskeletal research underway at the Kolling Institute,” she said. The award will highlight the research assessing the suitability of kangaroo tendons to treat ACL injuries. “As a sport loving country, Australia is seeing a consistent rise in the number of ACL injuries, particularly in children between 5 and 14 years, and a rise in surgical reconstructions,” Dylan said. “If you were to rupture your ACL today, your surgeon would source a tendon from either your own leg or a tissue donor. However, each has inherent
limitations which has driven research into alternative graft sources. Off-the- shelf synthetic grafts aim to address these issues but release synthetic particles which can lead to spontaneous failure. “Our team is working with orthopaedic company Bone Ligament Tendon to develop a natural graft using kangaroo tendonwhich is superior, environmentally sustainable and uniquely Australian. “We have welcomed the chance to discuss this important program of research.”
“I’m very grateful to have been able to compete in this year’s early career research competition and delighted to have won. This however, has always been a team effort and I could not have achieved anything without the ongoing support, encouragement and wisdom of my supervisors A/Professor Elizabeth Clarke, Professor Christopher Little and Dr Carina Blaker.” As the Director of the Murray Maxwell Biomechanics Laboratory, A/Professor Clarke said Dylan’s award represents a significant achievement.
Dylan Ashton
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KOLLINGNEWS | DECEMBER 2021
Research identifies swallowing problems following whiplash
Research conducted by a team from the Kolling Institute has found that swallowing difficulties after a whiplash injury appear to be an under-recognised consequence of the injury. The study investigated a group of 60 patients with low-grade whiplash, finding 50 per cent of patients reported swallowing problems within 12 months of their whiplash injury. In 31 of these patients, there was a statistically significant worsening of their swallowing problems between three and 12 months post injury. Clinical specialist speech pathologist and PhD student Danielle Stone said the study was the first of its kind to use a standard patient-reported outcome measure to investigate whether swallowing issues were an under-recognised condition following whiplash.
“Before our study, there was a small amount of literature suggesting swallowing difficulties were a possible consequence of whiplash, but following our work, we now have additional data linking the two conditions. “Further research is needed, but this information will help in the treatment of whiplash by encouraging clinicians to consider a broader range of symptoms following a whiplash injury.” The study also investigated whether swallowing changes were related to a change in volume of the pharynx (throat) as prior studies demonstrated a narrowing of the pharyngeal lumen in people presenting with persisting disability. “Contrary to what we thought, there was no change in the volume of the pharynx in our cohort and therefore, no association with swallowing problems.
Danielle Stone
“Our investigations have played an important part in raising awareness of the conditions. “As our study was the first to explicitly look at swallowing and whiplash using a well-accepted outcome measure, we now have more confidence that swallowing may be a feature of whiplash that warrants further investigation.” The research has been published in the medical journal, Dysphagia.
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This Christmas, help our researchers increase the impact of their valuable work and improve the care we all receive.
Scan the QR code, choose Kolling Institute and select which area you would like to support.
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