237 general newsletter no 15 august 2012
TRANSCRIPT
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7/30/2019 237 General Newsletter No 15 August 2012
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Weareverypleasedto
announce that our
director,Assoc.Profes
sor Julie Bernhardt
was recently awarded
theveryprestigiousChurchillFellowship.The
Churchill Trust was established in 1965 to
honourthememoryofSirWinstonChurchill
by awarding overseas research fellowships
knownas'ChurchillFellowships'.
Since its inception The Churchill Trust has
awardedChurchillFellowships tomore than
3,700Australianswho, likeChurchill,are in
novative,filledwithaspiritofdetermination
andpossess a strongdesire tobenefit their
community.
Churchill Fellowships allow recipients tode
sign their own research project, travel the
Biannua l News le t t e r Edi t ion 15 August 2012
AVERT NEWSLETTERA VERY EARLY REHABILITATION TRIAL
Patients currently
enrolled
1359
Ins ide th is i ssue:
Churchill Fellowship Page 1
Trial Progress/Message from our Director Page 2
A Very Exciting Riding Trip Page 3
AVERT in UKSite profiles Page 4-5
Our Swedish Connections/Alan's Story Page 6-7
Meet our Trial Manager/Connecting/Contact us Page 8
Churchi l l Fe l low ship Aw ard - Ju l ie Ber nhardt
world and further their knowledge in their
chosen field,before returning tomakea real
contributiontoAustraliansociety.
Juliewilltakeaonemonthsabbatical inearly
2013 to further research ways of enriching
healthcare
environments
to
improve
brain
recovery.Shewillbesuretokeepyouallupto
datewithherfindings.CongratulationsJulie!
Julie receiving her award from The Hon.Alex Chernov, Governor of Victoria
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7/30/2019 237 General Newsletter No 15 August 2012
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TheAVERT trial started recruitingpa
tientsbackin2006,andaimstodeter
mineif
early
exercise
after
stroke
will:
reducedisabilityandcomplications
afterstroke
improvethe rateofrecovery and
thenumberofpeopleabletowalkun
assistedafterstroke
reducecognitiveproblemsandre
sultinbetterqualityoflifeforstroke
patients
becosteffectivecomparedtocur
rentstandardtreatmentofstroke.
Whilstweareoverhalfwaywiththe
trial,thereisstillconsiderableworkto
dotogettoourfinalnumberof2104.
Since our last newsletter we have
reachedanothermajormilestonethe
recruitmentofpatientnumber1300to
the AVERT trial. The Austin hospital
team,whohavebeen involved in the
trialfromtheverybeginning,recruited
thecelebratedpatient.
Theongoing
commitment
from
our
involvedhospitalshasbeen critical to
the success of the trial so far. The
number of hospitals who have re
cruited patients to the AVERT trial is
now51.
There are inevitable staff changes at
hospitals for many reasons including
maternityand
family
leave,
travel
and
other job opportunities. This helps to
explain why over 1000 clinicians have
been involved in AVERT so far! You
might also be interested to learn that
we now have over 60 babies born to
staff who have worked on the AVERT
trialandthisnumbercontinuestogrow!
AlargetrialsuchasAVERTrequiresalot
ofdaytodaymaintenanceinareassuch
as
data
management,
training
and
on
going supportof all involved staff, and
endless listsof administrative tasks.To
allow this support to continue we re
mainveryactive intryingtosecuresuf
ficient funding toallowus to complete
thetrialinthenext2years.
Overthelast6monthsithasbeenexcit
ing to celebrate 16 new UK hospitals
joiningtheAVERTcollaboration.Allhos
pitalsintheregionarenowfullytrained
andmost
are
now
recruiting
patients.
We hope that the contribution from
our northern partners will help us to
reach our target number of patients
withinourprojectedtimeframes.
inspired by the AVERT community, an
amazinggroup
of
committed
individuals
who shareour vision.Now thatwe are
welloverthehalfwaymarkinthetrial,it
isgettingveryexciting.Wedohowever
need to finish the study as planned to
ensure that the results of the trial are
credibleandrespected.
SoforthoseinvolvedinthetrialIaskyou
toholdontothevisionofhowmuchbet
tercaremightbe ifwesucceed.And to
thosewhohaveparticipatedor support
thetrialinotherwaysIsayTHANKYOU!
Researchers need to have courage
andvision:
the
courage
to
follow
their
convictions and to not give upwhen
theyfail(afairlyfrequentevent,espe
ciallywhen itcomes tograntwriting)
andaclearvisionofabetterfuture if
theirworkchangesthingsforthebet
ter.
AVERTisthefirstglobaltrialofareha
bilitation intervention forpeoplewith
stroke. We thought big, and are de
lightedthatthestrokecommunityand
people affected by stroke have feltexcitedbytheproject.Iamconstantly
Tr ia l Progr ess
Page 2 AVERT NEWSLETTER
Ourrecruitmentthermometer
iswarmingup!
A message f rom our Di rect orJul ie Bernhardt
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On 31st May this year, the AVERT
teamrode
around
the
Capital
City
TrailinMelbournetohelpraisesome
additional funds for the AVERT trial.
16ridersralliedfriendsandfamilyto
sponsor them to take part, donned
lycra and helmets, and enjoyed a
pleasant days ridetaking in the
many wonderful sites of Melbourne
alongtheway.
Thecourse took the ridersmeander
ingalong
the
Yarra
River,
past
acon
vent, farms and falls, before leading
intotheheartofthecitysparksand
gardens. A lunch stop at Southgate
was followedby a tourof theDock
lands area, through the industrial
West along the Maribyrnong Creek
andpastthezooandthendownand
alongtheMerriCreekandsurrounds.
Our efforts were rewarded as we
ended up raising a very impressive
$8,745.00for
the
trial.
We
were
thrilled tohavean additional$4,000
subsequently donated to the trial
fromaphilanthropic
source
because
ofourfabulouscyclingeffort.
Themoneythatwasraisedwillbeput
towards improving our data collec
tionprocessesfortheAVERTtrial.We
aimtomakeoursecurewebsite eas
ier for our research team and our
hospitalstafftouse,whichinthelong
runwillsaveustimeandmoney.Our
hospitals in Australia, New Zealand,
UK,Singapore
and
Malaysia
use
this
essential tool every day. We are
changingourupdatesbasedonfeed
backfromouruserstomakethesys
temmore easytouse.
Wewillalsousesomeofthismoney
tofurthersupportoursiteswithaddi
tional training and equipment. We
hope that this in turn will help the
hospitals to increase recruitment of
stroke patients to the trial and help
usreach
our
target.
Fundrais ingA Very Exc i t ing Riding Tr ip
Our effortswere rewardedas we ended upraising a very
impressive$8,745
Page 3AVERT NEWSLETTER
Pictured are:JanChamberlain,AlanEllery,FionaEllery,CarolynPhiddian,Annastrand,JennyKulin,CharlieSaxin,JulieBernhardt,TobyCumming,TonyCross,Aaron,JaniceCollier,Kit,andKarenBorschmann.(notpicturedCarmenLahiffJenkinsandQuinn)
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At
Aberdeen
Royal
Infirmary
we
have
enjoyed
beingpartoftheAVERTteamoverthepastyear
andahalf.Thestudyhashelpedus interactwith
eachothermore and appreciate everyones dif
ferentroleintheteam.Ithasalsoreinforcedhow
every interaction with a patient can be made
meaningful in terms of contributing to their re
covery.
Ourunithas16bedsandthereare
over600acutestrokeadmissionsa
year,whichmeansthattherecanbe
quiterapidthroughput. Alltheclinical
staffare
aware
of
the
AVERT
study
and
contributetoidentifyingpotentialpa
tients. Havingthestudystaffonduty
atthesametimeasasuitablepatient
comesincanbequitechallenging! Last
yearwestruggledtorecruit,duetoa
combinationofstaffshortagesandbed
pressures. AsourMainInvestigator
DrMaryMcLeodsays,itnowlookslike
theplanetshaveallaligned andwe
arebackinthegamewithregularre
cruitmentin2012.
Theyear
saw
some
staff
changes.
A
big
thank
you
to Maggie Bruce (AVERT Nurse) Susan Cathcart
(AVERT Occupational Therapist) and Rebecca
Duncan (AVERTPT) forbeingpartofAVERTand
helping us get going. They have nowmoved to
differentdepartments. Wehavealsohad afew
additions
to
the
team
Mari
Drummond
and
Suz
anneRattrayasAVERTNurses,HeatherGowasRe
searchNurse,andDeirdreONeillasAVERTOccupa
tionalTherapistand theyhavemadehugecontribu
tionstotheteam.
WenowhavetwoAVERTbabies(anAVERTbabyisa
babyborntoanAVERTinvestigator).
Our babies are Ellen Jennifer Robertson,
daughterofJennyRobertsonourAVERTPT,
whoisnowbackfrommaternity leaveand
Ailsa Ann Davies, daughter of Joy Davies
ourOccupationalTherapist.
OurAVERTnurseshavebeenveryproactive
andhavehadagroupsessiontocomeup
withfreshideasofdifferentactivitiesthat
couldbeusedfortheAVERTpatients. Ini
tiallythepaperworktookabitofgetting
usedto,butwecanconfidentlysaythat
nowwearemuchmorerelaxedwiththe
trialandhaveworkedouthowtointegrate
itintodailylifeintheunit.
The sconesbakedbyDrMary JoanMacleod atour
catchupmeetingprobablywentalongwaytowards
helpingrecruitment!
DrRebeccaClarkeourblindedassessorhasbeena
star,tryingtoseeallthepatientswithinthetarget
timeinwhatisalargegeographicalarea.
UK Hospi t a l Prof i leAberde en Royal Inf i rm ar yby Anu Joyson
Our AVERTnurses have beenvery proact ive coming up w i thf resh ideas on
d i f fe ren tac t i v i t i es
Page 4 BIA NNUA L N EWSLETTER EDITION 1 5
Fromleft
to
right:
Nicola
Murphy,
Jenny
Robertson,
Dr
Rebecca
Clarke,
Jacqui
Bell,
Anu
Joyson,
Kathleen
Bennett,DeirdreONeill,HeatherGow,DrJacquelineFurnaceandDrMaryJoanMacleod.
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Yeovil
District
Hospital
is
an
acute
hospital
lo
cated inoneof the larger towns inSomerset a
ruralareaofEnglandknownforitsciderorchards,
helicopter manufacture and a naval airbase
nearby.
Althoughwe are a relatively small hospital, the
stroketeamstrivestostayattheforefrontofbest
practiceincludingactiveinvolvementinanumber
of stroke research trials sowealready
hadafantasticteamofstrokeresearch
nurses inplacewithgoodcommunica
tion links into the Emergency Depart
mentand
Stroke
Unit.
We
have
also
developed, and are researching, an
innovative poststroke exercise, infor
mationandsupportprogrammeknown
asASPIRE.Whenwe firstheardabout
theAVERTtrialwethoughtitwouldbe
an exciting opportunity to become in
volvedinamulticentrestrokerehabili
tationtrial.
After our sitetraining day with Rose
mary Morrison last autumn we were
finally ready to start recruitingonNovember30
2011.We
decided
to
take
the
approach
that,
as
AVERTlookedchallengingtorecruitto,wewould
considernewarrivalswithstroke forAVERT first
andthenotherstroketrialsiftheywereineligible
for AVERT. Amazinglywe recruited our first pa
tient late intheafternoononthatveryfirstday.
TherewasthenabitofalulltilltheNewYearbut
since thenwe havemanaged to recruit steadily
twopatientsamonthapartfromMarchwhenwe
found four despite only about 300 new stroke
admissionseachyear.
We
found
we
had
to
increase
the
number
of
AVERTNurses(knownassecretsquirrels)onthe
StrokeUnit tomakesure therewasat leastone
availableonmostshifts.Wealsohad to identify
and train a second physio to allow the AVERT
Physio to attendoffsitemeetings and have an
nual leave.We have learnt all sorts ofways to
ensure thatparticipantsget the rightamountof
inputwithoutcompromising the studyorhaving
other patients feeling that AVERT patients get
moreattention!
As
the
Principal
Investigator
for
our
site
I
have
found
itcanbechallengingtomakesurethattheresearch
paperwork is filled in and this has occasionally re
quiredsomedetectivework! Ontheotherhandwe
havehad lotsofenthusiasticstaffdutifullycomplet
ingpaperworkinthemiddleofthenightandonSun
days.Whathasmade life somuch easier forme is
the strokeresearchteamsbrilliantBlindedAssessor
EmmaJones,whotracksdownandfollowsupallour
participants. In addition, the Research
Nurses Donna Hayward, Sarah Board and
Hayley Smithwhodomostof the recruit
ing,enterdataanddealwiththedataque
ries that arise, are an integral part of the
team. The number of queries we get are
reducing after16patientswearegetting
much better as a team at getting it right
firsttime!
AstheAVERTPhysiothemostexcitingpart
ofthetrialformeisthecreativityrequired
to ensure participants have interesting,
varied and relevant therapy at every ses
sion. It has also been a real privilege to
meet so many patients and their family members
whoare
willing
to
sign
up
for
AVERT
and
to
share
in
thoseearlydifficulthoursanddaysaftertheirstroke
Itiscommonthoughthatmanyrememberlittleor
nothingaboutthatbusytime!
WehavehadsomesadnessastwoofourAVERTpar
ticipantshavepassedaway.
WithoutexceptionallofourAVERTparticipantshave
beenlovelyandinterestingpeople.
UK Hospi t a l Prof i leYeovi l Dist r ic t H ospi t a lby Debbie Neal
I t has a lso beena rea l p r iv i lege tomee t so many
pat ien ts and the i rfami ly members
w ho a re w i l l ing t os ign up fo rAVERT ...
Page 5BIAN NUAL NEWSLETTER EDITI ON 15
Lefttoright:DebbieNeal(AVERTPhysioandPI),JacquelineHarrup(AVERTparticipant),DonnaHayward(StrokeResearchNurse),HayleySmith(StrokeResearchNurse),PaulWood(AVERTparticipant)andseatedinfrontGeorginaPark(AVERTparticipant).
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Quote
Weare
two
lucky
Swedish
physiotherapy
stu
dents from the University of Gothenburg who
got the opportunity to spend 10weeks at the
FloreyNeuroscienceInstituteattheAustinhospi
tal inMelbourne.With thehelpand supportof
theAVERTteamwewroteourfinalthesisforour
degreeinphysiotherapy.
When aperson suffers from a stroke theymay
needalongerperiodofrehabilitationaftertheir
initialhospitalisation.Theacutephaseofhospi
talisation is oftenwhere patients undergo suit
ablemedical
assessments
and
early
treatment,
butforlongertermongoingtherapy these
patients often go to inpatient rehabilita
tion. During their rehabilitation stay the
aimisforpatients torelearnskillslostdue
tothestroke.Thisoccursthroughdifferent
typesofactivitiesandtherapywithphysio
therapists,occupationaltherapists,speech
therapistsandotherrehabilitationspecial
ists.
Ourinitialthoughtwasthatpatientswould
bemuchmore activewhen theyhad en
tered the rehabilitation hospital, com
paredtowhentheywereintheacutehos
pital. Inourthesiswewereinterestedinlooking
at strokepatients levelofphysical activity and
socialinteractioninthesetwodifferentstagesof
their care: at the acute ward and during their
rehabilitationperiod.Ouraimwastodetermine
if therewasadifference inpatientactivitypat
ternsbetween
the
two
settings.
Were
the
re
habilitation patients really more active?
We compareddata collected from104 stroke
patients in rehabilitationwards at fourdiffer
enthospitals in theWestGothia region,Swe
den,with86patientsatanacutestrokeward
inStockholm,Sweden.Therewasnodifference
inage,sexorabilitytowalkbetweenthefour
hospitalgroups.Thedatawascollectedbyob
serving each patient during a typical day be
tween8amand5pm. In10minutes intervals,
the
physical
activity,
location
and
social
inter
actionofthepatientwasascertained.
Interestingly, the resultsdidnotmatch
ourinitialthoughtthatpatientsinreha
bilitation would spend more time in
physicalactivitiesthanthoseinanacute
setting. Patients in the acute setting
spentmore time in theirbeddoingno
activityatall,butwhenlookingatmore
demanding activities such as sitting
without support, standing andwalking,
therewas
no
difference
between
the
acuteandtherehabilitationsetting.Pa
tientswere also observed to be alone
morethan50percentofthedayatboth
settings. A major difference between the
groupswas that patients in the rehabilitation
setting spent less time in their bedroom and
moretimeintheunitsloungearea.
Manyfactorsmightcontributetohowactivea
patient is: the hospital environment, the pa
tientscognitivestatusandotherissuessuchas
physicalandmentalfatigue.Itisthereforedifficulttodrawanyconclusionsastowhypatients
in rehabilitation were not much more active
thanthoseinacutecare.
Theresultsofourworksuggestthatthe levels
ofphysical activity in rehabilitationmightnot
beashighaswebelievethemtobe.
Our Sw edish Connect ionsChar l ie Sax in and Anna st rand
Page 6 AVERT NEWSLETTER
CharlieSaxinandAnnastrand ourSwedishphysiotherapystudents.
Pat ien tsw ere a lso
observed tobe a lone
more than50% of theday a t bo thset t ings.
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Alanis
in
his
early
seventies
and
he
is
semi
retired.AlanagreedtojointheAVERTrehabilitation research trial when he firstcametohospitalbecausehefelthecouldhelpand that itwouldbenefitotherpeoplewithstrokeinthefuture.ThisisAlansstrokestory.
Ihadbeensleepingonmybackandas I
awokeinthemorninginJanuary2011my
firstthoughtwasthatsomethingwaslying
acrossmystomach.Pullingback thecov
ersIfound
it
was
my
left
arm,
it
was
de
voidof feelingandmy lefthandwasnot
functioningatall.
BeingonmyownatthetimeIphonedmy
partner to let her know of this butwas
unabletocontacther,soIdecidedtoget
dressed,whichwasdifficultwithonlyone
functioningarm,andtohavesomebreak
fast.
It did not occur tome that I had had a
stroke.Ithought
the
lack
of
sensation
wouldprobablywearoff,abit likewhen
yourhandorfootgoestosleep.
Afterbreakfast itwas still the same so I
rangmyGPssurgeryandspoketothere
ceptionist.
She told me to Call an ambulance
straightawaywhich Ididandwastaken
to theAlfredwhere I receivedexpertat
tentionfromthestrokeclinicteamofdoc
tors,physiotherapists
and
occupational
therapists.
Iwas givenmany diagnostic testswhich
showedmy right carotid arterywas80%
blocked.AnMRIscanofthebrainshowed
thatIhad indeedsufferedastroke,but it
also showed that therewasagrowthon
mypituitarygland.
Ihadsurgerywithinafewweekstoclean
out the artery. I am very fortunate that
the
stroke
was
not
more
severe
and
made
worsebymydelay inseekingmedicalat
tention. Ihada fewproblemsgettingmy
bloodpressure
stable,
as
it
could
be
too
high or too low. This has settled and I
have a blood pressure unit at home. I
checkmybloodpressureathomeoncea
week,anddoadailyBPchartforaweek
orsoformyGPbeforeIseehim.
Iwasfortunatehavingthediagnosticscan
for the stroke so that the growth was
found. It needed to be treated so I had
surgeryto
remove
the
growth
afew
monthsafterthestroke.
There were quite a lot of hospital and
doctorsvisitsforseveralmonthsafterthe
stroke. By Christmas 2011, Iwas feeling
completelywell again,back todoing the
shopping, cooking, vacuuming, trimming
the hedges and managing my invest
ments. Iamalsomakingapointofexer
cising by walking for 30 minutes every
day.
Par t ic ipant Prof i leAlans s tor y
I t d id no t
occu r t o me
that I had had
a s t r oke
Page 7AVERT NEWSLETTER
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A Very Ear ly Rehabi l i tat ion Tr ia l
Would you l i ke t o Cont r ibu te?
Thisnewsletter showcases someof thewayspeo
plehavebecome involved in theAVERTResearch
Program.Wethankyouallforyourcontributions.If
youwould liketoassist inanywaywewould love
tohear
from
you.
PleaseemailJanChamberlain:[email protected]
orcallJaninMelbourneon(+613)90357000.
Would you l i ke to s t ay in touch?
IfyouareaparticipantintheAVERTtrial,youmay
want togiveyour contactdetails toyourassessor
at12months so thatyou can continue to receive
furtherupdatesaboutthetrial.
Would you l i ke t o Donate?
Ifyouareinterestedindonatingtothe
AVERTprogram, alldonations are tax
deductibleandcanbemadebycalling
the Florey Neuroscience Institutes
(Phone:+61390357000).
Connect ing
Fionahasanursingbackgroundandearlyinher
careerbecameinvolvedwithcoordinating clini
caltrials
with
afocus
on
neuroscience
at
anum
berofhospitals.Shelatermovedtoindustryand
was involved in the management of trials for
various pharmaceutical companies. She joined
theAVERTCentralteamastheAVERTTrialMan
ager in 2006.Her rolewith the team includes
thedevelopmentof trialprocessesand theon
going training and management of trial staff
bothinAustraliaandinternationally.
Fionahas2girlsandspendsmuchofherleisure
time at netball, swimming and dance venues
withthem!Occasionallyshegetstopotterinhergarden.
Fiona and her family re
cently raised and trained
aGuideDogpuppyfor18
months . Al though
Geanie did not make
the grade it was a very
rewardingexperienceand
Geanie has now become
amuch
valued
family
pet!
Meet Fiona El lery
We have been updating our section of the FNIwebsite and you can find out much more
about the trial at: http://bit.ly/AVERT1
Our Websi t e
The Florey Institute of Neuroscience andMental Health
Melbourne Brain Centre - Austin Campus
245 Burgundy Street
Heidelberg VIC 3084
Contac t Us