NSLHD News 29 September 2023


Main story Short blurb celebrating 10 years of graythwaite Staff and patients came together to mark the impact the centre has had on patients and their families over the last decade since its opening. Page 3 Read more on Page x

RNSH concussion clinic premier’s award finalist Page 5

3D printing a new cancer treatment Page 4


Message from the board chair Trevor Danos AM

Earlier this month NSLHD Chief Executive Anthony Schembri and I provided an update on the district’s recent planetary health and sustainability efforts and direction moving forward. The district committed in 2022 to reaching net zero carbon emissions by 2035, with most of the reduction – 70 to 80 per cent – to be achieved by 2030. An important activity we recently undertook was completing baseline carbon footprinting for the district. Using our own financial spend and activity-based data, we were able to quantify and categorise the district’s emissions including the sources of those emissions. This process has been essential to know what our emissions currently are and to have a solid measurable foundation to improve on. We have been able to model the district’s trajectory to net zero based on our emissions and their sources. For the greenhouse gas (GHG) emissions the district controls directly (known as scope 1 + scope 2), the district aims to reach net zero by 2035, with a 70-80% reduction by 2030. For the GHG emissions the district does not control directly but can potentially influence (scope 3), the district aims to reach net zero by 2050, with a 50% reduction by 2035. The planetary health team is also in the process of evaluating the success and lessons learned over the last three years and is developing a new NSLHD Planetary Health Framework for 2024-2027. There are many ways in which individuals can get involved in the district’s planetary health and sustainability efforts. I encourage all of you to find opportunities to participate. For more information see here. I look forward to following our progress as our district continues to pave the way as a sustainability-driven health service.

There are extraordinary people in this district who help us make a real difference in our community and show incredible commitment. They include staff, consumers, patients, volunteers and other stakeholders. Last year we introduced the NSLHD Honour Roll. It recognises the exceptional and outstanding service provided by a person who has had a strong involvement with NSLHD over an extended period, generally of five years or more. Up to five winners each year can receive this award which is presented at the Annual Public Meeting along with a lasting tribute on the NSLHD website. Nominations for the 2023 NSLHD Honour Roll are open until 30 September and details on how to submit an entry for consideration by the NSLHD Board can be found on the website. With just a few days left to submit an entry, I encourage you to consider nominating someone you feel deserving of this prestigious award. I would like to extend sincere congratulations to the Royal North Shore Hospital Concussion Clinic on being named a finalist in this year’s Premier’s Awards. This is a huge achievement, and we look forward to cheering on the team at the award ceremony later this year. The recent NSLHD Senior Leadership Development Program graduation ceremony was attended by some of our Board members. The program aims to support and develop the skills of future executive-level leaders across the district, and it was great to see another cohort graduate. I would like to extend a sincere congratulations on behalf of the Board to everyone who took part in the most recent program. Trevor Danos AM Board Chair Northern Sydney Local Health District



NSLHD CE Anthony Schembri with staff at Graythwaite

a decade of supporting patients at Graythwaite Over the last decade thousands of patients have come through the doors of Graythwaite

fantastic rehabilitation facility,” he said. “I am proud we have such a dedicated team providing excellent stroke, amputee, orthopaedic and burns rehabilitation.” Ryde Hospital Allied Health, Rehabilitation, Aged Care and Ambulatory Care Services Manager Anna Butcher said the service has worked hard over the last decade to expand the rehabilitation services offered at the centre, “Despite the challenges of COVID and a redevelopment, the team has always maintained the high level of patient centred rehabilitation care throughout,” she said. “I am looking forward to working with the team on continuing to improve rehabilitation care offered at Ryde over the next 10 years.”

Rehabilitation Centre after injury, illness or surgery to improve their health, regain function, achieve their goals and return to home, work, and social life. Current and former staff and patients came together earlier this month to mark the impact the centre has had on patients and their families over the last 10 years since its opening. NSLHD Chief Executive Adjunct Professor Anthony Schembri thanked the multidisciplinary rehabilitation team at the centre and all involved in the establishment of the rehabilitation service. “It is an honour to celebrate 10 years of this

RNSH school celebrates 100 years The Royal North Shore Hospital School has celebrated 100 years at the campus.

Being one of the first hospital schools to open in 1923, the school has a decorated history of helping patients at the hospital receive an education. The school continues to provide continuity of education for all students in kindergarten to year 12 who are patients at the hospital. The paediatric ward’s recreation room is set up as a group

Staff members from the school celebrated the occasion at the RNSH paediatric ward

learning space when required. There is also a school space just outside the ward which is equipped with a range of resources to support student learning and wellbeing.

The school supports the child and adolescent ward and any enrolled school aged patients admitted to adult wards.



3D printing a new cancer treatment A team at RNSH’s radiation oncology department are in the early stages

of testing 3D-printed customised vaginal inserts for cancer patients. They are being used on women with endometrial cancer after a hysterectomy and vaginal cancer. The inserts are a new development in the field of brachytherapy, a type of cancer treatment that involves placing radioactive material inside the body. For the past 30 years, plastic cylinders have delivered radiation. But as each woman’s anatomy — and cancer— is different, in recent

(Left to right) Dr Marita Morgia, Judith Martland and Florence Ko - staff from the Radiation Oncology department

years at RNSH, a specialist technician has been handmaking wax model inserts, which meant the treatment was more targeted. Unfortunately, this method was time- consuming. Judith Martland, senior medical physicist in radiation oncology, said the new 3D-printed inserts are quicker to make and even more customised. “We are tailoring the treatment to the patient more closely rather than using a one-size-fits- all— literally,” she said. “It’s also more widely applicable. Anyone can use the software and produce a 3D print.” The department is currently doing a study where ten patients will be treated with 3D-printed applicators while others with plastic cylinders. Later in the year, the department hopes to run a proper trial of the inserts, which are currently printed in Canada by a medical technology company. Key clinical position appointed Royal North Shore Hospital Interventional Cardiologist Professor Ravinay (Ravi) Bhindi has been appointed to the position of Clinical Director of Cardiothoracic and Vascular Health Network. NSLHD Chief Executive Anthony Schembri said Ravi brings a breadth of clinical experience and clinical research expertise to the role. “As part of the new role, Ravi will provide strategic co-clinical leadership to the NSLHD Clinical Network,” he said. “He will have a strategic role in identifying clinical priorities, models of care and new technologies; and advise the NSLHD executive on funding allocation.”

“We’re pretty excited about it all,” said Jeremy Booth, head of medical physics, Radiation Oncology at the Northern Sydney Cancer Centre. “We have more options with the 3D print. With the plastic cylinders, the channel that the radioisotope moves along is fixed. “Whereas with the 3D option, we can put multiple channels and position them how we like. It allows us to control where the dose goes a little bit more.” The department is one of a handful in the district utilising 3D printing in their work. Statistics show that worldwide, gynaecological cancers account for 40 per cent of cancer incidence and 30 per cent of all cancer mortality in women. The current standard of care for all gynaecological malignancies

involves a combination of surgery, chemotherapy and radiotherapy.

Professor Ravi Bhindi has been appointed Clinical Director of Cardiothoracic and Vascular Health Network



Barker College students watching staff at the simulation centre

P.A.R.T.Y is back Transfixed by the scene unfolding in front of them, a group of Year 10 Barker College students watch as staff from Royal North Shore Hospital’s trauma team, in a simulated resuscitation, work on a 17-year-old “patient”. She is intoxicated, haemorrhaging, and seriously injured after her car crashed at 120km per hour. The team try to stop her bleeding but she needs to go to surgery – there is nothing else they can do to help her. This patient’s journey now begins, and the students travel along with her from the emergency department to surgery to intensive care and finally recovery. While the trauma and intensive care teams may only be demonstrating what happens at the Sydney Clinical Skills and Simulation Centre, elements of it have an intensity that draws the students into what is a real-life experience on a far too frequent basis. After a hiatus due to COVID-19, the popular P.A.R.T.Y. (Prevent Alcohol and Risk-Related Trauma in Youth) Program is finally back. Programs are running at RNSH and at the newly developed Simulation Education Centre at Hornsby Hospital. The one-day program targets 15-to-25- year-olds about the consequences of risky behaviour before they are injured. It began VALE SONIA MALAR Northern Sydney Local Health District would like to express its condolences to the family, friends and colleagues of Sonia Malar. Sonia’s career spanned 44 years with 38 of those working within NSLHD between Manly Hospital and Mona Vale Hospital. Sonia was a much-loved and respected staff member of the Assessment and Rehabilitation unit (ARU) at Mona Vale Hospital. She was a

in Canada in 1986 and is licensed to 173 sites globally. It was introduced at RNSH in 2013. Program coordinator Tara Sole said it has a positive influence on the students. “They arrive with no expectation of what they’re going to see and by the end of the day, we’ve had quite a significant impact on them,” she said. The program includes presentations from trauma doctors, nurses, paramedics, police, a social worker, and a trauma ambassador. “The students really enjoy and appreciate hearing from a group of highly skilled professionals who are talking about their own personal real-life experiences,” she said. “It’s real life. It’s not just a story.” One student, Zara, said she found the day interesting, but it also made her think. “Situations don’t just affect me — they affect everyone and not just my family and friends, but also the team working on it. So much goes on behind the scenes,” she said. Another student, Mary, was inspired by the day. “I’ve loved it because I want to become a nurse when I’m older. So, I just loved watching it all and learning. I found it fascinating,” she said. passionate and caring nurse who advocated for her patients and colleagues. Her two loves were her family and her work as a nurse, caring for others. Sonia will be remembered for her dazzling smile, infectious personality, her friendship, and her commitment to the nursing profession. She will be greatly missed by her colleagues.



Concussion Clinic named as finalist for Premier’s Awards The Royal North Shore Hospital Concussion Clinic has been named as a finalist for the 2023 Premier’s Awards for ‘Highest Quality Healthcare’. The clinic, which opened in 2022, has been helping patients across the Northern

Sydney Local Health District navigate their concussion journey by offering a multidisciplinary health service. The multidisciplinary clinic, which is composed of adult and paediatric neurologists, a clinical nurse consultant and a neuropsychologist, reviews patients’ cognitive function, psychological wellbeing and associated post-concussive symptoms. Concussion Clinical Nurse Consultant at RNSH Vicki Evans (Roach) AM said the clinic is delighted to be named as a finalist for the prestigious awards. “It is an absolute privilege for our service to be recognised at a state-wide level,” she said. “There was a definite community need for this type of service and we are pleased that we are making a difference by assisting patients in our community manage their

Neurologist Dr Miriam Priglinger, neuropsychologist Dr Vince Oxenham, patient Maddy Corbett and clinical nurse consultant Vicki Evans (Roach) AM

summarising the best available evidence and detailing the most effective supplements. Rheumatology fellow Dr Xiaoqian Liu from the Osteoarthritis Research Team said they have developed a traffic light diagram that provides easily obtainable information for clinicians and patients. “Following our review, we conditionally recommend a short period of use of curcumin, Boswellia serrata extract and pine bark extract as the current evidence shows they have a large treatment effect in relieving pain and improving function,” she said. “Other supplements however, have only demonstrated a minimal treatment effect in pain relief.” Researchers say the quality of the current evidence is low and larger studies are needed to confirm the findings, but they hope their review will help those with osteoarthritis make an informed decision. “There are a tremendous number of supplements on the market, so it’s crucial the community has access to the latest, reliable information around the impact of these supplements,” she said. concussion symptoms as well as educating the community with our concussion video series we released. “It is really important to understand the potential ramifications that could occur if a concussion is not taken seriously.”

Latest evidence ON supplements for osteoarthritis With a large number of people relying on supplements to reduce their osteoarthritis pain, researchers at the Kolling Institute have conducted a much-needed review of the most popular ones.

The condition is impacting an increasing number of people, with many experiencing joint pain and functional impairment due to the disabling disease. There is a lack of effective drugs to treat the condition so many people resort to supplements in the hope of achieving some relief. Researchers at the Kolling Institute have completed a comprehensive review,



Researchers saving those with silent heart disease For many years we’ve understood that heart

the usual risk factors. These patients have no current way of accessing effective treatment for their underlying plaque as it silently develops.” In response to these challenges, Gemma is spearheading a new approach and working with physicians, scientists and industry experts to support this group. Researchers are developing a series of blood tests to identify biomarkers of the underlying disease itself in its silent phase, and confirm whether they point to potential new therapeutic targets. They say if a marker could identify even 50 per cent of people with plaque independently of the risk factor profile, it would allow intervention with effective treatments that stabilise plaque and dramatically reduce the number of heart attacks. Gemma said this will be a crucial step forward, revolutionising heart attack prevention. “Most current medications for heart disease target the known risk factors like high cholesterol and high blood pressure, however we are working to develop medications which could benefit all those at risk of heart disease, not just those with the obvious risk factors,” she said. “It’s important that this cohort, which has been largely invisible until now, is given the focus they need. “We know the development of new drugs can take many years, but we’ve seen with the success of the COVID-19 vaccines that progress can be made in a short period of time, and we’re convinced that by bringing together the best minds from across the globe, we’re in a strong position to effect change and reduce preventable deaths.”

disease is linked to unhealthy habits and underlying health issues, but researchers at the Kolling Institute are pioneering a new approach to identify and treat those with the disease without the traditional risk factors. In Australia, a heart attack occurs every nine minutes, often with a tragic outcome or lifelong consequences. Many of these attacks are associated with smoking, high blood pressure, diabetes and high cholesterol, where arteries have been damaged and obstructed by plaque. But researchers are turning their focus to a group of patients who have developed silent cardiovascular disease, without any warning signs. This group accounts for an alarming 25 per cent of people who have had a heart attack without any of the standard modifiable risk factors. Internationally recognised researcher and Royal North Shore Hospital interventional cardiologist Professor Gemma Figtree said we’ve seen an increase in patients like this over the last 10 years, and worryingly, many fared poorly after initial hospital treatment. “A greater number of them died within 30 days of the initial heart attack compared to patients with traditional risk factors, and women were disproportionately affected,” she said. “This group has until now, not been the focus of research or disease management, but we are working to gain a better understanding of how the disease develops in these patients and how we can capture them early and save lives. “It’s estimated 1.3 million people worldwide die each year due to heart attacks without

Professor Gemma Figtree with Dr Steve Vernon from the Kolling Institute research team



Child Safe Action Plan Empower, listen and act together

We’re implementing the Child Safe Standards

August 2023 @ NSW Ministry of Health.

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