2014 research abstracts - eastern health

Research that is relevant, improves practice and informs the wellbeing of our community

2014 RESEARCH ABSTRACTS

1

2014 Eastern Health Research Forum Abstracts

Presentations

Are weekend rehabilitation services value for money? An economic evaluation alongside a randomised controlled trial with a 30 day, 6 and 12 month follow up

Natasha K Brusco1,2,3 Jennifer J Watts4 Nora Shields3,5 Nicholas F Taylor1,3 .................................................. 4

Evaluation of Digital Breast Tomosynthesis(DBT) in a BreastScreen assessment service Darren Lockie1, Zoe Aitken2 and Carolyn Nickson2 ........................................................................................ 5

Impact of primary tumour site on bevacizumab efficacy in metastatic colorectal cancer (mCRC) H Wong1, K Field2, A Lomax3, M Tacey4, J Shapiro5, J McKendrick3, A Zimet6, D Yip7, L Nott8, R Jennens6, G Richardson5, J Tie1-2,9, S Kosmider9, P Parente3,10, L Lim3, P Cooray3, B Tran1-2,9, J Desai1-2, R Wong3, P Gibbs1-2,9 ......................................................................................................................................................... 6

The maximum tolerated dose of walking for people with osteoarthritis of the knee: a phase I trial Jason A Wallis1,2, Kate E Webster2, Pazit Levinger3, Parminder J Singh1,4,5, Chris Fong1,4, and Nicholas F Taylor1,2 .......................................................................................................................................................... 7

Outcomes of patients who require emergency response for clinical deterioration within and beyond 24 hours of emergency admission

Julie Considine,1,2 Judy Currey,2,3 David Charlesworth4 ................................................................................. 8

Three datasets are better than one! Alcohol related diagnoses from ambulance to hospital admission in Melbourne

Sharon Mattthews1,2, Belinda Lloyd1,2, Jason Ferris3 ..................................................................................... 9

2

3 Minute Presentations

Mutation profile of differentiated thyroid tumours in an Australian urban population

Michael Mond1,2, Maria Alexiadis1, Peter Fuller1, Christopher Gilfillan2 .................................................... 10

Trends in alcohol related chronic conditions in the context of residential location and social deprivation C. Heilbronn1,2*, S. Matthews1,2, B. Lloyd1,2 ................................................................................................. 11

Leading the way – evaluation of an innovative seven day allied health service model in the acute setting Jude Boyd, Geraldine Millard, Katherine Harding, Nicholas Taylor, Anne Pagram, Annabelle Bond ......... 12

Survival impact of adjuvant chemotherapy for resected early stage rectal adenocarcinoma R Tay1, M Jamnagerwalla2, M Steel2, HL Wong3-4, JJ McKendrick1,5, I Faragher6, S Kosmider6, I Hastie7, J Desai7, M Harold3, P Gibbs3-4,6-7, R Wong1,5. ................................................................................................ 13

Nursing assessment ofpatients for discharge from post-anaesthetic care: a detailed analysis Street M1, 2, Phillips NM2 ,Kent B3 ................................................................................................................ 14

Specific Timely Appointments for Triage (STAT) reduce waiting time in Physiotherapy Outpatients Katherine Harding1 and Judy Bottrell2 ......................................................................................................... 15

First Impressions count – an analysis of thrombolysis decision making, comparing initial clinician assessment with multimodal CT imaging

Skye Coote1, Tanya Frost1, Shaloo Singhal1, Amanda Gilligan1,2 ................................................................. 16

Posters

Prognostic impact of clinicopathological features in metastatic rectal vs colon cancer

A J Lomax1, H Wong2, K Field3, M Harold4, J Shapiro5, J McKendrick1, A Zimet6, D Yip7, L Nott8, R Jennens6, G Richardson5, J Tie2-3,9, S Kosmider9, P Parente1,10, L Lim1, P Cooray1, B Tran2-3,9, J Desai2-3, R Wong1, P Gibbs2-4,9 ....................................................................................................................................................... 17

Daily Subcutaneous Parecoxib Injection for Cancer Pain: an Open Label Pilot Study David J Kenner1, Sandeep Bhagat2, Sonia L Fullerton3 ................................................................................ 18

Developing a national surveillance system for suicidal behaviour: first findings of population level harm Belinda Lloyd, Cherie Heilbronn, Dan Lubman ............................................................................................ 19

Morbidity and mortality following neck of femur fracture in a metropolitan health system in Australia Jonathan Raw1, Farshad Ghazanfari1, 2, Christopher Fong1, 2, 3 .................................................................... 20

MS FIRST – a longitudinal, prospective, comparative drug safety module for use in MS clinical practice Jodi Haarsten1, Tim Spelman2, Lisa Morgan2, Susan Agland3 , Josephine Baker4 Marie Canty5 Janette Lechner-Scott 3 Louise Rath5 , Helmut Butzkueven2, on behalf of the MS FIRST Investigators. ................ 21

Somatic mutations of FOXE1 in papillary thyroid cancer Michael Mond1,3, Martyn Bullock2, Yizhou Yao1 Roderick J. Clifton-Bligh2, Christopher Gilfillan3, Peter J. Fuller1 ........................................................................................................................................................... 22

3

Posters (continued)

Evaluation of the client experience using Digital Breast Tomosynthesis in the BreastScreen assessment setting

Janis Uhe1, Elizabeth Sundram1, Carolyn Molk1, Ramola Schwartz1, Zoe Aitken2,Carolyn Nickson2 & Darren Lockie1 .......................................................................................................................................................... 23

Treatment pathways and associated outcomes for clients with AOD problems in Victoria and Western Australia

Manning, V1,2., Best, D1,2., Larner, A1., Garfield, S2., McGavin, J1 and Lubman, D1,2 .................................. 24

Evaluation of a new risk assessment matrix for assessment of self-harm risk in borderline personality disorder

Dr Sathya Rao1, Dr. Katherine Thompson2, Dr. Paul Katz1, Dr. Jillian Broadbear1 ....................................... 25

Infliximab infusion protocols are time consuming and severe infusion reactions are rare - is it time for change?

Lauren Beswick1, Lionel Soh2, Anne McFarlane1,, Daniel R van Langenberg1,2 ........................................... 26

Should we be measuring nutritional quality of life in patients with end stage renal failure receiving renal replacement therapy?

Anne-Marie Desai1, Shaylyn Bertino1, Melissa Corken1, Matthew Roberts2, Louis Huang2, Tanya Osicka3, Sarity Dodson4 .............................................................................................................................................. 27

Not enough time or a low priority? Barriers to evidence-based practice for allied health clinicians Katherine Harding, Judi Porter, Anne Horne-Thompson, Euan Donley, Nicholas Taylor ............................ 28

Comparison of mortality and morbidity outcomes in hip fracture patients with and without diabetes Pratyusha Naidu, Johnathan Raw , Christopher Fong, Christopher Gilfillan ............................................... 29

Improving recognition and response to clinical deterioration Andrea Doric, Brenda Birch, David Charlesworth ........................................................................................ 30

The menu regemeration study: exploring the effects of an alternative foodservice approach among geriatric evaluation and management (GEM) patients

Jorja Collins1, Catherine Huggins1, Judi Porter1,2, Helen Truby1 .................................................................. 31

Incident delirium in the acute general medical setting Emily Cull 1, Alison M. Hutchinson 2, Nicole M. Phillips 3 ............................................................................. 32

Exploring the influence of social identity on recovery capital amongst individuals in alcohol and other drug (AOD) treatment

Michael Savic, Ramez Bathish, Melinda Beckwith, David Best & Dan Lubman ........................................... 33

Effectiveness of clinical supervision of physiotherapists: a survey Mr. David Snowdon1, Ms. Geraldine Millard1, Prof Nicholas Taylor2, 3 ....................................................... 34

Thai Emergency Nurses’ Perceptions of Using an Evidence-Based Care Bundle for Initial Nursing Management of Patients with Severe Traumatic Brain Injury

Jintana Damkliang1,2, Julie Considine2,3, Bridie Kent2,4 , Maryann Street2,3 ................................................. 35

Biology and Significance of Prostate Cancer Basal and Luminal Cellular Subtypes Pavel Sluka, Hady Wardan, Carmel Pezaro, and Ian D. Davis ...................................................................... 36

4

Presenting Author:

Natasha Brusco

Title: Are weekend rehabilitation services value for money? An economic evaluation alongside a randomised controlled trial with a 30 day, 6 and 12 month follow up Authors: Natasha K Brusco1,2,3 Jennifer J Watts4 Nora Shields3,5 Nicholas F Taylor1,3

Authors’ affiliation 1Allied Health Clinical Research Office, Eastern Health, 5 Arnold Street, Box Hill, 3128 2Physiotherapy Services, Cabrini Health, 183 Wattletree Road, Malvern, Victoria, 3144 3 Faculty of Health Science, La Trobe University, Bundoora Campus, Victoria, 3086 4Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, Victoria, Australia, 3125 5Northern Health, Department of Allied Health, 1231 Plenty Rd, Bundoora, Victoria, 3083

Background Providing additional Saturday rehabilitation can improve clinical outcomes, but is it cost effective? Aim We aimed to determine if providing additional rehabilitation to inpatients on a Saturday was cost effective, in the 12 months following discharge. Methods Cost effectiveness analyses were undertaken alongside a multi-centre, single-blind randomised controlled trial with a 30-day, 6 and 12 month follow up after discharge. Participants were adults admitted for inpatient rehabilitation in two rehabilitation facilities. The control group received usual care rehabilitation services from Monday to Friday and the intervention group received usual care plus Saturday rehabilitation. Results 996 patients (mean age 74 years) were assigned to the intervention (n = 496) or the control group (n = 500). Intervention group participants had higher functional independence (mean difference (MD) FIM 2.3, 95% confidence interval (CI) 0.5 to 4.1, P = 0.01) and health-related quality of life (MD EQ-5D 0.04, 95% CI 0.01 to 0.07, P = 0.009) on discharge and may have had a shorter length of stay by 2 days (95% CI 0 to 4, P = 0.1). From admission to 6 months there was a significant difference in cost favouring the intervention group (MD AUD$6,445; 95% CI 3,368 to 9,522; p=0.04) and from admission to 12 months there was a non-significant difference in cost favouring the intervention group (MD AUD$6,325; 95% CI -4,081 to 16,730; p=0.23), with no cost shift into the community. Conclusions The provision of an additional Saturday rehabilitation service during inpatient rehabilitation is likely to be cost effective as it significantly improved patient clinical outcomes and was likely to reduce length of stay and provide a cost savings for the rehabilitation admission, with clinical outcomes and cost savings sustained over the medium term. Implications for practice This study supports the implementation of this additional Saturday rehabilitation into practice.

5

Presenting Author:

Darren Lockie

Title: Evaluation of Digital Breast Tomosynthesis(DBT) in a BreastScreen assessment service

Authors: Darren Lockie1, Zoe Aitken2 and Carolyn Nickson2

Authors’ affiliation 1 – Maroondah BreastScreen

2 – The University of Melbourne

Background/Aim In the BreastScreen program 5% of screened women are recalled for assessment due to

suspected abnormalities on screening mammograms. Women undergo ultrasound and biopsy to reach a definitive

outcome, at psycho-social cost to women and financial cost to the program. This study evaluates whether routine

DBT imaging at assessment would reduce the number of biopsies and ultrasounds required to reach a diagnosis.

Methods During the study period, 560 participants (73% of invited women) received DBT imaging prior to the

standard workup. Radiologists assigned separate BIRADS scores to 2D and 3D images. For our analysis, we use 2D

and 3D BIRADS scores to estimate the expected number of investigations that would have occurred under 2D

versus 3D imaging, and compare positive and negative predictive values (PPVs and NPVs) of 2D and 3D scores

against final outcomes. We also compare the radiation dose of 2D workup versus 3D imaging.

Results Rates of cancer diagnosis, biopsy and ultrasound during the study were 17%, 30% and 58% respectively. 93

cancers were diagnosed in the study group (16.8%). For the 462 (83.2%) of participants with a benign final

diagnosis, we estimate that DBT (instead of 2D imaging) would reduce biopsies from 15% to 11.8% (26% reduction),

and ultrasound use from 58% to 51% (13% reduction). The PPV of BIRADS scores 4/5 was 82% for 2D imaging and

82% for DBT (p=0.9). The NPV of score 3 was 85% for 2D imaging and 92% for DBT (p=0.06). Total radiation dose

was on average 1.5 mGy lower for DBT than 2D imaging (mean 4.3 versus 5.9 mGy, p<0.0001).

Conclusions/Implications for practice These findings indicate that imaging in assessment using DBT rather than 2D

mammography could safely reduce the need for biopsies (by 26%) and ultrasound (by 13%) at a lower radiation

dose. DBT imaging in assessment improves clinical outcomes and reduces unnecessary investigations and resources

at a lower radiation dose and is well accepted by clients.

6

Presenting Author:

Anna J Lomax

Title: Impact of primary tumour site on bevacizumab efficacy in metastatic colorectal cancer (mCRC)

Authors: H Wong1, K Field2, A Lomax3, M Tacey4, J Shapiro5, J McKendrick3, A Zimet6, D Yip7, L Nott8, R Jennens6, G Richardson5, J Tie1-2,9, S Kosmider9, P Parente3,10, L Lim3, P Cooray3, B Tran1-2,9, J Desai1-2, R Wong3, P Gibbs1-2,9

Authors’ affiliation 1Walter and Eliza Hall Institute of Medical Research, Parkville, VIC; 2The Royal Melbourne

Hospital, Parkville, VIC; 3Department of Medical Oncology, Eastern Health, Box Hill, VIC; 4Melbourne EpiCentre, University of Melbourne and The Royal Melbourne Hospital, Parkville,

VIC; 5Cabrini Health, Malvern, Australia; 6Epworth Hospital, Richmond, VIC; 7The Canberra Hospital and the ANU Medical School, Australian National University, Canberra,

ACT; 8Royal Hobart Hospital, Hobart, TAS; 9Western Hospital, Footscray, VIC; 10Monash

University, Faculty of Medicine, Nursing and Health Sciences, Eastern Health Clinical School,

Box Hill, VIC

Background

With an increasing focus on personalised medicine, factors affecting treatment response need to be considered to

define optimal therapy. The prognostic impact of primary tumour site on colorectal cancer outcomes has been

described. Emerging data suggests differences in response to biologic therapies.

Aim

Explore the impact of primary tumour site on bevacizumab efficacy in patients receiving 1st-line chemotherapy for

mCRC in routine clinical practice.

Methods

Analysis of pts enrolled in an Australian prospective multicenter mCRC registry. Pts diagnosed from July 2009 -

December 2013 & treated with 1st line chemotherapy were included. Tumor site defined as: right colon (RCC):

cecum - transverse, left colon (LCC): splenic flexure - rectosigmoid, rectum (RC). Kaplan Meier & Cox models were

used for survival analyses.

Results

Of 784 pts, 245 (31%) had RCC, 297 (38%) LCC and 242 (31%) RC primaries. Median age: 69, 66 and 63 years

respectively (p=0.001). No significant difference in performance status, comorbidities or number of metastatic

sites. RCC associated with peritoneal (32, 19 vs 9%, p<0.0001) & RC with lung disease (24, 28 vs 41%, p<0.001).

Overall survival was longest in pts with RC, followed by LCC & RCC (median: 29, 23 and 20 mths, p=0.004). 525

(67%) pts received BEV. Progression-free survival (PFS) was superior for BEV-treated pts in all groups, particularly

pts with right colon primaries.

Conclusions

Tumor site appears to be prognostic in mCRC, with RC and RCC associated with best and worst outcomes

respectively. Pts who received BEV with chemotherapy had superior PFS, the effect greatest in RCC pts. Although

known prognostic factors were adjusted for, other clinicopathologic differences that may contribute to pt

outcomes cannot be excluded.

Implications for practice RCC, LCC and RC’s have distinct differences in their presentation, underlying biology & pt outcomes. Further exploration may allow improved understanding of the optimal management of mCRC.

(This abstract was accepted and presented as an Oral presentation at the Medical Oncology Group of Australia Annual Scientific Meeting, 2014. It was also accepted for publication for the American Society of Clinical Oncology Annual Meeting, 2014. This abstract has been accepted as a poster presentation at the Australasian Gastro Intestinal Trials Group Annual Scientific Meeting 2014).

7

Presenting Author:

Jason Wallis

Title: The maximum tolerated dose of walking for people with osteoarthritis of the knee: a phase I trial

Authors: Jason A Wallis1,2, Kate E Webster2, Pazit Levinger3, Parminder J Singh1,4,5, Chris Fong1,4, and Nicholas F Taylor1,2

Authors’ affiliation 1. Eastern Health 2. La Trobe University 3. Victoria University 4. Monash University 5. Deakin University

Background Increasing physical activity is important for people with knee osteoarthritis (OA) as their risk of mortality from cardiovascular causes is substantially increased in this population with walking disability. Due to overloading the joint and possible exacerbation of their symptoms during physical activity, there is uncertainty on how much physical activity is safe to recommend for people with knee OA. Therefore investigation of the highest dose of walking that can be tolerated would inform current guidelines.

Aim To determine how much physical activity, in the form of walking, can be safely and feasibly prescribed for people with severe knee OA.

Methods Phase I dose response trial with escalating doses of 10, 20, 35, 50, 70 and 95 minutes over one week, of at least moderate intensity, in a minimum of 10 minute bouts were prescribed to people with severe knee OA. The primary stopping rule was intolerable pain levels that either prevented the person from completing the dose, or did not settle within two hours of completing each bout of walking. The primary outcome was an estimation of the maximum tolerated dose of walking.

Results Twenty-four participants (13 women, 11 men) aged between 53 and 83 years were assigned to each dose between 10 and 95 minutes. Three participants in the 95 minute dose reported intolerable pain levels, therefore the previous dose of 70 minutes was deemed to be the maximum tolerated dose. No participant stopped due to reasons related to feasibility.

Conclusions Seventy minutes per week of moderate intensity supervised walking was safe and feasible to prescribe for people with severe OA of the knee; for higher doses there was a risk of exacerbating knee pain levels.

Implications for practice Seventy minutes per week of walking, in bouts of 10 minutes or more, may be a safe and achievable target for people with severe knee OA. Caution should be applied as the medium term effect of this dosage on clinical outcomes remains to be tested.

8

Presenting Author:

Julie Considine

Title: Outcomes of patients who require emergency response for clinical deterioration within and beyond 24 hours of emergency admission

Authors: Julie Considine,1,2 Judy Currey,2,3 David Charlesworth4

Authors’ affiliation 1 Eastern Health – Deakin University Nursing & Midwifery Research Centre 2 School of Nursing and Midwifery, Faculty of Health, Deakin University, Melbourne 3 Centre for Quality and Patient Safety Research, Deakin University 4Eastern Health, Melbourne, Australia

Background

The Australian Government National Emergency Access Target (NEAT) promotes that > 90% of patients will have their emergency department (ED) care completed within four hours. One concern about NEAT is whether shorter ED length of stay (LOS) will result in an increased incidence of clinical deterioration during early stages of hospital admission. Aim

To compare the characteristics and outcomes of patients who required an emergency response for clinical deterioration (cardiac arrest team or medical emergency team activation) within and beyond 24 hours of admission to medical and surgical units via the ED. Methods

A retrospective exploratory approach was used. Participants were adult patients (aged ≥18 years) admitted to a medical or surgical ward via the ED, and who required an emergency response for clinical deterioration during 2012. Results

There were 819 emergency responses for clinical deterioration in 587 patients; in 28.4% of patients the first emergency response occurred <24 hours after emergency admission. Patients with their first emergency response <24 hours after emergency admission: were more likely to be triaged to category 1 (5.4% vs 1.2%, p=0.005); less likely to need ICU admission (7.6% vs 13.9%, p=0.039) or have recurrent emergency responses (9.7% vs 34.0%, p<0.001); and had shorter median hospital LOS (7 vs 11 days, p<0.001). There were no significant differences in ED LOS or in-hospital mortality. Conclusions

One quarter of emergency responses following admission via ED occurred within 24 hours and one in eight patients required ICU admission following emergency response. Further research is needed to understand the antecedents to deterioration in patients requiring admission via the ED. Implications for practice Patients admitted to medical and surgical units via the ED are at high risk of an emergency response for clinical deterioration within the first few days of admission so require high levels of surveillance by ward nursing staff.

9

Presenting Author:

Sharon Matthews

Title: Three datasets are better than one! Alcohol related diagnoses from ambulance to hospital admission in Melbourne

Authors: Sharon Mattthews1,2, Belinda Lloyd1,2, Jason Ferris3

Authors’ affiliation 1 Turning Point, 2 Eastern Health Clinical School, Monash University, 3 University of Queensland,

Brisbane

2

Background The nature of medical care for acute alcohol presentations is not currently adequately documented or understood. Routine monitoring of alcohol harms is an integral aspect of the identification of changing trends. The development of responsive and appropriate policy, prevention and intervention is compromised by the incomplete and accurate identification of alcohol related cases. Aim This paper explores the diagnostic path from an alcohol related ambulance attendance to admission to hospital via the emergency department. Methods Five years of data of ambulance attendances, hospital emergency presentations and hospital admissions were linked. Data were derived from the Ambo Project dataset which includes all alcohol related ambulance attendances in Melbourne and the Victorian emergency and hospital admission datasets (VEMD, VAED). These datasets were linked using a number of validation techniques. The linked data set was analysed in terms of alcohol related attendance and ED and hospital admission diagnoses. Results The main diagnoses recorded for patients transported to the ED following an alcohol-related attendance were for alcohol intoxication (ICD10 - F10.0), and toxic effects of alcohol (T51.9). Over time the proportion of cases in alcohol related groups has declined, with less than 50% of all ED presentations initially identified as acute alcohol intoxication being coded as alcohol related in the ED. Alcohol intoxication-related diagnoses represented a sizeable proportion of all primary diagnosis on admission to hospital accounting for just over half. Conclusions Simply relying on single data sources when examining alcohol related harms underestimates the true picture. Through linking these data sources a more comprehensive understanding can be obtained. Implications for practice Using multiple data sources allows identification of key points for intervention to reduce alcohol harms and the burden on health services.

10

Presenting Author:

Michael Mond

Title: Mutation profile of differentiated thyroid tumours in an Australian urban population

Authors: Michael Mond1,2, Maria Alexiadis1, Peter Fuller1, Christopher Gilfillan2

Authors’ affiliation 1 MIMR-PHI Institute of Medical Research Clayton 2Eastern Clinical School and Eastern Clinical Research Unit, Monash University, Box Hill

Hospital, Box Hill, Victoria 3128

Background The majority of differentiated thyroid cancers are characterised by one of several point mutations or gene rearrangements. Limited data are available on the prevalence and clinical correlations of these mutations in the Australian population. Aim The aim of the study was to characterise the mutation profile of differentiated thyroid tumours in the local population. Methods The study involved 148 patients with differentiated thyroid cancer. The following tumours were examined: 109 papillary carcinomas (PTC), 27 follicular carcinomas (FC) and 12 Hurthle cell carcinomas (HCC). PCR was performed for BRAF and RAS mutations (RNA and DNA) as well as for RET-PTC rearrangements and PAX8-PPARγ translocations (RNA). Clinicopathological parameters and outcome data were analysed according to BRAFV600E status in PTC and RAS mutation status in FC. Results

BRAFV600E was identified in 74/109 (68%) PTC. BRAFV600E was not significantly correlated with clinicopathological features of aggressive disease. At a median follow-up of 48 months, there was no significant difference between BRAFV600E and wild-type BRAF PTC with respect to the rates of nodal recurrence, distant metastases or disease-specific death. In FC, RAS mutations (5 NRAS and 3 HRAS) were present in 8/27 (30%) tumours. RAS mutation was significantly associated with widely invasive histology (p=0.01) and distant metastases (p=0.01) on follow-up.

Conclusions

In this study, BRAF mutation was not associated with negative prognostic indicators or adverse outcomes in PTC. RAS mutation was positively correlated with aggressive features in FC suggesting potential prognostic utility although confirmation is required from larger studies.

Implications for practice The mutation status of thyroid tumours has potential implications for the diagnosis, prognosis and treatment of thyroid tumours. RAS mutant follicular tumours may warrant aggressive initial treatment and vigilant follow-up.

11

Presenting Author:

Cherie Heilbronn

Title: Trends in alcohol related chronic conditions in the context of residential location and social deprivation Authors: C. Heilbronn1,2*, S. Matthews1,2, B. Lloyd1,2

Authors’ affiliation 1 Turning Point, Melbourne, Australia

2 Monash University, Melbourne, Australia

Background: The role of social determinants of health in alcohol-related chronic conditions has not been adequately

explored in Australia.

Aims: This paper is part of a wider project examining trends of alcohol-related chronic health conditions in the

context of apparent stable alcohol consumption, exploring how trends are impacted by social determinants of health

Methods: Exploration of wholly and partially attributable alcohol-related chronic disease trends from 1999 to 2008,

using hospitalisation and death indictors. Joinpoint, using piecewise regression methodology, identified change-

points in the magnitude and direction of trends in metropolitan and non-metropolitan Victoria. Trends specific to

social deprivation were also explored.

Results: Wholly attributable chronic alcohol-related condition hospital patients increased from 138.6 to 194.6 per

100,000 Victorians between 1999 and 2008, with statistically significant increase of 4.5 per cent annually (95% CI 3.7,

5.3). While non-metropolitan rates were higher, the magnitude of increase was greater in metropolitan areas. Also,

substantial and statistically significant negative social gradients were present. While Victorian partially attributable

alcohol-related hospital patient rate did not significantly change, mortality rates declined from 340.0 to 234.6 per

100,000 Victorians from 1999 to 2008. Statistically significant negative social gradients were present.

Conclusion: Complex relationships exist between alcohol consumption and harm in the form of chronic conditions.

By analysing population level data, a greater understanding of the complexities influencing alcohol-related harms at

a community level can be achieved.

Implications for practice: Through identification of social, contextual and environmental factors that influence

chronic alcohol-related harm, targeted prevention, intervention and treatment responses can be developed to

address disparities in health and reduce alcohol related-harm in the community.

12

Presenting Author:

Jude Boyd & Geraldine Millard

Title: Leading the way – evaluation of an innovative seven day allied health service model in the acute setting.

Authors: Jude Boyd, Geraldine Millard, Katherine Harding, Nicholas Taylor, Anne Pagram, Annabelle Bond

Authors’ affiliation

Background:

Allied health (AH) services in the acute setting optimise function, facilitate discharge and prevent readmission.

Traditionally this has been provided within a Monday to Friday staffing model with a separate roster of significantly

reduced service provision on weekends. In response to an organisational redesign initiative across Eastern Health’s

(EH) Emergency Departments and General Medical wards , the disciplines of Occupational Therapy (OT) and

Physiotherapy (PT) sought to join multi-disciplinary colleagues as ‘one team with one plan and one direction’ to

provide equitable access to services, 7 days of the week.

Aim:

The aim of this project was to evaluate the impact of clinical service provision changes to patient flow, length of stay

and staff satisfaction with the implementation of a 7 day AH service model.

Methods:

A mixed methodology research design including quantitative retrospective medical record audits and qualitative staff

focus groups were conducted to gather information both pre and post service delivery changes.

Results:

Outcomes have demonstrated that the changes to service delivery have more evenly distributed discharges

throughout the days of the week, with a notable doubling of discharges on Sunday; and length of stay was reduced

by 0.5 days per patient. The equitable distribution of OT and PT staffing across 7 days, has reduced peak times of

clinical activity on Monday’s and Friday’s thereby improving patient flow. However, maintaining continuity of care

and efficient management of handovers have been key challenges in the implementation of the 7 day service.

Conclusions:

Implementing a seven day service model can positively contribute to patient outcomes in the acute setting.

Implications for practice: The length of stay reduction of 0.5 days per patient is clinically significant for the organisation from an access and flow perspective, and this new model of AH service should be considered in other clinical areas at EH.

13

Presenting Author:

Rebecca Tay

Title: Survival impact of adjuvant chemotherapy for resected early stage rectal adenocarcinoma

Authors: R Tay1, M Jamnagerwalla2, M Steel2, HL Wong3-4, JJ McKendrick1,5, I Faragher6, S Kosmider6, I Hastie7, J Desai7, M Harold3, P Gibbs3-4,6-7, R Wong1,5.

Authors’ affiliation 1Department of Medical Oncology, Eastern Health, Melbourne, Australia, 2Department of

Surgery, Eastern Health, Melbourne, Australia, 3Walter and Eliza Hall Institute of Medical

Research, Melbourne, Australia, 4University of Melbourne, Melbourne, Australia, 5Monash

University, Eastern Health Clinical School, Melbourne, Australia, 6Western Hospital,

Melbourne, Australia, 7The Royal Melbourne Hospital, Melbourne, Australia.

Background

There is uncertainty regarding the benefit of adjuvant fluoropyrimidine-containing chemotherapy following

preoperative chemoradiotherapy and surgical resection for locally advanced rectal cancer.

Aim

To evaluate the impact of adjuvant chemotherapy following preoperative chemoradiotherapy and surgical

resection for early stage rectal cancer on relapse-free and overall survival.

Methods

This is a retrospective analysis of patients with early stage rectal adenocarcinoma, diagnosed between 1 January

2003 and 30 June 2013 at three Melbourne health services (Eastern Health, Royal Melbourne Hospital and Western

Health). Patients were identified from a search of the ACCORD (Australian Comprehensive Cancer Outcomes and

Research Database) database, where a defined data set is prospectively collected on consecutive patients.

Results

A total of 580 patients with localised rectal cancer were identified, of whom 451 had received neoadjuvant long

course chemoradiation followed by resection of the primary tumour. 369 patients (82%) subsequently received

adjuvant 5-fluorouracil. At a median follow-up of 45.9 months, 63 (19%) patients in the adjuvant chemotherapy

group and 21 (29%) in the surveillance only group had relapsed. Median relapse-free survival (RFS) has not been

reached in either group; 3-year RFS was 81% in the adjuvant chemotherapy group compared to 71% in the

surveillance only group (p=0.034). Five-year overall survival was 83% in the adjuvant chemotherapy group compared

to 71% in the surveillance only group (p=0.038).

Conclusions

A high proportion of patients in routine practice receive adjuvant chemotherapy following neoadjuvant treatment

and surgery for early stage rectal cancer. Adjuvant chemotherapy was associated with a significant improvement in

3-year relapse-free and 5-year overall survival.

Implications for practice Our findings would support use of adjuvant chemotherapy following neoadjuvant treatment and surgery for early stage rectal cancer.

14

Presenting

Authors:

Maryann Street

Title: Nursing assessment ofpatients for discharge from post-anaesthetic care: a detailed analysis

Authors: Street M1, 2, Phillips NM2 ,Kent B3

Authors’ affiliation 1 Eastern Health – Deakin University Nursing and Midwifery Research Centre

2 Deakin University, School of Nursing and Midwifery

3 Plymouth University, School of Nursing and Midwifery

Background

Nurses routinely use scoring systems to assess patient discharge from the Post-Anaesthetic Care Unit (PACU).

Consistency of use of discharge scores, documentation of early warning signs of deterioration and relationship to

safe patient discharge from PACU has not been established.

Aim

To evaluate the relationship between nursing assessment for PACU discharge and patient outcomes.

Methods

An exploratory observational study of 728 consecutive elective adult surgical admissions between June and

October 2012. Patient care in PACU was observed and verified with the medical record following patient discharge

from hospital.

Results

42% of patients were day surgery cases, 11% were single overnight admissions and 47% in-patient admissions.

Median age was 56 years and 58% were female. 145 patients experienced an adverse event; 31 in PACU, 89 after

PACU discharge and 25 both in PACU and after discharge. The most frequent adverse events were clinical

deterioration (36%), uncontrolled pain (31%) and cardiac complications (18%). Overall rate of adverse events was

199 per 1000 (145/728) surgical patient admissions. If a patient was unwell in PACU, greater accuracy and

completeness of documentation was noted. Patients experiencing an adverse event in PACU required a longer

handover time, had a longer stay in PACU and longer hospital admission. Most patients were discharged from

hospital to home (680/728, 93%), 35 (4.8%) were transferred to another hospital and 6 (0.8%) died.

Conclusions

This study demonstrated a relatively high overall risk of experiencing an adverse event following elective surgery of

19.9%. If a patient was unwell in PACU this appears to trigger more complete nursing assessment and

documentation, a doubling of stay in PACU, longer time spent on handover and substantially longer hospital

admission.

Implications for practice These findings highlight the importance of patient monitoring in the immediate post-operative period, in PACU and continuing on the ward.

15

Presenting Author:

Katherine Harding

Title: Specific Timely Appointments for Triage (STAT) reduce waiting time in Physiotherapy Outpatients

Authors: Katherine Harding1 and Judy Bottrell2

Authors’ affiliation 1. Allied Health Research Office, Eastern Health

2. Maroondah Hospital Physiotherapy Department

Background

Outpatient physiotherapy referrals have traditionally been placed on a waitlist and prioritised using a triage system.

Triage in similar allied health settings has been shown to have only moderate reliability, and does not always

impact on waiting time.

Aim

This study aimed to trial an alternative triage model, Specific Timely Appointments for Triage (STAT) in which all

clients are allocated an initial appointment immediately on referral and their needs are prioritised directly by

treating clinicians.

Methods

Retrospective data was collected for 11 months prior to the intervention, and compared to data for the equivalent

11 months following the introduction of STAT. Time from referral to first assessment, the number of interventions,

occasions of non-attendance and total length of stay in the service was compared. Staffing resources were not

changed following the intervention.

Results

Mean time from referral to first appointment pre intervention (n=723) was 24 days (SD 20.9 days ), compared to

17 days (SD 12.4, P<0.01) in the post-intervention period (n=708), a mean difference of 7 days in favour of STAT.

The mean number of physiotherapy appointments reduced from 3.7 in the pre-intervention period to 3.0 post

intervention (p<0.01) but there was no change in average time from first to last appointment.

Conclusions

A new model of access and triage reduced waiting time for outpatient physiotherapy by about 29% with no

additional resources. A reduction in mean number of appointments per patient suggests that reductions in waiting

time were partly achieved by reducing the availability of review appointments.

Implications for practice Waiting times for ambulatory services can be reduced with strategies that aim to improve patient flow, and consider review appointments alongside appointments for new patients in priority decision making. Prompt physiotherapy assessment and management has potential to reduce anxiety and contribute to improved outcomes.

16

Presenting Author:

Skye Coote

Title: First Impressions count – an analysis of thrombolysis decision making, comparing initial clinician assessment with multimodal CT imaging

Authors: Skye Coote1, Tanya Frost1, Shaloo Singhal1, Amanda Gilligan1,2

Authors’ affiliation 1. Eastern Health

2. Monash University

Background

Time is brain and the decision to thrombolyse an acute stroke patient should not be inappropriately delayed.

Multimodal CT (MMCT) imaging, utilising CT angiogram (CTA) and CT perfusion (CTP) scans, are becoming

increasingly common in guiding thrombolysis decision making, but the potential delay to treatment decision while

awaiting image acquisition and analysis may be significant and unnecessary

Aim

To examine the frequency with which MMCT scans change the clinicians’ initial decision to thrombolyse

Methods

This prospective study examined clinician’s initial thrombolysis decisions based on primary patient assessment and

non-contrast CT (NCCT), compared to their final decisions, following MMCT scans, as well as any reasons for

change. NIHSS scores, treatment times and patient diagnoses were also examined

Results

107 cases were recorded, 15 were excluded due to missing data or lack of MMCT scans, leaving 92 for analysis. The

initial treatment assessment highly correlated to the final decision (r=0.77), only 8 cases (9%) recorded a treatment

change as a result of the MMCT scans. Seven patients with a CTP perfusion deficit went on to receive t-PA, while 1

patient with a large necrotic core on CTP, not obvious on NCCT, was not thrombolysed. NIHSS scores were

significantly lower in those with an initial decision not to treat (median NIHSS 2 (IQR=4) vs. 10 (IQR=11), p=0.009.)

Twenty-eight of the 29 thrombolysed patients, with an initial decision to treat, had a final diagnosis of stroke, as

did, 2 of the 15 patients not initially for treatment based on presumed aetiology. The median door-to-decision time

was 18 minutes.

Conclusions

In spite of a short door-to-decision time, clinicians’ initial thrombolysis assessments highly correlate to the final

treatment decision based MMCT scans

Implications for practice

This study allows clinicians to have the confidence in their stroke diagnostic capabilities and thrombolysis decision making processes in times of rapid Code Stroke assessments.

17

Presenting Author:

Anna J Lomax

Title: Prognostic impact of clinicopathological features in metastatic rectal vs colon cancer

Authors: A J Lomax1, H Wong2, K Field3, M Harold4, J Shapiro5, J McKendrick1, A Zimet6, D Yip7, L Nott8, R Jennens6, G Richardson5, J Tie2-3,9, S Kosmider9, P Parente1,10, L Lim1, P Cooray1, B Tran2-3,9, J Desai2-3, R Wong1, P Gibbs2-4,9

Authors’ affiliation 1Department of Medical Oncology, Eastern Health, Melbourne, Australia; 2Walter and Eliza Hall

Institute of Medical Research, Melbourne, Australia; 3The Royal Melbourne Hospital,

Melbourne, Australia; 4BioGrid Australia, Melbourne, Australia; 5Cabrini Health, Melbourne,

Australia; 6Epworth Richmond Hospital, Melbourne, Australia; 7Canberra and Calvary Hospitals

and ANU Medical School, Canberra, Australia; 8Royal Hobart Hospital, Hobart, Australia; 9Western Hospital, Melbourne, Australia; 10Monash University, Faculty of Medicine, Nursing

and Health Sciences, Eastern Health Clinical School, Box Hill, Australia.

Background

Variation in outcomes for rectal (RC) & colon (CC) cancer have been reported. Patterns of metastatic spread &

molecular analyses suggest differences in clinicopathological features that may impact on prognosis.

Aim

Compare presenting features, management and outcome of patients (pts) with metastatic rectal vs colon cancer.

Methods

Analysis of pts with newly diagnosed metastatic colorectal cancer enrolled onto an Australian prospective multi-

centre registry. Disease characteristics, treatment & overall survival (OS) were compared for pts with RC vs CC using

the chi-square & Cox proportional hazards methods.

Results

1381 pts identified. 398 (29%) had RC & 983 (71%) CC. RC pts were younger (median age 64 vs 70 years, p<0.001) &

more likely male (65% vs 55%, p<0.001). Pts with rectal primaries had more lung (39% vs 27%, p<0.001) & brain (2%

vs <1%, p = 0.029) metastases & a trend to more bone metastases. Pts with colon primaries had more liver (66% vs

58%, p = 0.003) & peritoneal (23% vs 8%, p<0.001) disease. KRAS mutation status was available for 571/1381 (41%).

Trend to fewer KRAS mutations in RC pts. Treatment intent was palliative in 71% of CC pts vs 61% with RC

(p<0.001). No significant difference in choice of initial chemotherapy regimen according to tumor site. Median OS

was significantly longer for RC pts (median 29 vs 23 mths, HR = 0.78, 95% CI 0.65 – 0.94, p=0.009).

Conclusions

Significant differences were observed between the presenting features of pts with a RC vs CC. RC pts tended to be

younger, male, with lung & brain metastases. Pts with CC were older, female, with liver & peritoneal disease.

Notably worse survival seen for CC pts. Treatment intent was less likely palliative in RC pts.

Implications for practice Colon & rectal cancers have distinct differences in their presentation & underlying biology, impacting on pt outcomes. Further exploration may allow improved understanding of the optimal approach to managing metastatic colon & rectal cancer.

(This abstract was accepted and presented as an Oral presentation at the Medical Oncology Group of Australia Annual Scientific Meeting, 2014. It was also accepted for publication for the American Society of Clinical Oncology Annual Meeting, 2014. It will be presented as a poster at the Australasian Gastro Intestinal Trials Group Annual Scientific Meeting 2014).

18

Presenting Author:

Dr David J Kenner

Title: Daily Subcutaneous Parecoxib Injection for Cancer Pain: an Open Label Pilot Study

Authors: David J Kenner1, Sandeep Bhagat2, Sonia L Fullerton3

Authors’ affiliation 1. Palliative Care Services, Eastern Health; Monash University, Australia

2. Palliative Care Services, Eastern Health

3. Pain & Palliative Services, Peter MacCallum Cancer Centre; Monash University

Background: Bone pain is common in patients with advanced malignancy and is a major cause of morbidity. Non-

steroidal anti-inflammatory agents, or cyclo-oxygenase (COX)-2 inhibitors are used to target the somatic component

of bone pain. Parecoxib sodium (Dynastat) is a parenteral selective COX-2 inhibitor with comparable analgesic

activity to the non-selective agent ketorolac tromethamine.1,2 The specific use of subcutaneous parecoxib for cancer

related pain has not been reported.

Aim: To establish the efficacy and side effect profile of short term sequential single daily dose subcutaneous

parecoxib in patients with severe cancer pain.

Methods: 20 hospitalised patients with advanced cancer (10 males), 19 with uncontrolled bone pain and 1 with

severe retroperitoneal pain, received 25 courses of 1, 2 or 3 days sequential therapy with ‘off-label’ subcutaneous

parecoxib. All patients were receiving opioid therapy with a median baseline daily oral equivalent dose of 180 mg

morphine. Pain was assessed on an 11 point pain rating scale at baseline, 24 and 48 hrs after treatment. The

presence of any side effects and patient satisfaction with analgesia was recorded.

Results: A clinically significant decrease in pain scores was observed in 18 (72%) of the 25 treatments. The median

score of all (25) patient treatments decreased from 7 to 4.5 at 24 hrs (p<0.001). No major side effects were

observed during treatment. Subcutaneous site reactions occurred in 2 (8%) treatments and were mild and self-

limiting.

Conclusions: Short term daily subcutaneous parecoxib was effective for malignant bone pain when added to

existing analgesic therapy and was well tolerated. Further research into the use of this agent in malignant bone

pain is warranted.

Implications for Practice: Short term subcutaneous parecoxib may have a role for rapid pain reduction prior to, or

during palliative radiotherapy, or during terminal care when pain remains uncontrolled despite opioid dose

escalation and adjuvant therapy.

References:

1. Bikhazi GB, Snabes MC, Bajwa ZH, Davis DJ, LeComte D, Traylor L, Hubbard RC. A clinical trial demonstrates the analgesic activity of intravenous parecoxib sodium compared with ketorolac or morphine after gynecologic surgery with laparotomy. Am J Obstet Gynecol. 2004 Oct;191(4):1183-91.

2. Lloyd R, Derry S, Moore RA, McQuay HJ. Intravenous or intramuscular parecoxib for acute postoperative pain in adults. Cochrane Database Syst Rev, 2009 Apr 15;(2):CD004771

appropriate opioid dose escalation and adjuvant analgesic therapy.

Implications for practice:

http://www.ncbi.nlm.nih.gov/pubmed?term=Bikhazi%20GB%5BAuthor%5D&cauthor=true&cauthor_uid=15507939

http://www.ncbi.nlm.nih.gov/pubmed?term=Snabes%20MC%5BAuthor%5D&cauthor=true&cauthor_uid=15507939

http://www.ncbi.nlm.nih.gov/pubmed?term=Bajwa%20ZH%5BAuthor%5D&cauthor=true&cauthor_uid=15507939

http://www.ncbi.nlm.nih.gov/pubmed?term=Davis%20DJ%5BAuthor%5D&cauthor=true&cauthor_uid=15507939

http://www.ncbi.nlm.nih.gov/pubmed?term=LeComte%20D%5BAuthor%5D&cauthor=true&cauthor_uid=15507939

http://www.ncbi.nlm.nih.gov/pubmed?term=Traylor%20L%5BAuthor%5D&cauthor=true&cauthor_uid=15507939

http://www.ncbi.nlm.nih.gov/pubmed?term=Hubbard%20RC%5BAuthor%5D&cauthor=true&cauthor_uid=15507939

http://www.ncbi.nlm.nih.gov/pubmed/15507939

19

Presenting

Author:

Dr Belinda Lloyd

Title: Developing a national surveillance system for suicidal behaviour: first findings of population level harm

Author(s): Belinda Lloyd, Cherie Heilbronn, Dan Lubman

Authors’ affiliation Turning Point and Eastern Health Clinical School, Monash University

Background: Suicidal behaviour is a major public health issue. Although suicide is a priority area for development of

effective policy and treatment, there is currently a paucity of robust and timely data for monitoring suicidal

behaviour at a population level.

Aims: This study presents first findings from a national suicidal behaviour surveillance system.

Methods: Ambulance records potentially related to suicidal behaviour were extracted, reviewed and coded. Data

include detailed information regarding patient characteristics, paramedic assessment and treatment. Data for

Victoria, Australia are presented, and represent a service population of approximately 5.5 million residents.

Results: Between September 2012 and January 2013, there were 53 suicides, 2,840 suicide attempts, 2,862 suicidal

ideation cases with no suicide attempt, 946 self-injury cases, and 187 self-injury threat cases. The most common

suicide modality was hanging, while drug overdose was most common for suicide attempts. Males represented

64% of completed suicides, whereas women represented 63% of suicide attempts. The median age was lower for

suicide attempts (33 years (range 10-96)) than for suicides (41 years (range 15-86)).

Conclusion: This surveillance system provides a significant contribution to public health, policy and service delivery.

Implications for practice: Ongoing and timely population level monitoring of suicidal behavior allows the develop

and evaluation of evidence based interventions to reduce self harm and its impact on patients, health services and

the community.

20

Presenting Author:

Dr. Jonathan Raw

Title: Morbidity and mortality following neck of femur fracture in a metropolitan health system in Australia.

Authors: Dr. Jonathan Raw1, Dr. Farshad Ghazanfari1, 2, Dr. Christopher Fong1, 2, 3

Authors’ affiliation 1 Orthopaedic/Rheumatology/Aged Care Services, Eastern Health, 2 Rehabilitation and Aged Care Services, Monash Health, Melbourne, Australia 3 Monash University, Melbourne, Australia

Background

Hip fracture patients have annual mortality rate up to 25-30 %. Hip fracture mortality has been reported to be higher in males. However, there is a question as to whether this is due to the actual fracture or their comorbidities. Aim

To describe and compare neck of femur fracture outcomes based on gender in adult patients who presented to Box Hill Hospital, Eastern Health. Methods

We performed a prospective observational study of 100 consecutive adult hip fracture patients who presented to Box Hill Hospital between 1/1/13 - 3/6/13. Patient demographics, length of stay, postoperative complications, outcome and discharge destination were extracted from scanned digital medical records. The Charlson Comorbidity Index (CCI) was used to calculate morbidity and mortality risk. Results

There were 75 female and 25 male patients and a median age 83.4. Median length of stay was 5 days and median time to surgery was 1 day. The perioperative delirium rate was 44%. Significant postoperative complications included HAP (17.65%), delirium (13.24%), anaemia (11.76%) and AMI (8.82%). Mortality rates were 4% at 7 days, 11.2 % at 30 days and 19.4% at 150 days after surgery. Factors predictive of mortality include a CCI ≥ 4 (log rank=0.01,HR 4.45) and perioperative delirium (log rank= 0.001). Conclusions

Significant factors predictive of mortality include perioperative delirium, a CCI score of ≥ 4. There was no difference

in mortality between male and female hip fracture patients despite a higher mean CCI score in males (4 vs 2). This

proof of concept study suggests that comorbidities correlates with the risk of mortality in hip fracture patients

rather than the fracture itself in our cohort of female patients.

Implications for practice CCI correlates well with the risk of mortality in adult hip fracture patients and could be used on admission notes as

a tool to predict post surgical mortality and morbidity.

21

Presenting Author: Jodi Haartsen

Title: MS FIRST – a longitudinal, prospective, comparative drug safety module for use in MS clinical practice

Authors: Jodi Haarsten1, Tim Spelman2, Lisa Morgan2, Susan Agland3 , Josephine Baker4 Marie Canty5

Janette Lechner-Scott 3 Louise Rath5 , Helmut Butzkueven2, on behalf of the MS FIRST Investigators.

Authors’ affiliation 1Eastern Health, Melbourne, Australia 2 MSBase Foundation Royal Melbourne Hospital, Melbourne, Australia 3John Hunter Hospital, New South Wales, Australia 4Royal Melbourne Hospital, Melbourne, Australia 5Westmead Hospital, New South Wales, Australia 6Alfred Health, Melbourne, Australia

Background

The comparative long term safety profile of disease-modifying drugs (DMD) in Multiple Sclerosis treatment is

unknown.

MS FIRST, a sub-study of the MSBase registry, is an Australian multi-centre study to implement a user-friendly safety

module to track incidence and characteristics of safety outcomes.

Aim

The primary objective of this study is to track and compare the incidence of safety outcomes in MS patients who

either receive DMD or no treatment, in routine clinical practice. The secondary objective is to characterize the

longitudinal distribution of lymphocyte count and LFT abnormalities in fingolimod treated patients.

Methods

Data from the module was extracted April 2014. Patients contributing a baseline and at least 1 post-baseline follow-

up visit were included in the descriptive analyses.

Results

As at the date of data compilation, MSFIRST had enrolled 1704 patients contributing 3462 clinic visits and a

cumulative 802.7 person-years of prospective follow-up since enrolment Jan 2012. Across the observation period 14

infective SAEs , 14 Herpes Zoster, 2 malignancies (excluding non melanoma skin cancer , NMSC) and 5 NMSC were

recorded on fingolimod, compared with and 9 infection SAE’s, 8 Herpes Zoster , 4 malignancies , 7 NMSC on any

other DMT. 575 patients on fingolimod contributed 2300 lymphocyte counts and LFTs. Of these, 21 (3.7%) recorded

at least one lymphocyte count <0.2 whilst no patients recorded a count <0.1. 74 recorded GGT level > 5x ULN at least

once on fingolimod during follow-up. 7 recorded an ALT > 5x ULN at least once during the study period whilst no

patients recorded an ALP > 5x ULN on fingolimod.

Conclusions

The establishment of a large, prospective multi-drug safety module for use in routine MS practice has been successful

to date.

Implications for practice Developing a systematic tool for safety monitoring and event reporting can provide important insights into both the incidence and timing of treatment-associated SAE’s.

22

Presenting Author:

Michael Mond

Title: Somatic mutations of FOXE1 in papillary thyroid cancer

Authors: Michael Mond1,3, Martyn Bullock2, Yizhou Yao1 Roderick J. Clifton-Bligh2, Christopher Gilfillan3, Peter J. Fuller1

Authors’ affiliation 1MIMR-PHI Institute of Medical Research, Clayton 2Cancer Genetics Unit, Hormones and Cancer Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney 2065, Australia 3Eastern Clinical School and Eastern Clinical Research Unit, Monash University, Box Hill Hospital Background

Population-based studies have demonstrated an association of single nucleotide polymorphisms (SNP) close to the thyroid transcription factor forkhead box E1 (FOXE1) gene with thyroid cancer. The dysregulation of forkhead proteins is increasingly recognised to play a role in the development and progression of cancer.

Aim The objective of the study was to seek to identify novel mutations in FOXE1 in papillary thyroid cancer (PTC) and to assess the effect of these mutations on protein expression and transcriptional function on FOXE1 responsive promoters.

Methods The coding region of FOXE1 was sequenced in tissue-derived DNA or RNA from 120 patients with PTC and 110 patients with multinodular goitre (MNG). In vitro studies were performed to examine the protein expression and transcriptional function of FOXE1 mutants. A molecular model of the forkhead domain (FHD) of FOXE1 was generated using the SWISS-MODEL online server with the three-dimensional structure of FOXD3 as a template.

Results

Three somatic missense mutations were detected in PTC resulting in the following amino acid substitutions: P54Q, K95Q, L112F. One additional mutation was detected in a MNG (G140R). Two of the three FOXE1 mutant PTC were also positive for BRAFV600E mutation and these were recurrent tumours with clinically aggressive features. In vitro studies demonstrated marked impairment in transcriptional activation by all four FOXE1 mutants which was not explained by differences in protein expression. Molecular modelling localised three of the mutations to highly conserved regions of the FHD.

Conclusions and implications for practice

We have identified novel somatic mutations of FOXE1 in PTC. Mutational inactivation of FOXE1 is an uncommon event in thyroid tumours but may contribute to thyroid carcinogenesis and dedifferentiation in concert with other oncogenic drivers (such as BRAF mutation). Potential therapeutic implications include an impaired response to radioactive iodine therapy.

23

Presenting Author:

Janis Uhe

Title: Evaluation of the client experience using Digital Breast Tomosynthesis in the BreastScreen assessment setting

Authors: Janis Uhe1, Elizabeth Sundram1, Carolyn Molk1, Ramola Schwartz1, Zoe Aitken2,Carolyn Nickson2

and Darren Lockie1

Authors’ affiliation 1 – Maroondah BreastScreen

2 – The University of Melbourne

Background This study was part of a larger study aimed to evaluate the potential contribution of Digital Breast Tomosynthesis (DBT) to BreastScreen assessment services, and to pilot the routine inclusion of DBT imaging in BreastScreen assessment workflow, without withdrawing the current Standard Protocol and without requiring significant staff time to perform additional readings. Aim This component of the study focused on the acceptability of DBT to BreastScreen clients. Methods The participation rate was 73% of invited and eligible women, with 556 women participating in the study. Study participants completed a brief questionnaire administered by BreastScreen staff, with the aid of an interpreter as required. They were asked about their experience of compression time and discomfort, and invited to give feedback about DBT and study participation. Results The results from the client survey are summarised below:

1. Most respondents (81%) found DBT the same, better, or much better than their screening mammogram. 2. A majority of respondents (82%) reported that DBT compression was a little, or not at all, painful 3. The type of compression associated with DBT appeared to be marginally more important than the time. 4. Participants had a range of views about whether DBT imaging was more or less comfortable than 2D cone

views. 5. A majority (76%) found DBT to be the same or better; however, 4% (19/539) of respondents found DBT to be

‘much worse’. Conclusions The main study estimates that imaging in assessment using DBT rather than 2D mammography could reduce the need for biopsies by 27% and ultrasounds by 11%, with a reduced average radiation dose (average 1.5 units lower), while producing similar cancer detection rates. Implications for practice The client survey found that DBT was highly acceptable to BreastScreen clients.

24

Presenting Author:

Dr Victoria Manning

Title: Treatment pathways and associated outcomes for clients with AOD problems in Victoria and Western Australia

Authors: Manning, V1,2., Best, D1,2., Larner, A1., Garfield, S2., McGavin, J1 and Lubman, D1,2

Authors’ affiliation 1 Turning Point, Melbourne, Victoria, Australia 2 Eastern Health Clinical School, Monash University

Background

To date there have been only two AOD treatment outcome studies in Australia. These have examined illicit drug

users (heroin and methamphetamines) and focussed on the impact of discrete treatment episodes.

Aim

To delineate the treatment pathways of AOD clients, examining the impact of engagement in specialist AOD and

non-AOD community service use on treatment outcomes (abstinence and reduced use) at 12-months in a sample of

alcohol and illicit drug users.

Methods

Using a prospective outcome design, 796 clients from 21 AOD services in VIC and WA completed a baseline

interview on AOD use, QoL and service use in the year prior to intake with 70% re-interviewed 12-months later.

Results

The primary index treatment (PIT) was residential rehabilitation for 29%, acute withdrawal services (detox) for 44%,

and outpatient services (OP) for 27% and the primary drugs of concern (PDOC) were alcohol (47%), cannabis (15%),

meth/amphetamine (20%), opioids (15%) and other drugs (3%). At follow-up 53% were 'treatment successes'

(abstinent or had at least halved their frequency of use), 38% were abstinent from their PDOC with significant

improvements in QoL. AOD outcomes were superior among methamphetamine clients and poorest among alcohol

clients. Most (3/4) engaged in further specialist AOD treatment post-PIT and 77% engaged in community services

(excluding GP). PIT-completion, mutual aid attendance post-PIT and RR were predictors of treatment outcome, but

community service use and more intensive/extensive treatment pathways only predicted outcomes for alcohol

clients.

Conclusions

At least half responded well to treatment, with marked improvements in AOD use and QoL. The client journey is

protracted and involves engagement with multiple agencies.

Implications for practice

Services should promote AOD treatment, increase access to RR, enhance treatment completion rates, provide

assertive linkage to mutual aid and prioritise intensive/extensive care pathways for alcohol clients.

25

Presenting Author:

Dr. Sathya Rao

Title: Evaluation of a new risk assessment matrix for assessment of self-harm risk in borderline personality disorder Authors: Dr Sathya Rao1, Dr. Katherine Thompson2, Dr. Paul Katz1, Dr. Jillian Broadbear1


2. Orygen Youth Health

Background

Borderline personality disorder (BPD) is associated with significant self-harm, the frequency of which may trigger

health service interventions that aren’t appropriate for BPD clients. We have developed a self-harm risk assessment

matrix for BPD incorporating four risk categories; high or low lethality self-harm and new or chronic pattern of self-

harm.

Aim

This study compared clinician-assessed self-harm risk and choice of intervention according to (i) standard clinical

practice or (ii) the new BPD risk assessment matrix.

Methods

62 clinicians were randomly assigned to the standard or risk matrix group; the latter was trained in the use of the

new risk matrix. We used a BPD case vignette comprising four clinical scenarios inclusive of high/low lethality self-

harm acts and chronic and new patterns of self harm. There were four interventions to choose from, each

corresponding to a risk category.

Results

The standard and risk matrix clinician groups did not differ in their assessment of self harm risk. However the

groups differed with respect to intervention choice on assessments of low lethality, chronic risk (p<.01) and high

lethality, chronic risk (p<.005).

Conclusions

The new risk assessment model for BPD is well aligned with standard practice for the assessment of self harm-

associated risk. However BPD-appropriate interventions were identified more reliably by the risk matrix-trained

group.

Implications for practice Wider dissemination of this self-harm matrix may improve utilisation of medical services and optimise outcomes in the treatment of BPD. A modified version of this has been incorporated into the National Health and Medical Research Council guidelines for treatment of BPD in Australia (2012).

26

Presenting Author:

Lauren Beswick

Title: Infliximab infusion protocols are time consuming and severe infusion reactions are rare - is it time for change?

Authors: Lauren Beswick1, Lionel Soh2, Anne McFarlane1,, Daniel R van Langenberg1,2

Authors’ affiliation 1. Department of Gastroenterology, Eastern Health, Melbourne, Australia

2. Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia

3. Monash University, Melbourne, Australia

Background: Infliximab (IFX) infusion reactions in patients with inflammatory bowel disease (IBD) vary from minor

urticaria to anaphylaxis. Although studies have previously observed infusion reactions in up to 10-50% of patients

receiving infliximab infusions, anecdotally the prevalence appears far lower than this.

Aim: To evaluate current practice of administering IFX infusions in patients with IBD, assess prevalence of IFX

infusion reactions at a large volume, single IBD centre & evaluate predictive factors that are associated with an

increased risk of an IFX infusion reaction.

Methods: A retrospective case note review of all patients with confirmed IBD who received IFX at Eastern Health

between 1/1/2005-1/1/2014 was conducted.

Results: 2214 IFX infusions were administered to 169 patients. The median number of infusions per patient was 10,

with median age 38 (range 19-83) and 56% males; 75% patients had Crohn’s disease; 25% patients had ulcerative

colitis. The median duration of IFX infusion was 2 hours 30 minutes (door-door at infusion unit) and 1 hour 25

minutes (start-finish infusion only) for their first documented infusion compared to 2 hours 15 minutes & 1 hour 15

minutes respectively for their most recently documented infusion. The adverse reaction rate per patient was 13.6%;

18 patients classified as having a mild reaction & 5 having a serious reaction (rate per patient 3.6%, per infusion

0.2%) according to the Common Toxicity Criteria. 94% with a mild reaction tolerated subsequent IFX infusions when

rechallenged. Predictive factors of an IFX infusion reaction included episodic or gap >3 months in IFX dosing (OR 8.7,

95% CI [1.8, 41.4], concurrent immunomodulator OR 9.4 [1.5, 57.4], smoker at time of reaction OR 3.8 [1.01, 13.9],

duration of IBD when IFX started (per year, OR 1.11 [1.04, 1.2]) (each p<0.05), with a non-significant trend for

previous adverse drug reaction(s) OR 3.2 [0.8, 13.3] (p=0.1).

Conclusion: Serious IFX infusion reactions are uncommon and milder reactions can be simply and effectively treated,

with IFX continuation possible in >90% of cases. High risk groups include smokers, those with longer disease duration

pre-IFX, recipients of episodic IFX dosing & possibly those with prior drug reactions.

Clinical Implications: There may be an opportunity for the administration protocols for infliximab infusions to be

performed more rapidly, with less precautions such as use of pre-medications and less frequent observations and

ultimately via a community-based, rather than hospital-based, infusion service. With these possibilities, there is a

significant positive health economic impact if they could be safely implemented.

27

Presenting Author:

Anne-Marie Desai or Shaylyn Bertino

Title: Should we be measuring nutritional quality of life in patients with end stage renal failure receiving renal replacement therapy?

Authors: Anne-Marie Desai1, Shaylyn Bertino1, Melissa Corken1, Dr Matthew Roberts2, Dr Louis Huang2, Tanya Osicka3, Dr Sarity Dodson4

Authors’ affiliation 1. Dietitians, Department of Renal Medicine (Eastern Health) and Eastern Health Dietetics 2. Nephrologist, Department of Renal Medicine (Eastern Health) and Eastern Health Clinical

School, Monash University 3. Student, Deakin Population Health Strategic Research Centre, Deakin University

4. Clinical & Health Psychologist, Department of Renal Medicine (Eastern Health) and Research Fellow, Deakin Population Health Strategic Research Centre, Deakin University

Background Dialysis patients are at risk of poor nutritional Quality of Life (QoL) due to diet restrictions, health literacy, chronic disease, reduced finances and symptoms impacting intake, with no routine measure of nutritional QoL in Australia. Aim To examine the impact of diet restrictions on nutritional status and QoL of dialysis patients. Methods A cross-sectional observational study of 100 dialysis patients audited measures of nutritional status using Subjective Global Assessment (SGA); QoL using the Food Enjoyment in Dialysis (FED) and the Kidney Disease Quality OF Life (KDQOL) questionnaires; potassium intake and primary source of nutrition information; mental health status using Depression Anxiety Stress Scales (DASS21); health literacy using Health Literacy questionnaire. Results Correlation was noted between nutritional QoL as measured by the FED questionnaire and KDQOL and between the FED questionnaire and DASS21. Patients with a lower level of food enjoyment were more likely to have a lower level of health literacy. Analysis identified significant nutritional concerns relating to thirst, taste and mealtime enjoyment. Pill burden and locus of control did not impact significantly on nutritional QoL. Conclusion The FED questionnaire is useful in identifying factors contributing to reduced QoL in dialysis patients. Use of the FED questionnaire together with SGA and intake assessment provides better indication of nutritional status, enabling tailored dietary education. Implications for practice Dialysis patients have many dietary and social problems. Dialysis can affect enjoyment of eating, resulting in decreased food intake. Decreased appetite and food intake often precede and predict declines in nutritional status. Use of the FED questionnaire can increase the clinician’s awareness of the dialysis patient’s compliance difficulties with a restricted diet to inform delivery of a patient centred nutrition service, and may assist in preventing malnutrition.

28

Presenting Author:

Anne Horne-Thompson

Title: Not enough time or a low priority? Barriers to evidence-based practice for allied health clinicians

Authors: Dr. Katherine Harding; Dr Judi Porter; Anne Horne-Thompson; Euan Donley; Prof. Nicholas Taylor


2. Eastern Health, Monash University

3. Eastern Health

4. Eastern Health

5. Eastern Health, La Trobe University

Background: Evidence based practice (EBP) is a key principle in the delivery of effective and high quality health care.

Existing research suggests that allied health professionals are generally supportive of EBP, but rarely participate in

activities associated with EBP.

Aim: The aim of the project was to explore the barriers to the implementation of EBP by allied health clinicians.

Methods: This mixed-method study used 8 focus groups of allied health professionals and managers and a

questionnaire of all participants to explore the attitudes and barriers to EBP in a large metropolitan health service.

Qualitative data were analysed using a thematic analysis of focus group transcriptions. Questionnaire data were

analysed descriptively.

Results: 50 clinicians and 10 managers across 7 allied health disciplines participated in the study. The questionnaire

identified that clinicians have a positive attitude but low participation in EBP. Qualitative data revealed that EBP

was not highly valued by clinicians and managers or viewed as a core component of clinical care, with activities

directly related to maintaining patient flow viewed as higher priorities. Lack of skills and resources, and difficulty

associated with implementing evidence into practice were further barriers.

Conclusions: Allied health professionals have a positive attitude to EBP, but often do not participate in EBP

activities. The findings suggest that the reasons for his are more complex that the common impression that

clinicians “don’t’ have time” for EBP activities.

Implications for practice: Achieving higher uptake of EBP among allied health clinicians requires a cultural shift,

placing higher value on these activities despite the challenging context of constant pressures to increase patient

flow. Addressing EBP through small group projects rather than considering it to be an individual responsibility may be

more acceptable to both clinicians and managers, with added benefits of peer support for both evaluating evidence

and translation into practice.

29

Presenting Author:

Pratyusha Naidu

Title: Comparison of mortality and morbidity outcomes in hip fracture patients with and without diabetes

Authors: Pratyusha Naidu, Johnathan Raw , Christopher Fong, Christopher Gilfillan

Authors’ affiliation Eastern Health

Aim

In this study, we assess the differences in peri-operative mortality and morbidity between diabetic and non-

diabetic patients following hip surgery.

Methods

This is a prospective study of 119 patients admitted with hip fracture during a 14 month period. Patients were

divided into two groups, diabetics (n=19) and non-diabetics (n=100). Information collected included patient

demographics, functional status, medical co-morbidities (Charlson Co-morbidity Index- CCI), history of fractures,

vitamin D level and treatment, fracture type and time to surgery. Immediate post-operative complications, rate of

30-day mortality and length of rehabilitation were analysed and compared between the two groups. The validity of

the results was assessed using the Chi-square statistic for categorical variables and the t-test for continuous

variables using the Systat program.

Results

The mean age was significantly different for each group with diabetics presenting 6 years earlier (age 77.5 versus

83.5, p = 0.03).The CCI score had a bimodal distribution in diabetics. Other baseline characteristics were

comparable between the two groups. Diabetic patients post hip fracture surgery had higher percentage of cardiac

complications (53.3 % versus 27.6%, p=0.049), including serious complications such as acute coronary syndromes

and heart failure (46.7% versus 10.5%, p=0.0005). Diabetic patients were also more likely to develop multiple (≥ 3)

complications than non-diabetic patients post hip surgery (53.3% versus 26.3%, p=0.037), notably anaemia

requiring blood products, cardiac, pulmonary and renal complications. 30-day mortality outcomes and length of

stay were not statistically significant between the two groups.

Conclusions

Diabetic patients have an increased risk of having multiple complications post hip surgery and importantly serious

cardiac complications.

Implications for practice The medical care in the peri-operative period should be maximised in diabetic patients to prevent complications.

30

Presenting Author: Andrea Doric

Title: Improving recognition and response to clinical deterioration

Authors: Andrea Doric, Brenda Birch, David Charlesworth

Authors’ affiliation Eastern Health

Background: Signs of clinical deterioration often precede cardiac arrest, unplanned admission to the intensive care unit and unexpected death. Early intervention in response to signs of deterioration has been shown to reduce morbidity and mortality. Aim: To develop and implement a clinical deterioration framework to improve detection, recognition and response to deteriorating patients across the organisation. Methods: A comprehensive risk analysis was conducted which revealed:

Poor measurement and recording of vital signs

Variation in observation charts and documentation

Different rapid response systems

Variation in resuscitation resources

Variation in data collection, analysis and reporting Systems were not designed to detect early clinical deterioration and there was no centralised governance. Enterprise-wide governance established with the Clinical Deterioration Expert Advisory Committee.

To improve recognition, observation charts to enable early detection of deterioration and guide escalation were implemented. To improve response, a standardised rapid response system and resources was implemented. To improve monitoring, data management and reporting were standardised. Results: Since the introduction of the framework there is:

• Improved observation measurement and recording • Improved detection and recognition of clinical deterioration • Increased activation of rapid response • Improved resuscitation planning • Decreased hospital mortality • Positive feedback from staff

Conclusion: The Clinical Deterioration Expert Advisory Committee has established a framework which is improving recognition and response to clinical deterioration across Eastern Health. The committee provides governance, clinical leadership and expert advice and takes a risk-based approach with monitoring and review of effectiveness of controls and overall assurance that the risk to patients is being effectively and efficiently managed.

31

Presenting Author:

Jorja Collins

Title: The menu regemeration study: exploring the effects of an alternative foodservice approach among geriatric evaluation and management (GEM) patients

Authors: Jorja Collins1, Catherine Huggins1, Judi Porter1,2, Helen Truby1

Authors’ affiliation 1. Department of Nutrition and Dietetics, Monash University

2. Dietetics Department, Eastern Health

Background Malnutrition affects approximately 30% of patients and results in adverse outcomes. Opportunities exist

to develop the foodservice system and engage this workforce to reduce the impact of poor nutrition.

Aim To determine if changing the foodservice system improves patients’ anthropometry and satisfaction with the

foodservice.

Methods The intervention was developed by making small changes to the foodservice system including increasing

the energy content of the menu and foodservice staff-patient interaction. In a parallel controlled study,

consecutively admitted patients on a GEM ward were allocated to receive the intervention or usual foodservices

for their length of stay (LOS). Body Mass Index (BMI), hand grip strength (HGS) and satisfaction with the foodservice

were measured. Change in BMI and HGS between admission and day 14 (or prior if discharge was earlier) and

satisfaction were compared between groups.

Results Data were available for 117 participants (n=59 control, n=58 intervention) with a median LOS of 20 days, age

of 83 years and malnutrition prevalence of 38%, determined via the Subjective Global Assessment (SGA). There was

no significant difference between groups in the mean change in BMI (intervention:-0.1±0.8kg/m2 vs. control:

0.1±0.7kg/m2, p=0.343) or HGS (intervention: 2.4±5.4kg vs. control: 1.4±5.7kg, p=0.383). Satisfaction with the

foodservice was also not significantly different.

Conclusions After receiving the intervention for a maximum of 14 days there was no discernible impact on

anthropometry, but no dissatisfaction with the alternative foodservice system.

Implications for practice Effective strategies are required to prevent and treat malnutrition in healthcare facilities.

Preliminary analyses suggest that this alternate foodservice approach does not significantly impact nutrition in the

very short term. Further analyses of longitudinal data are required to determine if a greater duration of

intervention offers benefits for longer-stay GEM patients.

32

Presenting Author:

Emily Cull

Title: Incident delirium in the acute general medical setting

Authors: Emily Cull 1, Alison M. Hutchinson 2, Nicole M. Phillips 3

Authors’ affiliation 1. Registered Nurse Eastern Health, Deakin University PhD candidate

2. Professor of Nursing, School of Nursing and Midwifery, Deakin University; Chair

in Nursing (Monash Health)

3. Associate Professor, School of Nursing and Midwifery, Deakin University

Background: Delirium, an acute disorder of attention and cognition, is increasingly recognised as a common and

serious problem for elderly patients. Rates of delirium can be used as a measure of the quality of patient care and

safety in hospital. Delirium is often misdiagnosed and can have detrimental implications for the overall outcomes

for patients.

Aim: To retrospectively examine the documented management of patients who developed delirium in a medical

setting.

Methods: Retrospective case-control study of patients with incident delirium, admitted to a medical setting at

Eastern Health. Extracted data included risk factors, cognitive assessments, delirium diagnosis, medication

management, and prevention/management strategies.

Results: Patient records for 161 delirium cases and 321 non-delirium controls were examined. Evidence of a

delirium risk factor assessment was not found in any records. Predisposing risk factors were: dementia, cognitive

impairment, functional impairment, advanced age, previous delirium, and fracture on admission. Only 2 patients

that developed delirium had a formal cognitive assessment on admission. 51.6% of patients with delirium were

prescribed haloperidol; this was newly prescribed 91.4% of the time. Delirium patients were more likely to fall,

have a decrease in functioning, have a code grey, and be discharged to a care facility. In the control group, 42

patients had documented evidence of possible delirium that was undiagnosed.

Conclusions: Delirium episodes were often unrecognised and there were lengthy delays in diagnosis. Haphazard

and widely varying treatment strategies were identified, resulting in poor outcomes overall for patients.

Implications for practice: Policy with respect to a comprehensive delirium education and management strategy is needed. Cognitive assessment and delirium risk identification tools need to be implemented. Family members need to be informed about the cognitive impairment and involved in the patient’s care.

33

Presenting Author:

Michael Savic

Title: Exploring the influence of social identity on recovery capital amongst individuals in alcohol and other drug (AOD) treatment

Authors: Michael Savic, Ramez Bathish, Melinda Beckwith, David Best, & Dan Lubman

Author(s) affiliation Turning Point, Eastern Health

Eastern Health Clinical School, Monash University

Background

There is evidence to suggest that an individual's level of recovery capital – the strengths and resources people

working to overcome AOD problems have access to – predicts sustained recovery. One theory also argues that

recovery involves a social identity transition, in which people begin to identify less with groups that support their

AOD use while increasing their identification with groups that support their recovery. However, there has been

little empirical research to test the influence of social identity on recovery capital.

Aim

This paper investigates whether people who identify more highly with groups that support their recovery have

higher recovery capital than those who don’t.

Methods

Residents of a Therapeutic Community for the treatment of AOD-related problems undertook a social identity

mapping exercise, in order to identify group belonging, and the degree to which substance use and recovery was

present in each of the groups they belonged to. In addition, clients completed a structured survey about their AOD

use, wellbeing and recovery capital to enable us to test the association between social identity and recovery

capital.

Results

Preliminary results reveal that AOD use was prevalent in the groups that clients belonged to. Identification with

mutual aid groups appeared to be strong, and in some cases stronger than identification with families. Further

analysis will explore how levels of identification with groups supportive of recovery, and groups supportive of AOD

use influence recovery capital..

Conclusions

Given that the prevalence of AOD use was high amongst clients’ social groups, developing supportive social groups

after treatment is likely to be important in order to act as a buffer against relapse, and sustain long-term recovery.

Implications for practice AOD treatment agencies are well placed to foster recovery capital, but a greater emphasis on linking clients in to supportive groups and activities may be needed.

34

Presenting Author:

David Snowdon

Title: Effectiveness of clinical supervision of physiotherapists: a survey

Authors: Mr. David Snowdon1, Ms. Geraldine Millard1, Prof Nicholas Taylor2, 3

Authors’ affiliation 1 Eastern Health Physiotherapy Department, 2 Eastern Health Allied Health Clinical

Research Office, 3 La Trobe University

Background Limited literature exists on the practice of clinical supervision (CS) of professional physiotherapists despite current Australian safety and quality health standards recommending CS be provided to all physiotherapists. Aim We aimed to evaluate the effectiveness of CS of physiotherapists at Eastern Health. Methods CS was measured using the allied health specific 26-item modified Manchester Clinical Supervision Scale (MCSS-26). Subscales of the MCSS-26 were summed for three domain scores (normative, restorative and formative), and a total score, which was compared to the reported threshold score of 73 for effective supervision. Results Sixty registered physiotherapists (response rate 92%), working across 6 site locations, completed the survey. The mean MCSS-26 total score was 71.0 (s.d. 14.3, 95%CI 67.4 to 74.6). Hospital site was the only variable that had a significant effect on total MCSS-26 score (P=0.005); there was no effect for supervisor or supervisee experience, or hospital setting (acute versus subacute). Physiotherapists scored a significantly lower mean percentile MCSS-26 score on the normative domain when compared to the restorative domain (mean diff 7.8%, 95%CI 2.9 to 12.7, P= 0.002) and the formative domain (mean diff 9.6%, 95%CI 6.3 to 13.0, P< 0.001). Of the two sub-scales that form the normative domain, ‘finding time’ had a significantly lower mean percentile MCSS-26 score when compared to ‘importance/value of CS’ (mean diff 35.4%, 95%CI 31.3 to 39.4, P< 0.001). Conclusions There was uncertainty about the effectiveness of CS, with more than half of physiotherapists rating their supervision as less than effective. Physiotherapists scored lowest in the normative domain, indicating that they found it difficult to find time for CS. Implications for practice Finding time for CS appears to be the main barrier to effective CS. Focus should be directed towards developing a framework within which includes protected time for participation in CS.

35

Presenting Author:

Jintana Damkliang

Title: Thai Emergency Nurses’ Perceptions of Using an Evidence-Based Care Bundle for Initial Nursing Management of Patients with Severe Traumatic Brain Injury

Authors: Jintana Damkliang1,2, Julie Considine2,3, Bridie Kent2,4 , Maryann Street2,3

Authors’ affiliation 1Faculty of Nursing, Prince of Songkla University, Songkhla, Thailand, 2School of Nursing

and Midwifery, Faculty of Health, Deakin University, Melbourne, Australia, 3Eastern

Health, Melbourne Australia, 4 School of Nursing & Midwifery, Plymouth University, UK

Background

Thai emergency nurses play a vital role in caring for patients with severe TBI, particularly during initial emergency

care and resuscitation. However, there is known variation in Thai emergency nurses’ knowledge and care practices

for patients with severe TBI. In addition, there are no specific evidence-based practice guidelines available for

emergency nursing management of patients with severe TBI that suit with the Thai context. Thus, an evidence-

based care bundle for initial nursing management of patients with severe TBI was developed to help Thai

emergency nurses to deliver more consistent, evidence-based care for patients with severe TBI.

Aim

The purpose of this study was to understand emergency nurses’ perspectives of using an evidence-based care

bundle and to identify barriers and facilitators to care bundle use.

Methods

In this descriptive qualitative study, data were collected from interviews with ten emergency nurses working at a

regional hospital in southern Thailand. Data were analysed using a thematic analysis.

Results

Nurse participants reported positive impacts of the care bundle: improving quality of care, increasing nurses’

awareness of care, establishing a standard of care, and improving nurses’ knowledge and understanding of care.

Four factors were identified in relation to barriers and facilitators to care bundle use: competing priorities,

inadequate equipment, agitated patients, and teamwork.

Conclusions

Implementation of this evidence-based care bundle developed specifically for the Thai emergency nursing context

helped to improve the care of the patients with severe TBI. However, strategies to support implementation of the

care bundle must take into account local structure, staffing, processes and resources for maximum uptake in a busy

clinical environment.

Implications for practice A care bundle approach can be used as a tool to guide Thai emergency nurses to deliver best care to patients with severe TBI.

36

Presenting Author:

Pavel Sluka

Title: Biology and Significance of Prostate Cancer Basal and Luminal Cellular Subtypes

Authors: Pavel Sluka, Hady Wardan, Carmel Pezaro, and Ian D. Davis

Authors’ affiliation Eastern Health Clinical School, Monash University

Background The prostate epithelium is made up of two major cell subsets: basal cells and luminal cells, both of which have distinct molecular and functional phenotypes. While prostate cancers (PCs) contain cells that most closely resemble luminal cells, the cell type responsible for generating PCs is unknown. Furthermore, it is possible that these two cell types are able to switch phenotypes in order to acquire unique functions to allow them to metastasise and thrive. Aim Our aim was to develop a method to selectively purify cells resembling basal and luminal cells from PC specimens, to culture them in vitro, and to study their ability to switch phenotypes. Methods PC specimens were obtained from patients undergoing radical prostatectomy through Eastern Health. Specimens were enzymatically digested to generate single-cell suspensions. Epithelial cells (containing both basal and luminal cells) were purified using magnetic beads linked to an antibody against epithelial cell adhesion molecule (EpCAM). Basal and luminal cells were further purified by culturing under conditions that promote their selective growth. Cells were identified by staining for Trop2 and CD49f and flow cytometric analysis. Results and Conclusions Luminal and basal cells were selectively cultured by plating EpCAM-purified epithelial cells on untreated plastic and on plastic that was pre-coated with fetal calf serum, respectively. Current experiments involve taking the selectively cultured basal and luminal cells and exposing them to the alternative culture conditions to determine whether their phenotypes are interchangeable. Implications for practice Understanding the biology of basal and luminal PC cell subsets will enable identification of the cell type(s) responsible for PC initiation and formation of metastatic lesions. This in turn will allow future work to predict outcomes for men with PC, guide treatment choices, and point to novel therapeutic approaches.

2014 research abstracts - eastern health

Documents