Cabrini Institute Annual Report 2017-18

EDUC ATION

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RE SE ARCH

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HE ALTH PROMOTION

CABRINI INSTITUTE ANNUAL REPORT 2017-18

ABOUT THE CABRINI INSTITUTE Established in 1996, the Cabrini Institute supports a wide range of education and research activities across Cabrini. Senior medical staff and researchers oversee a diverse research program, as well as developments in clinical education. The research program includes allied health, arthritis, back pain, cancer, care of the elderly, health literacy, medicine, nursing, palliative care, patient safety, psycho-oncology and surgery. The Cabrini Institute plays a significant role in the education of our current and future health professionals.

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Highlights of 2017-18

4

Message from Chair of the Cabrini Institute Council

6

Message from Group Director of Nursing, Clinical Education and Research

8

Cabrini Research Week 2017 report

10

Supporting research and staff development at Cabrini Health

12

Monash Department of Clinical Epidemiology at Cabrini Hospital

16

Centre for Nursing Research

26

Cabrini Monash University Department of Medical Oncology – the Szalmuk Family Department of Medical Oncology

32

Cabrini Monash University Department of Surgery – the Frölich West Chair of Surgery

38

Szalmuk Family Psycho-oncology Research Unit

46

Palliative and Supportive Care Research

50

Centre for Allied Health Research and Education

54

Alan, Ada and Eva Selwyn Emergency Department

58

Intensive Care Research

62

Clinical database registries

66

Clinical education

70

Cabrini Human Research Ethics and Research Governance Office

76

Cabrini Institute team

84

Cabrini Institute Council

88

Supporters

92

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HIGHLIGHTS

16,006

2

Nursing and allied health student placement days offered

Book chapters

198

11,387

Trained preceptors

BLS program RQI completions

119

1200

Courses and workshops to support professional development

79

Graduate nursing positions offered (2018)

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Just-in-time education encounters

217 Seminars and presentations

46.8m

$

290 Total projects approved and ongoing in 2018

Research grants awarded or held

134

82

Journal articles

New projects approved

17 Masters and PhD students supervised

AL MO ST

500k

$

Cabrini grants and scholarships awarded

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90 Clinical trials

I

t is a privilege to introduce the Cabrini Institute Annual Report. This report highlights another highly productive year in both education and research across Cabrini.

It is pleasing to note that the Cabrini Institute remains an integral and vital component of Cabrini’s mission.

It makes contributions beyond Cabrini, both nationally and internationally.

Professor Gary Richardson OAM, Head of the Cabrini Monash Department of Medical Oncology – The Szalmuk Family Department of Medical Oncology, obtained support to appoint a research fellow and genetics counsellor from funds raised by the Cabrini Foundation. The department continues to promote access of Cabrini’s patients to clinical trials; this is now regarded as standard of care in oncology.

The Cabrini Institute Council continues to fulfil its mandate to provide support, guidance and critical independent advice to the Board, the Chief Executive of Cabrini and the Group Director of the Nursing, Clinical Education and Research.

This year we welcomed Professor Alison Hutchinson to the Council; Alison is a Professor in the School of Nursing and Midwifery at Deakin University. The Cabrini Institute Council continues to be impressed with the quality, innovation and commitment of the heads of each of the departments.

The Cabrini Institute’s strength in cancer research is reflected in the work of the Cabrini Monash University Department of Surgery, the Frölich West Chair of Surgery, led

by Associate Professor Paul McMurrick. Associate Professor McMurrick has continued to provide leadership of academic surgical colorectal cancer research through the colorectal cancer registry; this has enabled a number of high profile publications. An ongoing, highly productive collaboration with scientists at Monash University and the Hudson Institute is addressing key issues in the biology of colorectal cancer, with potential for patient specific therapeutic targeting, also known as precision medicine.

This year, clinical education at Cabrini has benefited from new developments in services for the medical staff, and the development and realignment of postgraduate and graduate nursing programs to meet the needs of Cabrini’s workforce.

Associate Professor David Brewster has completed his first year as Director of Medical Education. He has increased the involvement of visiting medical staff in teaching threefold. Also, he has continued the tradition of innovative interprofessional learning at Cabrini, involving medical, nursing and allied health students. The Council has been impressed with what Associate Professor Brewster has achieved in such a short time. Together, Jo Schlieff (as Manager of Clinical Education) and Amanda Peat (as Manager of Quality and Safety Education) lead nursing clinical education. The pair presented to the Council for the first time last year, outlining changes and innovations that have seen nursing education shift to a more proactive education model. With Cabrini hosting more than 12,000 nursing student clinical-placement days in 2018, with students from across the tertiary sector, this is a major undertaking.

The Cabrini Institute’s work in both medical and surgical oncology is complemented by Cabrini’s commitment to all aspects of the care of patients with cancer. The Szalmuk Family Psycho-oncology Research Unit, and the Palliative and Supportive Care Research Unit, work to provide a program of patient-centred research in clinical practice, which contributes not only academically but clinically to Cabrini.

The Cabrini Institute Council was delighted by the award of the Companion in the Order of Australia (AC) to Professor David Kissane in the 2018 Australia Day Honours. Professor Kissane leads the Szalmuk Family Psycho-oncology Research Unit, which has recently completed three psychosocial intervention studies on the key themes of: meaning and purpose therapy in advanced cancer; selfcompassion for individuals diagnosed with cancer; and the clinical utility of a diagnosis of demoralisation (in collaboration with palliative care).

CHAIR’S MESSAGE –6 –

Associate Professor Natasha Michael, Head of the Palliative and Supportive Care Research Unit, continues to support both the care of Cabrini’s patients and unique, innovative research focused on several themes including advance care planning and spirituality. The unit has strong external collaborations, including with the University of Notre Dame in Sydney, and has attracted a number of external research grants.

Associate Professor Helena Frawley, Head of the Cabrini Centre for Allied Health Research and Education, has continued to build the centre with seven allied health clinicians undertaking research projects towards higher degrees; they are based in physiotherapy, speech pathology and dietetics. She has built strong partnerships with Monash and Australian Catholic universities in allied health student training. Associate Professor Frawley is a high performing researcher and an asset to the Cabrini Institute.

During the year, Professor Rachelle Buchbinder, Head of the Monash Department of Clinical Epidemiology at Cabrini, moved her team to new accommodation at 4 Drysdale Street in Malvern. The new premises accommodates her team of more than 20 staff. Professor Buchbinder is one of Cabrini’s strongest advocates. She continues to provide the Cabrini Institute with an international profile through a series of high impact publications in the areas of health implementation and evaluation science. As in previous years, Professor Buchbinder has been extremely successful in obtaining competitive grants including the NHMRC Centre for Research Excellence for the Australia and New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network, which was opened by the Federal Minister for Health Greg Hunt MP in March 2018.

Cabrini’s Centre for Nursing Research led by Professor Lee Boyd has enjoyed another productive year with significant collaborations, grants and academic publications. This is an impressive achievement given Professor Boyd holds the role of Group Director of Nursing, Clinical Education and Research. We are looking to support Professor Boyd with the

appointment of an Associate Professor of Nursing Research in 2018-19. Professor Boyd has been a key driver in the Monash Partners’ ethics harmonisation project. The Cabrini Institute Council is most supportive of this initiative, which will see a single, structured ethics program within Monash Partners with separate governance reviews at each of the sites. The initiative will provide a streamlined process for researchers thereby removing one of the barriers to increasing clinical trials. It is appropriate to recognise the enormous contribution of all those who have given their time to serve on the Cabrini Human Research Ethics Committee over many years.

I am pleased to see that, with the encouragement of the Cabrini Board Chair Richard Rogers, the important work outlined in the subsequent pages is being more actively communicated to the community through newsletters, the Cabrini website and social media.

On behalf of the Cabrini Institute Council, I would emphasise that the Cabrini Institute’s many achievements would not have been possible were it not for the commitment and dedication of Professor Lee Boyd, the department heads and all of the dedicated staff. We specifically wish to acknowledge the support for its deliberations provided by Dr Emma Baker, the Director of Research.

I now invite you to go beyond my brief outline of the activities of the Cabrini Institute and to learn of the achievements through 2017-18 detailed in this report. The commitment of Cabrini to support and nurture research and education is exemplary, reflecting a commitment to address a broader mission beyond simply that of private healthcare provision.

BY P ROF E S S OR P E T E R F U LLE R A M C H A I R OF T H E C A B R I N I I N ST I T U T E COU N C I L

The commitment of Cabrini to support and nurture research and education is exemplary, reflecting a commitment to address a broader mission beyond simply that of private healthcare provision.

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T

he healthcare landscape continues to be challenging.

Drivers for change include escalating costs, funding model changes, regulatory reform with the opt out approach to the My Health Record, clinical workforce shortages, changing consumer needs and finally, a technology leap to catch up with other industries.

The development of the Cabrini Institute Strategy, which aligns with the Cabrini Renew health strategy to 2020, has been a key focus this past year. The strategic themes identified to address the challenges we face are: 1) Readiness to provide value-based care: aiming to use research to reduce spending while improving quality patient outcomes 2) Advancement of precision medicine: tailoring drugs and treatments based on genetic profiles or other individualised factors

Our fourth theme continues to develop, whereby Cabrini Institute is the enabler of partnerships and subsequent trials for innovative technologies. Our strategic partnerships with organisations such as Monash Partners, Monash and Australian Catholic universities have strengthened over the year with more collaborative projects underway, as well as better consultative processes in place with the communities and patients we serve.

F OUNDATI ON G RANT ROUND S

This year the Cabrini Foundation, with the support of the Cabrini Institute, funded more than $315,000 in grants and $122,687 in scholarships. We held a successful donor high tea event in September 2017, in order to share the outcomes of the previous year’s funded projects and to introduce our donors to their scholarship recipients for the 2017-18 year.

H I G H ER D EG RE E BY RE SE ARC H ST UD ENTS

3) Smart, change-enabled clinical workforce deployment

We are seeing more PhD students within Cabrini and plan to increase our numbers and the variety of project options.

There are currently 17 PhD and Master students being supervised by our excellent researchers within the various research departments.

4) Innovation partner of choice Themes one and two have been the focus of a number of our research departments. Refer to our chapters on the Monash Department of Clinical Epidemiology at Cabrini Hospital, the Cabrini Monash Department of Surgery and the Cabrini Monash University Department of Medical Oncology for more detail.

F UNDE D P H D P RO G RA M S

In keeping with our third theme, we have increased postgraduate programs, graduate numbers and undergraduate student placements, and supported our clinical staff to provide an exceptional student experience. This is an important investment in our current health professionals and leaders of the future. The unprecedented surge in health intelligence and connected technology available today will reengineer the delivery of care. Change agility is foundational for success in this domain, and will be a focus of education and research efforts moving forward.

Cabrini continues our funding of a PhD scholarship in partnership with Monash University, investigating the implementation of a perinatal mental health screening tool to improve health outcomes for refugee women and their families. Our partnership with Capital Markets Cooperative Research Centre (CMCRC) continues to grow. Our current PhD student has had an excellent year with successful confirmation of candidature and a published article, as well as organisational systems improvement and financial gains attributed to his research.

The CMCRC has been successful in applying for a new Digital Health CRC (Cooperative Research Centre), which will invest more than $200m to develop and test digital health solutions

GROUP DIRECTOR’S MESSAGE –8 –

AC K NOW LE D G E ME NTS

that work for patients in hospitals and health services, while equipping Australians to better manage their own health and wellness. Cabrini is an industry partner in this CRC, which will see us support another two PhD students who will undertake research investigating digital health solutions that will facilitate sustainable care.

Our annual patient and family forum provided many valuable insights to inform our education curriculum and research agenda for the next 12 months and beyond. Our heartfelt thanks to participants who gave their valuable time to contribute.

K EY PA RTN E R S H I P S

There has been much to celebrate over the past 12 months and much to look forward to in the next year. I would like to thank our excellent researchers, clinicians, administration team and educators who have worked with such passion and commitment, and our Cabrini Sisters for their ongoing support and prayers. We are also grateful to our Cabrini doctors, nurses and allied health staff for their support of our research and education programs. We especially thank Cabrini’s generous donors, who want to help Cabrini provide the best possible care and without whom much of our work would not be possible.

The Cabrini Institute is unique in the number and quality of the partnerships we have created and fostered. Our university partnerships with Monash, LaTrobe, Notre Dame and Australian Catholic universities continue to grow. In 2017-18, we received Australian Nursing and Midwifery Accreditation Council (ANMAC) accreditation for an enrolled-nurse clinical school at Cabrini in conjunction with ACU College.

PE T E R M E E S E LE C T UR E

In March 2018, we welcomed an audience of more than 120 for the annual Peter Meese memorial lecture delivered

by Associate Professor Susan Lee. Her lecture focused on defining person and family-centred care. The feedback from the event was excellent with clinicians identifying a number of opportunities for practice improvement based on the data presented.

I want to make special mention of the extraordinary efforts put in by members of the Cabrini Institute Council. The Council is chaired by Professor Peter Fuller AM, who gives freely of his time and considerable expertise. We are indeed fortunate to have this group of high calibre multidisciplinary professionals to guide the work of the institute.

C A B R IN I R E S E A RC H W E E K

In 2017, we changed our format from a one-day event to a week-long event to cater for the increased number of abstracts that were submitted. Cabrini Research Week was held from 18-22 September across Cabrini’s Brighton, Elsternwick and Malvern campuses. The calibre of presentations was extremely high and we had more abstract submissions than ever before, with 59 selected for oral or poster presentation.

The keynote by Julian McMahon AC and Associate Professor Natasha Michael ‘Human Rights, Human Life – Towards the Common Good’ was a highly anticipated presentation around the importance of dignity, leadership and respect for human life and human rights.

Finally, I would like to acknowledge each and every patient and family member who has contributed by participating in a clinical trial or supporting education for our health professionals and thank our donors for their continuing support of Cabrini.

BY P ROF E S S OR LE E B OY D GROU P D I R E C TOR , N U R S I N G , C LI N I C A L E D U C AT I ON A N D R E S E A RC H

I want to make special mention of the extraordinary efforts put in by members of the Cabrini Institute Council. The Council is chaired by Professor Peter Fuller, who gives freely of his time and considerable expertise. We are indeed fortunate to have this group of high calibre multidisciplinary professionals to guide the work of the institute.

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CABRINI RESEARCH WEEK 2017 REPORT

Each year, Cabrini hosts a research event to showcase and celebrate the clinical research being undertaken across the organisation.

Our 2017 event saw a change from the traditional full-day event of past years to a week-long program. The events, held from 18 until 22 September, included poster and oral sessions held across multiple campuses, demonstrating the growth and strengthening of the research culture at Cabrini. This year’s event was generously supported by MIA Radiology.

A highlight of the event was the dual keynote presentation given by renowned Melbourne barrister and 2016 Victorian of the Year Julian McMahon AC, together with Associate Professor Natasha Michael, Director of Palliative Medicine

at Cabrini and Head of the Cabrini Palliative and Supportive Care Research Unit. Their presentation ‘Human Rights, Human Life – Towards the Common Good’ was highly anticipated. The large audience was captivated by their discussion around the importance of dignity, leadership and respect for human life and human rights. Using examples from their legal and medical professions and experiences, the speakers captured that every life is valuable, that every person deserves to be treated with dignity and respect, and receive the greatest quality of care. They spoke about how great leadership is needed in complex situations that involve human lives, and if good people do not have the courage to speak up and do not act, we are at risk of corruption, racial issues, needless deaths and increase in poor behaviour.

The program showcased a high calibre of presentations across a wide variety of research topics.

This year’s awards and prize winners were:

ALLIE D H E A LTH R E S E A RC H P R E S E NTAT I O N

Dr Kuan-Yin Lin: Relationships between severity of urinary incontinence and physical activity levels in patients who have undergone a general exercise program following prostatectomy

END - O F - L IF E A N D PA L L I AT I V E C A R E RE S E A RCH PR E S E N TAT I O N

Dr Amber Mills: Understanding end-of-life care in acute hospitals in Australia

P ROV I D I NG B E T TER H E ALTH C ARE RE SE ARC H P RE SE NTATI ON

Susie Cartledge: Incorporating cardiopulmonary resuscitation training into cardiac rehabilitation: A feasibility study

L ATE ST ADVANC E S I N C ANC ER RI SK , TRE ATME NT AND PATI E NT C ARE RE SE ARC H P RE SE NTATI ON

Dr Genevieve Kerr: Predicting treatment outcomes for colorectal cancer patients using tumour-derived organoids

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Jasmine Kopcewicz (Coordinator of Infrastructure at the Cabrini Institute) with Associate Professor David Brewster (Director of Medical Education) at Research Week 2017.

Dr Emma Baker (Director of Research), Dr Margaret Staples (biostatistician) and Dr Katie Walker (Director of Emergency Medicine Research) examine a poster at Research Week 2017.

IM PROV IN G MED I C A L P RAC T I C E S R E S E A RCH PR E S E NTAT I O N

P EOP LE ’S C H OI C E AWARD F OR B E ST P OSTE R

Ellen Kolsky: Pelvic ultrasounds referred from the emergency department: How accurate are sonographer findings?

Jillian Hickey: The clinical evolution of skin tear classifications to Medical Adhesive Related Skin Injuries

B E ST R E S E A RCH P O ST E R P R I Z E S

• Bridget Gurry: Evaluation of patient symptom management diary • Christine Koulis: Adding patient reported outcome measures for bowel cancer into the Cabrini Monash colorectal neoplasia database • Melanie Vellios and Lyndal Emery: Best possible medication histories obtained by pharmacy technicians in the perioperative setting • Andrew Wang: The physician documentation quality instrument-9 score is not useful in evaluating scribe note quality in emergency medicine

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SUPPORTING RESEARCH AND STAFF DEVELOPMENT AT CABRINI

Generous donations for grants and scholarships allow Cabrini staff to undertake cutting-edge research and professional development to ensure we deliver best patient care and outcomes.

Nearly $500,000 in grants and scholarships was awarded in 2017-18. The outcomes of these awards align with the Cabrini Institute’s strategic themes of having an agility-enabled workforce, being change enablers, ensuring our growth is in value-based care and the advancement of precision medicine, and building sustainable and smart partnerships.

The Cabrini Institute and the grant and scholarship recipients are immensely grateful to the generous donors who fund these opportunities and to the expert work of the Cabrini Foundation team.

“The calibre of projects and the quality of applications continues to improve each year. As a member of the grant review panel, it is a joy to deliberate on projects that are well-articulated, collaborative, scientifically strong, and have translational potential.

It is exciting that research is becoming truly embedded in Cabrini’s mindset as a means of remaining at the forefront of innovative and quality healthcare” – PRO F E S SOR LEE B OYD

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SUPPORTING RESEARCH AND STAFF DEVELOPMENT AT CABRINI

C A B R IN I F O U N DAT I O N G RA NT RO UND

Beverley Barlow genetic cancer research grant $100,000

Twenty applications were received for the 2017-18 annual Cabrini Foundation clinical research and quality improvement grant round, the most since the grant scheme’s inception in 2015.

• Professor Gary Richardson: ‘Modelling human breast cancer disease using an experimental in vitro organoid culture system’ Cabrini Foundation quality-improvement grants $15,000

A total of $315,000 was awarded to nine projects, with the Sambor Family Grant for the best $30,000 project being awarded to patient experience manager Toula Saltas for her project ‘Identifying barriers to delivering compassionate care at Cabrini’. Other successful applicants were:

• Dr Felicity Hawker: Can a sepsis recognition tool improve the diagnosis of sepsis in ward patients at Cabrini Malvern and reduce the time to definitive treatment? – a pilot study

Cabrini Foundation clinical research grants $30,000

• Associate Professor Michael Rose: Can frailty describe the variation between clinically observed and calculated length of stay?

• Professor Rachelle Buchbinder: The Back Health Quest: understanding beliefs about low back pain

P I C S G RANT ROUND

• Dr Rebekah Engel: Using patient-derived organoids to guide the nonsurgical ‘watch and wait’ approach for rectal cancer

Cabrini Institute secured funding from the Private Infrastructure and Clinical Supervision (PICS) program, to enhance specialist registrar training in the private health sector and to support delivery of the specialist trainee program.

• Associate Professor Clare O’Callaghan and Associate Professor Natasha Michael: Using the modified Delphi method to establish expert consensus on optimising the applicability of the Code of Ethical Standards for Catholic Health and Aged Care Services in the clinical setting

The funds were offered as part of a competitive grant round to help supervising specialists develop education programs at Cabrini, for Cabrini specialist trainees. In 2017-18, the following grants were provided:

Peter Meese memorial oncology nursing research grant $15,000

• Dr Dane Horsfall: Cabrini Health practice ACEM (Australian College of Emergency Medicine) fellowship objective structured clinical examination

• Jacqui Hastings: Patient self-reported outcomes of toxicity experienced during chemotherapy Doreen Johnson oncology research grant $50,000

• Professor David Kissane: meaning and purpose (MAP) therapy in advanced cancer patients: a multisite randomised controlled trial

• Associate Professor Natasha Michael: Compassionate clinicians’ program: development and implementation of the Schwartz rounds program at Cabrini Health • Dr Steve Philpot: Shared decision making workshop

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SUPPORTING RESEARCH AND STAFF DEVELOPMENT AT CABRINI

S CHOL A R S H IP S

The 2017-18 year was a milestone year with ten medical students each awarded $1500 scholarships to develop their research skills under supervision, thanks to funding from the Cabrini Medical Staff Committee. Students are required to commit the equivalent of six weeks in research hours to their respective projects.

In 2017-18, $122,687 in scholarship funding was awarded to 58 recipients across all clinical disciplines. A significant portion of this funding was awarded to the Clinical Education Postgraduate Nursing Program to assist nurses to undertake graduate certificates in their respective nursing discipline including oncology, palliative care, ICU, cardiac, emergency and perioperative nursing.

Facilitation of team training was also a key area for scholarship investment. Emphasis on team training ensures education has wider impact and ensures legacy. Successful scholarships were awarded as follows: Brian H Gillies palliative nursing scholarship

Medical staff travel scholarships were awarded to nurse leaders from Cabrini’s hospital-in-the- home (HITH) unit to present quality-improvement work on intravenous antibiotic use and patient education, and to facilitate a quality and safety workshop at the 2017 HITH Society conference.

P E TER MEE SE ME MORI AL LE C T URE AND SC H OL AR SH I P AND G RANT P RO G RA M

An audience of more than 120 attended the seventeenth annual Peter Meese memorial lecture delivered by Associate Professor Susan Lee on defining person and family-centred care. Associate Professor Lee is the Director of Research Degrees, Nursing and Midwifery and a foundation member of the palliative care research team at Monash University. A Peter Meese memorial travel scholarship was awarded to two oncology nurses to visit the Chris O’Brien Lifehouse Cancer Centre in Sydney to observe and learn about its extensive, integrated cancer service.

Delivery of a master class on physical assessment to inpatient and home care palliative care team members Sarah Jane Merl Miskin palliative nursing scholarship

Five members of the palliative care leadership team learnt about DiSC profiling to assist them in focusing on better communication skills and dealing with conflict Sahhar family scholarship

Catheterisation workshop delivered to the three north teams by the Continence Foundation The 2016 recipients of a $30,000 grant for their project ‘Informing an Autism Friendly Children’s Centre at Cabrini’ received additional scholarship funding to expand their project to a domestic and international environmental scan. Led by Kelly Sherman, the environmental scan will consider how hospitals and non-clinical businesses adopt autism-friendly programs for their customers, and involve learning and knowledge sharing opportunities with two leading autismfriendly hospitals in Boston and Philadelphia in the USA.

Among the attendees was Dawn Adams, now aged 83 and former patient of Dr Meese, who credits him with the fact she is still working today. The Cabrini Institute thanks Dr Darren Lockie, Dr Sue Ronaldson, and Phil Ronaldson, who have been faithful supporters of the lecture since its inception.

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SUPPORTING RESEARCH AND STAFF DEVELOPMENT AT CABRINI

Top left: Associate Professor Susan Lee of Monash University delivered the 2018 Peter Meese Memorial Lecture on 20 March at Cabrini Malvern. Top right: Guests filled the auditorium for the annual Peter Meese Memorial Lecture. Bottom left: Recipients of 2017 scholarships with (foreground, centre) Cabrini Chief Executive Dr Michael Walsh and Professor Lee Boyd (Group Director, Nursing, Education and Research). Bottom right: From left: Dr Sue Ronaldson, Dawn Adams, Associate Professor Susan Lee, Dr Darren Lockie, Professor Lee Boyd, Chief Executive Dr Michael Walsh and Associate Professor Natasha Michael.

A N N U A L D O N O R HI G H T E A

G RATI T UDE

Cabrini celebrated the generosity of its donors who support the professional development of staff with the annual donor high tea. Some 80 guests came together on 7 September 2017 to hear about how scholarships provide opportunities to present at conferences, undertake short courses or tertiary study, and benchmark and learn from local and international industry leaders.

We are indebted to our wonderful donors who ensure the existence and longevity of our scholarships and grants programs. The impact of their generosity is life-changing.

If you would like to contribute towards Cabrini’s scholarships and grants program, please call the Cabrini Foundation on ph (03) 9508 1380 or email foundation@cabrini.com.au

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MONASH DEPARTMENT OF CLINICAL EPIDEMIOLOGY AT CABRINI HOSPITAL

More than

$41m

in grant and fellowship funding held

43

publications

75

presentations

8

clinical trials

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MONASH DEPARTMENT OF CLINICAL EPIDEMIOLOGY AT CABRINI HOSPITAL

The Monash Department of Clinical Epidemiology performs high quality clinical research to answer clinically important questions and to promote the translation of clinical evidence into practice and policy change.

Our current program of work concerns identifying and reducing low-value healthcare that arises from over-diagnosis and over-treatment, and identifying ways to improve the sustainability of the health care system. In 2017-18, we launched the NHMRC Centre of Research Excellence for the Australia and New Zealand Musculoskeletal (ANZMUSC) Clinical Trial Network. We continue to manage the Australian Rheumatology Association database and are an editorial base for Cochrane Musculoskeletal and Australasian Satellite of Cochrane Effective Practice and Organisation of Care (EPOC).

H E A D: P ROF E S S OR R AC H E LLE B U C H B I N D E R

H IGH L IGH TS

Professor Rachelle Buchbinder led an international group of authors in a groundbreaking series of three papers on low back pain published in The Lancet (online, 22 March and print, 9 June 2018). The series highlights the immense global burden of low back pain, and the fact many people with low back pain receive the wrong care, causing harm to millions of people across the world and wasting valuable healthcare resources. A better understanding of the link between the care that is delivered and outcomes is key to addressing this problem.

The ANZMUSC Centre of Research Excellence was officially launched by the Federal Minister for Health Greg Hunt on 22 March 2018 at the Cabrini Institute. The event was officiated by Cabrini Chief Executive Dr Michael Walsh. Speakers included:

• Dr Andrew Black, Director of Research Development and Collaboration at the University of Sydney • Professor Rachelle Buchbinder, Chair of the ANZMUSC Executive Committee ANZMUSC is a collaboration of more than 200 clinicianresearchers from 30 universities, 31 hospitals and 17 research institutes, and aims to optimise musculoskeletal health through high quality collaborative research.

The department hosted the Wiser Healthcare National Scientific Meeting at Cabrini Institute on 26 and 27 February 2018. Research collaborators and consumer representatives from around Australia met to present research and exchange ideas addressing over-diagnosis and over-treatment in Australia.

• Professor Marc Parlange, Provost and Senior Vice-President of Monash University

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MONASH DEPARTMENT OF CLINICAL EPIDEMIOLOGY AT CABRINI HOSPITAL

OUR R E S E A RCH

Cochrane Effective Practice and Organisation of Care (EPOC) – Australasian Satellite

Identifying alternative delivery models to increase value and sustainability of healthcare: A scoping review of systematic reviews and a Delphi study

Healthcare expenditure is growing at an unsustainable rate.

Alternative models of service delivery may lead to improved efficiencies and a more sustainable health system. This project aims to identify and prioritise promising alternative ways of delivering healthcare for further investigation.

The Australasian EPOC Satellite assists evidence-based policy making by supporting, promoting and helping to implement systematic reviews of interventions designed to improve health care practice and the delivery of effective health services. The satellite supports EPOC review activity through training and mentoring authors based in Australia who contribute to EPOC reviews.

Australian Rheumatology Association database

Development of a tool for setting priorities for trials in the musculoskeletal field

Research priority setting typically involves a range of stakeholders identifying and ranking all possible priorities. This study aims to develop a multi-attribute priority setting tool for the explicit and transparent ranking of musculoskeletal research questions.

ANZMUSC living evidence

Clinician, patient and general public beliefs about diagnostic imaging for low back pain: Qualitative evidence synthesis

Living evidence, living systematic reviews (LSRs) and guidelines, are updated whenever new research becomes available. Aims: to conduct Cochrane living systematic reviews (platelet rich plasma and stem cell injections for knee osteoarthritis) to feed into ‘living’ recommendations in Therapeutic Guidelines Ltd: Rheumatology.

Aims to synthesise qualitative research exploring clinician, patient or general public beliefs about diagnostic imaging for low back pain.

Consumer understanding of terms used in imaging reports requested for low back pain

SUcceSS: Surgery for Spinal Stenosis – a randomised placebo-controlled trial

Spinal stenosis is a well-recognised debilitating condition. It is unclear if removal of the bone during surgery is the best solution to treat the condition. This trial aims to assess if removal of the bone during surgery is more effective than not removing the bone.

Cochrane Musculoskeletal – Australia

NHMRC funding supports the Cochrane Musculoskeletal Review Group in Australia. Cochrane is considered the benchmark around the world for the production of highquality, reliable, up-to-date and un-conflicted systematic reviews. Thus, we contribute by producing the best available evidence to inform decision in treating arthritis and musculoskeletal disorders.

We collect long-term observational data about the outcomes of Australians with inflammatory arthritis (rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and juvenile idiopathic arthritis). In collaboration with the Australian Arthritis and Autoimmune Biobank Collaborative (A3BC), ARAD has been in the process of upgrading and expanding the database with the incorporation of a biobank.

Aims to investigate the understanding, perceived seriousness and worry that typical terms used in lumbar spine imaging reports elicit in a random sample of the general population.

Experiences and perceptions of people living with shoulder pain: A qualitative evidence synthesis

Aims to synthesise qualitative research exploring the experiences of people with shoulder pain, including their symptoms and perceived impact upon their daily lives.

Perceived barriers and facilitators to reducing inappropriate use of imaging in people with shoulder pain

Aims to explore the perceived barriers and facilitators among health professionals and patients to reducing inappropriate use of imaging in people with shoulder pain.

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MONASH DEPARTMENT OF CLINICAL EPIDEMIOLOGY AT CABRINI HOSPITAL

Scoping review of the volume and scope of implementation research conducted in knee OA

Best practice care of musculoskeletal conditions by general practitioners

Aims to describe the volume and scope of implementation of research conducted in osteoarthritis of the knee to inform implementation planning of the Australian Commission for Quality and Safety in Health Care’s clinical care standard for knee osteoarthritis.

Aims to explore, develop and evaluate interventions to improve the management of musculoskeletal conditions in general practice, particularly radiological imaging requests.

Linguistic and content analysis of musculoskeletal diagnostic imaging reports

Aims to validate two instruments for measuring back pain beliefs.

Back pain questionnaires validity testing

The content of diagnostic imaging reports for musculoskeletal conditions will be analysed and assessed for their comprehensibility to clinicians and patients using a linguistic framework.

P UB LI C ATI ONS

Bell S, Kong JC, Wale R, Staples M, Oliva K, Wilkins S, McMurrick P, Warrier SK. (2018) The effect of increasing body mass index on laparoscopic surgery for colon and rectal cancer. Colorectal Dis. doi:10.1111/codi.14107

Interventions for improving the appropriate use of imaging in people with musculoskeletal conditions: An updated systematic review

Update of a Cochrane review investigating the effectiveness of interventions designed to improve appropriate use of imaging in people with musculoskeletal pain.

Black RJ, Lester S, Buchbinder R, Barrett C, Lassere M, March L, Whittle S, Hill CL. (2017) Factors associated with oral glucocorticoid use in patients with rheumatoid arthritis: A drug use study from a prospective national biologics registry. Arthritis Res Ther 19(1):253.

Follow-up evaluation of the effects of a back pain mass media campaign

Buchbinder R, Bourne A. (2018) Content analysis of consumer information about knee arthroscopy in Australia. ANZ J Surg 88(4):346-53.

Reassessment of whether a mass media campaign regarding the appropriate management of back pain has continued to alter GP perceptions on back pain management.

Buchbinder R, Johnston R, Rischin KJ, Golmohammadi K, Jones A, Homik J, Kallmes DF. (2018) Percutaneous vertebroplasty for osteoporotic vertebral compression fracture (Updated Review). Cochrane Database of Systematic Reviews. 4:CD006349.

Develop, pilot and evaluate a knee arthroscopy decision aid (de-implementation tool)

Arthroscopic surgery for degenerative knee disease is a lowvalue treatment practice where large variation exists. Aims to develop, pilot and evaluate the effectiveness of a patient decision aid for knee arthroscopy in a randomised trial in Australian primary care.

Buchbinder R, van Tulder M, Öberg B, Costa L, Woolf A, Schoene M, Croft P, for the Lancet Low Back Pain Series Working Group. (2018) Low back pain: a call for action.

Lancet. 391(10137):2384-88.

Media campaign to promote EVOLVE (evaluating evidence, enhancing efficiencies) Australian Rheumatology Association (ARA) ‘top 5’ list of low value practices

Dissemination of guidelines such as the ARA’s top-5 list of lowvalue practices is critical in ensuring that clinicians are aware of practices that are of limited effectiveness, inappropriate, overused or potentially harmful. Aims to assess the impact of a social media campaign for disseminating the EVOLVE list.

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Chiarotto A, Boers M, Deyo RA, Buchbinder R, Corbin TP, Costa LOP, Foster NE, Grotle M, Koes BW, Kovacs FM, Lin CW, Maher CG, Pearson AM, Peul WC, Schoene ML, Turk DC, van Tulder MW, Terwee CB, Ostelo RW. (2018) Core outcome measurement instruments for clinical trials in non-specific low back pain. Pain. 159(3):481-95.

MONASH DEPARTMENT OF CLINICAL EPIDEMIOLOGY AT CABRINI HOSPITAL

Craig LE, Taylor NZ, Grimley R, Cadilhac DA, McInnes E, Phillips R, Dale S, O’Connor D, Levi C, Fitzgerald M, Considine J, Grimshaw J M, Gerraty R, Cheung NW, Ward JE, Middleton S. (2017) Development of a theory-informed implementation intervention to improve the triage, treatment and transfer of stroke patients in emergency departments using the Theoretical Domains Framework (TDF): The T3 Trial.

Implementation Science. 12:88.

Day, R, Frensham L, Nguyen A, Baysari M, Lau A, Westbrook J, Zwar N, Reath J, Laba T, Li L, McLachlan A, Runciman W, Buchbinder R, Clay-Williams R, Coiera E, Braithwaite J, McNeil P, Hunter D, Pile K, Portek I, Williams K. (2017) Effectiveness of an electronic patient-centred selfmanagement tool for gout sufferers: A cluster randomised controlled trial protocol. BMJ Open 7(10):e017281.

Hay SI, Abajobir AA, Abate KH, et al. (2017) Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390(10100):1260-344.

Hosking SM, Brennan-Olsen SL, Beauchamp A. Buchbinder R, Williams LJ, Pasco JA. (2018) Health literacy and uptake of anti-fracture medications in a population-based sample of Australian women. Res Soc Admin Pharm. doi: 10.1016/j. sapharm.2018.05.002 Jessup RL, Osborne RH, Beauchamp A, Bourne A, Buchbinder R. (2018) Differences in health literacy profiles of patients admitted to a public and a private hospital in Melbourne, Australia. BMC Health Serv Res 18(1):134.

Foster NE, Koes B, Chou R, Peul W, Turner JA, Cohen SP, Cherkin D, Anema JR, Gross DP, Fritz J, Ferreira P, Maher C, for the Lancet Low Back Pain Series Working Group. (2018) Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet. 391(10137): 2368-83.

Lenza M, Buchbinder R, Staples MP, dos Santos OFP, Brandt RA, Lottenberg CL, Neto MC, Ferretti M. (2017) Second opinion for degenerative spinal conditions: An option or a necessity? BMC Musculoskel Dis 18(1):354.

Karjalainen T, Jokinen K, Sebastin S, Luokkala T, Kangasniemi O, Reito A. (2018) Correlation Between Objectively Measured Impairment, Outcome Classification Systems, and Subjectively Perceived Disability After Flexor Tendon Repair. J Hand Surg Am. Accepted for publication

Frydman A, Johnston R, Smidt N, Buchbinder R. (2018) Manual therapy and exercise for lateral elbow pain (Protocol).

Cochrane Database of Systematic Reviews. 6:CD013042 Gagnier JJ, Page MJ, Huang H, Verhagen A, Buchbinder R. (2017) Creation of a core outcome set for clinical trials of people with shoulder pain: A protocol. Trials 18(1):336.

Karjalainen T, Sebastin SJ, Peng YP, Chong AKS. (2018) Flap Related Complications Requiring Secondary Surgery in a Series Of 851 Local Flaps Raised From Fingers to Cover Fingertip Soft Tissue Defects. J Hand Surg Asian & Pacific.

Accepted for publication

Gilmartin JF, Bell S, Liew D, Arnold C, Buchbinder R, Chapman C, Cicuttini F, Dobbin M, Gibson S, Giummarra M, Gowan J, Katz B, Lubman D, McCrone M, Pilgrim J, Synnot A, van Dyk E, Workman B, McNeil JJ. (2018) Chronic pain medication management of older populations: key points from a national conference and innovative opportunities for pharmacy practice. Res Social Admin Pharm. doi: 10.1016/j. sapharm.2018.03.060

Leppänen OV, Jokihaara J, Jämsen E, Karjalainen T. (2018) Survey of hand surgeons’ and therapists’ perceptions of the benefit of common surgical procedures of the hand. J Plast Surg Hand Surg. 52(1):1-6.

Hartvingsen J, Hoy D, Smeets R, Ferreira M, Louw Q, Pransky G, Kongsted A, Hancock M, Karppinen J, Genevay S, Sieper J, Underwood M, for the Lancet Low Back Pain Series Working Group. (2018) What low back pain is and why we need to pay attention. Lancet. 391(10137):2356-67.

Linnanmäki L, Göransson H, Havulinna J, Sippola P, Karjalainen T, Leppänen OV. (2018) Gap Formation During Cyclic Testing of Flexor Tendon Repair. J Hand Surg Am. 243(6):570.e1-8.

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MONASH DEPARTMENT OF CLINICAL EPIDEMIOLOGY AT CABRINI HOSPITAL

Luokkala T, Flinkkilä T, Paloneva J, Karjalainen TV. (2018) Comparison of Expert Opinion, Majority Rule, and a Clinical Prediction Rule to Estimate Distal Radius Malalignment.

J Orthop Trauma. 32(3):e97-101.

Machado G, Richards B, Needs S, Buchbinder R, Harris I, Howard K, McCaffery K, Billot L, Edwards J, Rogan E, Facer R, Cowell DL, Maher C, for the SHaPED trial Investigators. (2018) Implementation of an evidence-based model of care for acute low back pain in emergency departments: Protocol for the SHaPED trial. BMJ Open. 8(4):e019052.

McGann J, Manohar J, Hiscock H, O’Connor D, Hodgson J, Babl F, Sung V. (2018) Caring for crying babies: A mixedmethods study to understand factors influencing nurses’ and doctors’ management of infant colic. J Paediatr Child Health.

54(6):653-660.

Morony S, Webster A, Buchbinder R, Kirkendall S, McCaffery K, Clerehan R. (2018) Application of the Evaluative Linguistic Framework (ELF) to assess patient education materials for chronic (kidney) disease. Health Literacy Res Prac 2(1):e1-14.

Morris R, Soh SE, Hill KD, Buchbinder R, Lowthian J, Redfern J, Etherton-Beer C, Hill AM, Osborne R, Barker A. (2017) Measurement properties of the Health Literacy Questionnaire (HLQ) among older adults who present to the emergency department with a fall: a Rasch analysis. BMC Health Services Res 17(1):605.

Morrisroe K, Nakayama A, Soon J, Arnold A, Barnsley L, Barrett C, Brooks P, Hall S, Hanrahan P, Hissaria P, Jones G, Katikireddi VS, Keen H, Laurent R, Nikpour M, Poulsen K, Robinson P, Soden M, Wood N, Cook N, Hill C, Buchbinder R. (2018) EVOLVE: The Australian Rheumatology Association’s ‘top five’ list of investigations and interventions doctors and patients should question. Intern Med J. 48(2):135-43.

Räisänen MP, Karjalainen T, Göransson H, Reito A, Kautiainen H, Malmivaara A, Leppänen OV. (2018) DupuytrEn Treatment EffeCtiveness Trial (DETECT): a protocol for prospective, randomised, controlled, outcome assessorblinded, three-armed parallel 1:1:1, multicentre trial comparing the effectiveness and cost of collagenase clostridium histolyticum, percutaneous needle fasciotomy and limited fasciectomy as short-term and long-term treatment strategies in Dupuytren’s contracture. BMJ Open. 8(3):e019054.

Rose M, Yang A, Welz M, Masik A, Staples M. (2018) Novel modification of the Reported Edmonton Frail Scale.

Australasian J Ageing. doi: 10.1111/ajag.12533 Shrubsole K, Worrall L, Power E, O’Connor DA. (2018) Priorities for Closing the Evidence-Practice Gaps in Poststroke Aphasia Rehabilitation: A Scoping Review. Arch Phys Med Rehabil.

99(7):1413-23.

Shrubsole K, Worrall L, Power E, O’Connor DA. (2018) Barriers and facilitators to meeting aphasia guideline recommendations: what factors influence speech pathologists’ practice? Disabil Rehabil. 29:1-12.

Siemieniuk RAC, Harris IA, Agoritsas T, Poolman RW, Brignardello-Petersen R, Van de Velde S, Buchbinder R, Englund M, Lytvyn L, Quinlan C, Helsingen L, Knutsen G, Olsen NR, Macdonald H, Hailey L, Wilson HM, Lydiatt A, Kristiansen A. (2018) Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline.

Br J Sports Med. 52(5):313.

Smith D, Lane R, McGinnes R, O’Brien J, Johnston R, Bugeja L, Team V, Weller C. (2018) What is the effect of exercise on wound healing in patients with venous leg ulcers? A systematic review. Int Wound J. 15(3):441-53.

Moynihan R, Dakin T, Scott I, Buchbinder R, et al. (2018) Australia is responding to the complex challenge of overdiagnosis. MJA Perspectives. Med J Aust. Accepted

Suman A, Bostick GP, Schopflocher D, Russell AS, Ferrari R, Battié MC, Hu R, Buchbinder R, Gross DP. (2017) Long-term evaluation of a Canadian back pain mass media campaign.

Eur J Spine 26(9):2467-74.

Pompilio da Silva M, Tamaoki MJ, Blumetti FC, Belloti JC, Smidt N, Buchbinder R. (2018) Electrotherapy for lateral elbow pain. (Protocol) Cochrane Database of Systematic Reviews (in press)

Suman A, Schaafsma FG, Buchbinder R, van Tulder M, Anema JR. (2018) Cost-effectiveness of a multimedia campaign to improve coping with non-specific low back pain.

Occup Environ Med. 75:A547.

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MONASH DEPARTMENT OF CLINICAL EPIDEMIOLOGY AT CABRINI HOSPITAL

Suman A, Schaafsma FG, Van de Ven PM, Slottje P, Buchbinder R, van Tulder MW, Anema JR. (2018) Effectiveness of a multifaceted implementation strategy compared to usual care on low back pain guideline adherence among Dutch general practitioners. BMC Health Services Research. 18(1):358.

NHMRC Partnership Centre in Health System Sustainability.

(2017-2021), $10,700,000 (NHMRC $5,250,000; Partners: Bupa Health Foundation, NSW Health, Telstra and the University of Notre Dame) Braithwaite J, Ward RL, Westbrook J, Glasziou P, Scott A, Karnon JD, Buchbinder R (CI).

Synnot A, Chau M, Pitt V, O’Connor D, Gruen RL, Wasiak J, Clavisi O, Pattuwage L, Phillips K. (2017) Interventions for managing skeletal muscle spasticity following traumatic brain injury. Cochrane Database Syst Rev. 11:CD008929.

NHMRC Centre of Research Excellence. ‘Translation of Research into Improved Outcomes in Musculoskeletal Pain & Health (CRE TRIUMPH)’, $2,500,000, Bennell K, Hunter D, Hodges P, Buchbinder R (CI), Pirotta M, Hinman R, Harris A, Foster N, Michie S, Vicenzino B.

Traeger A, Buchbinder R, Harris I, Maher C. (2017) Diagnosis and management of low back pain in primary care.

CMAJ 189(45):E1386-95.

NHMRC Program Grant. ‘Musculoskeletal pain and disability: improving outcomes through conservative interventions.’

(2016-20), $8,268,140, Hodges P, Bennell K, et al. and Buchbinder R (AI).

Traeger A, Buchbinder R, Harris I, Clavisi O, Maher C. (2018) Avoid routinely prescribing medicines for non-specific low back pain. Br J Sports Med. doi: 10.1136/bjsports-2017-098614

NHMRC Partnership Grant. ‘Patient-centred eHealth approach to improving outcomes for gout sufferers.’ (2015-20), $660,656, Day R, et al., and Buchbinder R (AI).

Traeger A, Reed B, O’Connor DA, Hoffmann TC, Machado G, Bonner C, Maher CG, Buchbinder R. (2018) Clinician, patient and general public beliefs about diagnostic imaging for low back pain: protocol for a qualitative evidence synthesis.

BMJ Open. 8(2):e019470.

NHMRC Project Grant. ‘Hype or Hope? platelet-Rich plasma as a symptom- and disease-modifying Treatment for knee osteoarthritis - the RESTORE trial.’ (2016-19), $1,400,359, Bennell K, Buchbinder R (CI), Wang Y, Forbes A.

Vos T, Abajobir AA, Abbafati C, et al. (2017) Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390(10100): 1211–59.

NHMRC Project Grant. ‘CROSSFIRE: Combined Randomised and Observational Study of Surgery for Fractures In the distal Radius in the Elderly.’ (2016-19), $511,076, Harris I, Buchbinder R (CI), Ivers R, Naylor J, Balogh Z, Smith P.

GRA N TS H E L D

NHMRC Senior Principal Research Fellowship, $911,915, Buchbinder R. NHMRC Centre of Research Excellence. ‘ANZMUSC – Australia and New Zealand Musculoskeletal Clinical Trials Network.’

(2017-22), $2,497,653, Buchbinder R (CI), Maher C, March L, Day R, Hinman R, Harris I, Ferreira M, Glasziou P, Green S, Billot L, and AIs Latimer J, Whittle S, Cicuttini F, Hill C, Lin C, Taylor W, Hunter D, Harris A, Winzenberg T, McAuley J.

NHMRC Project Grant. ‘SUcceSS: Surgery for Spinal Stenosis – a randomised placebo-controlled trial.’ (2017-21), $2,300,000, Ferreira M, Harris I, Davis G, Latimer J, Beard D, Li Q, Mobbs R, Maher C, Quan G, Rogers M, Buchbunder R (AI), Stanford R, Jan S. NHMRC The Cochrane Collaboration Round 7 Funding Program. ‘Cochrane Musculoskeletal Review Group, Australian Editorial base.’ (2017-20), $368,086, Buchbinder R (CI), O’Connor D, Winzenberg T, Johnston R.

NHMRC Program Grant. ‘Using Healthcare wisely: reducing inappropriate use of tests and treatments.’ (2017-21), $9,578,895, Glasziou P, Buchbinder R (CI), Maher C, McCaffery K.

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MONASH DEPARTMENT OF CLINICAL EPIDEMIOLOGY AT CABRINI HOSPITAL

NHMRC Medical Research Future Fund (MRFF) Research Grant. ‘CRISTAL: Cluster Randomised Trial of Aspirin versus Low molecular weight heparin for venous thromboembolism prophylaxis in joint replacement surgery, a registry-nested study.’ (2018-22), $910,700, Harris I, Graves S, Buchbinder R (CI), Naylor J, Pratt N, de Steiger R, Chong B, Ackerman I, Harris A. Cabrini Foundation Clinical Research Grant. ‘Back Pain Questionnaires Validity Testing Study’ (2018-19), $30,000, Buchbinder R (CIA), Osborne RH (CIB), Hawkins M (AI).

Cabrini Foundation Clinical Research Grant. ‘Innovative systematic review methods: A Cochrane living systematic review of autologous injections for knee osteoarthritis.’

(2017-18), $30,000, Buchbinder R (CIA), Johnston R, O’Connor D, Staples M, Green S.

Patient-Centered Outcomes Research Institute (PCORI) Engagement Award. ‘Development of a core outcome measurement set for clinical trials in shoulder disorders.’

(2015-17), US$237,126, Gagnier JJ, Buchbinder R (CI).

Rockefeller Foundation Academic Writing Fellow, Bellagio Center, Italy. (Awarded 2017 for four weeks full board, 10 July to 7 August 2018). Buchbinder R. MRC-NIHR methodology state-of-the-art workshop on methods for placebo comparator group selection and use in surgical trials. (Awarded 2017 for December 2018), £49,471, Beard D, Cook J, Blazeby J, Campbell M, Pinkney B, Tracey I, Buchbinder R, Savulescu J, Farrah-Hockley D, Blencowe Nm Carr A.

Cochrane Strategic Development Support Funding for Australian Cochrane Review Group Satellites – Effective Practice and Organisation of Care (EPOC) (2017-18), $60,000, O’Connor D (CI).

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MONASH DEPARTMENT OF CLINICAL EPIDEMIOLOGY AT CABRINI HOSPITAL

MULTI-MILLION DOLLAR NHMRC FUNDING TO SUPPORT BETTER HEALTHCARE RESEARCH Cabrini is celebrating the recent astounding NHMRC funding success for world renowned musculoskeletal researcher and clinician Professor Rachelle Buchbinder.

P

rofessor Buchbinder and her collaborators were awarded almost $23m dollars in funding to support research into musculoskeletal health, wiser use of healthcare and health system sustainability.

NH MRC AUSTRALI A AND NEW Z E AL AND MUSC ULOSK ELE TAL ( ANZ MUSC ) C LI NI C AL TRI AL S NE T WORK C E NTRE OF RE SE ARC H E XC E LLENC E (CRE )

Arthritis and musculoskeletal (MSK) conditions are an immense burden on the world’s population, accounting for 18.3 per cent of years lived with disability globally. In Australia, MSK conditions are the most common chronic disorder, affecting 28 per cent (or 6.1 million) Australians and making up almost one-quarter of the total disability burden.

ANZMUSC is a collaboration of more than 200 clinicianresearchers from 30 universities, 31 hospitals and 17 research institutes, and aims to optimise musculoskeletal health through high quality collaborative research.

The successful outcome of this grant was enabled by identifying current deficit areas in the field of MSK research and formulating strategies to effectively address each field.

• Current evidence shows more than 80 per cent of research investment is wasted. ANZMUSC will reduce research waste and provide definitive answers to the most pressing questions in our field by:

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MONASH DEPARTMENT OF CLINICAL EPIDEMIOLOGY AT CABRINI HOSPITAL

diagnosis is difficult to quantify, it is now acknowledged in many areas of medicine, such as in early detection and screening for some cancers and heart conditions. However, many diagnoses and treatment practices are hard to change.

– conducting clinical trials that address important evidence gaps – establishing stakeholder priorities for future ANZMUSC trials

Wiser Healthcare will conduct research to support effective action to reduce over-diagnosis and over-treatment in the areas of musculoskeletal conditions, cancer and cardiovascular disease. We will particularly focus on overdiagnosis caused by imaging (like CT scans and MRI scans), testing biomarkers (for example, blood tests like the Prostate Specific Antigen test), and genetic tests.

– fostering strong links between clinical and consumer groups • When clinically relevant research is produced, it is often not associated with timely or adequate change in practice, and therefore not translated into better outcomes for patients. ANZMUSC will address these research translation challenges by:

NH MRC PARTNER SH I P C E NTRE F OR H E ALTH SYSTE M SUSTAI NAB I LI T Y

– implementing the clinical care standards for hip fracture and knee osteoarthritis into routine care

This is the third national centre funded under the NHMRC Partnership Centres for Better Health program. Established on 1 July 2017, the centre is a collaboration of Australia’s best research investigators, expert advisors and system implementation partners who have joined forces to tackle interventions, which will significantly improve the sustainability of our health care system. The centre is jointly governed and funded to the value of $10.7m over five years by the NHMRC, Bupa Health Foundation, NSW Health, Department of Health Western Australia and the University of Notre Dame Australia. Cabrini is a system implementation partner.

– developing continually updated reviews with the latest scientific evidence and living recommendations (updated when new research becomes available) for MSK health • A long-lasting benefit of the grant will be a significantly increased research workforce well positioned to meet the rapidly growing burden MSK diseases imposes on Australians. ANZMUSC will achieve this by developing large-scale project management processes to streamline all aspects of the clinical trial process, reduce duplication of effort and embed clinical trials into routine care.

The ANZMUSC CRE funding will establish high quality clinical trials, build research capacity and enable effective transfer of research outcomes into clinical practice and health policy for improved patient outcomes.

The partnership centre is focused on three areas of research: 1) Using analytics, technology and shared data to improve health and system performance 2) Reducing waste and low-value care

N H M RC WIS E R HE A LT HC A RE P RO G RA M G RANT

3) Promoting better value for the health dollar Wiser Healthcare is a research collaboration involving Monash University, the University of Sydney, Bond University and international colleagues. It is funded by the NHMRC, through both its centres for research excellence scheme and its program grant scheme. It aims to conduct research that will reduce over-diagnosis and over-treatment in Australia, and around the world. Over-diagnosis and over-treatment occur when patients receive diagnoses and treatment that are unnecessary and do more harm than good. While over-

Our team is leading part of the work for research area two, with a focus on greater value and lower cost delivery of effective and appropriate services. Our research aims to examine the current evidence on different ways of providing health services (e.g. care provided in the home instead of in hospital), and exploring opportunities for system gain where effective, appropriate and potentially greater-value alternatives exist.

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CENTRE FOR NURSING RESEARCH

$335,000 in grant funding held

08

publications

01

presentation

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CENTRE FOR NURSING RESEARCH

Improving the patient, family and community experience of healthcare is integral to the research agenda of the Centre for Nursing Research.

Nurses’ frontline roles put them in a unique position to understand the needs and concerns of patients, residents and their families. Encouraging nurses to lead and contribute to research keeps research activity focused on patient care and the needs of our healthcare service. Further, this supports meaningful engagement with patients, residents, carers and families. Nursing research can help to make healthcare more efficient and cost-effective. By encouraging ongoing improvements to practice and investigating new models of care, nursing research can inform new practices, which improve the patient experience, prevent waste and improve efficiency.

On 1 June 2018, the Centre for Nursing Research temporarily closed to work towards a MonashCabrini appointment of an Associate Professor/Director to the Centre for Nursing Research. Once an appointment is made, a new team will be established in line with the centre’s research directions and the grants awarded. This report highlights work from 1 July 2017 to May 2018.

H E A D: P ROF E S S OR LE E B OY D

H IGH L IGH TS

This year, Professor Lee Boyd was asked to chair a policy chapter on workforce sustainability for the Australian College of Nursing. The focus of the work throughout 2018 is the assistant in nursing role, and whether regulation is required.

budget. Resource usage within the first nine months was 12,957 page views in 4260 sessions; most (83 per cent) were from Australia. ACPTalk was nominated for a Catholic Health Australia award in 2017 for Excellence in Pastoral Care, supporting health professionals in addressing religious and cultural needs of diverse Australian communities.

Completion of ACPTalk project

Scholarship funding

The ACPTalk project, which was funded through the Australian Government Department of Health’s National Public Health Chronic Disease and Palliative Care Projects, was completed on 30 June 2017. All deliverables including the website www.acptalk.com.au were delivered on time and within

Amanda Pereira-Salgado was awarded competitive scholarship funding from Deakin University’s Scholarship for Excellence for her Master of Health Economic studies.

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CENTRE FOR NURSING RESEARCH

Important collaborations and grant success

We have been collaborating with Swinburne University and Peter MacCallum Cancer Centre to secure funding for SAMSOM (formerly Remind). The system is designed to increase patients’ medication adherence to oral drug therapy and improving self-management of medication side-effects. A prototype has been completed and a health services research fellowship has been awarded to Dr Lisa Grech, Swinburne University, through the Victorian Cancer Agency (2018-19), with Amanda Pereira-Salgado a member of the project team.

The clinical feasibility and acceptability of the first iteration of SAMSOM was published in the Journal of Medical Internet Research Mhealth Uhealth, which has an impact factor of 4.636 (first author: Amanda Pereira-Salgado). SAMSON is a core project of the recently-funded national Digital Health CRC for which Cabrini is an industry partner.

Mani Suileiman’s PhD work is identifying positive financial results for Cabrini. The Capital Markets Cooperative Research Centre (CMCRC) is a successful research centre that has won prizes for its research and has already spun off several businesses. The CMCRC’s research is supported by government, industry partners, security exchanges and regulators in Australia, the UK, Singapore, Hong Kong and North America. Cabrini is partnering with CMCRC and funding two PhD scholarships with one additional scholarship being provided through government funding.

Mani Suleiman’s work is progressing well. He has just published his first paper focusing on using regression approaches to predict incorrect diagnosis related groups (DRG) assignment.

This work has already resulted in positive financial results.

Since introducing the scoring method in July 2017, the revenue raised per audited episode has risen 30 per cent from $717 in January-June to $935 in July-December. A total of 155 fewer episodes were audited in July-December but raised $13,000 more in revenue due to greater accuracy.

Using Jeffries’ simulation design framework, the project developed and piloted an ACP SBL intervention for outpatient nurses at Cabrini. Quasi-experimental design examined prepost differences in knowledge, self-confidence and behavior.

Qualitative description explored benefits, improvements and impact on clinical practice. A total of 13 nurses completed the intervention with significant changes in participant’s selfconfidence in initiating and revisiting ACP conversations with patients following the intervention.

Benefits to participants’ confidence, knowledge and implementation to clinical practice were evidenced through qualitative findings. The study demonstrated that with appropriate training, nurses may be better engaged in initiating and revisiting ACP conversations with patients and families. This project was supported by funding from the Cabrini Foundation Research and Quality Improvement grant round.

A Website Supporting Sensitive Religious and Cultural Advance Care Planning (ACPTalk): Formative and Summative Evaluation

Researchers: Pereira-Salgado A, Mader P, O’ Callaghan C, Boyd L This project utilised the context, input, process, and product (CIPP) framework to conduct a formative and summative evaluation of the ACPTalk website. Research questions were embedded within the framework for each evaluation type.

A combination of mixed methods were used consistent with formative and summative evaluation techniques. Notably, 16 health professionals provided website solutions in relation to website requirements.

The majority of 37 content reviewers strongly agreed or agreed that the content used appropriate language and tone, would support health professionals and was accurate. A total of 107 Australian-based users completed the website survey with similarly positive feedback.

OUR R E S E A RCH Development and pilot of an advance care planning (ACP) simulation-based learning (SBL) intervention for nurses

Researchers: Pereira-Salgado A, Philpot S, Schlieff J, Peat A, O’ Driscoll L, Mills A

Qualitative findings indicated overall positivity in relation to accessibility, functionality, usefulness, design and increased knowledge of ACP. This project was funded by the Australian Government’s Department of Health.

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CENTRE FOR NURSING RESEARCH

Researchers: Pereira-Salgado A, Mader P, O’ Callaghan C, Boyd L, Staples M

Three themes emerged which focused on: religious leaders’ ACP understanding and experiences; explanations for religious followers’ approaches towards end-of-life care; and health professionals’ need to enquire about how religion matters.

Most leaders had some understanding of ACP and, once fully comprehended, most held ACP in positive regard.

International guidance for advance care planning (ACP) supports the integration of spiritual and religious aspects of care within the planning process. Religious leaders’ perspectives could improve how ACP programs respect patients’ faith backgrounds. This study examined: how religious leaders understand and consider ACP and its implications; how religion affects followers’ approaches to end-of-life care and ACP; and their implications for healthcare.

Religious followers’ preferences for end-of-life care reflected family and geographical origins, cultural traditions, personal attitudes, and religiosity and faith interpretations.

Implications for healthcare included the importance of avoiding generalisations and openness to individualised and/or standardised religious expressions of one’s religion.

This project was funded by the Australian Government’s Department of Health.

P U B L IC AT ION S

System): Clinical Feasibility and Acceptability Assessment.

JMIR Mhealth Uhealth. 5(12):e184

Religious leaders’ perceptions of advance care planning: a secondary analysis of interviews with Buddhist, Christian, Hindu, Islamic, Jewish, Sikh and Bahá’í leaders

Alexander L, Sheen J, Rinehart N, Hay M, Boyd L. (2018) Mental health simulation in student nurses: a qualitative review. Clinical Simulation in Nursing. 14:8-14.

Alexander L, Sheen J, Rinehart N, Hay M, Boyd L. (2018) The role of television in perceptions of dangerousness. The Journal of Mental Health Training, Education and Practice. 13(3):187-196 Patterson E, Boyd L, Mnatzaganian G. (2017) The impact of undergraduate clinical teaching models on the perceptions of work-readiness among new graduate nurses: A cross sectional study. Nurse Education Today. 55:101 – 106

Suleiman M, Demirhan H, Boyd L, Girosi F, Aksakalli V. (2018) Bayesian logistic regression approaches to predict incorrect DRG assignment. Health Care Management Science. doi: 10.1007/s10729-018-9444-8 Wong D.F, Spencer C, Boyd L, Burkle F, and Archer F. (2017) Disaster Metrics: A Comprehensive Framework for Disaster Evaluation Typologies. Prehospital and Disaster Medicine.

32 (3): 1-14 G RANTS H ELD

Pereira-Salgado A, Mader P, O’ Callaghan C, Boyd L (2018).

A Website Supporting Sensitive Religious and Cultural Advance Care Planning (ACPTalk): Formative and Summative Evaluation.

JMIR Research Protocols. 7(4):e78

Swinburne Research Institutes Seed Grants Scheme ‘Wearable gait and neurological diagnostics system in the form of a smart insole’ (2017), $20,000, Fuss FK, Weizman Y, Tirosh O, Lambert E, Jayaraman PP, Liao K, George T, Boyd L. (2017)

Pereira-Salgado A, Mader P, O’ Callaghan C, Boyd L, Staples M. (2017) Religious leaders’ perceptions of advance care planning: a secondary analysis of interviews with Buddhist, Christian, Hindu, Islamic, Jewish, Sikh and Baha’i leaders. BMC Palliative Care. 16:79

Cabrini Foundation Quality Improvement Grant ‘ACP enACT Development and pilot of an advance care planning simulationbased learning intervention for nurses’ (2017-18), $15,000, Pereira-Salgado A, Philpot S, Schlieff J, Peat A and O’Driscoll L.

Pereira-Salgado A, Westwood JA, Russell L, Ugalde A, Ortlepp B, Seymour JF, Butow P, Cavedon L, Ong K, Aranda S, Breen S, Kirsa S, Dunlevie A, Schofield P. (2017) Mobile Health Intervention to Increase Oral Cancer Therapy Adherence in Patients With Chronic Myeloid Leukemia (The REMIND

Victorian Cancer Agency Health Services Research Fellowship ‘Improving oral medication adherence and reducing medication errors in cancer treatment’ (2018-19), $300,000, Grech L (CIA). Project team: Schofield P, Tam C, Lingaratnam S, Forkan, Pereira-Salgado A, Quinn S.

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CENTRE FOR NURSING RESEARCH

IMPROVING HEALTH OUTCOMES FOR REFUGEE WOMEN Cabrini is supporting PhD scholar Sue Willey to evaluate the implementation of a perinatal mental health screening program to improve health outcomes for refugee women and their families.

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CENTRE FOR NURSING RESEARCH

W

hen she saw the Cabrini advertisement for a PhD scholarship in refugee perinatal mental health, it was like a dream come true. Ms Willey has a strong career in nursing and midwifery, with substantial experience in maternal and child health and refugee health nursing and teaching. The PhD scholarship was an opportunity to undertake research fulltime in the areas she was most passionate about: refugee health, mental health, primary healthcare, health promotion and maternity care. She is guided in her studies by her three supervisors, Associate Professor Jacqueline Boyle and Dr Melanie Gibson-Helm at Monash University, and Professor Lee Boyd at Cabrini.

Now in her third year of her PhD, Ms Willey is excited about how her work can improve care provided to women and clinical practice: “I really love how it can improve care provided to the women and clinical practice. The midwives are valuing the program and it allows them to provide more holistic care for the women visiting the clinic. The program has also been well embraced by the other health professionals involved. I’m excited knowing my research will contribute to an improvement in healthcare.”

The perinatal mental health national guidelines recommend women are screened for mental health in pregnancy, at the beginning, during and postnatally. While postnatal depression is commonly screened, it is less well appreciated that depression and anxiety can develop in earlier stages of pregnancy. By picking up the signs early, it is hoped women can be referred to services and get the support they need.

Ms Willey’s research is based at a dedicated refugee health antenatal clinic at Dandenong Hospital. While most who attend the clinic are women from a refugee background, she has also been working with a group of non-refugee migrant women who have culturally and linguistically diverse backgrounds. Early screening in women of refugee or migrant backgrounds is particularly important because previous research has shown less than five per cent of refugee women in the Monash Health database were being identified as having a mental health condition in pregnancy.

This is low given that in the general refugee population,

31 per cent experience mental health issues. Following the implementation of the perinatal mental health screening program at the antenatal clinic at Dandenong Hospital, 36 per cent of refugee women are self-reporting mental health issues during pregnancy, including depression and anxiety symptoms.

The screening program utilises the digital platform ICOPE, which has been developed by the Centre of Perinatal Excellence. All women attending their first antenatal appointment with a midwife are given an iPad on arrival and asked to complete the self-report questionnaires: the Edinburgh Postnatal Depression Scale (which includes a sub-anxiety assessment and self-harm question) and the Monash Health psychosocial assessment. Midwives are able to access an online clinical report and make an assessment from the score as to whether further clinical discussion and referral is required to assist a woman. The assessments have been translated into a number of common refugee and migrant languages including Arabic, Dari, Farsi, Pashto, Tamil and Vietnamese. The program also frequently uses interpreters because a lot of women attending the clinic have limited education and cannot read. The research team is in the process of developing the iPad assessments to be delivered in an audio format so women can listen to it and respond accordingly.

Ms Willey’s PhD project forms part of a large-scale program.

Her aims are to evaluate the effectiveness of the program, including whether: • the women are being supported effectively • the program is effective in identifying mental health concerns • women are being referred for help Her studies will investigate what still needs improvement and what would be required to scale up the program across all maternity services. Ms Willey has completed interviews and focus groups with health professionals and is in the process of completing interviews with refugee and non-refugee migrant women.

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CABRINI MONASH UNIVERSITY DEPARTMENT OF MEDICAL ONCOLOGY – THE SZALMUK FAMILY DEPARTMENT OF MEDICAL ONCOLOGY

$265,000 in grant funding held

20

publications

35

presentations

57

clinical trials

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CABRINI MONASH UNIVERSITY DEPARTMENT OF MEDICAL ONCOLOGY – THE SZALMUK FAMILY DEPARTMENT OF MEDICAL ONCOLOGY

Cabrini’s cancer research program allows the discovery and development of new agents to better treat cancer, which not only translates into better cure rates but also increased symptom control and better quality of life for our patients.

In Australia, cancer will affect one in two people at some stage in their life. Of those affected, 35 per cent will die from the disease. But for those who survive, there are often long-term consequences of the diagnosis and treatment received. Current treatment, which is more efficacious and less toxic than older therapies, has all been determined through years of clinical research. Without research we are condemning tomorrow’s generation to today’s treatments. This is why it is vitally important that Cabrini’s participation in cutting-edge projects continues so that new treatments can be developed for the next generation.

The department’s focus has been firmly on the development of new agents for the treatment of cancer.

This has allowed participation in phase one, two and three clinical trials using novel agents displaying efficacy in the treatment of various cancers. Exposure to these agents benefits our patients, they will achieve better treatment outcomes and often less toxicity. These agents are not available outside clinical trials, so our patients benefit from early access to the agents. This also allows our doctors, nurses and pharmacists to become familiar with new classes of cancer agents well before they become mainstream.

Our research also has a significant focus on patient outcomes, particularly looking at tools and interventions to improve the patient experience through better quality-of-life, less toxicity, and better patient survivorship.

H E A D: PRO F E S S OR G A RY R I C H A R D S ON OA M

H IGH L IGH TS OF T HE Y E A R New collaboration

We have established an exciting collaboration between the Cabrini Brightways Breast Cancer Service, the Monash Biomedicine Discovery Institute, the Department of Anatomy and Developmental Biology Monash University, and the

Department of Biochemistry and Molecular Biology Monash University to develop breast tumour organoids. Using small tumour organoids, isolated directly from patients, we will screen tumour susceptibility against a panel of FDA-approved cancer drugs and identify those able to destroy or suppress tumour growth. This information can then be used to tailor individually suited therapies for patients.

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CABRINI MONASH UNIVERSITY DEPARTMENT OF MEDICAL ONCOLOGY – THE SZALMUK FAMILY DEPARTMENT OF MEDICAL ONCOLOGY

Cabrini the largest recruiter for the icecream colorectal oncology trial

Institute), Maree Bilandzic (Hudson Institute), Tom Jobling (Epworth HealthCare).

The icecream oncology clinical trial for colorectal patients was recently completed. Cabrini recruited the largest number of patients of any centre in Australia for the trial. Associate Professor Jeremy Shapiro was the Cabrini principal investigator and lead author on the publication:

This project aims to develop novel platforms for the rapid determination of drug sensitivity in individual patients with breast cancers. Using small tumour clusters called organoids, isolated directly from patients, we will screen tumour susceptibility against a panel of FDA-approved cancer drugs.

This information can then be used to tailor individually suited therapies for patients.

Segelov E, et al (2016) Response to Cetuximab With or Without Irinotecan in Patients with Refractory Metastatic Colorectal Cancer Harboring the KRAS G13D Mutation: Australasian Gastro-Intestinal Trials Group ICECREAM Study.

J Clin Oncol. 34(19):2258-64.

Car-T cell ovarian cancer program

Co-Investigators: Richard Boyd (Catherics), Alan Trouson (Catherics), Peter Hudson V, Ian Nesbit (Catherics), Maureen Howard (Catherics), Irv Weissman (Stanford University), Jose Polo (Monash University), Hiroshi Kawamoto (Kyoto University), Kathy Skoff (Catherics), Stephen Goodall (Process Biotech Pty Ltd), Miles Prince (Epworth Healthcare), Tom Jobling (Epworth Healthcare), Michael Brown (Royal Adelaide Hospital), Jake Shortt (Monash University), Andrew Stephens (Monash University), Miltenyi Biotech (HIMR), and Berry Genomics (Beijing).

Successful Telematics grant application

Professor Gary Richardson and Dr Tali Lang were successful this year with a $50,000 grant awarded from the Telematics Trust. The grant will allow development of an innovative web-based app where patients can report side-effects from chemotherapy. Electronic self-reporting is an innovative app, which allows patients to report any issues in real–time from home. In severe cases this prompts immediate clinical intervention, or in milder cases provides educative material for the self-management of symptoms. The overall aim is to improve patient management and standard of care.

OUR R E S E A RCH Clinical trial program

The department held 57 trials between 1 July 2017 and 30 June 2018. Multiple new chemotherapeutic agents were tested in various tumour types and included immunotherapy agents and targeted therapies, all designed to create personalised patient treatments. Four first-in-human phase 1a oncology trials have started at Cabrini since the beginning of the program in May 2017.

Organoid research program

Co-Investigators: Roger Daly (Monash University), Christina Mitchell (Monash University), Peter Gregory (Cabrini), Paul McMurrick (Cabrini), Helen Abud (Monash University), Antonella Papa (Monash University), Ico Ma (Monash University). Andrew Stephens (Epworth

Development and translation of a novel, dual specific cytotoxic CAR-T cell immunotherapy for the treatment of relapsed ovarian cancer: a tripartite initiative with research, industry and government. The prototype product will be a T cell created by in vitro differentiation of an iPSC derived from a homologous haplotype donor, carrying two or more CARs against cancer targets, and further engineered for enhanced efficacy and safety. Key activities for initiation of a clinical trial will include: development and validation of tech transfer CAR-T cell process to CTPL for GMP clinical manufacturing; completion of preclinical safety and efficacy studies; development and approval of a CTX submission to the TGA; identification of clinical trial sites and investigators.

Data collection

Co-investigators: Joanna Morgan, Karen Taylor, Melissa Vereker, Peter Gibbs (VCCC), Lok Sheau Wen (VCCC), Christine Semira (VCCC), Kathryn Field (VCCC).

Through databases and tumour registries we are collecting information to collate with clinical and translational research to better understand the mechanisms of cancer, better select

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CABRINI MONASH UNIVERSITY DEPARTMENT OF MEDICAL ONCOLOGY – THE SZALMUK FAMILY DEPARTMENT OF MEDICAL ONCOLOGY

patients for appropriate treatment, and audit our results to ensure we maintain the highest standards of care.

• Brightways: A Cabrini breast cancer service database: We have developed the breast cancer database to monitor our cancer services and ensure we provide timely, safe, appropriate and effective treatment. This database is a valuable resource for epidemiological studies, clinical research and clinical trials.

• Treatment of recurrent and advanced colorectal cancer database: A prospective and comprehensive metastatic colorectal registry from 26 sites across Australia, this database is coordinated through BioGrid Australia Ltd (BioGrid). Data is used to analyse treatment outcomes and enhance patient care.

• TABITHA database: This database is a study of the clinical outcomes and analysis of anti-HER2 therapy in treatment of metastatic HER2 positive breast cancer. Jointly initiated by clinicians and BioGrid with support from Roche, it will help to evaluate the presentation, treatment and outcomes of patients with HER2+ metastatic breast cancer managed in routine clinical practice.

Allied health/supportive care research

Co-investigators: Zillan Nieron, Lachlan Terry, Margaret Staples.

Supportive care programs have been established around nutrition and exercise, including a study of the intermittent versus daily energy restriction for weight loss in women receiving chemotherapy treatment for breast cancer. The aims of the study include determining if: • an intermittent diet is more effective for weight loss and changing body composition • if controlled weight loss during chemotherapy alters quality-of-life and distress • changes in metabolic and endocrine biomarkers impact on the success of dietary interventions

Professor Gary Richardson with Mrs Sufang Chen and her daughter Li.

Another study, the evaluation of an exercise-based prehabilitation program on colorectal cancer patients undergoing surgery, is intended to evaluate the impact of a multimodal, exercise-based prehabilitation program on colorectal cancer patients undergoing surgery. The study endpoints focus on cardiopulmonary fitness, anthropometry, quality of life, fatigue and physical function.

Familial cancer research

Co-investigators: Lara Lipton, Yoland Antill, Tess Schenberg, Lynne McKay, Margaret Staples.

Familial cancer research combines clinical and laboratorybased research to identify new hereditary cancer predisposition genes, improve the identification of people with hereditary cancer syndromes, and develop new strategies for cancer risk-management and personalising cancer treatments.

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CABRINI MONASH UNIVERSITY DEPARTMENT OF MEDICAL ONCOLOGY – THE SZALMUK FAMILY DEPARTMENT OF MEDICAL ONCOLOGY

P UB L IC AT ION S

Greystoke A, Steele N, Arkenau HT, Blackhall F, Md Haris N, Lindsay CR, Califano R, Voskoboynik M, Summers Y, So K, Ghiorghiu D, Dymond AW, Hossack S, Plummer R, Dean E. (2017) SELECT-3: a phase I study of selumetinib in combination with platinum-doublet chemotherapy for advanced NSCLC in the first-line setting. Br J Cancer. 117(7):938-946

Abou-Alfa GK, Blanc JF, Miles S, Ganten T, Trojan J, Cebon J, Liem AK, Lipton L, Gupta C, Wu B, Bass M, Hollywood E, Ma J, Bradley M, Litten J, Saltz LB. (2017) Phase II Study of First-Line Trebananib Plus Sorafenib in Patients with Advanced Hepatocellular Carcinoma. Oncologist. 22(7):780-e65

Jayasekara H, English DR, Haydon A, Hodge AM, Lynch BM, Rosty C, Williamson EJ, Clendenning M, Southey MC, Jenkins MA, Room R, Hopper JL, Milne RL, Buchanan DD, Giles GG, MacInnis RJ. (2018) Associations of alcohol intake, smoking, physical activity and obesity with survival following colorectal cancer diagnosis by stage, anatomic site and tumor molecular subtype. Int J Cancer. 142(2):238-250

Adler NR, Wolfe R, Kelly JW, Haydon A, McArthur GA, McLean CA, Mar VJ. (2017) Tumour mutation status and sites of metastasis in patients with cutaneous melanoma.

Br J Cancer. 117(7):1026-1035 Allen P, Gately L, Banks P, Lee AYS, Hamilton G, Tan L, Sim S. (2017) Direct access colonoscopy: impact of intervention on time to colorectal cancer diagnosis and treatment in North West Tasmania. Intern Med J. 47(10):1129-1135 Au L, Turner N, Wong HL, Field K, Lee B, Boadle D, Cooray P, Karikios D, Kosmider S, Lipton L, Nott L, Parente P, Tie J, Tran B, Wong R, Yip D, Shapiro J, Gibbs P. (2018) How accurate are medical oncologists’ impressions of management of metastatic colorectal cancer in Australia? Asia Pac J Clin Oncol. 14(2):e167-e174 Burge M, Semira C, Lee B, Lee M, Kosmider S, Wong R, Shapiro J, Ma B, Dean AP, Zimet AS, Steel SA, Lok SW, Torres J, Eastgate M, Wong HL, Gibbs P. (2018) Previous Bevacizumab and Efficacy of Later Anti-Epidermal Growth Factor Receptor Antibodies in Metastatic Colorectal Cancer: Results From a Large International Registry. Clin Colorectal Cancer.

S1533-0028(18)30113-0.

Eggermont AMM, Blank CU, Mandala M, Long GV, Atkinson V, Dalle S, Haydon A, Lichinitser M, Khattak A, Carlino MS, Sandhu S, Larkin J, Puig S, Ascierto PA, Rutkowski P, Schadendorf D, Koornstra R, Hernandez-Aya L, Maio M, van den Eertwegh AJM, Grob JJ, Gutzmer R, Jamal R, Lorigan P, Ibrahim N, Marreaud S, van Akkooi ACJ, Suciu S, Robert C. (2018) Adjuvant Pembrolizumab versus Placebo in Resected Stage III Melanoma. N Engl J Med. 378(19):1789-1801 Gately L, McLachlan SA, Dowling A, Philip J. (2017) Life beyond a diagnosis of glioblastoma: a systematic review of the literature. J Cancer Surviv. 11(4):447-452.

Lam M, Tran B, Beck S, Tie J, Herath D, Whittle J, Kwan EM, Fox SB, Fellowes A, Ananda S, Lipton L, Gibbs P, Rosenthal MA, Desai J. (2018) Precision oncology using a clinician-directed, tailored approach to molecular profiling. Asia Pac J Clin Oncol.

14(1):84-90 Lee B, Wong HL, Tacey M, Tie J, Wong R, Lee M, Nott L, Shapiro J, Jennens R, Turner N, Tran B, Ananda S, Yip D, Richardson G, Parente P, Lim L, Stefanou G, Burge M, Iddawela M, Power J, Gibbs P. (2017) The impact of bevacizumab in metastatic colorectal cancer with an intact primary tumor: Results from a large prospective cohort study.

Asia Pac J Clin Oncol. 13(4):314-321 Loke LPY, Chen TYT, Lewis CR, Ward RL, Rushton SA, Shapiro JD. (2018) Quality and impact of eviQ Cancer Treatments Online (www.eviq.org.au): the medical oncologist’s perspective. Asia Pac J Clin Oncol. 14(2):e203-e210 Long GV, Hauschild A, Santinami M, Atkinson V, Mandalà M, Chiarion-Sileni V, Larkin J, Nyakas M, Dutriaux C, Haydon A, Robert C, Mortier L, Schachter J, Schadendorf D, Lesimple T, Plummer R, Ji R, Zhang P, Mookerjee B, Legos J, Kefford R, Dummer R, Kirkwood JM. (2017) Adjuvant Dabrafenib plus Trametinib in Stage III BRAF-Mutated Melanoma. N Engl J Med. 377(19):1813-1823 Luen S, Wong SW, Mar V, Kelly JW, McLean C, McArthur GA, Haydon A. (2018) Primary Tumor Thickness is a Prognostic Factor in Stage IV Melanoma: A Retrospective Study of Primary Tumor Characteristics. Am J Clin Oncol. 41(1):90-94

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CABRINI MONASH UNIVERSITY DEPARTMENT OF MEDICAL ONCOLOGY – THE SZALMUK FAMILY DEPARTMENT OF MEDICAL ONCOLOGY

Lang T, Lee JPW, Elgass K, Pinar AA, Tate MD, Aitken EH, Fan H, Creed SJ, Deen NS, Traore DAK, Mueller I, Stanisic D, Baiwog FS, Skene C, Wilce MCJ, Mansell A, Morand EF, Harris J. (2018) Macrophage migration inhibitory factor is required for NLRP3 inflammasome activation. Nature Commun. 9(1):2223.

Vincent FB, Lang T, Kandane-Rathnayake R, Downie-Doyle S, Morand EF, Rischmueller M. (2018) Serum and Urinary Macrophage Migration Inhibitory Factor (MIF) in Primary Sjögren’s Syndrome. Joint Bone Spine. doi: 10.1016/j. jbspin.2018.07.001.

Mende R, Vincent FB, Kandane-Rathnayake R, Koelmeyer R, Lin E, Chang J, Hoi AY, Morand EF, Harris J, Lang T. (2018) Analysis of Serum Interleukin (IL)-1β and IL-18 in Systemic Lupus Erythematosus. Front Immunol. 9:1250

G RANTS H ELD

Parakh S, Park JJ, Mendis S, Rai R, Xu W, Lo S, Drummond M, Rowe C, Wong A, McArthur G, Haydon A, Andrews MC, Cebon J, Guminski A, Kefford RF, Long GV, Menzies AM, Klein O, Carlino MS. (2017) Efficacy of anti-PD-1 therapy in patients with melanoma brain metastases. Br J Cancer.

116(12):1558-1563

Telematics Trust ‘Patient-Self Reporting Outcomes of Chemotherapy App’ (2018-19) $50,000 Richardson G (CIA), Lang T (CIB) Peter Meese Memorial Oncology Nursing Research Grant ‘Patient-Self Reported Outcomes of Toxicity Experienced During Chemotherapy” (2018-19) $15,000 Hastings J (CIA), Lang T (CIB), Richardson G (CIC) Beverley Barlow Genetic Cancer Research Grant ‘Modelling Human Breast Cancer Disease Using an Experimental in-vitro Organoid Culture System’ (2018-19) $100,000 Richardson G (CIA)

Pittman K, Antill YC, Goldrick A, Goh J, de Boer RH. (2017) Denosumab: Prevention and management of hypocalcemia, osteonecrosis of the jaw and atypical fractures. Asia Pac J Clin Oncol. 13(4):266-276 Tang M, Price TJ, Shapiro J, Gibbs P, Haller DG, Arnold D, Peeters M, Segelov E, Roy A, Tebbutt N, Pavlakis N, Karapetis C, Burge M. (2018) Adjuvant therapy for resected colon cancer 2017, including the IDEA analysis. Expert Rev Anticancer Ther.

18(4):339-349

John Sutherland Hamling Breast Cancer Research Grant Dietary Intervention in Patients Receiving Adjuvant Chemotherapy for Early Stage Breast Cancer (2016-18) $100,000 Richardson G (CIA), Nieron Z (CIB)

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CABRINI MONASH UNIVERSITY DEPARTMENT OF SURGERY – THE FRÖHLICH WEST CHAIR OF SURGERY

Over

$3.7m

in grant funding held

05

publications

21

presentations

01

clinical trial

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CABRINI MONASH UNIVERSITY DEPARTMENT OF SURGERY – THE FRÖHLICH WEST CHAIR OF SURGERY

Bowel cancer is a leading cause of cancer death in Australia and has one of the highest (and increasing) incidence rates in the world. We are committed to highly innovative research, medical advances and greater public awareness to help patients, families and clinicians beat bowel cancer.

Through the Cabrini Monash University database, our department incorporates a number of clinical research projects. These outline which of our patients are at highest risk of developing complications, which patients are at risk of relapse of their cancer and how we can modify treatment to improve outcomes for patients. Together with clinical governance at Cabrini, we now have a quality assurance loop to ensure that not only are the overall results for treatment of bowel cancer at Cabrini of a world standard, but the outcome for each individual surgeon is carefully scrutinised and reported.

H E A D: A S S O C I AT E P ROF E S S OR PAU L MC MU R R I C K

R E S E A RCH PRO G RA M S

The department is involved in a great range of research projects on all aspects of colorectal cancer, from investigating genes and proteins involved in cancer development to multicentre clinical research trials. There are three streams of clinical research within the department: 1) Screening and prevention of bowel cancer

and scientists. Patient-reported outcome measures brings the opinion and the experience of individual patients into the loop, allowing aggregation of vital information from questionnaires and outcome measurements reported by the patients themselves. Only by using PROMS can we truly be certain of the quality of life and the satisfaction patients experience after their treatment.

Individualised medicine

2) Perioperative care (including surgical techniques) of bowel cancer

Through the twin projects of organoids and tissue microarray, we are now able to match the individual tumour and DNA markers of patients with bowel cancer to their clinical outcomes and the success of their treatment. This has the capacity to provide individualised or personalised medicine for each patient being treated for bowel cancer in future.

3) Patient outcomes following treatment for bowel cancer The department is also involved in a number of external collaborations.

Patient Reported Outcome Measures (PROMS)

Traditionally, research into treatment of bowel cancer has hinged on reports of outcomes made by the treating clinicians

• Colorectal organoids are three-dimensional cultures of cells derived from healthy patient tissues and tumours.

We are establishing tumour-derived organoids from

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CABRINI MONASH UNIVERSITY DEPARTMENT OF SURGERY – THE FRÖHLICH WEST CHAIR OF SURGERY

colorectal cancer (CRC) patients for the development of drug response assays and testing routine cancer therapies, including radiotherapy and chemotherapy. Ultimately, this project aims to develop a pre-clinical test to predict treatment outcomes for CRC patients, before they undergo therapy.

• Tissue microarray is a technique in the field of pathology which allows high throughput identification of prognostic and predictive biomarkers achieving accelerated research transition from bench to bedside.

Researchers: Paul McMurrick, Simon Wilkins, Boris Ruggiero, Karen Oliva Bowel cancer screening is suggested for the over 50s. Recent literature has suggested an increase in recent years of cases in the under 50s. This project aims to: • investigate why the under 50s were excluded from screening in previous guidelines

An anastomosis during colorectal cancer surgery can be performed with a stapler or be hand-sewn. This project aims to assess whether oversewing staple lines may reduce anastomotic complications after colorectal cancer surgery.

This project seeks to add a new dimension to the current database by including patient reported outcomes. A series of questions will be included in the database. The questions specific to colorectal patients have been designed by an international collaboration (ICHOMS). This project has completed a retrospective study of existing cancer patients with a prospective study due to commence in late 2018. The project has been funded by a Collie Foundation grant of $40,000.

Collaborative research project – development of a colorectal cancer tissue (CRC) microarray

• analyse the incidence of under 50s cases in the departmental database and within databases and registries across Australia

Researchers: Ali Baqar, Simon Wilkins, Karen Oliva, Paul McMurrick

Carcinoembryonic antigen (CEA) is associated with colorectal cancer and a blood test is widely available to detect it. This study aims to clarify its role in predicting long-term outcomes in patients who have colorectal cancer.

Researchers: Christine Koulis, Simon Wilkins, Karen Oliva, Paul McMurrick

Screening and prevention – analysis of colorectal cancer in the under 50s in Australia

Perioperative care – over-sewing staple lines and the relationship to anastomotic complications in colorectal cancer resections

Researchers: Ali Baqar, Angus Lee, Simon Wilkins, Karen Oliva, Paul McMurrick

Patient reported outcome measures

OUR R E S E A RCH

This project will also conduct a cost-benefit analysis of screening in the under 50s group and identify whether an increase in incidence warrants a change in the guidelines.

Patient outcomes – prognostic significance of preoperative CEA value in stages 1 and 2 colon cancer

Researchers: Christine Koulis, Simon Wilkins, Karen Oliva, Camilla Cohen, Bill Downey, Paul McMurrick This project proposes the transfer of 2000 tumour and normal tissue specimens of patients who have undergone surgical treatment of CRC to tissue microarray (TMA) blocks. These tumour specimens are linked to the departmental database with 99 per cent clinician-led follow-up. The project will encompass many clinical departments of Cabrini including surgery, radiology, oncology and pathology. The resultant TMA blocks will be tested in collaboration with laboratories, including the Abud lab, Department of Anatomy and Developmental Biology, Monash University. This project is partly funded by a VCA Grant awarded in 2016 ($2m) and the Margaret Walkom Trust ($30,000 in 2017 and $30,000 in 2018). Assembly of the first TMA blocks featuring patients with stage 4 colorectal cancer were completed in May 2017. Assembly of further blocks is currently ongoing and immunohistochemistry testing of the TMAs has started.

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CABRINI MONASH UNIVERSITY DEPARTMENT OF SURGERY – THE FRÖHLICH WEST CHAIR OF SURGERY

intestinal tissue and colorectal tumours. The cultures will be characterised for their cellular composition and molecular phenotype.

Modelling human intestinal disease using in vitro organoid culture

Researcher: Rebekah Engel, Genevieve Kerr, Thierry Jarde, Christine Koulis, Simon Wilkins, Karen Oliva, Helen Abud, Paul McMurrick

A three-year $300,000 grant has been provided by the Collie Foundation in addition to a Monash University faculty strategic grant of $49,810, and laboratory work is underway. A new member of staff was recruited in 2016 to work on this project and more than 95 organoids have been grown.

A collaborative project with the Department of Anatomy and Developmental Biology, Monash University, to establish a panel of human organoid cultures derived from normal

PUBLICATIONS

Margaret Walkom Trust ‘Genetic Testing of Colorectal cancer’ (2018-19), $30,000, Koulis C, Wilkins S, McMurrick P.

Abbott SC, Stevenson RL, Bell S, Clark D, Merrie A, Hayes J, Ganesh S, Heriot AG, Warrier SK. (2018) An assessment of an Australasian pathway for the introduction of transanal total mesorectal excision (taTME). Colorectal Disease 20(1): O1-O6

Collie Foundation ‘Patient reported outcome measures’, $40,000, Oliva K, Wilkins S, McMurrick P.

Adamina M, Buchs NC, Penna M, Hompes R, on behalf of the St.Gallen Colorectal Consensus Expert Group (Inc. Bell S.) (2018) St.Gallen consensus on safe implementation of transanal total mesorectal excision. Surgical Endoscopy 32(3):1091-1103 Bell S, Kong JC, Wale R, Staples M, Oliva K, Wilkins S, McMurrick PJ, Warrier SK. (2018) The effect of increasing body mass index on laparoscopic surgery for colon and rectal cancer. Colorectal Disease doi 10.1111/codi.14107 Grant M, Haydon A, Au L, Wilkins S, Oliva K, Segelov E, Antill Y, Carne P, Ranchod P, Polglase A, Farmer C, Chin M, Wale R, Simpson P, Bell S, Skinner S, McMurrick P, Shapiro J. (2018) Immunohistochemistry testing for mismatch repair deficiency in Stage 2 colon cancer: a cohort study of two cancer centres. International Journal of Surgery 51:71-75 Parkin C, Bell S, Mirbagheri N. (2018) Colorectal Cancer Screening in Australia - An Update. Australian Journal of General Practitioners. Accepted for publication

Collie Foundation ‘Human Organoids’ (2017-19), $300,000, Wilkins S, McMurrick P. Margaret Walkom Trust ‘Tissue Micro Array’ (2017-18), $30,000, Wilkins S, McMurrick P. Urquhart Charitable Fund ‘Patient education with a view to expanding uptake of the National Bowel Cancer Screening Program’ (2017-18), $14,490, McMurrick P. Victorian Cancer Agency ‘Super-enhancer templated RNAs as predictive biomarkers of BET inhibitor sensitivity in prostate and colorectal cancer’ (2016-18), $2m, Firestein R, Azad A, Abud H, McMurrick P, Risbridger G, Wilkins S. Cancer Australia ‘Translating Colorectal Cancer Organoids into Patient Care’ (2018-20), $597,557, Abud HE, Worthley D, Burgess A, McMurrick P, Firestein R, Gibbs P, Clevers H, Price T, Padbury R, Hewett P.

GRANTS HELD

NHMRC Project Grant ‘Role of Snail proteins in mediating intestinal stem cell identity’ (2016-19), $646,698, Abud H, Hime G, Jones L, McMurrick P.

Cabrini Foundation Clinical Grant Round ‘Using Patientderived organoids to guide the ‘watch and wait’ nonsurgical approach for rectal cancer’ (2018-19), $30,000, Engel R, McMurrick P, Abud H.

Monash Faculty of Medicine Platform Access Grant ‘Characterisation of transcriptional alterations controlling colorectal cancer stem cell maintenance’ (2018), $11,500, Jarde T, Abud H, McMurrick P.

– 41 –

CABRINI MONASH UNIVERSITY DEPARTMENT OF SURGERY – THE FRÖHLICH WEST CHAIR OF SURGERY

ORGANOIDS: POWERFUL WAY TO PROBE BOWEL CANCER BIOLOGY

– 42 –

CABRINI MONASH UNIVERSITY DEPARTMENT OF SURGERY – THE FRÖHLICH WEST CHAIR OF SURGERY

Colorectal cancer is the third most commonly diagnosed cancer and the second leading cause of cancer death in Australia.

I

n order to increase survival rates for colorectal cancer, we need to apply current therapies effectively and develop new treatment targets. A personalised cancer medicine approach could transform therapeutic management of disease through individualised treatment strategies tailored for each patient, providing the greatest possible benefit with the fewest side-effects.

Our research aims to predict patient sensitivity to common treatment regimens using a three-dimensional tissue model of a patients’ tumour, called organoids. Organoids are essentially mini-tumours that can be grown in a laboratory dish from tissue biopsies, and mimic the complex features of the tissue from which they are derived. This powerful research tool can be used to test common cancer therapeutics to determine if a patient is likely to respond to treatment. This project was recently awarded a Cancer Australia grant, supporting our collaborative efforts with local and interstate research teams. This research has also been presented at both national and international meetings, receiving a travel award for scientific excellence at the 2018 International Society for Stem Cell Research meeting.

Another exciting project, led by postdoctoral researcher Dr Rebekah Engel, focuses on predicting complete

pathological response for patients who have rectal cancer.

A significant proportion of patients who have rectal cancer (15 to 25 per cent) who are treated with chemoradiotherapy achieve a pathologic complete response, with histological examination reporting no residual tumour. In the absence of residual tumour, these patients could be spared from radical surgery to remove all or part of the rectum. The impact on quality of life following surgery is significant, with patients experiencing a range of dysfunction and colostomy complications.

This project aims to predict which patients are likely to achieve a complete pathological response through chemotherapy and radiotherapy-sensitivity testing on their own tumour-derived organoids. Recently awarded a Cabrini Foundation research grant, this research has potential to be practice-changing, providing clinicians with a technique to identify patients who could be managed through a non-surgical ‘watch and wait’ approach, ultimately sparing these patients from unnecessary surgery, preserving organ function and improving quality of life.

The colorectal cancer organoid program is a collaborative effort between the Cabrini Monash University Department of Surgery led by Associate Professor Paul McMurrick and the Monash Biomedicine Discovery Institute’s Epithelial Regeneration Laboratory led by Associate Professor Helen Abud.

Opposite page: Dr Rebekah Engel is a Postdoctoral Research Fellow with the Cabrini Monash University Department of Surgery. She is pictured examining organoids.

– 43 –

LET’S BEAT BOWEL CANCER

Let’s Beat Bowel Cancer (LBBC) is a health promotion initiative of Cabrini. Our mission is to significantly lower deaths related to bowel cancer through prevention and research.

their family and friends. The Golf Classic Winner’s Award is now named in honour of the late Andrew Florent, former international tennis player and supporter of Let’s Beat Bowel Cancer, who tragically passed away in 2016.

Our work mitigates suffering and ultimately, we hope will help to find a cure for bowel cancer. Through the LBBC initiative, we are campaigning for awareness, prevention and cure of bowel cancer.

G RANT SUP P ORT AND PATI E NT EF F I C ACY

WH Y IS B OWE L C ANC E R A N I M P O RTA NT I S S UE ?

Bowel cancer is a major public health issue. Australia has one of the highest rates of bowel cancer in the world and the incidence has continued to rise, particularly in younger patients. It is the second most common type of newly diagnosed cancer in Australia with almost 15,000 Australians diagnosed annually. It is Australia’s second biggest cancer killer behind lung cancer, affecting the lives of 80 Australians every week, both men and women almost equally. The risk of bowel cancer rises sharply and progressively from age 50, although incidence rates in younger people are also rising.

EDU C AT ION

LBBC, through its website, social media and public lectures, continues to promote the national bowel cancer screening program among adult Australians. We also promote primary prevention through education regarding awareness of symptoms and healthy diet and exercise.

Recently we have been involved in an important initiative with the Victorian Department of Health and Human Services, creating an education series for general practitioners in Victoria to help promote the bowel cancer screening program. Although most Australians aged 50 to 75 are offered faecal occult blood testing, uptake remains at less than 40 per cent in Victoria. This needs to be improved if we are to save lives.

OUR GO L F DAY

The LBBC Golf Classic is held annually to encourage fundraising and public awareness through our committee headed by Des Jackson. More than 200 people attend at Kingston Heath Golf Club each year and apart from raising funds, the event has been important in improving uptake of the screening program among participants, as well as

LBBC has been a strong supporter of research initiatives and grant applications by the Cabrini Monash University Department of Surgery, where our education and research focus is based. Members of our committee have acted as patient advocates for grant applications and continue to support our fundraising efforts.

RE SE ARC H P RO G RA M

LBBC supports the research efforts of the Cabrini Monash University Department of Surgery led by Associate Professor Paul McMurrick. Our research initiatives include the following: • Who is listening to the patients? Patient-reported outcome measures are a vital new area of research related to the treatment of bowel cancer. Rather than just measuring outcomes as reported by treating clinicians or researchers, patients are now participating in this process by completing online questionnaires about their perspective on the success of their treatment, and return to full social and physical activities. Only through support of patient reported outcome measures can we accurately ascertain the success of treatment through the eyes of the patients themselves.

Investigators: Dr Christine Koulis, Karen Oliva, Dr Simon Wilkins.

• How safe can our surgery be? Our research includes important investigations of improving the safety of techniques used in removing cancers and rejoining the bowel to avoid colostomy bags. Data from our Cabrini Monash colorectal neoplasia database has been critically important in ascertaining whether sewing or stapling joins in the bowel is the safest way of ensuring a good outcome for patients and avoiding colostomy bags. The Cabrini University Monash Department of Surgery now participates in a quality assurance program and ensures the safety of treatment for all patients at Cabrini hospital.

We have been successful in identifying patient factors

– 44 –

LET’S BEAT BOWEL CANCER

Top left: Participants in the 2017 LBBC Golf Day. Top right: From left (back): Melissa Monks (LBBC Ambassador), Rob William and Matt Holmes. Front: Des Jackson, Sue Parkes (Director, Cabrini Foundation), Geoff Stansen (Chair of the LBBC Committee) and Cameron Smith. Bottom left: Associate Professor Paul McMurrick addresses guests at the 2017 LBBC Golf Day. Bottom right: Emeritus Professor Adrian Polglase (far right), who has been a strong advocate for bowel cancer awareness and research, pictured at a valedictory dinner for retiring doctors.

that increase the risk of adverse outcome after surgery, such as diabetes and immune suppression, to allow forward planning to minimise the risk of complications.

Investigators: Mr Ali Baqar, Dr Simon Wilkins, Dr Christine Koulis, Karen Oliva.

• Individualised patient treatments. Through our organoid and tissue microarray programs, we have been able to match the clinical outcomes data from our Cabrini Monash colorectal neoplasia database with specimens of tumour tissue and DNA, to investigate the role of predictive paradigms for individual patients and individualised treatment. The organoid program takes microscopic biopsies of tissue from patients being treated for bowel cancer and allows their tissue to be

grown in a laboratory for investigation while the patient is still recovering from their surgery. The tissue microarray program allows us to investigate tumours from all patients who have undergone treatment for bowel cancer at Cabrini since February 2010, correlating their treatment outcome with tissue from their tumours.

Investigators: Dr Rebekah Engel, Dr Christine Koulis, Dr Simon Wilkins, Karen Oliva.

E NG AG I NG OUR PATI E NTS

Many of our bowel cancer patients from Cabrini have become active participants and supporters of LBBC and assist us regularly with community education and fundraising programs.

– 45 –

SZALMUK FAMILY PSYCHO-ONCOLOGY RESEARCH UNIT

Almost

$275,000 in grant funding held

19

publications

12

presentations

05

clinical trial

– 46 –

SZALMUK FAMILY PSYCHO-ONCOLOGY RESEARCH UNIT

The Szalmuk Family Psycho-oncology Research Unit strives to achieve clinical research outcomes that make a difference to people’s lives. Our focus is researching psychosocial interventions to support adjustment in people affected by cancer.

Our research covers the full cancer experience from diagnosis to treatment and survivorship. Our research groups focus on psycho-oncology endeavours to tackle real-world clinical challenges that patients meet when diagnosed with cancer. Collaboration has been crucial to advance this agenda.

On the international stage, our studies of demoralisation (a form of poor coping involving lowered morale) link our group to researchers in Canada, Germany, Taiwan, USA and other countries. Nationally, our collaboration with the Psycho-Oncology Cooperative Research Group of Australia has sought to develop the implementation of shared-care treatment for clinical depression, seeking to grow the psycho-oncology workforce. Locally, we have steadily developed a targeted brief psychological treatment, which we call meaning and purpose (map) therapy to alleviate existential distress.

We also actively collaborate with the Palliative and Supportive Care Research Group through monthly team meetings. We support their studies of spirituality in cancer care led by Associate Professor Clare O’Callaghan, and of advanced care planning led by Associate Professor Natasha Michael. We support projects undertaken by trainee registrars and University of Notre Dame students involved with the palliative care program.

H E A D: P ROF E S S OR DAV I D K I S SA N E AC

H IGH L IGH TS

Grant support from DHHS to launch the shared-care model to treat depression in the community

Delivery of the Dame Cecily Saunders lecture at Kings College

Professor David Kissane AC was honored to be invited by Professor Irene Higginson to deliver this annual lecture on his studies of demoralisation among palliative care patients. The lecture was broadcast live to nine countries.

This grant culminates two years’ work with the PsychoOncology Cooperative Research Group of Australia to develop a collaborative care model for community-based psychologists to be trained to support patients with cancer and treat their clinical depression.

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SZALMUK FAMILY PSYCHO-ONCOLOGY RESEARCH UNIT

Australia Day Awards 2018

Studies of demoralisation in palliative care

Professor Kissane AC was made a Companion in the General Division of the Order of Australia for his work in developing the disciplines of psycho-oncology and palliative care.

Researchers: Kissane DW (PI), Bobevski I, Michael N.

OUR R E S E A RCH Innovative shared care model for treating cancer-related depression

Researchers: Kissane DW (PI), Richardson G, Wong CW, Poon P, Sherwell S. This pilot program aims to support cancer patients with clinical depression by testing a model of shared care, which involves hospital-based psycho-oncology/psychiatry staff, communitybased clinical psychologists and GPs. It builds upon preliminary work completed by the Psycho-Oncology Cooperative Research Group’s (POCOG) Scientific Advisory Committee.

In this collaborative care program, we will train and supervise a cohort of community psychologists to deliver a manualised cognitive-coping model of therapy for clinical depression, while in parallel training and supervising the patients’ corresponding GPs in the application of medication algorithms that have also been developed by POCOG.

Demoralisation is a form of maladaptive coping in which morale and hope can be lost. We have refined a quantitative measure of demoralisation and studied clinicians’ perceptions of its utility as a clinical diagnosis in palliative care. Alongside German collaborators, we recently undertook a latent class analysis of a large cohort of cancer patients to show that, while severe demoralisation was comorbid with depressive and anxiety states, moderate demoralisation represented the phenomenology of adjustment disorder as a discrete construct.

We now plan to develop and validate a structured clinical diagnostic interview (a categorical process) to diagnose demoralisation against patients whose score on the dimensional measure is elevated. This body of work lays the evidence base to have demoralisation accepted as a clinical diagnosis.

Randomised controlled trial of meaning and purpose therapy in patients who have advanced cancer

Researchers: Kissane DW (PI), Lethborg C, Brooker J, Shapiro J, Michael, N, Brady B, Seah D, Bobevski I. Advanced cancer can create an existential crisis that potentially challenges a person’s sense of the meaning and value of life. MAP therapy is designed to integrate meaningbased coping with the sense of coherence that a person can make of their life, empowering them to live life out fully with true value, hope, purpose and determination. We have piloted and refined this therapy, initially testing four sessions which proved too brief, and then testing six sessions, which established the feasibility and acceptability of the intervention and showed clear benefits. We now embark on a formal RCT to examine the efficacy of MAP therapy in alleviating psychological and existential distress.

– 48 –

P UB LI C ATI ONS

Bobevski I, Kissane DW, Vehling S, McKenzie DP, Glaesmer H, Mehnert A (2018) Latent class analysis differentiation of adjustment disorder and demoralisation, more severe depressive and anxiety disorders, and somatic symptoms in patients with cancer. Psycho-Oncology. In press Creighton A, Kissane DW, Davison T. (2018) The Factors Associated with Anxiety Symptom Severity in Older Adults Living in Nursing Homes and Other Residential Aged Care Facilities. Journal of Aging and Health. doi: 10.1177/0898264318767781 Graham A, Brooker J, Hasking P, Clarke D, Meadows G. (2017) Receipt and perceived helpfulness of mental illness information: Findings from the Australian Survey of Mental Health and Wellbeing. Health Communication. 20:1-7 Grassi L, Costantini A, Kissane DW, Brunetti S, Caruso R, Piazzza G, Marchetti P, Sabato S, Nanni MG. (2017) The factor structure and use of the Demoralisation Scale in Italian non-advanced cancer patients. Psycho-Oncology. 26(11): 1965-1971

SZALMUK FAMILY PSYCHO-ONCOLOGY RESEARCH UNIT

Grossman C, Brooker J, Michael N, Kissane D. (2018) Death anxiety interventions in patients with advanced cancer: A systematic review. Palliative Medicine. 32(1): 172-184 Hartung TJ, Kissane DW, Mehnert A. (2018) COMSIL Communication Training in Oncology – Adaptation to German Cancer Care Settings in Goerling U, Mehnert A. Eds. Psycho-Oncology. 210:191-205, Springer, Cham, Switzerland.

Vehling S, Kissane DW, Lo C, Glaesmer H, Hartung TJ, Rodin G, Mehnert A. (2017) The association of demoralisation with mental disorders and suicidal ideation in patients with cancer.

Cancer. 123(17): 3394-3401 Warren N, Melrose D, Brooker J, Burney S. (2018) Psychosocial distress in women with gynecological cancer. Journal of Health Psychology. 23(7): 893-904

Kissane DW. (2017) Under-resourced and under-developed family-centred care in palliative care. Palliative Medicine. 31(3): 195-196

Watson M, Kissane DW, Editors (2017) Psycho-Oncology Care Companion Guides for Clinicians I: The management of clinical depression and anxiety. Oxford University Press, New York.

Kissane DW. (2018) Jimmie C. Holland, MD: IN Memoriam (1928-2017). Cancer Research, 78:2147-2148

Watts KJ, Butow PN, Goldstein D, Hale S, Perry A, Aranda SK, Kissane DW. (2018) Perspectives of oncology nurses and oncologists regarding barriers to working with patients from a minority background: systemic issues and working with interpreters. European Journal of Cancer Care. 27(2):e12758

Kissane DW. (2018) Psychosocial care of families in palliative care. Ch 7 in Lloyd-Williams Mari. Ed. Psychosocial Issues in Palliative Care – A Community Based Approach For Life Limiting Illness, pp. 121-135. Oxford University press, UK. Manne SL, Myers-Virtue S, Darabos K, Ozga M, Heckman CJ, Kissane DW, Rotter D. (2017) Emotional Processing During Psychotherapy Among Women Newly Diagnosed with Gynecological Cancers. Palliative and Supportive Care. 15(4): 405-416 Sanjida S, Mulvogue K, Shaw J, Couper J, Kissane DW, Pearson, S, Price MA, Janda M. (2018) What type and dose of antidepressants are cancer and non-cancer inpatients being prescribed: a retrospective case-control study at an Australian tertiary hospital. Supportive Care in Cancer. 26(2): 625-634 Schuler TA, Zaider TI, Li Y, Masterson M, McDonnell GA, Hichenberg S, Loeb R, Kissane DW. (2017) Perceived family functioning predicts baseline psychosocial characteristics in US participants of a family-focused grief therapy trial. J Pain and Symptom Management. 54(1): 126-131 Shand L, Brooker J, Burney S, Fletcher J, Ricciardelli L. (2018) Psychosocial factors associated with posttraumatic stress and growth in Australian women with ovarian cancer. Journal of Psychosocial Oncology. 4:1-14

Yuen E, Knight T, Dodson S, Chirgwin J, Busija L, Ricciardelli L, Burney S, Parente P, Livingston, P. (2018) Measuring cancer caregiver health literacy: Validation of the Health Literacy of Caregivers Scale-Cancer (HLCS-C) in an Australian population.

Health and Social Care in the Community. 26(3): 330-344 Yuen E, Knight T, Ricciardelli L, Burney S. (2018) Health literacy of caregivers of adult care recipients: A systematic scoping review. Health & Social Care in the Community. 26(2): e191-e206 G RANTS H ELD

Department of Health and Human Services Grant. ‘Innovative shared care model for treating cancer-related depression’ (2018-19), $224,804, Kissane DW (CI), Richardson G, Wong CW, Poon P, Sherwell S. Doreen Johnson Oncology Research Grant. ‘Meaning and Purpose (MaP) Therapy in Advanced Cancer Patients: A Multi-site Randomised Controlled Trial’ (2018-19), $50,000, Kissane DW (CI), Michael N, Shapiro J, Brady B, Seah D, Brooker J, Bobe

– 49 –

PALLIATIVE AND SUPPORTIVE CARE RESEARCH

Almost

$80,000

in grant funding held

10

publications

17

presentations

– 50 –

PALLIATIVE AND SUPPORTIVE CARE RESEARCH

Palliative and supportive care promotes dignity in care by helping patients and families find comfort and meaning in their living.

We strive to further research, develop robust evaluations and interventions, and partner collaboratively to ensure benefit to those who deserve the best care possible as they face their illness. Our research on pancreatic cancer and Palliative Care Outcomes Collaboration (PCOC) data has provided valuable knowledge on the current palliative care clinical and quality outcomes, and identified areas for service improvement and development. We anticipate the findings of our spirituality study will have direct translational benefit to palliative care services as this is the first study of its kind to be undertaken in Australia.

H E A D: A S S O C I AT E P ROF E S S OR N ATA S H A M I C H A E L

H IGH L IGH TS OF T HE Y E A R

OUR RE SE ARC H

• We have fostered multisite collaborations, strengthening our relationships with St Vincent’s Health, Eastern Palliative Care, the University of Notre Dame and Catholic Health Australia.

Timing of palliative care referral and aggressive end-of-life care in pancreatic cancer. A retrospective, single-center observational study

• We are particularly proud of our introduction of the Schwartz Rounds to Cabrini, recognising Cabrini as a Schwartz Centre for Compassionate Care.

• We continue to invest in teaching and training of students from Monash University and the University of Notre Dame, as well as advanced trainees in palliative medicine and geriatrics. We are participating in assessments and examinations, working closely with training bodies and specialist colleges.

Researchers: Michael N, Shapiro J, Beale G, O’Callaghan C, De Silva W, Hiscock R. Pancreatic cancer is a diagnosis associated with a poor prognosis. We completed a retrospective cohort analysis of end-of-life care outcomes of patients diagnosed with pancreatic cancer who died between 2012 and 2016, benchmarking against key indicators of aggressive care in the last 30 days of life. Of the 278 eligible deaths, 67.3 per cent were categorised as receiving a late referral to palliative care (less

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PALLIATIVE AND SUPPORTIVE CARE RESEARCH

than three months before death). Those with late referrals were more likely to present to the emergency department and acute hospital particularly for symptom management and complications of cancer. More than half of the patients died in an inpatient palliative care unit.

Exploring the knowledge and attitudes of euthanasia and physician-assisted dying (EPAD) among ethnic minority groups

Researchers: Michael N (PI), Ng A, O’Callaghan C, Kissane D, Mendz G. Our research aims to explore the knowledge and attitudes of the four minority groups: Chinese, Indian, Greek and Italian on EPAD. Our primary hypothesis is that the majority of people from these minority groups will not understand what constitutes EPAD. Understanding spiritual encounters and requirements of patients and caregivers with an incurable, serious illness

Researchers: O’Callaghan C, Brooker J, De Silva W, Clayton J, Weltz M, Hiscock R, Seah D, Michael, N. Our study will be the first Australian study examining the spiritual well-being, concerns, and requirements of patients

Associate Professor Clare O’Callaghan is Senior Research Associate with the Palliative and Supportive Care Research Unit.

with incurable, serious illnesses, and their views about spiritual and/or religious support received in healthcare. Findings, based on what matters to patients, will be used to maintain and/or improve Cabrini’s spiritual care and religious activity, including determining whether any specific religious or nonreligious subgroup requires additional support.

Compassionate Professional Caregivers Program: Development and implementation of the Schwartz Rounds Program at Cabrini

Researchers: Michael N, O’Callaghan C, Melia A, Morton N. This study will examine the feasibility of developing and implementing Schwartz Rounds at Cabrini. Schwartz rounds are a unique, multidisciplinary forum where clinical caregivers discuss and process difficult emotional and social issues, which arise when caring for patients and their families. Other institutions have shown the Schwartz rounds to have a unique and profound impact on those involved. Participants have reported decreased feelings of stress and isolation, better insight into emotional and social aspects of patient care, an increased ability to feel and demonstrate compassion towards patients and overall increased readiness to respond to patients’ and families’ needs.

Associate Professor Natasha Michael, Head of the Palliative and Supportive Care Research Unit, with Julian McMahon at Research Week 2017.

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PALLIATIVE AND SUPPORTIVE CARE RESEARCH

Pereira-Salgado, A, Mader, M, O’Callaghan, C, Boyd, L. (2018) Evaluation of a website supporting sensitive religious and cultural advance care planning: ACPTalk. JMIR Research Protocols. 7(4): e78

P U B L IC AT ION S

Blaschke S, O’Callaghan C, Schofield P. (2017). Identifying opportunities for nature engagement in cancer care practice and design: protocol for four-round modified electronic Delphi. BMJ Open. 7(3):e013527

Pereira-Salgado A, Mader P, O’Callaghan C, Staples M, Boyd L. (2017) Religious leaders’ conceptualisation of advance care planning: a secondary analysis of interviews from Buddhist Christian, Hindu, Islamic, Jewish, Sikh and Bahá’í leaders.

BMC Palliative Care. 16:79

Blaschke S, O’Callaghan C, Schofield P. (2017) Nature-based care opportunities and barriers in oncology contexts: A modified international e-Delphi survey. BMJ Open 7(10):e017456

Ugalde A, O’Callaghan C, Byard C, Brean S, MacKay J, Boltong A, Daroven S, Lawson S, Parente P, Michael N, Livingston P. (2018) Does implementation matter if comprehension is lacking? A qualitative investigation into perceptions of advance care planning in people with cancer.

Supportive Care in Cancer. doi: 10.1007/s00520-018-4241-y

Blaschke S, O’Callaghan C, Schofield P. (2018) Nature-based supportive care opportunities: A conceptual framework.

BMJ Palliative and Supportive Care. doi: 10.1136/ bmjspcare-2017-001465 Grossman C, Brooker J, Michael N, Kissane DW. (2018) Death anxiety interventions in patients with advanced cancer.

A systematic review. Palliat Med. 32(1):172-184

G RANTS H ELD

Cabrini Foundation Clinical Grant Round ‘Using the modified Delphi method to establish expert consensus on optimising the applicability of The Code of Ethical Standards for Catholic Health and Aged Care Services in the clinical setting’ (2018-19), $30,000, O’Callaghan C (CIA), Michael N (CIA), Fleming D (CIB), Symons X (CID), Lynch S (AI), Garner C (AI), Kissane D (AI)

O’Callaghan, C. (2017). Telehealth for Supportive Survivorship Care. Evaluative reports for Cancer Council Victoria based on focus group research with cancer survivor participants and program facilitators. Report one completed October, 2017; Report two completed March 2018. [Report three due November 2018.]

O’Callaghan C, Byrne L, Cokalis E, Glenister D, Santilli M, Clark R, McCarthy T, Michael N. (2017) ‘Life within the person comes to the fore’: Pastoral workers use of arts in palliative care. American Journal of Hospice and Palliative Medicine.

35(7):1000-1008 O’Callaghan C, Trimboli J, Symons X, Patterson E, Staples M, Michael N. (2018) Extending awareness of Catholic Healthcare ethics amongst junior clinicians: A qualitative study. Journal of Religion and Health. 57(4):1440-1450

Doreen Johnson Oncology Research Grant, Cabrini Foundation Clinical Grant Round ‘Meaning and Purpose (MaP) Therapy in Advanced Cancer Patients: A Multi-site Randomised Controlled Trial’ (2018-19), $50,000, Kissane D (CIA), Michael N (CIB), Shapiro J, Brady B, Seah D, Lethborg C, Bobsevski I

– 53 –

CENTRE FOR ALLIED HEALTH RESEARCH AND EDUCATION

$68,500

in grant funding held

09

publications

36

presentations

08

clinical trial

– 54 –

CENTRE FOR ALLIED HEALTH RESEARCH & EDUCATION RESEARCH UNIT

Our vision is to be the leader in allied health research in Australian private healthcare.

We strive to improve the health of Cabrini patients and our local community, through development and implementation of clinically-focused research, which translates into best clinical practice.

Our research themes are: • Implementation of clinical practice guidelines • Rehabilitation and self-management of chronic disease • Health economic evaluations

H E A D: A S S O C I AT E P ROF E S S OR H E LE N A F R AW LEY

H IGH L IGH TS

OUR RE SE ARC H

Over the past year, our department head and research fellow Associate Professor Helena Frawley and Dr Tash Brusco have been involved in a number of journal reviews for a variety of journals including Australian Health Review, BMJ Open, Journal of Physiotherapy, Journal of Science and Medicine in Sport, and Physiotherapy and Practice.

Malnutrition in Victorian cancer services (VCS) phase 3: Appraisal of hospital patient food service models to best support improving nutrition care

We are pleased to have finalised an industry scholarship between La Trobe University and Cabrini. Helen Kugler, a physiotherapist at Cabrini, is the successful candidate who is undertaking postgraduate studies and working on the Cabrini research project: Development and evaluation of a nursing manual handling program for patients with a stroke and other conditions affecting mobility: Risk Assessment for Moving Patients (RAMP).

Researchers: Anderson B (PI), Doyle L Cabrini participated in this multisite project, led by St Vincent’s Health and supported by Victorian Cancer Services and the Department of Health and Human Services. This project has multiple phases to review food service models in hospitals to inform best practice nutritional care.

Investigating patient satisfaction and nutritional adequacy of the free fluids diet at Cabrini Malvern

Researchers: Anderson B (PI) This review provided recommendations to Cabrini Malvern’s food services department to improve the nutritional adequacy

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CENTRE FOR ALLIED HEALTH RESEARCH & EDUCATION RESEARCH UNIT

and patient satisfaction of the free fluids diet by: fortification of soups, offering mid-meal snacks, developing a free fluids menu, and strategies to implement and support best practice guidelines for early-reintroduction of usual diet.

An evaluation of multiple financially-driven projects run in parallel across a private health service: The Advisory Board projects

Researchers: Brusco T (PI), Boyd L, Gallagher M-A, Frawley H This study identified barriers and facilitators to project implementation and sustainability to assist design of future private health service leadership programs.

Implementation of stroke clinical practice guidelines at Cabrini

Researchers: Brusco T (PI), Frawley H, Clissold B, Foster S, McCaskie D, Goodman S, Nation B, Keren C, Barnes C, O’Brien C The success of research implementation strategies on evidence-based decision-making by allied health managers: a randomized controlled trial

Researchers: Brusco T (PI) Sarkies M, Haines T Implementation of massage therapy to Cabrini inpatient palliative care services

Barriers and enablers for referrals and participation in Cabrini’s new evidence-based osteoarthritis management program: Capturing referrer and patient perspectives

Researchers: Pryde K (PI), Brusco T, Michael N, Baird A, Stockley J

Researchers: Wallis J (PI), Brusco T, Ackerman I, Crossley K, Young K, Barton C, Jennings S

Do post-operative sitting and activity restrictions impact on the outcome following elective lumbar micro discectomy?

Development and evaluation of a nursing manual handling program for patients with a stroke and other conditions affecting mobility: Risk Assessment for Moving Patients (RAMP)

Researchers: Goldschlager T (PI), Risbey R, Jennings S

Researchers: Kugler H (PI), Brusco T, Peat A, Stagnoll W, Losinksi L, Stella L, Fock J, McCaskie D, McAleer R Evaluation of meal serve sizes at Cabrini

Researchers: Matthews C (PI) Effect of staff e-learning and simulation training for a dysphagia screening tool on time from patient admission to dysphasia screening and incidence of pneumonia (ASSIST)

Researchers: Reyes N (PI), Brusco T, Goodman S Threshold concepts, ways of thinking and practicing and curriculum: a phenomenological heuristic research enquiry in an entry-level physiotherapy context

Telephone or electronic nutrition care delivery (TEND) to upper gastro-intestinal cancer patients: a randomised controlled trial

Researchers: Frawley H (PI), Low L, Huggins K Jejunal verses oral nutrition for one month post hospital discharge after major upper gastrointestinal surgery – a multicentre RCT

Researchers: DeLuca M (PI), Wright K, Dorey A, Brearley L, Smith J Reducing the impact of aphasia in stroke patients and their caregivers a year post onset via a brief early intervention: a cluster randomised control trial of the action success knowledge (ASK) program

Researchers: Lamborn E (PI), McCaskie D, Hilton-Thorp E, Frawley H

Researchers: Barradell S (PI), Kugler H

– 56 –

CENTRE FOR ALLIED HEALTH RESEARCH & EDUCATION RESEARCH UNIT

The feasibility of increasing inpatient rehabilitation duration by implementing an additional self-directed independent exercise program: My Therapy

A multidisciplinary rehabilitation program for patients following surgery for abdomino-pelvic cancer

Researchers: Tilley L (PI), Walpole B, Kugler H, Li R, Kennedy E, Brusco T, Higgins R, Radia-George C

P U B L IC AT ION S

Bakker E, Shelly E, Hogen-Esch F, Frawley HC, McClurg D, Meyers P (2017) ICS-supported pelvic physiotherapy education guideline. Neurourology and Urodynamics. 37(2):869-876 Duarte T, Bonacin M, Brito L, Frawley HC, Dwyer P, Thomas, E, Ferreira C (2018) Does pelvic floor muscle function change after pelvic organ prolapse surgery? Neurourology and Urodynamics, DOI: 10.1002/nau.23503 Frawley HC, Neumann P, Delany M (2018) An argument for competency-based training in pelvic floor physiotherapy practice. Physiotherapy Theory and Practice. 10:1-14 Hanna L, Huggins C, Furness K, Silvers M, Savva J, Frawley H, Croagh D, Cashin P, Low L, Bauer J, Truby H, Haines T. (2018) Effect of early and intensive nutrition care, delivered via telephone or mobile application, on quality of life in people with upper gastrointestinal cancer: study protocol for a randomised controlled trial. BMC Cancer 18(1):707 Harrison, AL, Shields N, Taylor N, Frawley HC (2017) Attitudes, barriers and enablers to physical activity in pregnant women: a systematic review. Journal of Physiotherapy. 64(1):24-32 Lin KY, Denehy L, Frawley HC, Wilson L, Granger C (2018) Pelvic floor symptoms, physical, and psychological outcomes of patients following surgery for colorectal cancer, Physiotherapy Theory and Practice. 34(5): 442-452 Pierce JE, Menahemi-Falkov M, O’Halloran R, Togher L, Rose ML (2017) Constraint and multimodal approaches to therapy for chronic aphasia: A systematic eview and meta-analysis. Neuropsychological Rehabilitation.

Doi: 10.1080/09602011.2017.1365730

Researchers: Frawley H (PI), Lin K-Y, Higgins R, Denehy L, Granger C

Peiris CL, Shields N, Brusco NK, Watts JJ, Taylor NF (2018) Additional physical therapy services reduce length of stay and improve health outcomes in people with acute and subacute conditions: An updated systematic review and meta-analysis.

Archives of physical medicine and rehabilitation. doi: 10.1016/j.apmr.2018.03.005 Slade S, Hay-Smith J, Mastwyk S, Morris M, Frawley H (2018) Strategies to assist uptake of pelvic floor muscle training for people with urinary incontinence: A clinician viewpoint, Neurourology and Urodynamics. doi: 10.1002/nau.23716 G RANTS H ELD

Physiotherapy Research Foundation ‘Pelvic floor dysfunction in women with gynaecological cancer’ (2017-18), $17,000, Frawley H (CI), Lin K-Y, Jobling T, Brennen R. Australian Bladder Foundation ‘Urinary Incontinence in exercising women: are women being helped?’ (2017-18), $20,000, Dakic J (CI), Frawley H, Cook J, Lin K-Y, Gill N. Monash University Faculty of Arts and Faculty of Medicine, Nursing and Health Sciences ‘Development of a taxonomy to measure communication content and approach during health consultations’ (2017-18), $20,750, Haines T (CI), Frawley H et al.

Physiotherapy Research Foundation ‘Are pelvic floor disorders a barrier to women’s participation in their chosen exercise and how do physiotherapists screen and manage them?’ (2017-18), $10,000, Dakic J (CI), Frawley H, Cook J, Lin K-Y. Annual Palliative Care Research Network travel grant to speak at the National Palliative Care Conference in September, $750, Krikheli L.

– 57 –

ALAN, ADA AND EVA SELWYN EMERGENCY DEPARTMENT

Over

$1.1m

in grant funding held

05

publications

10

presentations

05

clinical trials

– 58 –

ALAN, ADA AND EVA SELWYN EMERGENCY DEPARTMENT

Cabrini’s Alan, Ada and Eva Selwyn Emergency Department continues to undertake unique and influential bedside research with our goal being to improve the timeliness and quality of emergency care.

Emergency medicine provides one in ten medical consultations in Australia, which is about 7.5 million consultations every year. Most acute care of urgent medical problems starts in an emergency department. Cabrini’s Alan, Ada and Eva Selwyn Emergency Department (ED) has been researching how to enable emergency doctors to get to the bedsides of patients sooner by offering them a clerical assistant, called a scribe. We have demonstrated that scribes allow the doctor to see 25 per cent more new patients an hour and reduce patients’ stay in the emergency department by 20 minutes (both in public and private hospitals). This could allow doctors to see 9.4 million patients across Australia with its current medical workforce, if scribes were available in every emergency department.

Blood pressure is a medical vital sign. It is measured in almost all clinical settings; it is also measured in gyms, offices, pharmacies and our veterinarians measure blood pressure in animals. The current blood pressure measuring equipment causes discomfort when measured with an arm cuff and is invasive when continuous blood pressure measurements are required, such as for patients undergoing highrisk surgery or being treated in intensive care. Engineers at Monash University have developed a new device, which can be placed on the skin and held on with a patch or tape. We tested this device in our ED, using the clinical skills of our research team and the engineering skills of our university partners.

This is the first clinical testing of the device anywhere in the world and puts Cabrini at the forefront of developing new and better medical technology. These wearable devices are likely to improve patient comfort and safety in future.

Patients approaching the end of their lives currently receive care in our hospitals, which is based around the needs of the hospital. Most patients and their families fare better if they are able to discuss their prognosis, and then guide medical staff regarding their preferences for care in their last year or so of life. Our ED is studying how to enable doctors to have goals-of-care conversations with acutely unwell patients and their families. This will enable us to better care for our most vulnerable families. It will also inform the rest of the country in best practice of end-of-life ED care.

HE A D: D R K AT I E WA LK E R

– 59 –

ALAN, ADA AND EVA SELWYN EMERGENCY DEPARTMENT

H I G H L IGH T S

The multicentre scribe study was completed this year. We have been working on this project for several years, gradually introducing Victorian EDs to a new health workforce. It has been positive to collaborate with clinicians, business people and academics to answer this important economic question.

Cabrini’s ED, Ambulance Victoria and the Victorian Department of Health and Human Services came together to contribute to an important problem facing the Victorian community. In 2016, we experienced thunderstorm asthma and in 2017, we endured an influenza epidemic. These events affected a large part of the health system in Victoria. The collaboration arranged for public ambulance patients to be diverted to private EDs in Victoria, reducing the burden on public hospitals. This is the first time private EDs have helped manage disasters in this way.

OUR R E S E A RCH Feasibility evaluation of a communication training course for senior emergency-physician trainees

Cabrini trains emergency specialists and has identified the gap in their preparations for specialist practice. A $20,000 specialist training program (STP) education and research grant from the Cabrini Institute is being used to evaluate a pilot communication course to ensure that we are providing future specialists with the best skills to enable them to deliver emergency care in their future careers.

Clinical performance testing of a new, non-invasive, wearable device for measuring blood pressure in healthy volunteers

Researchers: Joe K (PI), Walker K, Yuce M, Redoute JM, Hebblewhite M. Blood pressure is a clinical vital sign that is used in all medical settings. Measurement technology has not improved in many decades. Monash University engineers have developed a wearable device that can sit on the skin. Research grants of $827,000 from the Victorian Government and the Australian Research Council are being used to develop the device, and test its accuracy on healthy volunteers at Cabrini. Safe and convenient technology could change the practice of medicine in multiple settings and in many countries across the world.

Researchers: Horsfall D (PI), Walker K. Communication is a core skill for emergency doctors, which is not routinely taught during specialist training.

Dr Katie Walker is Director of Emergency Medicine Research with Cabrini’s Alan, Ada and Eva Selwyn Emergency Department.

Medical Scribe Jennifer Hanning at work in Cabrini’s Alan, Ada and Eva Selwyn Emergency Department. Her work assisting ED doctors enables them to spend more time directly engaged in patient care.

– 60 –

ALAN, ADA AND EVA SELWYN EMERGENCY DEPARTMENT

Proof-of-concept evaluation of diverting public ambulances to private emergency departments during disasters in Victoria

Researchers: Walker K, Ben-Meir M, Stephenson M. The last couple of years have challenged Victorian community and ambulance services. Public hospitals are often at capacity during normal times. When there is a disaster (such as thunderstorm asthma and influenza epidemics), emergency surge capacity is required. We have been evaluating how private EDs can contribute to disaster responses. We have set up a system where we can assist by treating Victorian public ambulance patients, freeing up capacity for Victoria’s ambulances to return to our community sooner.

Evaluation of the understanding and use of goals-of-care discussions in emergency medicine for patients approaching their end-of-life.

Researchers: Walker K (PI), Hanning J, Mills A, Levinson M. Cabrini provides care to a high proportion of older patients who have complex medical needs, and some are approaching the end of their lives. We received a $10,000 research grant from the Cabrini Institute, which has enabled us to investigate how emergency doctors approach shared decision-making with patients to establish their goals of care for treatment of an acute illness during their final year of life. This work will allow us to enable our patients to retain more control over their care, providing better outcomes for patients, their families and their healthcare staff.

P U B L IC AT ION S

G RANTS H ELD

Cohen MM, Ben-Meir M, Andrianopoulos N. (2018) Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non-inferiority trial. Med J Aust. 208(4):189

Phyllis Connor Memorial Fund. ‘Evaluation of scribes in Emergency Medicine in Australia’, $300,000, Walker K (CI), Ben-Meir M.

Jackman C, Waddell R, Fisher L, Ben-Meir M, Blecher G, Goh GS, Walker K. (2018) Konjac flour noodles associated with gastric outlet obstruction. Emergency Medicine Australasia.

30(2):283-284.

Mills AC, Levinson M, Dunlop WA, Cheong E, Cowan T, Hanning J, O’Callaghan E, Walker KJ. (2018) Testing a new form to document ‘Goals-of-Care’ discussions regarding plans for end-of-life care for patients in an Australian emergency department. Emergency Medicine Australasia. doi: 10.1111/1742-6723.12986

Future Industries Fund – Victorian Government Grant ‘Connected health - continuous vital signs monitoring’, $380,000, a collaboration between Cabrini, Joe K (CI), Monash University and Planet Innovation Australian Research Council Grant ‘Wearable device design with continuous cuffless blood pressure measurement’, $447,000, a collaboration between Cabrini, Joe K (CI), Monash University and Planet Innovation Cabrini Institute, Specialist Training Program education grants.

‘Cabrini Health practice, ACEM fellowship OSCE’, $20,000, Horsfall D (CI)

Walker K, Ben-Meir M. (2018) Choosing public or private emergency departments in Australia. Emergency Medicine Australasia. 30(1):122-4 Walker KJ, Wang A, Dunlop W, Rodda H, Ben-Meir M, Staples M. (2017) The 9-Item Physician Documentation Quality Instrument (PDQI-9) score is not useful in evaluating EMR (scribe) note quality in Emergency Medicine. Appl Clin Inform.

8(3):981-93

– 61 –

INTENSIVE CARE RESEARCH

20

publications

10

presentations

06

clinical trials

– 62 –

INTENSIVE CARE RESEARCH

Our research on intensive care is based on questioning current practices and determining how we can get the best outcomes for our patients based on the evidence found.

Cabrini’s intensive care unit (ICU) admits approximately 1570 patients each year, following procedures such as cardiothoracic and abdominal surgery as well as medical admissions requiring multi-organ support. The average length of stay in our unit is 48 hours.

ICU research is increasingly trending towards examining the outcomes of patients after they have been discharged from the unit. We do this by following up patients over extended periods of time, in order to determine quality of life and disability, as well as standard outcome measures such as morbidity and mortality. Through this method, we hope to ascertain the long-term impact an intensive care admission can have on both patients and their families – emotionally, physically, financially and socially.

This would ultimately lead to standard practices and procedures possibly being changed or modified to ensure beneficial long-term outcomes for our patients.

H E A D: A S S O C I AT E P ROF E S S OR V I N E E T SA ROD E

H IGH L IGH TS

Over the past year, we have participated in the TRANSFUSE and TRICS 3 randomised, controlled trials. The outcomes from both trials were recently published in the prestigious New England Journal of Medicine. The TRANSFUSE trial was also recently selected as an Australian Clinical Trial Alliance (ACTA) finalist for trial of the year in 2018.

Our ICU physicians Associate Professor David Brewster, Professor Warwick Butt, Associate Professor Vineet Sarode and Dr Ben Turner were invited speakers and panel experts at a number of national and international conferences.

Our research team collaborates with multiple sites including Monash Partners, Australia and New Zealand Intensive Care Society Research Centre (ANZICS RC), Sunnybrook Research Centre in Toronto, Canada and the Medical Research Institute of New Zealand.

We will soon be collaborating with the Cabrini physiotherapy team to participate in a study investigating early mobilisation versus standard care in a mechanically ventilated cohort of ICU patients. This will aim to improve our patient outcomes for their ICU stay and beyond.

– 63 –

INTENSIVE CARE RESEARCH

OUR R E S E A RCH

TRICS 3 extension study

ANZ-CODE

Researchers: Brewster D, Simpson S.

Researchers: Brewster D, Simpson S.

This is a follow-up of patients who participated in the TRICS 3 study while undergoing cardiac surgery. We are following up patients at 12, 18 and 24 months post-surgery, looking at any hospital readmissions as well as completing a quality-of-life survey.

This is an Australia and New Zealand cardiac arrest outcome determinants and ECMO suitability study. All code-blue (cardiac arrest) calls on the wards are screened and those requiring cardio-pulmonary resuscitation (CPR) are then further screened for admission details, details of the cardiac arrest, and outcome. Survivors of the initial cardiac arrest are then followed up within six months and interviewed to determine survival status, functional status and quality of life.

SIQ

Researchers: Sarode V, Simpson S. A multicentre survey of the sources of health information used by surrogate decision-makers of patients admitted to the intensive care unit.

BALANCE

Researchers: Sarode V, Brewster D, Murphy D, Simpson S. ICU ROX TRIPS

BALANCE stands for bacteraemia length actually needed for clinical effectiveness. Upon confirmation of a positive blood culture in the ICU, patients are randomised to receive seven days versus 14 days of an appropriate antibiotic. The purpose is to determine survival rates at 90 days, and whether patients can ultimately be treated with a shorter duration of antibiotics.

PREDICT

Researchers: Philpot S, Simpson S. This is a registry of critically ill patients designed to determine predictors of disability free survival. ICU patients who were mechanically ventilated for more than 24 hours will be contacted and consented after hospital discharge. The aims are to:

Researchers: Brewster D, Simpson S. This is the standard versus intervention use of oxygen in mechanically ventilated patients, translating research into practice (TRIPS) study. With the ICU ROX study now having completed recruitment, the focus shifts to translating research into practice. Do we change our practice in line with recommendations from research? Practice of clinicians was examined pre-commencement of ICU ROX and will be examined further now that recruitment has finished, and after ICU ROX TRIPS has been published.

P UBLIC ATIONS Best D, Millar J, Kornilov I, Sinelnikov Y, Chiletti R, Rycus P, Butt W. (2017) Extracorporeal membrane oxygenation for Kawasaki disease: two case reports and the extracorporeal life support organisation experience 1999-2015. Perfusion.

32(7):609-612

1) Identify epidemiology of disability-free survival 2) Build a risk prediction model for disability 3) Measure long-term outcomes and economic consequences of critical illness for ICU patients ventilated for more than 24 hours, at six months after admission

Brewster DJ, Nickson CP, Gatward JJ, Staples M, Hawker F. (2018) Should ongoing airway education be a mandatory component of CPD for CICM fellows? Anaesth Intensive Care. 46:2; 190-196

The objectives are to measure and describe the longterm outcomes of critically ill patients, in order to identify effectiveness of care in the wider community and costs associated with the burden on the community.

Brewster DJ, Nickson CP, Gatward JJ. (2018) Airway education in Australasian intensive care medicine: What are we doing? Anaesth Intensive Care. 46:2; 239-241

– 64 –

INTENSIVE CARE RESEARCH

Brewster DJ, Rees CE, Leech M, Thompson G. (2018) Kindness and competition: Are we striking the right balance in medical education? AMJ. 11(5):313–315 Burrell AJC, Salamonsen RF, Murphy DA. (2018) Complications of mechanical circulatory and respiratory support, ch16 in Gregory SD, Stevens MC, Fraser JF. Eds. Mechanical Circulatory and Respiratory Support. Academic Press, Elsevier, Cambridge Butera D, Passam F, Ju L, Cook KM, Woon H, AponteSantamaria C, Gardiner E, Davis AK, Murphy DA, Bronowska A, Luken BM, Baldauf C, Jackson S, Andrews R, Grater F, Hogg PJ. (2018) Autoregulation of von Willebrand factor function by a disulfide bond switch. Science Advances. 4(2):eeaq147 Butt W. (2017) What is the outcome of children admitted to intensive care? This is the most important question we need to answer! Pediatric Critical Care Medicine. 18(3): p. 292-293 Carter BG, Carland E, Monagle P, Horton SB, Butt W. (2017) Impact of thrombelastography in paediatric intensive care.

Anaesthesia and Intensive Care. 45(5):589-599 Chiletti R, Horton S, Bednarz A, Bartlett R, Butt W. (2018) Safety of nitric oxide added to the ECMO circuit: a pilot study in children. Perfusion. 33(1):74-76 Cooper DJ, McQuilten ZK, Nichol A, et al. (2017) Age of red cells for transfusion and outcomes in critically ill adults.

N Engl J Med. 377:1858-67 Cortina G, Best D, Deisenberg M, Chiletti R, Butt W. (2017) Extracorporeal membrane oxygenation for neonatal collapse caused by enterovirus myocarditis. Archives of Disease in Childhood. Fetal and Neonatal Edition. 103(4):F370-F376 Cortina G, McRae R, Chiletti R, Butt W. (2018) Therapeutic plasma exchange in critically ill children requiring intensive care. Pediatric Critical Care Medicine. 19(2):e97-e104 Eyeington CT, Glassford NJ, Darvall J, Casamento A, Haydon T, Taori G, Knott C, McGain F, Vetro J, Simpson N, Sarode V, Richardson A, Dunnachie C, Crisman M, Musci J, Woinarski C, Lynham R, Eastwood GM, Bellomo R, Karalapillai D. (2018) Ventilation management in Victorian intensive care unit patients without acute respiratory distress syndrome.

Crit Care Resusc. 20(2):101-8 Mazer CD, Whitlock RP, Fergusson DA et al. (2017) Restrictive or liberal red-cell transfusion for cardiac surgery.

N Engl J Med. 377:2133-2144

McKenzie JM, Scodellaro T, d’Udekem Y, Chiletti R, Butt W, Namachivayam SP. (2017) Late-term gestation is associated with improved survival in neonates with congenital heart disease following postoperative extracorporeal life support.

Pediatric Critical Care Medicine. 18(9):876-883 Nehme Z, Namachivayam, S, Forrest A, Butt W, Bernard S, Smith K. (2018) Trends in the incidence and outcome of paediatric out-of-hospital cardiac arrest: A 17-year observational study. Resuscitation. 128:43-50 Scheltema NM, Gentile A, Lucion F, Nokes DJ, Munywoki PK, Madhi SA, Groome MJ, Cohen C, Moyes J, Thorburn K, Thamthitiwat S, Oshitani H, Lupisan SP, Gordon A, Sanchez JF, O’Brien KL, Group PS, Gessner BD, Sutanto A, Mejias A, Ramilo O, Khuri-Bulos N, Halasa N, de-Paris F, Pires MR, Spaeder MC, Paes BA, Simoes EAF, Leung TF, da Costa Oliveira MT, de Freitas Lazaro Emediato CC, Bassat Q, Butt W, Chi H, Aamir UB, Ali A, Lucero MG, Fasce RA, Lopez O, Rath BA, Polack FP, Papenburg J, Roglic S, Ito H, Goka EA, Grobbee DE, Nair H, Bont LJ. (2017) Global respiratory syncytial virus-associated mortality in young children (RSV GOLD): a retrospective case series. Lancet Global Health.

5(10):e984-e991 Scodellaro T, McKenzie JM, d’Udekem Y, Butt W, Namachivayam SP. (2017) Extubation failure is associated with increased mortality following first stage single ventricle reconstruction operation. Pediatric Critical Care Medicine.

18(12):1136-1144 Thien F, Beggs PJ, Csutoros D, Darvall J, Hew M, Davies JM, Bardin PG, Bannister T, Barnes S, Bellomo R, Byrne T, Casamento A, Conron M, Cross A, Crosswell A, Douglass JA, Durie M, Dyett J, Ebert E, Erbas B, French C, Gelbart B, Gillman A, Harun N-S, Huete A, Irving L, Karalapillai D, Ku D, Lachapelle P, Langton D, Lee J, Looker C, MacIsaac C, McCaffrey J, McDonald CF, McGain F, Newbigin E, O’Hehir R, Pilcher D, Prasad S, Rangamuwa K, Ruane L, Sarode V, Silver JD, Southcott AM, Subramaniam A, Suphioglu C, Susanto NH, Sutherland MF, Taori G, Taylor P, Torre P, Vetro J, Wigmore G, Young AC, Guest C. (2018) The Melbourne epidemic thunderstorm asthma event 2016: an investigation of environmental triggers, effect on health services, and patient risk factors. The Lancet Planetary Health. 2(6):e255–e263

– 65 –

CLINICAL DATABASE REGISTRIES

AU ST RA L I A N R H E U M ATO LO GY A S S O CIATIO N DATA BA S E

B R I G H T WAYS: A C AB RI NI B RE A ST C ANC ER S ERV I C E DATABA SE

C AB RI NI MONA SH COLOREC TAL NEOP L A SI A DATABA SE

5536

Data for

Contains data on

patients receiving treatment at Cabrini has been collected

patients who have undergone treatment for bowel cancer at Cabrini, the Alfred Hospital and Monash Partners affiliated health services

Number of patients in database

4.62 yrs

Mean follow up time of each patient

25,573

Person years of follow up

730

Information has been collected for

1250

patients referred to breast MDT meetings at Cabrini

3077

3700

Uptake in Australia and New Zealand means data for

24,000

patients is available in the database

Total currently completing questionnaires

2153

Previously completed questionnaires, now tracking

– 66 –

CLINICAL DATABASE REGISTRIES

Without some form of clinical audit, it is difficult to know if healthcare is being delivered efficiently or effectively and even more difficult to demonstrate to others.

The purpose of clinical database registries is to improve the safety and/or quality of healthcare provided to patients by collecting key clinical information from individual healthcare encounters. This enables risk-adjusted outcomes to be used in evidence-based quality improvement. Cabrini leads the development and application of a number of high quality clinical database registries.

AU ST RA L IA N R HE UM ATO LO GY A S S O CIATIO N DATA BA S E

The Australian Rheumatology Association Database (ARAD) collects long-term observational data about the outcomes of Australians who have inflammatory arthritis, for example rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and juvenile idiopathic arthritis. The aim is to determine the long-term safety and effectiveness of biological disease modifying antirheumatic drugs (bDMARDs). ARAD promotes collaborative research that translates into improved outcomes for patients with these diseases.

A major focus for ARAD over 2017-18 has been the development of a new database platform in collaboration with the Australian Arthritis and Autoimmune Biobank Collaborative (A3BC). The aim is to identify causes and cures for a wide range of inflammatory arthritides and autoimmune conditions using biobank-enabled, data-linked, collaborative, and multidisciplinary research. Together, they aim to identify the biological/environmental causes and phenotypic consequences of musculoskeletal conditions. These are combined with a broad range of patient and population health data sets including cross-jurisdictional electronic medical

records (EMR), pathology and medical imaging data, and Commonwealth health datasets (that is, Medicare benefits schedule and pharmaceutical benefits scheme).

ARAD is also expanding the range of conditions to include ANCA-associated vasculitis, giant-cell arteritis, polymyalgia rheumatica, and developing new questions to expand the research capabilities to investigate environmental and dietary issues. New database platform and research laboratory infrastructure is being established at key nodes in each capital city and combined with the commitment of clinicians to follow an open, collaborative approach, all rheumatologists and rheumatology patients in Australia will benefit.

B RI G H T WAYS: A C AB RI NI B RE A ST C ANC ER SERV I C E DATABA SE

Breast cancer is the most common cancer among Australian women and is the second leading cause of cancer related death in Australian women, after lung cancer. One in eight Australian women will be diagnosed with breast cancer in their lifetime. The rate of mortality is decreasing due to earlier detection by screening mammography and advances in treatment.

The information in our Brightways database will be integrated with research findings to identify new biomarkers for prognosis, improve our understanding of tumour behaviour and heterogeneity, rapidly evaluate the effectiveness of anti-cancer agents and identify molecular subtypes which may lead to a poorer response or drug resistance. – 67 –

CLINICAL DATABASE REGISTRIES

Using the Brightways: a Cabrini Breast Cancer Service database, we aim to monitor and improve the quality of breast cancer treatment and outcomes at Cabrini. The information is used to: • compare variations in care and outcomes with clinical quality indicators • provide feedback to participating clinicians • promote compliance with breast cancer guidelines • reduce unfavorable variation • support epidemiological studies and translational research The registry was established in November 2016 and data has been collected for 730 patients receiving treatment at Cabrini.

This database supports management of multidisciplinary team (MDT) meetings, decision-making, cancer staging and patient treatment recommendations in line with Victorian cancer-service performance indicators. Clinicians receive patient clinical and treatment summaries prior to the weekly MDT meetings. The recommended care plan and staging are recorded at the meeting and the care team receives a record of their patient’s care plan.

Data for 1250 patients referred to the breast MDT meetings at Cabrini has been captured. An audit has been conducted to compare hospital admissions data with our database to ensure all patients, treatment and outcomes are captured. In 2017, 99.8 per cent of patients with a first diagnosis of early invasive breast cancer were referred for discussion at the breast MDT meeting. Dr Yoland Antill, Dr Steven David and Dr John Lai conducted a study on the impact of MDT meetings on the management of patients with breast cancer at Cabrini. The recommended care plan was recorded before and during the breast MDT meeting. The recommended care plan changed for 66 per cent of patients discussed at the breast MDT meeting. The MDT meeting recommendations were then implemented for 83.7 per cent of patients.

The database is a powerful tool for translational bioinformatics.

Unlike other cancer databases, this database has been specifically designed to capture complexity and variation in tumour heterogeneity and hormone-receptor expression for core biopsies, primary and metastatic tumours. The database also collects vital outcomes information including

treatment modification, response to therapy, toxicity, disease progression, recurrence and cancer status at death.

The information in our database will be integrated with research findings to identify new biomarkers for prognosis, improve our understanding of tumour behavior and heterogeneity, rapidly evaluate the effectiveness of anti-cancer agents for specific tumour molecular subtypes and identify molecular subtypes and variation in hormone receptor expression, which may lead to a poorer response or drug resistance.

C AB RI NI MONA SH COLOREC TAL NE OP L A SI A DATABA SE

Colorectal cancer remains a major health concern and is the second biggest cancer killer in Australia. For more than eight years, the Cabrini Monash colorectal neoplasia database has collected complete data on all patients treated at Cabrini, and has been used as the platform for all specialised bowel cancer treatment in Australia and New Zealand. This platform allows linkage of highly detailed and accurate patient outcome and risk data with their treatment and with genetic-based research, creating a powerful tool for improving treatment of bowel cancer patients, not only in Australia but around the world.

The database was established in February 2010 and now contains data on 3700 patients who have undergone treatment for bowel cancer at Cabrini and the Alfred Hospital, as well as other Monash Partners-affiliated health services, including Peninsula Health and Monash Health. This initiative has been entirely driven and funded by the Cabrini Monash University Department of Surgery. The success of the database has led to national uptake in both Australia and New Zealand by the Colorectal Surgical Society of Australia and New Zealand, using the database for the basis for the bi-national colorectal cancer audit, and now contains combined data on over 24,000 patients.

The data has emphasised the world-class treatment available at Cabrini. The risk of death within 30 days after surgery is less than one per cent and return-to-theatre rate is approximately five per cent. Data from the registry has supported the need for increased education and promotion of the national bowel cancer screening program. The registry shows only nine per cent of patients between the ages of 50 and 74 are diagnosed via the national bowel cancer screening program, emphasising

– 68 –

CLINICAL DATABASE REGISTRIES

A close-up view of organoids or ‘mini-guts’.

Melissa Vereker is a Data Manager with the Cabrini Monash Department of Medical Oncology.

the importance of improving participation. Clinical research is supported by the registry, including important information about the increased risk to patients who have immune suppression, patients taking steroids, patients who have diabetes and patients at the extremes of age, allowing special provision to be made for high-risk patients.

Organoid technology is being used to take small samples of normal tissue and tumour tissue from patients undergoing bowel cancer surgery, and grow the tissues in the laboratory in the form of an organoid known as a mini gut. Treatment responses of the organoids will be correlated with the patient’s clinical response captured in the database. In future, organoid technology will enable real-time implementation of treatment strategies such as chemotherapy or radiation therapy on organoids, while the patient is recovering from surgery, to further promote personalised medicine.

The database plays a vital role in supporting the Cabrini Monash University Department of Surgery translational research platform. The department is using tissue-microarray technology together with the database to identify genes and biomarkers that correlate with patient clinical outcomes.

Tissue microarrays allow small of amounts of hundreds of tumours to be tested simultaneously in high-throughput assays. The aim of the research is to identify which genes or biomarkers are important in guiding the use of different surgical, chemotherapy or radiotherapy strategies for individual patients, to move towards true personalised medicine.

A third project utilising the registry relates to patient reported outcome measures (PROMS), whereby a standardised set of colorectal cancer PROMS will be incorporated into the registry, to allow direct patient entry of patient reported data on all aspects of care. This data will allow feedback between the patient and the clinician to ensure best possible treatment for all patients.

– 69 –

CLINICAL EDUCATION

CL IN I C A L E D U C AT I O N D E PA RTM E NT

DE PARTME NT OF M ED I C AL E DUC ATI ON – C A B R I NI -MONA SH UNI V ER SI T Y C LI NI C AL SC H O OL

ALLI ED H E ALTH & A MB UL ATORY SERV I C E S E DUC ATI ON

11,710

10

Cabrini partners with La Trobe University, Monash University, Australian Catholic University and Holmesglen Institute to support student placements

student placement days offered for nursing and midwifery

79

medical student research project scholarships awarded in 2017

14

graduate nursing positions offered in 2018

Monash University adjunct appointments made in 2017-18

Basic life-support program recorded

Almost

11,387

resuscitation quality improvement activity completions

200

medical students undertook clinical placements at Cabrini in 2017-18

198

trained preceptors

119

courses and workshops to support professional development

1200

just-in-time education encounters

– 70 –

4296

clinical placement days completed across acute and rehabilitation sites at Cabrini

Placements in

7

disciplines completed including allied health assistants, dietetics occupational therapy, physiotherapy, social work, speech pathology and neuropsychology

CLINICAL EDUCATION

Cabrini is a strong supporter of education in healthcare, providing undergraduate and postgraduate education in medicine, nursing and allied health disciplines.

CL IN IC A L E D U C AT I O N D E PA RTM E NT

designed to ease the transition into the workforce. The structured program enables consolidation of clinical skills while enhancing critical thinking and clinical reasoning in a supported learning environment. The program incorporates simulation scenarios based on Cabrini’s risk data and focuses on patient deterioration, communication skills and cognitive impairment. Our team provides learning opportunities and clinical support to more than 70 graduates.

The clinical education department has a centralised model of education with a core curriculum informed by organisational risk and workforce requirements. Our department develops resources and training programs for nursing, allied health and medical staff, ensuring quality standards are maintained throughout our organisation. Our focus is to provide educational opportunities that will inspire confidence, professionalism, expertise and excellence in clinical care.

Postgraduate program

Undergraduate program

Cabrini is a teaching hospital, providing clinical training opportunities for future health professionals. During the 201718 year, Cabrini provided 11,710 placement days for nursing and midwifery students.

We have strong primary partnerships for nursing and midwifery with Monash University, Australian Catholic University (ACU) and ACU College. These partnerships are designed to support our workforce requirements and promote team-based nursing across the organisation. A recent outcome was the introduction of a night-duty pilot program for our ACU and Monash University third-year students, designed to expose students to the reality of shift work. The pilot was mutually beneficial, as night-duty staff were able to share their knowledge and expertise with the students.

The Cabrini ACU teaching, learning and research collaborative continues to support our clinical school for registered and enrolled nurses. This collaboration assists students to maximise their learning potential and creates opportunities for staff to embed the students within Cabrini’s culture.

Graduate program

Our transition to professional practice (TTPP) program for newly registered nurses, enrolled nurses and midwives is

Cabrini offers several postgraduate programs to support nurses in expanding their scope of practice and in pursuing their development goals. We offer courses in: • cancer and palliative care (University of Melbourne) • emergency nursing (Monash University) • intensive Care Nursing (Monash University) • perioperative nursing (Monash University) • cardiac nursing (La Trobe University) We have dedicated clinical support nurses who provide clinical learning opportunities to help course participants in contextualising their academic learning.

Clinical support nurses

We have six clinical support nurse (CSN) roles across Cabrini designed to support novices, postgraduates and clinical staff.

We also have a clinical facilitation team that provides support to our undergraduate students and their preceptors.

Our clinical deterioration and neurology and cognition roles provide just-in-time training to clinical staff at the bedside.

They utilise the patients’ clinical presentations to guide the content of the education session. These roles have recorded more than 1200 encounters with clinical staff across the Malvern, Brighton and rehabilitation campuses.

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CLINICAL EDUCATION

teaching programs for junior medical staff and targeted educational sessions for specialists.

Interprofessional learning

The clinical education (nursing, allied health and medicine) team facilitated the first in a series of inter-professional learning events in 2017. These medical mystery evenings provide an opportunity for undergraduate students to collaboratively explore a patient case and develop teambased clinical care pathways. The learning session is designed to engage the participants in discussions that will promote interdisciplinary understanding.

Monash University undergraduates

As a member of the Central Clinical School for Monash University, Cabrini provides clinical placements for students from Monash University’s Bachelor of Medicine and Bachelor of Surgery (MBBS) course. Associate Professor David Brewster and Jennie McInerney continue to develop and oversee the undergraduate educational program at Cabrini.

Stewardson Charitable Trusts Simulation Centre Third-year program

Clinical simulation is used in the training and assessment of healthcare professionals. Cabrini’s simulation activities provide engaging learning opportunities, ultimately promoting the delivery of safe and high-quality patient care. Staff and students have the opportunity to practise their skills in a safe learning environment prior to performing these clinically.

The advanced life support education programs have been redeveloped to include an emphasis on competency-based assessment, more immersive simulation scenarios and promotion of interdisciplinary participation.

The basic life-support program utilises the resuscitation quality improvement in situ simulation program to assess staff competence in basic life-support skills. The program provides staff with objective, real time feedback on performance through verbal prompting and performance analysis. Staff have the ability to practise and assess their basic life-support skills within the clinical setting anytime.

Third- and fourth-year medical students regularly utilise the simulation centre to practise and refine their skills on the manikins and part-task trainers before advancing to direct patient care. An example of our skills training is the scrubbing, gowning and gloving workshop where students practise this skill prior to commencing their placement in the perioperative services.

DEPA RTM E N T OF M E D I C A L E D UC AT I O N – C AB R IN I-MON A S H UNI V E R S I T Y C L I NI C A L S C HO OL

Medical education is thriving at Cabrini. Complementing a long-standing and successful Monash University undergraduate program, Cabrini has clinical rotations for medical students from the University of Notre Dame, multiple

Twenty-four medical students spent their third year of study on clinical placements in various specialties of medicine and surgery at Cabrini Malvern in 2017. They have additional learning through a problem-based learning program at the Alfred Hospital and an extremely popular curriculumenhancement program at Cabrini. Our Cabrini specialists donate their time and efforts to hold a local lecture series throughout the year. Naomi Snowden holds procedural skills training and simulation teaching to complement their development. Students receive a weekly bedside teaching session from their tutors and can apply for summer research grants.

Fourth-year program

Some 40 fourth-year medical students experience a fourweek paediatric rotation at Cabrini each year under the supervision of Dr Simon Costello. Fourth-year Monash University medical students participate in a mentor program in women’s health. These students spend a week at Cabrini shadowing an obstetrician.

Fifth-year program

During 2017-18, approximately 80 fifth-year medical students completed a six-week pre-intern rotation at Cabrini. These placements occur in many medical specialties and general surgery. Our registrars and supervising specialists provide valuable guidance and preparation to these students. The students form a part of the clinical team and contribute to patient care. They engage in multiple education programs (weekly case discussions, radiology sessions and registrar teaching programs) and learn how to function in interprofessional working environments.

– 72 –

CLINICAL EDUCATION

of GPs (to fulfil their RACGP CPD requirements), while offering the support of our expert consultants. This year we recorded our lectures and made them available through Praxhub, an online open access learning platform for GPs.

University of Notre Dame student program

Seven medical students from this university undertake placements during the year. Rotations include orthopaedic; cardiac; obstetrics and gynaecology; and palliative care.

These postgraduate students are in their fourth and final year of medicine based at the Melbourne Clinical School at Werribee.

S PE CIA L IST TRA I NI NG P RO G RA M

The specialist training program (STP) began at Cabrini in 2008 and is supported by the Federal Government and the specialist medical colleges. The program provides placements to doctors completing their specialty training. Learning at Cabrini offers trainees an opportunity to understand private health with exposure to conditions that are less common in public health services. The Federal Government has confirmed funding for most positions until 2020 but is seeking support to move more training positions to rural health centres. We are working on partnerships with rural hospitals and expect to have a partnership with Warrnambool Base Hospital for oncology rotations from 2019.

To complement teaching within their specialty units, the transition-to-consultancy program by educator Dr Tim Gray helps to prepare the registrars for life as consultant doctors.

Also, the registrars attend the shared decision-making workshops by intensive care physician Dr Steve Philpot. Many participants in the STP program have stayed on (or returned) as consultants, which strengthens our learning culture.

A highlight of GP education in 2018 was an all-day comprehensive update in cardiology called ‘Mending Hearts’ on 5 May. This interactive session included a range of expert consultants who covered issues including non-structural heart disease; lipids; everything you need to know about novel oral anticoagulants; and, in aortic stenosis, is transcatheter aortic valve implantation for everyone?

Q& A P RO G RA M

Held monthly, Cabrini’s Q and A series focuses on the patient experience and compliance with National Safety and Quality Health Service Standards. This interactive forum often includes an expert with a panel discussion and is open to the whole Cabrini community (including patients and families). A highlight of 2017-18 was a session focusing on a patient letter regarding dignity. Cabrini Chief Executive Dr Michael Walsh chaired the session and an actor read a letter from a patient.

The session covered open disclosure, equipment, safety and education. Moreover it highlighted staff responsibility for delivering a compassionate and respectful patient experience.

Other sessions included privacy, blood utilisation and supporting clinicians through stressful periods.

QU ICK CL IN IC AL UP DAT E S P RO G RA M

This is an educational program designed for specialist trainees and their supervisors, delivered by local Cabrini experts. The purpose is to share the latest research on medical topics likely to apply to medical care across the specialties. Held monthly, recent sessions have focused on novel anticoagulants, an update on medical cannabis, contemporary multidisciplinary treatment of cancer; and whether accreditation has changed our clinical practice.

GP S E R IE S

Engagement with our GP community to ensure continuity of care for our patients is a focus of our strategic plan. The GP series focusses on meeting the documented learning needs

Rick Peebles (Clinical Deterioration Educator) with Luke Flynn practising basic life support skills on a high-tech manikin in the Stewardson Charitable Trusts Simulation Centre.

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CLINICAL EDUCATION

TH E L E E & B R IA N J O HNSTO NE L I B RA RY

Funding available through The Lee & Brian Johnstone Fund allows the library to maintain its highly valued collection of resources, which in turn enables it to increase its profile as an integral partner in research and education activities of the Cabrini Institute.

The Lee & Brian Johnstone Library continues to be a valued service to all staff at Cabrini, assisting them in searching for research and sharing informative knowledge to promote and teach education based activities.

ALLI E D H E ALTH & A MB UL ATORY SE RV I C E S ED UC ATI ON

There was an overall 20 per cent increase in usage of the library usage from 2016 to 2017, and a 99 per cent increase in Cabrini nursing staff using resources and engaging in library services. Other notable increases were staff engagement in using point-of-care resources in a mobile phone and app format.

The Centre for Allied Health and Ambulatory Services Education strives to be the leader in allied health and ambulatory service education in Australian private health care.

Use of library services and resources has increased with trainees undertaking research work in the palliative care specialty of the 2017 STP program. There has also been increased engagement with other research departments, most notably the Monash Department of Clinical Epidemiology at Cabrini.

Our purpose is to educate staff and students for a successful health service career. We are characterised by our commitment to education, which enhances quality patient care and develops health service leaders.

The library continues to work closely with clinical staff to provide excellent patient care. The work done by Cabrini’s librarian with Cabrini’s Falls Prevention Committee was noted in the oral summation by accreditation surveyors in June 2018.

Allied health students now complete their clinical placement orientation online, with an updated course where students can access mandatory requirements, as well as clinical resources and support around study and wellbeing. Feedback via a student survey has been consistently positive.

Clinical education

Other highlights include: Staff education

• Embedding a ‘beginning library skills module’ in Cabrini’s clinical education learning system, combined with face-to face instruction for midwifery staff undertaking the special care nursery module in February 2018 • Supporting two Monash University year 3B students involved in the 2017-18 summer research program (held from December 2017 until June 2018) by teaching searching skills, providing expert advice on database information, and writing for publication • Increased use of the librarian’s services by nursing staff undertaking postgraduate studies including assistance with literature searching, publication writing and general reference queries

Allied health and ambulatory services staff have participated in internal and external education and professional development activities this past year, with many of the activities being supported financially and/or with study leave by Cabrini. This includes external courses on new evidence for treatments or postgraduate studies. The Centre for Allied Health Research and Education has supported senior staff development with external presenters providing a leadership development seminar to the staff in October 2017, as well as a course on health literacy in June 2018.

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CLINICAL EDUCATION

BUILDING A SMART CHANGE ENABLED CLINICAL WORKFORCE At Cabrini, our strategic workforce plan has seen the introduction of team-based nursing, where registered and enrolled nurses work collaboratively to deliver exceptional care to our customers.

I

n Victoria, there is an increasing demand for high-quality enrolled nurses in the acute sector, which has prompted Cabrini to consider how we recruit and retain enrolled nurses within our workforce.

Following the success of our enrolled nursing clinical-school partnership, we saw an opportunity to collaborate with Australian Catholic University (ACU) College to join forces in the education and training of our future enrolled nursing workforce.

ACU College is a registered training organisation that operates under ACU to deliver nationally accredited training.

ACU College aims to provide a high-quality teaching and learning environment, which upholds the distinct values and culture of ACU. The college is a recognised leader in the delivery of industry-relevant, accredited and professionally designed educational programs and learning experiences to meet the needs of their students, business and corporate clients and the wider community.

Cabrini has a history of delivering exceptional training for our nurses of the future. Collaborating with ACU College enables us to continue developing our enrolled nursing workforce, which supports our strategic direction and aligns with our organisational heritage and culture.

This new Diploma of Nursing qualification offers education and training at Melbourne’s ACU College campus and is a unique opportunity for students to learn valuable, practical skills through their clinical placements at Cabrini. Our dedicated clinical facilitation team will support students while they engage in clinical learning opportunities and assist with progression toward their personal and professional development goals.

Specialist nursing staff at Cabrini will have the opportunity to participate in guest lectures and tutorials to support students to become familiar with Cabrini’s clinical policies, guidelines and systems. The clinical education team at Cabrini will be involved in the recruitment of prospective Diploma of Nursing students and coordination of clinical placements and learning opportunities.

The program is known as the ACCENT program, with ACCENT standing for: ACU College and Cabrini educating nurses together. This is indicative of our commitment to work together in partnership to shape the future of our nursing workforce.

Cabrini and ACU College will be launching their first intake for the collaborative ACCENT program later this year. For more information about the ACCENT program please visit https://www.acu.edu.au/courses/771349

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CABRINI HUMAN RESEARCH ETHICS COMMITTEE (CHREC) AND RESEARCH GOVERNANCE OFFICE

Cabrini currently has

290

active research projects

82

new research projects approved by CHREC and Research Governance in 2017-18

CHREC has

13

members

– 76 –

CABRINI HUMAN RESEARCH ETHICS COMMITTEE (CHREC) AND RESEARCH GOVERNANCE OFFICE

Cabrini’s Human Research Ethics Committee (CHREC) and our Research Governance Office are responsible for reviewing research proposals before they can be conducted at Cabrini.

This is to ensure that research is conducted in accordance with the principles set out in the National Health and Medical Research Council’s (NHMRC) National Statement on Ethical Conduct in Human Research, and so that the interests of participants, researchers, the institution and the wider community are protected.

Research proposals are assessed in terms of merit and integrity, justice, beneficence and respect. The use of these guiding principles helps to ensure the research is designed in such a way that participants are afforded full respect, benefits are weighed against the risks of the research and new knowledge will ultimately lead to improved treatments and care. The Research Governance Office is responsible for ensuring that governance requirements are met, including adherence to the Code of Ethical Standards for Catholic Health and Aged Care Services in Australia, appropriate support from relevant departments and adequate resourcing.

K EY ACH IE V E M E NT S I N 20 1 7-18

of data across a wide selection of the target population while minimising risks, adjusting the number of participants needed to obtain meaningful results or including additional cohorts to test for efficacy in slightly different groups. The CHREC and Research Governance Office reviewed and approved about 80 protocol amendments in the last financial year.

The CHREC and Research Governance Office approved 82 new research projects in the last financial year. Of them, 56 received ethics and governance review and 26 received governance review with recognition of ethics approval from other institutions.

As well as annual progress reports, the office also receives journal publications and other forums in which researchers present their results and share new knowledge with colleagues, with successful projects culminating in new treatments and improved patient care.

Cabrini currently has 290 active research projects, with all researchers required to report to the CHREC and Research Governance Office at least annually on the progress of their research. Researchers monitor the progress and safety of participants using various methods, such as scheduled clinical visits, follow-up telephone calls, interviews or questionnaires.

Interim data analyses may be performed in the course of a clinical trial to evaluate early indications of treatment efficacy.

If an interim analysis indicates a poor risk/benefit ratio, the project may be terminated early. This means that resources can be redirected to other projects and overall development of more effective treatments accelerated rather than consuming resources in futile options.

H I G H LI G H TS

Alternatively, it may be more reasonable to make amendments to the existing project design. For example, changes such as adjusting the inclusion/exclusion criteria to allow for collection

A key highlight of the year was the twilight seminar held in August 2017. The use of mobile devices to collect data and the challenges of maintaining data security were discussed with keen interest from the audience. The session raised important considerations that may not always be obvious, such as knowing where the server is located and who owns the data once it is entered into a mobile app. If ownership remains in Australia, users may be confident that data will be maintained under standards of the Australian Privacy Principles and that they are protected under Australian law.

– 77 –

CABRINI HUMAN RESEARCH ETHICS COMMITTEE (CHREC) AND RESEARCH GOVERNANCE OFFICE

Another highlight was the successful resolution of issues raised following the Therapeutic Goods Administration (TGA) withdrawal of surgical mesh devices (slings) from the Australian Register of Therapeutic Goods (ARTG). These devices are used to treat female stress urinary incontinence (SUI). Commonly reported adverse effects include voiding difficulties, mesh exposure, and pain. These can sometimes be resolved by repositioning or loosening the device. The use of the devices has been controversial and seen much media attention worldwide.

Approximately 250 adverse events were reported from about 150,000 trans-vaginal repair procedures. There was an Australian Senate Enquiry and the TGA has been working with the Australian Commission on Safety and Quality in Healthcare to gain a better understanding of events. It has not been possible to clearly distinguish reported events between treatment for SUI and treatment for uterine prolapse. It was also not clear how many of the adverse event reports related to procedures performed by surgeons with limited experience.

Following the withdrawal of devices from the ARTG and suspension of trials at other hospitals, further recruitment into mesh trials at Cabrini was put on hold, pending a review of available data and further consideration of the continued ethical acceptability of such trials.

The most studied mesh device has been in use since 1997, and has been found to be 85 to 90 per cent effective. However, the manufacturers have withdrawn its supply in Australia due to mounting pressure amid the controversy. The use of similar devices to treat SUI is now only possible in Australia in the context of an HREC-approved clinical trial.

CHREC had discussions with various stakeholders, including the TGA’s chief medical advisor, Cabrini insurers, Cabrini’s Group Director of Medical Services and Clinical Governance, and clinical trial researcher and expert advisor to the senate inquiry Dr Anna Rosamilia.

The TGA had recognised that the only possible way of determining the safety and efficacy of these devices in the treatment of SUI is by collecting and analysing more data from well-designed clinical trials conducted by experienced researchers. Cabrini is one of the few Australian sites collecting such data.

In its appraisal, CHREC considered Cochrane reviews, TGA data on reported adverse events, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists position statement on mid-urethral slings and a progress report from the research team. Cochrane reviews are exhaustive and find a lack of evidence. It was recognised that a variety of products used for similar purposes, impedes clear attribution of adverse events. Cabrini insurers acknowledged the products were not withdrawn from the ARTG due to safety concerns, but rather due to lack of evidence.

After careful consideration, CHREC determined that, with all governance requirements met, well-designed trials with up to date patient consent are likely to be useful and should be supported. The CHREC and Research Governance Office coordinated discussions and worked with researchers to ensure all trial participants were informed of the TGA actions and need for reliable studies. A successful resolution of the matter has allowed ongoing collection of much needed data.

It is important to understand that while the use of new drugs and devices often comes with undesirable side effects, people who suffer from debilitating conditions, such as severe SUI, have limited treatment options. They may have exhausted all other avenues and be willing to take the chance on sideeffects that others consider unacceptable. It is our role to ensure they are made aware of the potential risks and burdens of being a trial participant, and respect their capacity to make their own decisions.

– 78 –

CABRINI HUMAN RESEARCH ETHICS COMMITTEE (CHREC) AND RESEARCH GOVERNANCE OFFICE

CH R E C ME MB E R S HI P NAME

C AT E G O RY

NA ME

C AT EGO RY

Mrs Beatrice Bastomsky

Layperson – male

Dr Margaret Staples

Chairperson

Mr Nir Bruner

Layperson – male

A/Prof Val Usatoff

Professional carer

Ms Joanne Cheah

Professional carer

Dr Katherine Walker

Researcher

A/Prof Henry Debinski

Researcher

Mr Robert Wojnar

Researcher

Dr Gordon Donaldson AM

Layperson – male

Mr Jeffery Gleeson QC

Lawyer

Dr Dane Horsfall

Professional carer

Dr Sophie Mepham

Researcher

Ms Emma Patterson

Pastoral carer

Associate Professor Helena Frawley, Amanda Pereira-Salgado and Associate Professor Marilyn Poole were valuable members of the committee in the researcher category and have now resigned. Lawyer Michele Britbart QC also resigned in 2017 after more than four years of service.

CH R E C PROJE C T S A P P ROV E D P ROJE C T TI TL E

PRINCIPAL INV E ST IG ATO R

A double-blind, placebo-controlled, randomised phase 3 study of ipatasertib in combination with paclitaxel as a treatment for patients with PIK3CA/AKT1/PTEN-altered, locally advanced or metastatic, triple-negative breast cancer or hormone receptor -positive, HER2-negative breast cancer

Dr Yoland Antill

A phase 3, randomised, double-blind study to evaluate pembrolizumab plus chemotherapy versus placebo plus chemotherapy as neoadjuvant therapy and pembrolizumab vs placebo as adjuvant therapy for triple negative breast cancer (TNBC)

Dr Yoland Antill

Impact of multidisciplinary team meetings on the management of patients with breast cancer at Cabrini

Dr Yoland Antill

Implementing mainstreaming of genetic testing of women who have ovarian cancer: evaluation of training program for oncology health professionals

Dr Yoland Antill

Phase 2, randomised, double-blinded, controlled study of tucatinib versus placebo in combination with capecitabine and trastuzumab in patients with pretreated unresectable locally advanced or metastatic HER2+ breast carcinoma

Dr Yoland Antill

Psychosocial aspects of genomic testing for breast cancer risk

Dr Yoland Antill

Patient, ED and ambulance service perspectives on redirection of public patients to private EDs to alleviate strain on the public EDs

Dr Michael Ben-Meir

– 79 –

CABRINI HUMAN RESEARCH ETHICS COMMITTEE (CHREC) AND RESEARCH GOVERNANCE OFFICE

CH R E C PROJE C T S A P P ROV E D PROJ E C T TI TLE

PRINCIPAL INV E ST IG ATO R

Application of data mining methods to health information using Bayesian techniques

Prof Leanne Boyd

Preventing inpatient falls on an acute medical ward by preventing unattended bed exits by piloting the Ocuvera falls prevention system

Prof Leanne Boyd

Airway education in Australian intensive care medicine: Do we speak the same language?

A/Prof David Brewster

ANZ CODE: Australia and New Zealand cardiac arrest outcome determinants and ECMO suitability study. A multicentre prospective observational study of in-hospital arrests in Australia and New Zealand

A/Prof David Brewster

Systematic review of literature on leadership in intensive care medicine

A/Prof David Brewster

Systematic review of perioperative renal protection strategies for patients undergoing cardiopulmonary bypass for cardiac surgery

A/Prof David Brewster

Systematic review of the literature of the clinical effects of team training in intensive care

A/Prof David Brewster

Barriers and enablers for referrals to and participation in a physiotherapy program for people with hip or knee osteoarthritis: capturing referrer and patient perspectives

Dr Tash Brusco

How do Cabrini maternity patients value the Eve maternity app? An observational study from the end user perspective

Dr Tash Brusco

The success of research implementation strategies on evidence-based decision-making by allied health managers: a randomised controlled trial

Dr Tash Brusco

Back pain questionnaires validity testing study

Prof Rachelle Buchbinder

Surveying palliative care inpatients and their significant others on their experience of music therapy at Cabrini Prahran

Caitlin Bull

Retrospective analysis of brain imaging in participants receiving deep brain stimulation to identify factors relating to health outcomes

Dr Kristian Bulluss

Creation of the Australasian Shunt Registry

Mr Gavin Davis

PREDICT-UC: Optimising infliximab induction therapy for acute severe ulcerative colitis – a randomised ,controlled trial

A/Prof Henry Debinski

Examining comorbidities obtained from administrative data, medical records and self-reported by men diagnosed with prostate cancer and undergoing radical prostatectomy

Dr Sue Evans

Authorised Prescriber – Histamine

A/Prof Ian Glaspole

A phase 3, placebo-controlled, randomised, observer-blinded study to evaluate the efficacy, safety and tolerability of a clostridium difficile vaccine in adults 50 years of age and older

A/Prof Stephen Hall

Patient self-reporting of toxicities during chemotherapy

Jacqui Hastings

– 80 –

CABRINI HUMAN RESEARCH ETHICS COMMITTEE (CHREC) AND RESEARCH GOVERNANCE OFFICE

CH R E C PROJE C T S A P P ROV E D P ROJE C T TI TL E

PRINCIPAL INV E ST IG ATO R

Modification of MET call criteria: What modifications are made at Cabrini Malvern and do they benefit the patient?

Dr Felicity Hawker

Is it feasible to run a communication training day for Australasian College for Emergency Medicine registrars who are approaching their fellowship exit exam?

Dr Dane Horsfall

A process evaluation of centralising surgical patient admission pilot program

Natalie Horvath

Designing future emergency departments: communication systems, spaces and devices

A/Prof Keith Joe

Monash University & Cabrini volunteer testing of a new real-time non-invasive cuffless blood pressure device: pilot clinical trial of efficacy

A/Prof Keith Joe

A phase 1, open-label, dose-escalation study of the safety and pharmacokinetics of HMPL-523 in patients with relapsed or refractory haematologic malignancies

Dr Melita Kenealy

CAPLA trial: Catheter Ablation for persistent atrial fibrillation: A multicentre randomised trial of Pulmonary vein isolation (PVI) vs PVI with posterior Left Atrial wall isolation (PWI).

Prof Peter Kistler

Does imposing financial consequences on private hospitals whose patients suffer a hospital acquired complication affect clinician procedural adverse event reporting behaviour?

Dr Simon Knight

Stroke safe moves program

Helen Kugler

Establishing a biobank of colorectal and pancreatic cancer models for the pursuit of personalised therapies

Dr Belinda Lee

Effects of pharmacological immunosuppression on perioperative outcomes in patients undergoing colorectal cancer surgery

A/Prof Paul McMurrick

Oversewing staple lines and relationship to anastomotic complications in colorectal surgery

A/Prof Paul McMurrick

To investigate elective and non-elective colorectal cancer surgery outcomes in patients aged 80 years and older at both private and public hospitals in Melbourne, Australia

A/Prof Paul McMurrick

The incorporation of patient reported outcome measures for bowel cancer into the Cabrini Monash colorectal neoplasia database

A/Prof Paul McMurrick

What are the effects of renal comorbidities on patient outcomes after colorectal cancer surgery?

A/Prof Paul McMurrick

When to resect? Management of patients with adverse histophathological features post colonoscopic polypectomy

A/Prof Paul McMurrick

Altis and Solyx Incision slings with TVT Abbrevo – clinical efficacy, ultrasound and biomechanical comparison

Dr Jerome Melon

Exploring the knowledge and attitudes of euthanasia and physician-assisted suicide among ethnic minority groups

A/Prof Natasha Michael

– 81 –

CABRINI HUMAN RESEARCH ETHICS COMMITTEE (CHREC) AND RESEARCH GOVERNANCE OFFICE

CH R E C PROJE C T S A P P ROV E D PROJ E C T TI TLE

PRINCIPAL INV E ST IG ATO R

Compassionate clinicians program: development and implementation of the Schwartz rounds program at Cabrini

A/Prof Natasha Michael

Investigating practices relating to supportive care screening in Victorian cancer services

Dr Amber Mills

What are the benefits of pastoral care to hospital patients and aged care residents?

Emma Patterson

Evaluation of the Cabrini clinical deterioration education program

Rick Peebles

ACP enACT: Development and pilot of an advance care planning simulation-based learning intervention for nurses

Amanda Pereira-Salgado

Preferences and willingness-to-pay for home-based end-of-life care (HBEOLC)

Amanda Pereira-Salgado

PREDICT: A registry of critically ill patients to determine predictors of disability free survival

Dr Steve Philpot

A phase 3, randomised, open-label study of nivolumab combined with cabozantinib versus sunitinib in participants with previously untreated advanced or metastatic renal cell carcinoma

Dr David Pook

A phase 3, randomised study comparing nivolumab and ipilimumab versus placebo in participants who have localised renal cell carcinoma and underwent radical or partial nephrectomy and are at high risk of relapse

Dr David Pook

A randomised, double-blind, placebo-controlled phase 2 study comparing CB-839 in combination with Cabozantinib (CB-Cabo) versus placebo with Cabozantinib (Pbo-Cabo) in patients who have advanced or metastatic Renal Cell Carcinoma (RCC)

Dr David Pook

A randomised, open-label, phase 3 study to evaluate efficacy and safety of pembrolizumab (MK-3475) plus epacadostat vs standard of care (sunitinib or pazopanib) as first-line treatment for locally advanced or metastatic renal cell carcinoma (mRCC)

Dr David Pook

A pilot study on the implementation of caregiver massage therapy in the inpatient palliative care setting

Katherine Pryde

A multicentre, open-label, phase 1b/2 study to evaluate safety and efficacy of avelumab (msb0010718c) in combination with chemotherapy with or without other anti-cancer immunotherapies as first-line treatment in patients who have advanced malignancies

A/Prof Gary Richardson

An open-label, multicentre, dose-escalation phase 1 study to evaluate safety, tolerability, pharmacokinetics and immunogenicity of KN046 in subjects with advanced solid tumors

A/Prof Gary Richardson

A phase 1, multicentre, open-label, single-arm, dose-escalation, clinical study to evaluate the safety, tolerability, pharmacokinetics (PK) and anti-tumor activity of FN-1501 monotherapy in patients who have advanced solid tumors

A/Prof Gary Richardson

A phase 1, open label, dose escalation study of CK-301 administered intravenously as a single agent to subjects with advanced cancers

A/Prof Gary Richardson

A phase 1b/2 open-label study to evaluate safety, clinical activity, pharmacokinetics and pharmacodynamics of avelumab (MSB0010718C) in combination with other cancer immunotherapies in patients with advanced malignancies

A/Prof Gary Richardson

– 82 –

CABRINI HUMAN RESEARCH ETHICS COMMITTEE (CHREC) AND RESEARCH GOVERNANCE OFFICE

CH R E C PROJE C T S A P P ROV E D P ROJE C T TI TL E

PRINCIPAL INV E ST IG ATO R

A phase 2a, open-label trial to investigate the safety, tolerability, pharmacokinetics, biological and clinical activity of AGEN1884 in combination with Pembrolizumab in subjects with chemotherapy naive, PDL1 high, metastatic non-small cell lung cancer

A/Prof Gary Richardson

Circulating tumour DNA as a marker of residual disease and response to adjuvant chemotherapy in stage I-IV epithelial ovarian, fallopian tube and primary peritoneal cancer

A/Prof Gary Richardson

Modelling human breast cancer disease using an experimental in vitro organoid culture system

A/Prof Gary Richardson

Treatment of advanced breast cancer in the HER2-positive Australian patient

A/Prof Gary Richardson

CO2 surgical laser for treatment of stress urinary incontinence in women - an RCT study

Dr Anna Rosamilia

Can frailty describe the variation between clinically observed and calculated length of stay

Dr Michael Rose

BALANCE – Bacteraemia antibiotic length actually needed for clinical effectiveness: randomised controlled trial

A/Prof Vineet Sarode

Prevalence and association of frailty with ICU and hospital outcomes at a large metropolitan private intensive care unit

A/Prof Vineet Sarode

Retrospective analysis of medical emergency team (MET) calls at transition of care

A/Prof Vineet Sarode

SIQ: A multicentre survey of the sources of health information used by surrogate decision-makers of patients admitted to the intensive care unit

A/Prof Vineet Sarode

Pancreatic cancer: understanding routine practice & lifting end results (PURPLE) registry: a prospective pancreatic cancer clinical registry

A/Prof Jeremy Shapiro

A phase 2 open-label extension study for subjects with prostate cancer who previously participated in an enzalutamide clinical study

A/Prof Jeremy Shapiro

EPIC 3: The extended study of prevalence of infection in intensive care III

Shannon Simpson

Authorised Prescriber – 68Ga Prostate Specific Membrane Antigen (68GaPSMA)

Dr Dinesh Sivaratnam

Evaluation of the memory support unit at Westhaven

Dr Constantine Tsingas

Evaluation of the memory support unit at Wyndham Lodge – third stage

Dr Constantine Tsingas

Family violence directed at kinship care placements (Tasmania)

Dr Constantine Tsingas

Occupational violence experienced by staff in Baptcare’s residential aged-care facilities

Dr Constantine Tsingas

Authorised prescriber – histamine

Mr Patrick Walsh

Authorised prescriber – Holistien (positive Histamine control)

Mr Patrick Walsh

Correlation of structure and function in multiple sclerosis

Dr Owen White

– 83 –

CABRINI INSTITUTE TEAM The Cabrini Institute’s team is responsible for developing, supporting and promoting the clinical education and research activities of Cabrini. The group brings with them a broad range of clinical and managerial experience.

Group Director Nursing, Clinical Education and Research

Visiting Honorary Research Fellow

Dr Teemu Karjalainen

Professor Leanne Boyd

Research Assistant

Director of Institute Infrastructure

Jia Xi (JC) Han

Anne Spence Director of Research

Executive Officer, Australia and New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network

Dr Emma Baker

Dr Sheila Cyril

Institute Administration and Infrastructure

Cochrane Musculoskeletal

Leesa Horrigan, Coordinator Engagement and Undergraduate Education Jasmine Kopcewicz, Coordinator Infrastructure Donna Li, Coordinator Postgraduate Education Michele Tonkin, Coordinator Scholarships, Grants and Communications Claire Turner, Cabrini Institute Receptionist

Dr Renea Johnston, Managing Editor Christina Geros, Assistant Managing Editor Biostatistician

Dr Margaret Staples Australasian Satellite of Cochrane EPOC

Dr Denise O’Connor, Director Dr Emma Tavender, Managing Editor Christina Geros, Assistant Managing Editor

Institute Health Data Management

Justin Lang Mr Gilbert Shardey

Australian Rheumatology Association Database (ARAD)

Professor Rachelle Buchbinder, Principal Investigator Vibhasha Chand, Data Manager Ashley Fletcher, Project Officer

Cabrini Human Research Ethics Committee (CHREC)

Grace Wijnen, Acting Manager, CHREC and Research Governance Deb Macdonald, CHREC Administrator

Administrative Assistant

Lee & Brian Johnstone Cabrini Library

Cathy Matthews

Di Horrigan, Manager of Library Services

PhD students

MO N A S H D E PA RTM E NT O F C L I NI C A L E P I D E M I O LO GY AT C A B R IN I H O S P I TA L

Caitlin Farmer, Monash University Dr Bethan Richards, University of Sydney Liana Cahill, Australian Catholic University

Director and NHMRC Senior Principal Research Fellow

Professor Rachelle Buchbinder Deputy Director, Senior Research Fellow and Director of Australasian Satellite of Cochrane Effective Practice and Organisation of Care (EPOC)

Dr Denise O’Connor Postdoctoral Research Fellows

Dr Allison Bourne Dr Romi Haas Dr Rebecca Jessup Dr Polina Putrik Honorary Research Fellow

Melanie Hawkins

C AB RI NI MONA SH DE PARTME NT OF ME DI C AL ONCOLO GY – TH E SZ AL MUK FA MI LY DE PARTME NT OF MED I C AL ONCOLO GY Head of Department

Professor Gary Richardson OAM Principal investigators

Dr Yoland Antil Dr Ben Brady Dr Andrew Haydon Dr Kirsten Herbert Associate Professor Melita Kenealy Associate Professor Lara Lipton – 84 –

CABRINI INSTITUTE TEAM

Dr David Pook Associate Professor Jeremy Shapiro Zillan Nieron Associate investigators

Dr Lucy Gately Dr Sanjeev Gill Associate Professor Ian Haines Dr Despina Handiolias Dr Henry Januszewicz Dr Sem Liew Dr Esther Lin Dr Ben Markman Miss Joanna Morgan Dr Tess Schenberg Professor Max Schwarz Dr Gaurav Srivastava Dr Robert Stanley Dr Karen Taylor Dr Mark Voskoboynik Dr Michelle White Associate Professor Max Wolff

CTA ethics specialist

Simer Khairi Acknowledgement of Research Coordinator Staff who have left (2017-18)

Kathryn Barton Nina Box Deeptika Chauhan Ella Modini Rosie Newman C AB RI NI MONA SH UNI V ER SI T Y DE PARTME NT OF SURG ERY, TH E F RÖH LI C H W E ST C H AI R OF SURGERY Head of Department - Fröhlich West Chair of Surgery

Associate Professor Paul McMurrick Consulting Surgeons

Dr Tali Lang

Mr Stephen Bell, colorectal surgeon, senior lecturer Mr Peter Carne, colorectal surgeon, senior lecturer and Director of Colorectal Fellowship Program Mr Martin Chin, colorectal surgeon Mr Chip Farmer, colorectal surgeon, senior lecturer Emeritus Professor Adrian Polglase Mr Pravin Ranchod, colorectal surgeon, lecturer Mr Paul Simpson, colorectal surgeon

Research coordinators

Senior Research Fellow

Li Hoon Lai (team leader) Daphne Antonopoulos James Baker Theresa Ealdama Melissa Groom Kate Hurford Joseph Miani Aish Murali Breegini Sahayanathan

Dr Simon Wilkins

Research Fellow

Family Cancer Clinic

Lynne McKaye Stephanie Groube

Postdoctoral Research Fellows

Dr Rebekah Engel Dr Christine Koulis Database Manager

Karen Oliva PhD student

Mr Stephen Bell, Monash University Acknowledgement of staff who have left the department (2017-18)

Matthew Holmes

Brightways Breast Cancer Program

Vicky Durston, Manager Melissa Vereker, Data Manager

– 85 –

CABRINI INSTITUTE TEAM

CEN TR E F OR N U R S I NG RE S E A RC H

SZ AL MUK FA MI LY P SYC H O - ONCOLO GY RE SE ARC H UNI T

Head of Department

Professor Lee Boyd, Group Director Nursing, Clinical Education and Research

Head of Department

Research Fellow

Research Fellows

Amanda Pereira-Salgado

Dr Irene Bobevski Dr Jo Brooker

Research Assistant

Professor David Kissane AC

Patrick Mader

Research Assistant

PhD students

Dr Tanya Osicka

Louise Alexander, Deakin University Tegwyn McManamny, Monash University Mani Suleiman, RMIT Sue Wiley, Monash University Diana Wong, Monash University

Adjunct Senior Research Fellow

Dr Sue Burney – Emeritus C AB RI NI ALLI ED H E ALTH RE SE ARC H AND E DUC ATI ON Head of Department

PAL L IAT IV E A N D SUP P O RT I V E C A RE RE S E A RCH U N IT

Associate Professor Helena Frawley

Head of Department

Dr Tash Brusco

Associate Professor Natasha Michael

Research Fellow

Senior Research Associate

Dr Kuan-Yin Lin

Associate Professor Clare O’Callaghan

Research Assistant

Research nurses

Sophie Jennings

Adelaide Melia (to February 2018) Nerida Morton Clinician collaborators

Dr Christopher Grossman Dr Devi McAlpine Dr Merlina Sulistio Dr Martina Welz Honorary appointment

Xavier Symons, Research Associate, University of Notre Dame Medical students

Greta Beale, University of Notre Dame William de Silva, Monash University Aashima Juneja, University of Notre Dame Catherine Manning, University of Melbourne

Research Fellow and Education Manager

PhD students

Edwina Lamborn, La Trobe University Lillian Krikheli, La Trobe University Brea Kunstler, Federation University John Pierce, La Trobe University Jason Wallis, La Trobe University Masters Students

Helen Kugler, La Trobe University Kellie Wright, La Trobe University Administration, Allied Health Education

Donna Li I NTENSI V E C ARE UNI T Director Intensive Care Unit

Associate Professor Vineet Sarode Deputy Director Intensive Care Unit, Head of ICU Research

Associate Professor David Brewster – 86 –

CABRINI INSTITUTE TEAM

Shannon Simpson

Natalie Horvath, Clinical Educator Perioperative Jess Hayward, Clinical Educator Allied Health Kim Kenwell, Clinical Educator Kelly Sherman, Clinical Educator Undergraduate and Clinical Educator Deterioration and Resuscitation Louise Suttie, Clinical Educator Transition to Professional Practice and Clinical Educator Deterioration and Resuscitation

E M E RGE N CY D E PA RTM E NT

Clinical support nurses

Intensive Care Physicians

Professor Warwick Butt Dr Deirdre Murphy Dr Steve Philpot Dr Ben Turner ICU Research Coordinator

Director of Emergency Medicine

Dr Michael Ben-Meir Director of Emergency Medicine Research

Dr Katie Walker Emergency physicians

Associate Professor Keith Joe Dr Christine Jackman

Andrea McDonald, Clinical Support Nurse Cardiac Simone Sherer, Clinical Support Nurse Clinical Deterioration Bernadette Tiberi, Clinical Support Nurse Advanced Care Alice Wandke, Clinical Support Nurse Neurology and Cognition Irene Zhao, Clinical Support Nurse Perioperative Undergraduate Clinical Placement Facilitators

CL IN IC A L E D U C AT I O N D E PA RTM E NT

Anie Abraham Stefanie Adlam-Smeele Eliza Burke Sarah Mann Marina Necoski Andrew Talbot Helen Thompson

Managers

Acknowledgement of staff who have left the education department (2017-18)

Jo Schlieff, Manager Clinical Education Amanda Peat, Manager Quality and Safety Education

Scott Dickson Chris Quinn

Co-director of Emergency Medicine Training

Dr Dane Horsfall MD candidate

Jennifer Hanning

Academic Coordinator

Geoff White

D EPARTMENT OF ME DI C AL ED UC ATI ON

Curriculum Administrator

Barb Miles

Director Medical Education Cabrini Health Clinical Dean, Cabrini-Monash University Clinical School

Clinical Education Curriculum Developers

Associate Professor David Brewster

Rick Peebles, Quality and Safety Education Curriculum Developer Tanya Harding, Clinical Education Curriculum Developer Lauren Williams, Clinical Education Curriculum Developer

Clinical Site Administrator Cabrini-Monash University Clinical School

Clinical educators

Abby Falla, Clinical Educator Transition to Professional Practice Kristin Hamer, Clinical Educator Midwifery

Jennie McInerney Clinical Educator Cabrini-Monash University Clinical School

Naomi Snowden

– 87 –

CABRINI INSTITUTE COUNCIL The Cabrini Institute Council is responsible for overseeing and advising on the Cabrini Institute’s clinical education, research and health promotion strategies and governance. The group brings a broad range of clinical and managerial experience to the Cabrini Institute Council’s governance role.

Professor Peter Fuller AM

Dr Emma Baker

Professor Lee Boyd

Member since June 2005, Chair from May 2014

Invitee since July 2015

Invitee from September 2014, Member since September 2015

Professor Peter Fuller AM is a National Health and Medical Research Council Senior Principal Research Fellow at Hudson Institute in Melbourne where he is Associate Director, Head of the Centre for Endocrinology and Metabolism Research Group, and Head of the Steroid Receptor Biology Group. He is Head of the Endocrinology Unit at Monash Health and Adjunct Professor in Medicine and Biochemistry and Molecular Biology at Monash University. His research interests include understanding the molecular mechanisms of adrenal steroid hormone action and the molecular pathogenesis of endocrine tumours.

Dr Emma Baker is the Director of Research at the Cabrini Institute. Emma has a research background in epigenetics and pre-clinical testing in cancer models and is a previous recipient of National Health and Medical Research Council and Cure Cancer Australia Fellowships. She is responsible for leadership of research activities at the Cabrini Institute. This includes overseeing the research teams, promotion of Cabrini’s research, strengthening Cabrini’s reputation for clinical research, and overseeing the oncology clinical trials program.

Professor Lee Boyd leads the Cabrini Institute as Group Director of Nursing, Clinical Education and Research. She has a clinical background in critical care and began working at Cabrini in 2012 as Director of Education and Staff Development.

Professor Boyd has more than 20 years’ experience in health professional education. Previously, she worked at Monash University as Director of Academic Programs (Middle East) and Head of Department Community Emergency Health and Paramedic Practice. She holds postgraduate qualifications in education and critical care from Monash University and a Master of Tertiary Education Management from the University of Melbourne.

– 88 –

Professor Alison Hutchinson Member since November 2017 Professor Hutchinson is Chair in Nursing, Deakin Centre for Nursing Research at Monash Health, and Professor of Nursing in the School of Nursing and Midwifery at Deakin University. She is Deputy Director of the Deakin University Centre for Quality and Patient Research.

Her research interests centre on translation of research evidence into clinical practice and the care of older people.

CABRINI INSTITUTE COUNCIL

Sam Low

Jeremy McCarthy

Professor Meg Morris

Invitee from May 2015

Member since February 2007

Member since February 2015

Jeremy McCarthy is a partner at national law firm HWL Ebsworth in its mergers and acquisitions group in Melbourne. He has extensive experience in corporate governance and general commercial matters and has drafted a broad range of commercial contracts. He advises clients in a range of industries, in particular the health sector.

Professor Meg Morris is a physiotherapist and fellow of the Australian College of Physiotherapists. She is Head of the School of Allied Health at La Trobe University, an Honorary Professor at Cabrini and an Honorary Professor at Melbourne Health. She is an international expert in ageing and neurological conditions such as Parkinson’s disease and is widely published.

Professor Morris is known for her work on physical activity, exercise and dancing for people with Parkinson’s disease, as well as physical activities and strength training. She has strong international research collaborations in Italy, Ireland and Singapore.

As Cabrini’s Finance and Treasury Manager, Sam Low is responsible for Cabrini’s financial accounting, compliance and treasury.

He has been a Chartered Accountant for 13 years and has a Graduate Diploma in Applied Finance from the Financial Services Institute of Australasia. Previously, he was the Corporate Finance Manager at a national logistics company jointly owned by Australia Post and Qantas. Prior to that, he worked at professional services firm Deloitte.

– 89 –

Professor Robyn O’Hehir AO Member since September 2010 Professor Robyn O’Hehir AO is Professor/Director Allergy, Immunology and Respiratory Medicine, Central Clinical School, Monash University and Alfred Hospital, Deputy Head, Central Clinical School, Monash University and Deputy Head Research, Alfred Health. She is a consultant physician, educator and internationally renowned researcher in allergy and antiinflammatory therapies with substantial grant support from the National Health and Medical Research Council.

Robyn was elected a Fellow of the Australian Academy of Health and Medical Sciences and a Fellow of the Thoracic Society of Australia and New Zealand in 2015 and she was made an Officer of the Order of Australia in 2016.

Robyn is a Life Governor of Asthma Victoria and a member of Council of the Sir Robert Menzies Memorial Foundation.

CABRINI INSTITUTE COUNCIL

Sue Parkes Invitee since July 2015 Sue Parkes, Director of the Cabrini Foundation, has more than 20 years’ experience working in not-for-profit organisations including some of Australia’s leading nongovernment organisations.

Sue has held leadership roles at Melbourne City Mission, Sacred Heart Mission, Brotherhood of St Laurence and Eastern Health. She has a strong commitment to social justice and is currently on the Board of the Fitzroy Learning Network.

Associate Professor John Santamaria Member since August 1996 Associate Professor John Santamaria is the Director of St Vincent’s Hospital Melbourne’s Intensive Care Unit. He is National and State President of the Australian and New Zealand Intensive Care Society. He was a member of the Cabrini Board of Directors for many years and served as Vice Chairman from September 2005 until October 2009.

Professor Julian Smith

Dr Michael Walsh

Member since July 2015

Member since December 2008

Professor Julian Smith is Head of the Department of Cardiothoracic Surgery at Monash Health, Head of Monash University’s Department of Surgery (School of Clinical Sciences at Monash Health) and Deputy Head of the School of Clinical Sciences at Monash Health. He has served as a Councillor of the Royal Australasian College of Surgeons. He is a consultant cardiothoracic surgeon at MonashHeart and has broad basic and clinical research interests in robotic and minimally invasive surgical techniques, acute kidney injury after cardiac surgery, utilising large databases to monitor patient outcomes and in surgical education.

Dr Michael Walsh has been Chief Executive of Cabrini Health since 2008. He has a distinguished career in hospital and health administration in Victoria, Western Australia, the UK and the Middle East. He is a medical graduate of Monash University and holds a Master in Public Administration from the Kennedy School of Government, Harvard University. He is a Fellow of the Royal Australasian College of Medical Administrators and the Australasian College of Health Service Managers.

– 90 –

CABRINI INSTITUTE COUNCIL

Professor Neville Yeomans AM Member since February 2010 Professor Neville Yeomans AM is Director of Research at Austin Health and Emeritus Professor of Medicine (previously Foundation Dean) in the School of Medicine, University of Western Sydney.

He is a gastroenterologist and a fellow of the Royal Australasian College of Physicians, American College of Gastroenterology and American Gastroenterological Association. His research has been mainly into the biology and pathology of the gastric mucosa, pharmacology of acid-related diseases and recently, medical education.

– 91 –

SUPPORTERS The Cabrini Foundation is grateful to our generous supporters, both those listed and those who wish to remain anonymous.

A S SO CIATE S

Alice Vaughan

Georgina Barraclough

B & A Wain

John & Liz Bate

Marcia Williams

Brighton Grammar School

Ms Margaret Wonson

The Sir Wilfred Brookes Charitable Foundation

Mrs Margaret O’Driscoll

Mr Richard Carter AM Estate of Maxwell Chapman

PATRONS

Stephen Charles AO

John & Ruth Adamson

Nelson & Julie Cheung celebrating our 50th Anniversary

Aquanita Racing

Mrs Margaret Coningsby

Pat & Sheril Aughterson

Cornelis Van Ek

Eric Ormond Baker Charitable Fund

In Memory of Ron & Joan Davies

Theodore (Ted) & Miriam Berman

Brian Davis

Besen Family Foundation

Dromana Football & Netball Club

Mr & Mrs Jack & Meg Bowen

Geoffrey H Thomas

Ron Bunker & Evelyn Abaya

John Graham

Reginald & Audrey Campbell

Edith Greiman

Caravan Industry Australia Victoria Trades Division

Jean & Ern Ireland - Sea Bee Pty Ltd

Carter Family Foundation

Mr & Mrs Simon & June Lubansky

Chris Chadwick

Ron & Fay Malouf

Estate Of Mrs Margaret Cochrane OAM

Mr Brian Marshall

Naja David & Family

Matear Family

Dr Bruce & Mrs Pat Davis

Desmond W Milner

Downie Family

In Memory of Judith Moir

Mary Drenen

E. Morris

The Duggan Foundation

Armando Poli

Mr & Mrs Wal Edgar & Family

Lyn Punter

The Marian & E H Flack Trust

Mrs Irene Reich

Gailey – Lazarus Foundation

Dr John Rogers AM & Mrs Rogers

Mr Michael & Mrs Helen Gannon

Richard Rogers & Ros Rogers OAM

Eli & Kerry Goldfinger

Pamela Shotton - in memory of John Shotton

Grenda Foundation

Yvonne Spencer

Dorothy Haines

The Springwaters Foundation

P & M Harbig (Holdings) Pty Ltd

The Strachan Family

Peter Heffernan

Leonie Thompson

The George Hicks Foundation

Yvonne Thompson

The Irvine Club Inc

Joan And Roderick Thomson

Jacobs Thomas & Associates – 92 –

SUPPORTERS

Dr Sharon Keeling

The Russell Foundation

Mr Doug Kefford AO

Dinah Tobias

Langton’s Pty Ltd

Mrs Valma Truin

Annie Rose & Andrew Lazar Foundation

Barbara Tucker

Lynette & Kevin Lee

In Memory of Suzanne Vass

Mrs Barbara J Lewis

Peter T. Wain & Family

The Lochtenberg Family

The Wallis Family

Lord Mayor’s Charitable Fund

Marie & John Warnock

Joan Loton

Mr Choo Keng Wee & Mrs Beverley Anne Wee

The Lowthian Family

The Werled Foundation

Andy Lyas

Geoffrey Robin Westacott

Men of Malvern

In Memory of Julie Young

Christopher Marriott In Memory Of Leigh Masel

B ENEFAC TOR S

Allan McNicol

John Allison Monkhouse

The Mezo Family

Amgen Australia Pty Ltd

Barry & Beatrice Moignard Charitable Trust

AON Risk Services Australia

Montague Group

Mr Nick & Miss Angela Baldi

R M Morgan AM

Beaconsfield & de Winter Families

Mr Bernard Sweeney

Bib Stillwell BMW

Mr Max Walters

W & G Bradshaw Trust

Mr John & Mrs Pamela Murphy

John Christophersen

Richard (Frederick) O’Brien

Collier Charitable Fund

O’Connor Duffy Foundation Proclaim Management Solutions Pty Ltd

Commonwealth Bank Of Australia – Corporate Financial Services Vic & Tas

John Reeves

The De Luca Family

Mr Benedict J Roche

David & Kristene Deague

Drs Sue & Phil Ronaldson

Mr Andrew C Facey

Rotary Club of Chadstone/East Malvern

Mr Geoff & Mrs Lesley Freeman

Rotary Club of Brighton Charitable Foundation

Mr John Grossi

Peter & Barbara Shearer

Herschel Asset Management Limited

Mr John Sircom & Mrs Helen Sircom

Mr Russell Hutchinson

Mr Daryl Somers OAM & Mrs Julie Somers OAM

Des & Cheri Jackson

Jean St Leger Educational Scholarship

Jack & Sheila Jenner

Mr & Mrs Frank & Heather Stewart

Kay & Burton Pty Ltd

In Memory of Margaret Roff Sutton

Eleanor Keamy & George Tate

The Hall Family

The Valda Klaric Foundation – 93 –

SUPPORTERS

Mrs Judith Lang & The Gideon Lang Foundation

F E LLOW S

J & M Lloyd

Associated Retailers Limited

Jeff Loewenstein

The Bachrach Charitable Trust

Helen Macpherson Smith Trust

In Memory of Jan Bucknall

Mr Colin & Mrs Jannene Madden

Charter Security Group

Alison McElroy

The Alfred & Jean Dickson Foundation

Ron & Valerie McLaughlan

The Fryer Family

MIA Victoria

Prue Gillies

Doris Mohl OAM

Brian Goddard

Mr Hugh Morgan AC & Mrs Elizabeth Morgan

Ken Grenda AM & Margaret Grenda

Paul Mullaly QC

Geoff and Helen Handbury Foundation

Mr Patrick Nalty

Mr & Mrs Higgins

The O’Donohue Family

Mrs Kerrie Hunter & Family

Paulusz Family Foundation Prostate Cancer Foundation of Australia Elinor Rabinov Margaret & Tony Reeves Gary Richardson Roche Products Pty Ltd Irvin Rockman CBE In Memory of Mrs Bella Rogers Rotary Club of Brighton Rotary Club of Malvern The Sanford Partnership Sanofi-Sythelabo Australia Pty Ltd Margaret Savill

Mrs Dinah Krongold & Family Anthony & May Barry Dr Laurence LeWinn Foundation The Matthey Family Kylie Minogue OBE Richard & Susan Mizgala Frank O’Shea OAM The Family of Duncan Powers In Memory of Marlene Regan The Sasse Family Mr & Mrs P Selzer & Family Signorino Family

Alexander Slade

Neville & June F.M. Smith

The Brian Smith Endowment

Victor Smorgon Charitable Fund

Smith & Nephew Pty Limited

Mr Brian J Sutton FCNA

Margery E Snowball

David & Chasya Tamir

Sotheby’s Australia

PF & RA Tomaino

Spooner Family

Dr Michael Walsh & Family

G & K Stansen Tattersall’s, The Estate of The Late George Adams

PARTNER S

Mr Stewart & Mrs Ingrid Webster

The Michael & Andrew Buxton Foundation

Yarra Valley Travel

Cabrini Medical Staff

Pharmacia Australia

Lady Patricia Connelly

The late John Saunders AO

Construction Engineering (Aust) Pty Ltd – 94 –

SUPPORTERS

Maureen Coomber

Szalmuk Family Department Of Medical Oncology

Marc & Bev Fookes

Mrs Anne Wollach-Szalmuk

Charles Holckner & Family - In Memory of Lily

Mr Geoff Szalmuk

Harold Johnston OAM & Kay Johnston AM

Mrs Simone Szalmuk-Singer

Jreissati Foundation

The Simonds Family

Susan Kavals Memorial

Dr David & Mrs Lisa Thurin

Equity Trustees Limited

Mr & Mrs Joseph & Helena Frőhlich West

Mr David & Mrs Barbara MacDonald

Frőhlich West Chair Of Surgery

Mr Louis Managan AO & Cecile Mangan The McMurrick Family

I N ME MORI A M

Peter Meese Cancer Nursing Fund

Mr Christopher Bedelis

Mr & Mrs Mark Newman

Dr Katrina Bottomley

Richard & Dorothea Nossbaum

John William Clapham

Ostomy Association Of Melbourne Inc

Kevin Elias

Alan, Ada & Eva Selwyn Family

Walter Lyle Fish

Michael & Donna Tricarico & Family

Kerrie Hunter Patricia Janes

COMPA N IO N S

Stephen Kelly

Aventis Pharma Pty Ltd

Dr Angela Marks

Mr John Gandel AO & Mrs Pauline Gandel

Mrs Christine Potts

Mr Ian & Mrs Linda Gandel

Joyce Reed

Ms Michelle Gandel

Timothy Russell

Mr Tony & Mrs Helen Gandel

In Memory of Richard John Savill

Heartbeat Cabrini Inc.

Charlotte Tait

Mr Alan Jackson AO & Mrs Esme Jackson

In Memory of George & Mira Szalmuk – The Szalmuk Family

Alan Jackson Nursing Research Fellow Mr John Laidlaw OAM & Mrs Betty Laidlaw

E STATE S

Mr Angus Mackay

In Memory of Claire Abrahams

Pfizer Australia Pty Ltd

Estate of Gustav G.H. Apituley

Mr David Mandie AM OBE

Estate of Ellen M Balderstone

Merrin Foundation

Estate of Nola Barnes

Nigel Peck AM & Patricia Peck

Estate of Elaine Louise Benger

The Moniek Sambor Family Memorial Research Fund – The Sambor Family

Estate of Carmel Mary Blanton

Richard Smith

Mrs Ann Brewer

The Stewardson Charitable Trusts

Estate of Rosina Violet Brown

Mr George & Mrs Mira Szalmuk

Estate of Nance Nevasa Buchanan

Estate of Doris Elaine Boyd

– 95 –

SUPPORTERS

Estate of Agnes Ferguson Clark

In Memory of Mrs Katherine Jane Mactier

Estate of Annie Marjorie May Clarke

Estate of Brian Charles Mander

Roger John Cleary

Estate of Katherine Mander

Estate of Joyce Mena Coxall

Estate of Lynette Mary Manzie

Estate of John Robert Edwards

Estate of June Masson

Estate of Dr Betty Elliott

In Memory of Kiril Miltenov

Estate of Carl & June Simpson

Frances Maria Miltenov

Estate of Barbara Feil

Estate of Marjorie May Murdoch

In Memory of Hubert Frances & Margaret Mary McCarthy

Estate of Rex Oxnam

Estate of Harold Francis

Estate of Leslie Charles Parkinson

Estate of U M Frawley

Estate of Domenico Romeo Pertile

Estate of Dorothy Cecelia Garbutt

Estate of AV Powers

Estate of Pamela Golding

Estate of Lindsay G Quinn

Estate of John Sutherland Hamling

Estate of William Clifford (Peter) Rawlins

Estate of Diana Mary Harcourt

Estate of Alexander Graeme Robertson

Estate of Pamela Mary Harper

Estate of Grace Saunders

Estate of Noel Arthur Hatherly

Mrs E C Seccull

Estate of Mary Kathleen Hauser

Estate of Alan Selwyn

Estate of Doris Mary Hawkless

Estate of Leslie Alfred Shapland

Estate of Doreen Johnson

Estate of Maria (Lina) Concetta Sinelli

Estate of Valda Irene Keil

Bella Taft

Estate of Irene Kozica

Estate of Hugh L Wallace

Estate of Belinda Lim

Estate of Wilma Elsa White

Estate of Robert Mackey

Estate of Betty Geddes Wood

– 96 –

K EY PARTNER S OF TH E C AB RI NI I NSTI T UTE

ACU

AC U COLLE G E

L A TROB E UNI V E R SI T Y

MONA SH UNI V E R SI T Y

SW I NB URNE UNI V ER SI T Y

UN I V ER SI T Y OF MELB OURNE

UNI V E R SI T Y OF NOTRE DA ME

MO N A SH PARTNE R S AC ADE MI C HE ALTH SC I ENC E C E NTRE ( K NOW N A S MONA SH PARTNE R S)

– 97 –

C AB R IN I MIS S ION

TH E C AB RI NI I NSTI T UTE MI S SI ON

Who we are: We are a Catholic healthcare service inspired by the spirit and vision of Saint Frances Xavier Cabrini and the Missionary Sisters of the Sacred Heart of Jesus.

The Cabrini Institute is committed to improving the clinical outcomes of patients of Cabrini. It embraces the mission, values and vision of Cabrini and works within an ethical framework. The Cabrini Institute has a vital role in helping Cabrini to achieve its vision – that is:

What we believe: We are a community of care, reaching out with compassion, integrity, courage and respect to all we serve.

What we do: We provide excellence in all of our services and work to identify and meet unmet needs.

“We will provide clinical excellence by learning, researching and continuously improving the quality of our care, and having motivated staff committed to our healthcare mission . . . We will enhance health and quality of life by treating sickness, and by working with our patients and their families to anticipate, prevent and ease suffering.”

C AB R IN I VA LU E S

Our values form the base of our mission, are built around what we believe and drive how we act. They are drawn from Saint Frances Xavier Cabrini’s life and reflect her heart, her spirit, her conviction and her approach.

Compassion: Our drive to care is not just a professional duty to provide excellent quality care but is born of a heartfelt compassion for those in need, motivated by God’s love for all people.

Integrity: We believe in the power of hope to transform people’s lives and remain faithful to the bold healing mission and legacy of Saint Frances Xavier Cabrini.

Courage: We have the strength, determination, vision and conviction to continue the work of Mother Cabrini and the Cabrini Sisters.

Respect: We believe that every person is worthy of the utmost respect and the best possible healthcare.

We know that our resources are entrusted to us to use for the benefit of others.

– 98 –

– 99 –

C ABRINI INSTIT UTE

154 Wattletree Road Malvern Victoria 3144 Australia ph (03) 9508 1222 email: institute@cabrini.com.au www.cabrini.com.au