Cabrini Institute Annual Report 2018-19 by Cabrini Health

CABRINI INSTITUTE: A YEAR IN REVIEW ANNUAL REPORT

THINK discover 2018-19

EDUCATE

Established in 1996, the Cabrini Institute supports a wide range of education and research activities. Researchers oversee a diverse research program, as well as developments in clinical education. The research program includes allied health, arthritis, back pain, cancer, health literacy, emergency medicine, reducing low value healthcare, intensive care, nursing, palliative care, patient safety, psycho-oncology and surgery. The Cabrini Institute plays a significant role in the education of our current and future health professionals.

PAG E 3

PAG E 4

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

Contents 6 9 10 12

Message from Chair of the Cabrini Institute Council State-of-the-art Cancer Centre for Cabrini Malvern Message from Group Director, Nursing, Clinical Education and Research Highlights of 2018-19

YEAR IN REVIEW 16 Our Strategy 18 Strategic Partnerships 22 Partnering with Consumers 24 Cabrini Research Week 2018 26 Supporting Research and Staff Development at Cabrini OUR RESEARCH 30 Cabrini Monash University Department of Nursing Research 34 Centre for Allied Health Research and Education (CAHRE) 38 Monash Department of Clinical Epidemiology – Cabrini 44 Cabrini Monash University Department of Medical Oncology – The Szalmuk Family Department of Medical Oncology 48 Cabrini Monash University Department of Surgery, The Fröhlich West Chair of Surgery 51 Let’s Beat Bowel Cancer 54 Szalmuk Family Psycho-Oncology Research Unit 58 Shared-Care model for cancer related depression – Funding Success 60 Palliative and Supportive Care Research Unit 64 Alan, Ada, and Eva Selwyn Emergency Department 66 Intensive Care Research Unit 70 Clinical Database Registries 73 Providing best cancer management for our patients SUPPORT SERVICES & EDUCATION 76 Clinical Education Department 79 Training our next generation of medical specialists 80 Medical Education 82 Providing educational lessons and resources for our staff and wider community 84 Improving how we prepare for and manage health disasters 86 Cabrini Human Research Ethics Committee (CHREC) and Research Governance Office 92 Cabrini Institute Team 96 Cabrini Institute Council 102 Supporters

CONTENTS

PAG E 5

CHAIR’S MESSAGE PROFESSOR MEG E. MORRIS, PHD, FACP

Compassion, integrity, courage and respect for all are values at the heart of Cabrini. I am delighted to bring you the 2018-19 Cabrini Institute Annual Report, showcasing another terrific year in research, education and partnerships. This is my first year as Chair of the Cabrini Institute Council and I am honoured to serve the Cabrini community. The report showcases the outstanding and unique achievements of the Cabrini Institute over the last 12 months. In particular, it illustrates how high quality research, education, training and clinical practice converge to ensure the best possible patient experiences and outcomes. By embedding an evidence-based, compassionate care culture through all of our activities, we are delivering world-class care provided by a committed and engaged workforce. The Cabrini Institute remains an integral component of Cabrini’s mission. This report highlights the proud commitment that Cabrini has to research-informed, patient-centred care. Cabrini Health has some of Australia’s greatest clinicians, researchers and managers supported by an environment facilitating learning and compassion. Aligning workforce training with clinical services in our datadriven, technology-enabled environment is a priority. A smart, change-enabled clinical workforce is key. Workforce capability is also fostered through high-quality education at entry to practice, post-graduate and higher degree research students. Also, through a rich array of partnerships

PAG E 6

with universities, industry and community stakeholders, we are accelerating the development of value-based care and precision medicine. Our patients and customers are at the centre of everything that we do and we understand and match their needs to the Institute’s projects and processes. The Cabrini Institute Council continues to fulfil its mandate to provide support, guidance and critical independent advice to the Board, the CEO of Cabrini Health and the Group Director of the Institute. I would like to thank the Cabrini Board Chair, Ms Sylvia Falzon, for her transformational leadership and positive approach towards supporting our endeavours. She has provided the Institute with direction and inspiration and has ensured that the important work outlined in the subsequent pages is quickly communicated to all of our stakeholders. In November 2018 we farewelled Professor Peter Fuller AM, who formally retired from the Institute Council after 13 years, four of those years as Council Chair. Peter was a key driver in the ongoing success of the Institute. A thoughtful, dedicated and future-focussed leader, the current success of the Institute is in no small measure due to his vision and influential contributions over the last 13 years. We also farewelled Professor Neville Yeomans AM, who retired in September 2018 after serving as a member since February 2010, and Mr Jeremy McCarthy who retired in May 2019 after serving as a member since February 2007. We thank both for

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

their dedication, wise counsel and influential service over many years. The Cabrini Institute Council welcomed Professor Judy Lowthian who joined in 2018. Judy is Head of Research and Principal Research Fellow at Bolton Clarke; an adjunct Professor in the Faculty of Health and Behavioural Sciences at The University of Queensland, an Associate Professor in the School of Public Health and Preventive Medicine at Monash University, and in the Institute of Future Environments, Queensland University of Technology. We also welcomed Professor Rosemary Calder AM, who joined in March 2019. Rosemary is the Director, Australian Health Policy Collaboration. Established at Victoria University, the Australian Health Policy Collaboration develops and promotes research-based policies that will have a profound impact on population health and education outcomes. Ms Sophie Pennington joined the Council in March 2019. As a partner in the Health Group at HWL Ebsworth Lawyers, Sophie brings expertise in the areas of health law, medical malpractice, professional indemnity and general insurance. The Institute Council continues to be impressed with the transformational leadership, dedication and achievements of the Heads of each of the Institute Departments. For example, the Monash Department of Clinical Epidemiology led by Professor Rachelle Buchbinder, has achieved considerable success in grants and research discoveries. Professor Buchbinder was recently recognised in the International 2018 Highly Cited Researchers list from Clarivate Analytics. This highlights world-class researchers selected for their exceptional research performance, demonstrated by the production of multiple highly cited papers that rank in the top 1% by citations for a given field in the last decade in the Web of Science. Cabrini continues to go from strength to strength in cancer research with breakthroughs in precision medicine. The Cabrini Monash Department of Medical Oncology – The Szalmuk Family Department of Medical Oncology, led by Professor Gary Richardson OAM, continues to provide access for Cabrini patients to clinical trials. The program continues to thrive, and includes Phase 1a through to Phase 3 oncology trials. The translational research program also continues to build through projects aimed at establishing breast cancer organoids to enable tailored individually suited therapies for patients, and incorporates patient reported outcome measures. The strength in cancer research is also reflected in the work of the Cabrini Monash University Department of Surgery, the Frölich West Chair of Surgery, led by Associate Professor Paul McMurrick. Associate Professor McMurrick has continued to provide leadership of academic surgical colorectal cancer research through the Colorectal Cancer

C H A I R ’ S M E S S AG E

The Institute Council continues to be impressed with the transformational leadership, dedication and achievements of the heads of each of the Institute departments.

PAG E 7

Registry; this has enabled a number of high profile publications. The Department also continues to build on highly productive collaborations with scientists at Monash University and the Hudson Institute making breakthroughs in understanding colorectal cancer biology and developing novel techniques to advance precision medicine including colorectal organoids, tissue micro-arrays and tissue slice technologies. The work in both medical and surgical oncology is complemented by Cabrini’s commitment to all aspects of the care of patients with cancer. The Szalmuk Family Psycho-oncology Research Unit and the Palliative and Supportive Care Research Unit both work to provide a program of patient-centred research in clinical practice which contributes not only academically but clinically to Cabrini. Associate Professor Natasha Michael, Head Palliative and Supportive Care Research Unit, continues to support both the care of Cabrini’s patients and innovative research focused on several themes including advanced care planning and spirituality. Professor David Kissane AC, Head Szalmuk Family Psycho-oncology Research Unit, continues to make good headway in research that will develop and test a collaborative care model for community-based psychologists to support patients with cancer. A highlight for Nursing Research has been the appointment of Associate Professor Philip Russo as the Director of Cabrini Monash University Department of Nursing Research in February 2019. Associate Professor Russo comes to the role with extensive clinical, leadership and academic experience and will lead nursing research at Cabrini to new strengths and champion the Choosing Wisely program. The Allied Health Research Unit said farewell to Associate Professor Helena Frawley, thanking her for her excellent contributions, and welcomed Dr Annemarie Lee as the new Senior Consultant for allied health research. With Dr Lee’s research expertise in cardiac and respiratory physiotherapy we envision a great intersect with Cabrini’s new acute cardiac service and new respiratory ward and look forward to seeing research growth and benefits. A highlight for the Emergency Medicine Research Department is new grant funding and collaborations that will see them working on innovative ways to improve patient wait times and experience in emergency rooms and the development of new medical devices. They also continue to extend their research in building emergency physician capacity and improving medical communication skills. The Intensive Care Unit (ICU) had a very active involvement in clinical trials over the year, collaborating with many organisations to expand the impact of ICU research. Their research outputs continue to make improvements in current practices which reduce the long-term impact of intensive care admissions on patients.

PAG E 8

Cabrini continues to excel as a teaching hospital. Associate Professor David Brewster and team have increased involvement of visiting medical staff in teaching threefold and has continued to engage our future medical staff in research through the Cabrini Senior Medical Staff Association research grants. Jo Schlieff, as the Manager Clinical Education, continues to lead the development of educational resources and training programs for nursing, allied health and medical staff, ensuring quality standards are maintained throughout our organisation. In 2018 they completed the development of 25 new courses and continue to build on their capacity to support placement days for nursing and midwifery students. A key highlight for the year was the establishment of the ACCENT program at Cabrini in collaboration with Australian Catholic University College. The program will help to shape the future of our enrolled nursing workforce. Congratulations also go to Council member Professor Robyn O’Hehir AO, who was inducted into the Victorian Honour Roll of Women 2019 for being a leading international figure in allergy and asthma research and clinical care. Notably, Dr Clare O’Callaghan from the Palliative and Supportive Care Research Unit received an AM in the recent Queen’s Birthday Honours List in recognition for outstanding service to community health through palliative care and music therapy. None of these achievements would have occurred without the vision, commitment and dedication of Professor Lee Boyd who has given inspirational leadership. The Department Heads and all of the dedicated staff at the Cabrini Institute and on our committees and working parties have also contributed to our success, as well as the patients, families and friends that make research possible. I now invite you to read the report and to learn firsthand some examples of the wonderful successes over the last year. The commitment of Cabrini Health to support and nurture research and education is exemplary. It reflects a commitment to address the broader mission of health and wellbeing, through building knowledge, reducing social disadvantage and contributing to more inclusive, equitable and compassionate communities.

PROFESSOR MEG E. MORRIS, PHD, FACP CHAIR OF THE CABRINI INSTITUTE COUNCIL

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

STATE-OF-THE-ART CANCER CENTRE FOR CABRINI MALVERN Cabrini received a Federal Government funding commitment of $6 million in the 2018-19 financial year that will enable the establishment of a new Institute of Cancer at Cabrini Malvern, allowing researchers and clinicians to work together towards life-saving breakthroughs. This funding is expected to allow for the number of patients on clinical trials to increase by more than 180 participants. Cabrini Health Chief Executive Dr Michael Walsh said the funding commitment would support access to the best possible treatment options for present and future generations. “Cabrini has always invested heavily in research and clinical trials, to find better ways of treating cancer and improving the patient experience, with the Cabrini Institute having recently marked 20 years of education, health promotion and research,” Dr Walsh said. “We welcome this investment from the Federal Government, which will enable us to undertake further research to help find new treatment methods so our patients can live longer lives with less pain and discomfort. “Cabrini’s new Gandel Wing will provide expert, holistic care with people at its heart. It includes a new radiotherapy service, an expanded day oncology service and a new inpatient oncology ward, which means we will be able to offer an integrated cancer service with all treatments available onsite at Cabrini Malvern.

(L-R): Cabrini Chief Executive Dr Michael Walsh, Federal Member for Higgins Dr Katie Allen and former Federal Member for Higgins Kelly O’Dwyer.

“The new Institute of Cancer will enable researchers and clinicians to work together, giving them the best chance of developing breakthroughs and delivering better health outcomes for patients.”

THE FEDERAL GOVERNMENT FUNDING COMMITMENT WILL PROVIDE:

$3m $2m $1m TO BUILD A NON-PROFIT, STATEOF-THE-ART INSTITUTE OF CANCER, TO ADVANCE TRANSLATIONAL CANCER RESEARCH AND DELIVER BETTER HEALTH OUTCOMES

F U N D I N G C O M M I TM E N T

FOR A CABRINI CANCER EXERCISE AND WELLNESS CENTRE, WHICH WILL EMPHASISE THE IMPORTANCE OF RESEARCH INTO EXERCISE IN THE DELIVERY OF CANCER SERVICES

TOWARDS THE SOUTH EAST MELBOURNE CANCER RESEARCH AND TREATMENT OUTREACH, A PARTNERSHIP WITH MONASH PARTNERS AND PENINSULA HEALTH AT ROSEBUD HOSPITAL, WHICH WILL ESTABLISH A TERTIARY REFERRAL AND SATELLITE ONCOLOGY RESEARCH CENTRE

PAG E 9

GROUP DIRECTORâ&#x20AC;&#x2122;S MESSAGE PROFESSOR LEE BOYD

This Annual Report is a celebration of the work undertaken by those who work within the Cabrini Institute and all of those who partner with us to improve patient care. This is at the heart of everything we do. In the past, patients and their families were expected to fit in with the routines and practices that health services and healthcare professionals felt were most appropriate. Thankfully, this is rapidly changing. Cabrini constantly strives to provide services that are flexible, connected and involve working with residents, patients and their families to heal, comfort and set goals for care. This partnership occurs individually on a daily basis and collectively whereby the community or patient/resident groups are involved in decisions regarding the design and delivery of our services. This underpinning philosophy also informed the strategic planning process for Cabrini Institute. We have engaged with our customers, residents, patients and their families through various forums to better understand what is important to them and how we can instil this within healthcare education and research. The strategic pillars which inform all activities and projects undertaken within the Institute are: 1. Value-Based Care Ready 2. Precision Medicine Advancement 3. Smart Change Enabled Clinical Workforce

PAG E 1 0

Innovation Partner of Choice As you will see when you read the detailed reports, the research that is generated from within each of our research departments creates new knowledge within these pillars and then contributes to research-informed education. Foundation Grant Rounds This year, the Cabrini Foundation with the support of the Cabrini Institute, funded $627,000 in grants and $160,000 in scholarships. We held a number of small engagement events with our donors throughout the year to introduce them to the donation recipients and hear about the project or study progress. These grants demonstrate a significant investment in our people and have proven to be an excellent strategic investment. We were very excited to launch the Auric Innovation Grant round for the first time in 2019. This $200,000 grant was made possible through the generosity of Brian and Lee Johnson. The Auric Innovation Grant round received 27 quality applications. Two shortlisted projects were sent to the donor for review and the Johnsonsâ&#x20AC;&#x2122; decided to fund both (totalling $347,000). The successful applicants were: Project 1: Ms Sharni Clark (Ashwood Director of Nursing/GM) ($200K) to develop a Living Lab in aged

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

care. This project aims to improve the lived experience of residents, families and staff in the aged care sector by delivering meaningful and innovative solutions designed onsite and informed by a deep understanding of the people using and delivering aged care services. They will establish a collaboration between Cabrini (Residential Care – Ashwood) and Monash (University) Art Design and Architecture (MADA) in the form of a Living Lab, a space for collaboration. Project 2: Dr Gabriel Blecher (Cabrini Emergency Department Physician) ($147K) to develop customised distraction techniques using multiple audio-visual media techniques such as virtual reality, close proximity screen and directed music for managing acute behavioural disturbance (ABD) of elderly patients in the emergency department setting. I look forward to sharing the project outcomes in next year’s Annual Report. Higher Degree by Research Students To become an innovation partner of choice, Cabrini invests in industry based PhDs to investigate complex problems found within healthcare. Our current focus is digital health. We are partnering with Monash Partners and the Digital Health Cooperative Research Centre (DHCRC) to better understand the challenges experienced by healthcare professionals and our patients in regards to data, information and telecommunication technologies. So far it would seem that technology offers more benefits to patients than healthcare professionals. People have a plethora of information at their fingertips with artificial intelligence capability, smartphone apps and devices to inform their healing process and monitor progress. They can follow their own care closely, ask questions, turn to online patient communities for support and seek information 24 hours a day, seven days a week from the comfort of their home. Navigating this maze, maintaining a sense of personal connectedness and sorting through the quality of the information is the new challenge. We are seeking to understand what is important to our healthcare professionals, patients and their families so that we can navigate through the jungle of digital health together.

Cabrini Research Week We had 71 abstracts submitted for Cabrini Research Week 2018 which was held 8-12 October. The keynote presentation titled “Human mini-guts – How colorectal organoid research will personalise treatment for bowel cancer patients” was delivered by Associate Professor Paul McMurrick and Associate Professor Helen Abud from Monash Partners. This presentation aligned with our strategic theme of ‘Precision Medicine Advancement’. Acknowledgements I would like to take this opportunity to thank our excellent researchers, clinicians, administration team and educators who have worked with such passion and commitment and our Cabrini sisters for their ongoing support and prayers. We are also grateful to our Cabrini doctors, nurses and allied health staff for their support of our research and education programs. It would be remiss of me not to mention the extraordinary effort that is put in by members of the Institute Council. Last year was a busy year for Council appointments. We farewelled our outgoing Council Chair, Professor Peter Fuller AM and thank him for his unfailing guidance and sound advice. Peter has been an Institute Council member since 2005 and Chair since 2014. It has been such an inspiration to work with him and the Institute is all the better for his valuable insights and contribution. It is my pleasure to welcome Professor Meg Morris as the new Chair. We are indeed fortunate to have this group of high calibre multidisciplinary professionals to guide the work of the Institute now and into the future. Finally, I would like to acknowledge each and every patient and family member who has contributed by participating in a clinical trial or supporting education for our health professionals and thank our donors for their continuing support of the Cabrini Institute. I am so proud of what has been achieved over the past year. While we continue to grow we do so with constant vigilance of our Cabrini mission and values which always inform our decision making and strategic direction.

Peter Meese Lecture The annual Peter Meese lecture held in March 2019 was titled “Treating People Not Just Cancer” with guest speakers Gail O’Brien AO and Catherine Lambert coming from the Chris O’Brien Lifehouse to share their lessons in patient focused holistic care.

G R O U P D I R E C TO R ’ S M E S S AG E

BY PROFESSOR LEE BOYD GROUP DIRECTOR, NURSING, CLINICAL EDUCATION AND RESEARCH

PAG E 1 1

$48,435,905 GRANT FUNDING HELD AND AWARDED (UP 2.7% FROM LAST YEAR)

171 PUBLICATIONS, BOOKS, CHAPTERS AND REPORTS (UP 39% FROM LAST YEAR)

98 156 81 ACTIVE CLINICAL TRIALS

PAG E 1 2

SEMINARS AND PRESENTATIONS

NEW PROJECTS APPROVED BY CHREC

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

$787,000 CABRINI GRANTS AND SCHOLARSHIPS AWARDED

17,943 NURSING AND ALLIED HEALTH STUDENT PL ACEMENT DAYS OFFERED 2018-19

27 143 58 MASTERS & PHD STUDENTS SUPERVISED

HIGHLIGHTS

COURSES AND WORKSHOPS TO SUPPORT PROFESSIONAL DEVELOPMENT (16.8% INCREASE FROM LAST YEAR)

GRADUATE NURSING POSITIONS OFFERED (2019)

PAG E 1 3

Kate Hurford (right), Oncology Research Study Coordinator with the Cabrini Monash University Department of Medical Oncology â&#x20AC;&#x201C; The Szalmuk Family Department of Medical Oncology, with Mrs Sufang Chen. PAG E 14

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

YEAR IN REVIEW 18-19 Y E A R I N R E V I E W 2 0 1 8 -1 9

PAG E 1 5

How research and education at the Institute is contributing to Cabrini’s growth and success in the healthcare environment, and embracing vulnerable customers and strengthening their confidence in life.

OUR STRATEGY Cabrini Institute’s strategy is premised on building the engine for growth and adaptability that Cabrini needs to succeed in a healthcare environment through digital technological advances, improving access to more effective healthcare, and supporting customers to take greater control of their own healthcare decisions. Cabrini Institute aims to lead the way in translating valuebased care so our customers can achieve their individual health goals. We will deliver the difference through four key outcomes that align with the Cabrini Health Strategy: • Preparing for a value-based care environment • Advancing precision medicine through research and education • Building a smart, change enabled clinical workforce • Being the innovative partner of choice How we will support Cabrini to become value-based care ready Customers trust Cabrini keeps up to date when it comes to new evidence on treatment practices. Value-based care PAG E 1 6

aims to reduce over-treatment and over-diagnosis while improving quality and outcomes for patients. Unsustainable growth of healthcare costs will drive changes to how health services will be funded, with a move towards rewarding outcomes, rather than fee-for-service. Cabrini Institute will initiate and support projects in health services research that will drive value-based care and optimise value-based health outcomes for our customers. We will do this by developing frameworks and internal capability to conduct health service research and economic evaluations that drive value-based care that is aligned with our customer needs, and builds quality, capacity and efficiency in our hospital services. Cabrini has joined Choosing Wisely Australia, a national platform that promotes value-based care, and is the first private hospital to do so in Australia. How we will help Cabrini to become the first preference when customers seek healthcare services, and transform how medicine is practiced Customers feel more confident in knowing that they have chosen the medicine or therapy that is going to work best for them. Individuals’ engagement with their health, combined with scientific and technological advances in C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

treatments and diagnosis, will transform how medicine is practiced. Precision medicine is the tailoring of drugs and other treatments to specific populations and individuals, based on their genetic profiles or other differentiating factors. It applies a deeper understanding of diseases with richer customer data and advanced analytics to enable individualised treatment. Precision medicine will improve the efficiency of the health system to the benefit of customers. Cabrini Institute will facilitate discovery and translational research programs that lead to the implementation and advancement of precision medicine including developing models that will allow clinicians to predict a best treatment strategy for an individual, reducing the risk of trial and error of standard treatment regimes. Cabrini Institute will also promote the integration of precision medicine products into clinical practice by expanding the oncology clinical trials program and look to opportunities to establish clinical trial programs in other clinical areas of need.

The surge in health intelligence and connected technology will reengineer how care is delivered with positive gains in productivity, customer and clinical outcomes.

How we will help to optimise the capability and capacity of Cabriniâ&#x20AC;&#x2122;s clinical workforce The surge in health intelligence and connected technology will reengineer how care is delivered with positive gains in productivity, customer and clinical outcomes. The adoption of technologies such as wearables and mobile-enabled diagnostics will give rise to a colossal amount of data. Combined with the digitisation of health records, and when connected with big data analytics and business intelligence platforms, this could help improve outcomes, reduce costs and increase efficiency. The Institute will play a key role in ensuring Cabrini clinical staff use the latest technology to support their decision making, know the latest practices, and deliver quality, contemporary compassionate care. We will do this by building a clinical workforce equipped with skills to manage in a data-driven, technology enabled environment through workforce training and education that is driven by an evidence-based compassion care culture. How we will invest to drive a better customer experience and build the reputation of Cabrini to attract the best people and partnerships In order to succeed in a transforming healthcare economy we need to build meaningful partnerships through collaboration and cooperation with new players and partnerships in technology, analytics, medicine, computing and others. Crossâ&#x20AC;&#x201C;industry partnerships will become commonplace as a way to acquire capabilities to complement our existing systems and deliver better outcomes for our customers. We will do this by identifying and driving partnerships to accelerate the development of value-based care and precision medicine. We will also align our research and education to value-based care and customer outcomes through initiatives that will understand and match customer needs to our projects and processes, increase participation of the clinical workforce in educational and research programs, and increase our utilisation of database information to improve research and business strategies.

Y E A R I N R E V I E W 2 0 1 8 -1 9

PAG E 1 7

In order to succeed in a transforming healthcare economy and innovate for better health, we need to build meaningful partnerships through collaboration and cooperation with new players and partnerships.

STRATEGIC PARTNERSHIPS As a single institution we have limited resources. We can achieve much more if we work with others and share our knowledge and our infrastructure. In order to succeed in a transforming healthcare economy and innovate for better health we need to build meaningful partnerships through collaboration and cooperation with new players and partnerships. As a single institution we have limited resources. We can achieve much more if we work with others and share our knowledge and our infrastructure. We partner with governments, other healthcare services, specialist colleges, universities and primary health care providers (general practitioners). We receive funding from the Australian Government Department of Health to support our Specialist Training Program. These trainees generally rotate from the public sector so we partner with healthcare services to achieve our objectives. Our largest specialist training partner is Alfred Health with whom we have worked closely over many years. This PAG E 1 8

partnership is supported by the fact that we are both part of Monash Universityâ&#x20AC;&#x2122;s Central Clinical School and we share undergraduate medical students. Our partnership with Monash University underpins the academic appointments at Cabrini Institute. We have 88 shared positions across the research departments of Clinical Epidemiology; Medical Oncology; Surgery; PsychoOncology; Nursing and Allied Health. We are most grateful to Professor Christina Mitchell, Academic Vice-President and Dean, Faculty of Medicine, Nursing and Health Sciences, at Monash University for her ongoing support. We seek and value opportunities to partner with general practitioners. We want strong relationships with these primary care providers so we can ensure coordinated care optimising the experience for our patients. We want to share our knowledge with these doctors and conduct regular education that is accredited by the Royal Australian College of General Practitioners. Monash Partners â&#x20AC;&#x201C; A message from our collaborators Cabrini is a founding member of Monash Partners Academic Health Science Centre, a partnership between ten healthcare, research and teaching organisations serving a community of 2.5 million Victorians. Established in 2011 C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

and accredited in 2015 by the NHMRC as an Advanced Health Research Translation Centre, the purpose of Monash Partners is to: ‘Connect researchers, clinicians and the community to innovate for better health’. Monash Partners have strategically focused on and achieved the following this year: • Secured additional Medical Research Future Funding of $6.1 million for 2019-21 platforms, support and projects. Optimised clinical research: • Improved clinical research processes including establishing a centralised shared ethics model for ethics review in partnership with Cabrini • Co-leading development of a national clinical research accelerator platform • Delivering a large-scale free clinical research training program to thousands of staff Enhancing data-driven healthcare improvement: • Progressed development of an innovative learning health system data hub • Progressed jointly agreed data sharing principles and data integration projects • Established a data fellows program • Contributed to and released free online and funded accredited data training programs for health professionals

We seek and value opportunities to partner with general practitioners. We want strong relationships with these primary care providers so we can ensure coordinated care optimising the experience for our patients.

Improving other platform activities: • Strengthened consumer and community involvement in health research • Supported clinical innovation coming directly from our frontline clinical staff in partnership with the Monash University Monash Institute of Medical Engineering platform • Strengthened our Indigenous health and capacity building program • Engaged and connected broadly to enhance and integrate research, education and clinical care and link across the translational research continuum Supporting theme projects and connection and networking: • Funding and enabling a range of theme and platformbased projects across cancer, heart disease, women’s and children’s health, primary care and other areas Monash Partners and Cabrini Monash Partners focuses on enhancing the health of our community through research and evidence translation. We network extensively and provide a community of practice where all health disciplines, our community and our researchers can genuinely collaborate for better health outcomes. We transcend the traditional silos across sectors and organisations and help ensure research addresses real health and community need and has real world impact. This is our core business, surpassing our important yet modest contribution to research and translation funding. As a founding member of Monash Partners, Cabrini, together with other partners, support research infused practice initiatives including training of our inter-professional workforce, career development, expediting ethics and governance processes and supporting innovative projects. “Indeed, these Partnerships are about so much more than

Y E A R I N R E V I E W 2 0 1 8 -1 9

PAG E 1 9

grant funding, they are here to deliver better health through research and to maximise impact for our communities,” says Professor Helena Teede, Executive Director of Monash Partners. Digital and data-driven healthcare improvement: Monash University Graduate Research Industry Partnership with Cabrini Monash University’s Graduate Research Industry Partnership (GRIP) program was developed in response to the rising demand for researchers with interdisciplinary capabilities and the readiness to apply their expertise to solving realworld problems in industry. Through a co-funded PhD program, PhD student Alexandra Mullins will review the utility, health and economic value of electronic medical records for patients and clinical staff in Cabrini’s emergency department. This innovative health service driven initiative will have real impact for staff and patients in the Cabrini emergency department. The second GRIP project by Ali Tehrani from Monash Business School’s Department of Economics is focused on improving patient-centered care through digital change: by implementing a ‘lightweight’ digital platform to link with patient systems and mobile devices. This research will be one of the first studies in Australia to look specifically at the implementation of a ‘lightweight’ platform for data sharing, particularly in relation to the exploration of the potential to interface with patient systems and mobile devices. With strong governance, the experienced project teams bring expertise in research, implementation science and leadership to co-design these strategies with Cabrini Health. The breadth of engagement and the translation focus of this work is reflective of the intent of the GRIP, which exceeds the contributions of traditional PhD projects and ensures tangible impact for Cabrini and the broader Monash Partners network. Supporting innovative projects Cabrini Health have been key stakeholders in innovative projects identified through a prioritisation process that involved clinicians, researchers and the community. Examples of the projects include: • Expansion of the lung cancer clinical quality registry to include 90% of all newly diagnosed patients across Victoria. This project is driving better care in lung cancer by recording and reporting on time to diagnosis, time to treatment and treatments, and multidisciplinary care planning. • An innovative approach to clinical trials enabling patients to more readily access new cutting-edge therapies for myeloma. Having a detailed, readily accessible source of information has enabled implementation of novel clinical trials and reduced the costs and time taken to set-up and deliver new trials in myeloma.

PAG E 2 0

•

The measure of quality of the more than 10,000 cardiac surgeries in Australia has traditionally been reporting of mortality however this measure ignores other injuries that may subsequently impact future quality of life. This project links cardiac surgical and intensive care data to calculate and generate a risk scale at Victorian hospitals. The contemporaneous nature of the feedback to clinicians will improve the capability to identify and intervene early. In the year ahead Monash Partners and Cabrini will continue to work in partnership to connect researchers, clinicians and the community and innovate for better health. Partnering for value-based care Value-based care aims to reduce over-treatment and overdiagnosis while improving quality and outcomes for patients. As compared to traditional models of healthcare service that focus on fee-for service, where payments are made based on the amount of health services delivered, value-based care measures health outcomes against the cost of delivering outcomes. For healthcare customers this means lower costs and better outcomes. Cabrini Institute is initiating and supporting projects in health services research that will drive value-based care and optimise value-based health outcomes for our customers. Other chapters in this report will detail how we are delivering this initiative. In 2019 Cabrini became the first private hospital to join Choosing Wisely Australia (www.choosingwisely.org.au), a national platform that promotes value-based care to improve the quality of healthcare. Offering our patients access to the latest developments in cancer treatment Cancer clinical trials offer patients access to treatment options that are often unaffordable or are completely non-accessible while in development. Access to affordable treatment through the Pharmaceutical Benefit Scheme is often years in the making, and sometimes never achieved. Cabrini partners with a large number of pharmaceutical companies to be able to offer our patients access to oncology clinical trials at Cabrini. Cabrini is partnering with Cancer Trials Australia (CTA), a not-for-profit member based organisation that provides support for oncology clinical trials. Our partnership with CTA facilitates a communication portal for trial opportunities with pharmaceutical companies, provides trial start-up and post-approval support services, provides access to a clinical trial management system, and financial management support of trials. Since partnering with CTA in 2015, we have seen continual growth and success in our trials program, translating to helping more patients every year.

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

Dr Rebekah Engel is a Postdoctoral Research Fellow with the Cabrini Monash University Department of Surgery. She is pictured returning organoid cultures to the incubator.

Cabrini has seen continual growth and success in our clinical trial programs, translating to helping more patients every year.

Y E A R I N R E V I E W 2 0 1 8 -1 9

PAG E 2 1

“No matter how

complicated the research or how brilliant the researcher, patients and public always offer unique invaluable insight” Professor Dame Sally Davies, Chief Medical Officer, Department of Health, England (Forward in Staley, K. (2009) Exploring impact: public involvement in NHS, public health and social care research. INVOLVE, Eastleigh.

PARTNERING WITH CONSUMERS At Cabrini Institute, we are committed to partnering with consumers – patients, residents, carers, family members and our community – to make informed choices and improvements in our research and education program goals. Our aim is to involve consumers in all aspects of our programs, not just as participants or just advising them of what we do, but to bring them in and involve them as part of our team. Consumers provide valuable insight and contributions that can help shape what research and education programs are being performed, how they are carried out and, importantly, how results and outcomes are shared and applied in practice. Our aim of involving consumers in all we do is in line with the Australian Commission on Safety and Quality in Health Care’s National Clinical Trials Governance Framework which is expected to be embedded in 2020 and will form part of hospital accreditation processes. This new framework will mandate that healthcare organisations need consumers to be involved at all levels of evaluation of research. At Cabrini Institute we involve consumers in many aspects of our research and education programs, from guiding how research funding should be committed, what type of research and how it should be conducted, informing education policies, clinical workforce training, and as panel members for education sessions.

PAG E 2 2

Research and education consumer forums to gain new ideas and insight The Institute meets twice yearly with a consumer group to discuss research being conducted and the delivery of education at Cabrini. The sessions are not designed as a dissemination platform for what we are doing, but are an opportunity to gain valuable insight and opinions from those who have been impacted in some way by healthcare, either directly as a patient or a carer, or as an interested community member. Their contributions help to guide us to better perform our research or improve our processes, advise on where and what we should be investing in research and education, and how we best communicate with staff and consumers. Community Advisory Committee, helping us to improve our customer experience The Community Advisory Committee comprises equal numbers of Cabrini staff and consumers who partner with the organisation to improve the customer experience through determining the needs, concerns and priorities of patients, residents, families and their carers. Chaired by Professor Lee Boyd, the Group Director of Nursing, Clinical Education and Research, the committee has informed many initiatives from the Institute including the Clinical Education Learning Space (CELS) online system, and a multitude of educational policies for patients and staff. Members of the Community Advisory Committee will be invited to our upcoming Institute Council Planning day which will look at embedding the new Cancer Institute within the Cabrini Institute strategy.

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

Training our future clinical workforce The Clinical Education team at Cabrini Institute facilitates inter-professional learning events. The Medical Mystery Evenings are focused on providing an opportunity for undergraduate students (Nursing, Allied Health and Medicine) to collaboratively explore a patient case and develop team-based clinical care pathways. The learning sessions are designed to engage the participants in discussions that will promote interdisciplinary understanding. In 2019, the team broadened the learning scope by inviting consumers to the Medical Mystery nights to provide a patient/carer/community perspective in the multidisciplinary learning scenarios, to encourage wider thinking by our future workforce in training. The Clinical Education Transition to Professional Practice Program also engages consumers in study days. Customers support the Clinical Education team to develop clinical case studies that are applied in a simulated environment. Customers provide valuable feedback to graduates during the study days which aids their skill development and professional growth.

Customers provide valuable feedback to graduates during the study days which aids their skill development and professional growth.

Providing expert opinion and first hand insights on discussion panels Cabriniâ&#x20AC;&#x2122;s Q&A series focuses on the patient experience, compliance with the National Standards and quality and safety. This interactive forum often includes an expert with a panel discussion and is open to the whole Cabrini community (including patients and families). Consumers are frequently invited to be on panels, to inform a patient and/or community perspective on the topic being discussed. Informing the ethical implications of our research The Cabrini Human Research Ethics Committee (CHREC) is responsible for the ethical review of human research projects under the terms of the National Statement on Ethical Conduct in Human Research (National Statement). As required by the National Statement, the CHREC membership always includes at least two lay community members, one man and one woman, who have no affiliation with Cabrini and do not currently engage in medical, scientific, legal or academic work. The role of lay members is to bring a community perspective to the deliberations of the committee.

Y E A R I N R E V I E W 2 0 1 8 -1 9

PAG E 2 3

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

CABRINI RESEARCH WEEK 2018 The week-long event from 8-12 October 2018, saw poster and oral sessions being held across multiple campuses, demonstrating the growth and strengthening of the research culture at Cabrini. This year’s event was generously supported by MIA Radiology. A highlight of the event was the keynote presentation delivered by Associate Professor Paul McMurrick and Associate Professor Helen Abud on ‘Human mini-guts – How colorectal organoid research will personalise treatment for bowel cancer patients’. This was a highly anticipated presentation, and the large audience was very captivated by their presentation on bowel cancer, the biology of the disease and the research being undertaken to move closer to personalised medicine and better outcomes for patients. The joint presentation highlighted the strengths of discovery and clinical researchers working together under the Monash Partners partnership. The calibre of presentations was extremely high and a wide variety of topics and projects were presented. Dr John Bolgna travelled from Modilon Hospital in Papua New Guinea to present his work on ‘Maternal near-misses at a provincial hospital in Papua New Guinea: A prospective observational study’. John was the recipient of the inaugural Professor John Griffiths Research Travel Scholarship, a joint initiative by Cabrini Outreach and Modilon Hospital in

PAG E 24

recognition of Professor John Griffiths’ years of voluntary service to Modilon Hospital. The program showcased a high calibre of presentations across a wide variety of research topics. This year’s awards and prize winners were: Patient Care Session Dr Romi Haas ‘Assessment of the content of lumbar spine imaging reports for back pain: a pilot study’ Caring for our patients and carers and supporting our clinical workforce Session Dr Denise O’Connor ‘Reducing low-value knee arthroscopy: Development and pilot testing of a patient decision aid to support translation’ Health Services Delivery Session Dr Dane Horsfall ‘Training ACEM registrars in communication skills for their Clinical Fellowship OSCE: a pilot feasibility study evaluating a pre-examination communication workshop’ Cancer – Care, Outcomes, Treatment and Biology Session 1 Stephen Foulkes ‘Cardiopulmonary fitness and cardiac reserve 12-months following anthracycline chemotherapy for breast cancer’ Cancer – Care, Outcomes, Treatment and Biology Session 2 Professor Gary Richardson ‘Immunotherapy in lung cancer – Impower150 and IMpower131 clinical trials’

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

Dr John Bolgna (left) from Modilon Hospital in Papua New Guinea, recipient of the inaugural Professor John Griffiths Research Travel Scholarship, receiving his award from Professor John Griffiths at Research Week 2018.

New Researchers Session Nakul Chaudhry ‘Female genital mutilation/cutting: Australian medical students’ knowledge and awareness’ Poster Session •

•

• • •

Alecia Pyke ‘How well do Hospital In The Home (HITH) patients comprehend and retain the emergency plan information provided through patient education by HITH nurses?’ Karen Oliva ‘When to resect? Management of patients with adverse histopathological features post colonoscopic polypectomy’ Dr Yoland Antill ‘Gene discovery through germline whole exome sequencing in patients with endometriosis-associated ovarian cancer’ Dr Ali Baqar ‘The impact of double stapled anastomotic technique in colorectal cancer surgery’ Olivia Grimwade ‘Retrospective analysis of MET (Medical Emergency Team) calls at Transition of Care’ Yi May Cheah, Donna Zhuang, Kit Foo ‘Can frailty describe the variation between clinically observed and calculated length of stay’

(L-R) Dr Christine Koulis and Dr Rebekah Engel, Postdoctoral Research Fellows with the Cabrini Monash University Department of Surgery, attending the Research Week 2018 Poster session.

Dr John Bolgna travelled from Modilon Hospital in Papua New Guinea to present his work on ‘Maternal near-misses at a provincial hospital in Papua New Guinea: A prospective observational study’.

Best Cancer Poster – sponsored by MPCCC Dr Christine Koulis ‘The predictive and prognostic role of p53, GLUT1 and TRAP1 in Stage IV colon cancer’ This year the poster session was opened to a public vote for best poster. The winner of the ‘People’s Choice Award’ for best poster was Dr Christine Koulis for poster 21 – ‘The predictive and prognostic role of p53, GLUT1 and TRAP1 in Stage IV colon cancer’. Y E A R I N R E V I E W 2 0 1 8 -1 9

PAG E 2 5

Generous donations for grants and scholarships allows Cabrini staff to undertake cutting edge research and professional development to ensure we deliver best patient care and outcomes. SUPPORTING RESEARCH AND STAFF DEVELOPMENT AT CABRINI 2018-19 was a year of evolution. New scholarship opportunities were implemented based on consumer and employee feedback. Some donors were consulted about expanding the original intent of their donations to have wider reach and greater impact. Funds were applied to assist staff through organisation changes brought about by the new Gandel Wing, and scholarships were offered in new clinical streams. $160,000 in scholarships was awarded in 2018-19, continuing our commitment to support the up-skilling of Cabrini’s workforce through strategically aligned activities. Fostering a culture of research and innovative thinking is another key function of the Institute. The inaugural Auric Innovation Grants ensured that every Cabrini employee had the opportunity to share their BIG IDEA. Coupled with the annual Cabrini Foundation Grant Round, more funding was awarded in 2018-19 than ever before – a total of $627,000. New Scholarships Visiting international centres of best practice and innovation to open channels for communication and knowledge sharing and supporting leadership development is highly regarded by Cabrini and its donors.

PAG E 2 6

A new scholarship awarded this year was the $10,000 Chair’s Award which seeks to identify and cultivate a future Cabrini leader from any clinical or non-clinical discipline, and honours the great contribution to Cabrini of all past and present Chairs of the Cabrini Board. The inaugural winner was medical scientist and Histology Manager Trung Nguyen, who will use the scholarship to travel to the United States to present his research at a histology conference in New Orleans, conduct facility visits that use the Leica Spectra Autostainer, and attend the Harvard University course ‘Managing Yourself and Leading Others’. The inaugural $25,000 Nursing & Midwifery Leadership Scholarship (a Cabrini Nursing & Midwifery Society initiative) was created to foster bold and exemplary leadership. • Kim Rogers, a Nurse Unit Manager from 1 North Cabrini Brighton, was awarded $25,000 to visit hospitals and health institutes in the US that incorporate Women and Heart Disease programs, and attend the ‘Leading and building a culture of innovation’ course at Harvard Business School. • Helen Thompson, a Nurse Unit Manager in the Intensive Care Unit at Cabrini Malvern, was awarded $8700 to attend the New Leaders Development Program run by Melbourne Business School. • Andrea Lea became the first Cabrini employee to receive funding for undergraduate study. Consumer feedback encouraged Cabrini to deviate from tradition and support an enrolled nurse wishing to transition to a registered nurse. Andrea is undertaking her Bachelor of Nursing at Deakin University.

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

Other Scholarships

Cabrini Foundation Grant Round

The annual Postgraduate Nursing Program afforded 17 employees scholarships to commence a 12-month graduate certificate in their areas of nursing specialty. The midwifery and cardiac nursing teams participated in workshops utilising the DISC profiling model to address leadership, working collaboratively and supporting a smooth transition to the new Gandel Wing. The Medical Staff Student Research Scholarship program continues to grow from strength to strength, this year awarding $1,500 each to 13 medical students to develop their research skills on a small supervised project. Many of these students will present at Research Week and some will experience the first-time success of co-authoring a published paper in reputable research journals.

The 5th annual Cabrini Foundation Grant Round attracted 18 high quality applications across a diverse range of health streams. $240,000 was awarded to projects that each represented strong alignment to Cabrini Institute’s strategic plan and research themes. The Sambor Family Clinical Research Grant – awarded to the round’s ‘Best $30,000 Project’ – went to ‘Development of a diagnostic interview to assess psychological adjustment and demoralisation in the medically ill’ – a highly collaborative project led by Professor David Kissane AC. The other successful projects included: • ‘Personalised medicine for colorectal cancer patients: Utilisation of Organoid Technology, Tissue Microarrays and Consensus Molecular Subtypes’ (Dr Christine Koulis and Dr Rebekah Engel – $30,000 Alan, Ada and Eva Selwyn Clinical Surgery Research Grant) • ‘Developing a new tissue-slice assay for modelling colorectal cancer tumours’ (Dr Simon Wilkins – $30,000 Cabrini Foundation Research Grant) • ‘Outcomes following Sacrocolpopexy in Pelvic Organ Prolapse’ (Professor Anna Rosamilia – $30,000 Cabrini Foundation Research Grant) • ‘Is spontaneous swallowing reduced in Parkinson’s compared to healthy controls?’ (John Pierce – $20,000 Cabrini Foundation Research Grant) • ‘A pilot randomised control trial of a video decision support tool (VDST) for advanced care planning in cancer patient caregiver dyads’ (Associate Professor Natasha Michael – $45,000 Medical Oncology Research Grant) • ‘Validation of Cabrini‘s new chemotherapy app’ (Professor Gary Richardson OAM, Dr Tali Lang, Kirsten Seletto and Jacqui Hastings – $25,000 Research including $15,000 from the Peter Meese Memorial Nurse-Led Oncology Research Grant) • ‘Combatting Compassion Fatigue and Burnout of Oncology Nurses Through Wellness Activities’ (Kirsten Seletto and Dr Tali Lang – $15,000 Cabrini Foundation Quality Improvement Grant) • ‘The development and implementation of a pictorial hospital food menu’ (Claire Matthews – $15,000 Cabrini Foundation Quality Improvement Grant)

Donor Recognition Donor appreciation events are a forum for donors to meet their recipients and learn how their donation had impact. Recipients are invited to give a short presentation about their learnings, and have the opportunity to say ‘thank you’ directly to their donor. Peter Meese Memorial Lecture: Treating People, Not Just Cancer Gail O’Brien AO and Catherine Lambert headlined the 18th Peter Meese Memorial Lecture this year. Gail spoke of facing significant adversity through her husband Dr Chris O’Brien’s brain cancer diagnosis and how the process of navigating a complex, non-patient-centred medical system spurred Chris to champion a purpose-built integrated cancer centre. The Chris O’Brien Lifehouse in Sydney offers everything a cancer patient needs in one place from surgery, chemotherapy and radiotherapy, to allied health, education, complementary therapies and psycho-social support. Lifehouse Director of Clinical Services Catherine Lambert discussed models of care her team continue to explore to enhance the patient journey including the involvement of nurse-practitioners. Auric Innovation Grant Round The Auric round aims to fund the next BIG IDEA, is open to any Cabrini employee or visiting medical officer, and is generously supported by donors Mr & Mrs Brian and Lee Johnstone. Two aged care projects were awarded as part of the inaugural Auric Innovation Grant round. Both presented strong alignment to the pillar of Cabrini’s Renew Health Strategy addressing the vulnerable market. The successful projects were: • ‘The Living Lab: Designing the Future of Aged Care – A Collaboration between Cabrini Health and Monash Art Design & Architecture’ (Ms Sharni Clark) $200,000 • ‘Development of customised distraction techniques for managing acute behavioural disturbance of elderly patients in the emergency department setting to limit use of chemical and physical restraint’ (Dr Gabriel Blecher) $146,993

Y E A R I N R E V I E W 2 0 1 8 -1 9

Gratitude We are indebted to our wonderful donors who ensure the existence and longevity of our scholarships and grants programs. We are grateful for their open-mindedness to new ideas and the trust they instil in us to ensure their generous intentions are met. We are also thankful for the tireless fundraising work of the Cabrini Foundation team. If you would like to contribute towards Cabrini’s Scholarships and Grants Program, call Cabrini Foundation on Tel: 9508 1380 or email foundation@cabrini.com.au.

PAG E 2 7

The colorectal cancer organoid program is a collaborative effort between the Cabrini Monash University Department of Surgery led by Associate Professor Paul McMurrick (left) and the Monash Biomedicine Discovery Instituteâ&#x20AC;&#x2122;s Epithelial Regeneration Laboratory led by Associate Professor Helen Abud (right). PAG E 2 8

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

OUR RESEARCH OUR RESEARCH

PAG E 2 9

CABRINI MONASH UNIVERSITY DEPARTMENT OF NURSING RESEARCH HEAD: ASSOCIATE PROFESSOR PHILIP RUSSO

Nursing research is integral to patient care, whether that care takes place at the bedside or during surgery. It provides the evidence to improve and support nursing practice.

$660K+

in grant funding

publications

A major pillar of Cabrini Institute, value-based care, aims to reduce spending while improving quality and outcomes. In alignment with this pillar, Cabrini has recently partnered with Choosing Wisely Australia (www.choosingwisely.org.au). Choosing Wisely Australia is a national initiative that aims to bring the community together to improve the quality of healthcare through considering tests, treatments and procedures where evidence shows they provide no benefit or, in some cases, lead to harm. Launched in Australia by NPS MedicineWise in 2015, in partnership with Australia’s health professional colleges, societies and associations, Choosing Wisely Australia challenges the way clinicians and consumers think about healthcare, questioning the notion that more is always better. Fundamental to value-based care, Choosing Wisely Australia encourages conversations between clinicians and consumers about which aspects of care are truly needed, and identifying those tests, treatments, and procedures that are helpful and those that are not.

PAG E 3 0

presentations

Australia’s peak colleges, societies and associations have developed lists of recommendations of the tests, treatments, and procedures that healthcare providers and consumers should question. Each recommendation is based on the best available evidence. Importantly, they are not prescriptive but are intended as a guide to start a conversation about what is appropriate and necessary. At Cabrini, a major focus of the Department of Nursing Research will be aiming to bring together key stakeholders to identify areas where value-based care can be improved using the Choosing Wisely framework.

Highlights In February 2019 Associate Professor Philip Russo commenced in his role as Director of Cabrini Monash University Department of Nursing Research. In July, Philip was also joined by Ms Julia Cassuitti in her role as Research Assistant.

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

In April 2019, Associate Professor Russo delivered an oral presentation on the national healthcare associated infection point prevalence study at the 29th European Congress of Clinical Microbiology & Infectious Diseases in Amsterdam, Netherlands. This was the first study of its kind in Australia for 34 years and identified that 1 in 10 adult inpatients from 19 large hospitals across Australia had a healthcare associated infection. In July 2019, Associate Professor Russo was invited as a keynote speaker at a Surgical Site Infection symposium held in Singapore.

Our Research Improved detection of infections following surgery for meaningful public reporting

admissions, pharmacy and operating room, patients who have an infection are easier to identify. This project is exploring the use of algorithms in the Australian setting that will generate more meaningful and accurate data that could be used for public reporting. Development of customised distraction techniques for managing acute behavioural disturbance of elderly patients in the emergency department setting to limit use of chemical and physical restraint RESEARCHERS: BLECHER G, KUHN L , WALKER K, FLYNN D, JOE K, RUSSO PL , PESIAH C

Investigating whether the use of virtual reality tools can calm older patients who are distressed, hence reducing the rate of chemical sedation and physical restraints applied in emergency departments.

RESEARCHER: RUSSO PL

Surveillance for surgical site infections is resource intensive and consistent application of definitions challenging. International studies have demonstrated that by applying a uniform algorithm sourcing data from microbiology,

An exploration of infection prevention and control services, practice and priorities in Australian residential and aged care facilities RESEARCHERS: MITCHELL BG, MACBETH D, SHABAN RZ , RUSSO PL

Publications, Books, Book Chapters, Reports • McManamny T, Lowthian J, Jennings P, Sheen J, Boyd L. (2018) Paramedic involvement in health education within metropolitan, rural and remote Australia: A systematic review of the literature. Australian Health Review. doi: 10.1071/AH17228. • Mitchell D, Raymond M, Jellett J, Webb-St Mart M, Boyd L, Botti M, Steen K, Hutchinson A, Redley B, Haines T. (2018) Where are falls prevention resources allocated by hospitals and what do they cost? A cross sectional survey using semi-structured interviews of key informants at six Australian health services. International Journal of Nursing Studies. 86:52-59. • Russo PL, Digby R, Bucknall T. (2019) Consumer knowledge and attitudes towards public reporting of healthcare associated infection data. Am J Infect Control. 47(6):656-660. • Mitchell BG, Northcote N, Cheng AC, Fasugba O, Russo PL, Rosebrock H. (2019) Reducing urinary catheter use using an electronic reminder system in hospitalised patients: a randomised stepped wedge trial. Infect Control Hosp Epidemiol. 40(4):427-431. • Mitchell BG, Shaban RZ, Macbeth D, Russo PL. (2019) Organisation and governance of infection prevention and control in Australian residential aged care facilities: A national survey. Infection Disease and Health. doi. org/10.1016/j.idh.2019.06.004. • Willey S, Gibson-Helm M, Blackmore R, McBride J, Highet N, Ball N, Gray K, Melvin G, Boyd L, East C, Boyle J.

C A B R I N I M O N A S H U N I V E R S I T Y D E PA RTM E N T O F N U R S I N G R E S E A R C H

(2019) The impact of a perinatal mental health screening program for women of refugee and migrant background: a post implementation medical record audit. Canadian Medical Association Journal. Accepted June 2019. • Willey S, Blackmore R, Gibson-Helm M, Ali R, Boyd L, McBride J, Boyle JA. (2019) “If you don’t ask it; you don’t tell”: Perinatal mental health screening for women of refugee background. Women and Birth. Accepted May 2019. • Suleiman M, Demirhan H, Boyd L, Girosi F, Aksakalli V. (2019) Incorporation of expert knowledge in the prediction of incorrect DRG assignment. Medical Decision Making. Accepted 2019. • Wong DF, Spencer C, Boyd L, Burkle FM, Archer F. (2019) Peer Reviewed Validation of the Comprehensive Framework for Disaster Evaluation Typologies. Prehospital Disaster Medicine. 34(3):230–240. • Mitchell BG, Russo PL, Cheng AC, Stewardson AJ, Rosebrock H, Curtis S, Robinson S, Kiernan M. (2019) Strategies to reduce non-ventilator-associated hospitalacquired pneumonia: a systematic review. Infection Disease and Health. doi.org/10.1016/j.idh.2019.06.002. • Willey SM, Gibson-Helm ME, Finch TL, East CE, Khan NN, Boyd LM, Boyle JA. (2019) Implementing innovative evidence-based perinatal mental health screening for women of refugee background. Women & Birth. doi.org/10.1016/j.wombi.2019.05.007. • Russo PL, Cheng AC, Stewardson A, Bucknall T, Mitchell BG. (2019) The prevalence of healthcare associated

PAG E 3 1

infections among adult inpatients at nineteen large Australian acute-care public hospitals: a point prevalence survey. Antimicrobial Resistance & Infection Control. doi.org/10.1186/s13756-019-0570-y. • Australian College of Nursing, Boyd L. (Chair of Workforce Sustainability Policy Chapter) (2019) Regulation of the Unregulated Health Care Workforce across the health care system – A White Paper by ACN, Canberra.

Grants Held • Industry Grant – Covidien. ACIPC 2018 Infection Control Grant. ‘An exploration of infection prevention and control services, practice and priorities in Australian residential and aged care facilities’. (2019) $15,000, Mitchell BG, MacBeth D, Shaban RZ, Russo PL.

• Auric Innovation Grant, Cabrini Foundation. ‘Development of customised distraction techniques for managing acute behavioural disturbance of elderly patients in the emergency department setting to limit use of chemical and physical restraint’ (2019-2021) $146,993. Blecher G, Kuhn L, Walker K, Flynn D Joe K, Russo PL, Pesiah C. • NHMRC Early Career Fellowship. ‘Improved Detection of Infections Following Surgery for Meaningful Public Reporting’. (2019-2022) $327,192. Russo PL, Cheng A, Bucknall T. • Rosemary Norman Foundation. ‘Establishing the prevalence of healthcare associated infections in Australian hospitals’. (2017-2020) $180,000. Russo PL (PI) Cheng A, Stewardson A, Bucknall T, Mitchell BG.

NEW TALENT Cabrini Institute was pleased to announce the appointment of Associate Professor Philip Russo to the shared Monash/Cabrini Associate Professor/ Director of Nursing Research position in 2019. Philip has over 35 years of nursing experience initially working in infectious diseases. After undertaking a Masters of Clinical Epidemiology, he worked in both state and national level positions in healthcare infection prevention. In 2016 he completed his PhD titled “Evidence based recommendations for national healthcare associated infection surveillance”. Philip has attracted over $1 million in research funding from government, industry and academic sources and is recognised internationally for work in infection prevention. He has presented at both national and international conferences, authored over 50 peer reviewed articles and several book chapters. Recently he led the Australian National Healthcare Associated Infection Point Prevalence Study, and is collaborating on several other healthcare associated infection-related national research projects. He is also the recipient of a National Health and Medical Research Early Career Fellowship. Leadership and engagement activities include being current President Elect of the Australasian College for Infection Prevention and Control, a member of the National Health and Medical Research Council Infection Control Guidelines Advisory Committee and formerly a member of the Healthcare Associated Infection Advisory Committee for the Australian Safety and Quality in Health Care Commission. His expertise and research interests are ideally suited to lead Cabrini Health’s partnership with Choosing Wisely Australia, in alignment with Cabrini’s strategy of providing value-based care to all patients. Philip aims to contribute to Cabrini’s mission by continuing to build nursing research capacity, and through strengthening relationships with partner organisations.

PAG E 3 2

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

Cabrini nurses, Helen Singleton (left) and Pardeep Kaur (right) work together to assist the patient.

Fundamental to value-based care, Choosing Wisely Australia encourages conversations between clinicians and consumers about which aspects of care is truly needed, and identifying those tests, treatments and procedures that are helpful and those that are not.

C A B R I N I M O N A S H U N I V E R S I T Y D E PA RTM E N T O F N U R S I N G R E S E A R C H

PAG E 3 3

CENTRE FOR ALLIED HEALTH RESEARCH AND EDUCATION (CAHRE) HEAD: DR ANNEMARIE LEE

Our vision is to be the leader in allied health research in Australian private healthcare. We strive to improve the health of Cabrini patients and the local community through development and implementation of clinically focused research, which translates into best clinical practice.

$125K

in grant funding

publications

Our research themes are: • Implementation of clinical practice guidelines • Rehabilitation and self-management of chronic disease to improve quality of life and wellbeing • Comorbidities and their management in chronic disease We are characterised by our commitment to Allied Health education that enhances quality patient care and develops future health service leaders. We strive to creatively deliver student education, and look forward to incorporating more interprofessional learning for staff and students.

Highlights CAHRE thrived under the leadership of Associate Professor Helena Frawley, who together with research fellows Dr Tash

PAG E 3 4

presentations

active clinical trials

Brusco and Dr Kuan-Yin Lin provided expert direction and development of allied health projects in a variety of fields. We thank them for their enormous contribution and are grateful they remain as honorary research fellows in 2019 and beyond as they embark on other pursuits. We warmly welcomed Dr Annemarie Lee to CAHRE in May 2019 as the Senior Consultant for Allied Health Research. Annemarie comes to us with a clinical and research background in cardiorespiratory physiotherapy, including chronic respiratory disease. She has a particular interest in the prevalence and impact of comorbidities in chronic respiratory conditions, adjunct therapies to rehabilitation and simulation education in allied health. A pilot study assessing the impact of a dementia education program with commencement of the dementia friendly garden started in May and we are part of a multi-site trial examining treatment of invasively ventilated adults with

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

early activity and mobilisation (TEAM), in conjunction with Alfred Health. Across the year Allied Health & Ambulatory Services worked collaboratively with our education providers to support student programs across seven disciplines. 6233 allied health clinical placement days were supported by Cabrini and there was excellent representation within Clinical Education multidisciplinary events such as Medical Mystery nights.

Our Research A Prospective Multicentre Phase III Randomised Controlled Trial of Early Activity and Mobilisation Compared with Standard Care in Invasively Ventilated Patients in Intensive Care RESEARCHERS: MURPHY D, LADE N, WAANDERS A , SIMPSON S

People who are receiving mechanical ventilation are typically immobile which leads to muscle weakness and wasting and increasing mortality following discharge. This multicentre project, led by Carol Hodgson and supported by the NHMRC, includes Cabrini Health as one of 20 participating sites in Australia and New Zealand. This project examines the effect of early activity and mobilisation during prolonged invasive mechanical ventilation on mortality, quality of life, cognitive and physical function and economic outcomes. A pilot study assessing the impact of a dementia education program targeted to staff RESEARCHERS: SMITH L , O’ TOOLE G, BURNS K, O’BRYAN C, PETROVICH T, KEMM R, VALLY H, ARCHIBALD D

As part of multi-phase project which includes several interventions directed towards improving outcomes for people with dementia, this study examines the effects of an education intervention on improving knowledge and attitudes of staff and volunteers involved in the care of people with dementia. A series of workshops have been undertaken, with surveys and interviews conducted with participants, of which the results are imminent.

Sophie Jennings, Allied Health & Ambulatory Services Clinical Educator and Allied Health Research Assistant with CAHRE.

C E N T R E F O R A L L I E D H E A LT H R E S E A R C H A N D E D U C AT I O N (C A H R E )

Barriers and enablers for referrals and participation in Cabrini’s new evidence-based physiotherapy program for people with hip or knee osteoarthritis: Capturing referrer and patient perspectives RESEARCHERS: WALLIS J, BARTON C, ACKERMAN I, CROSSLEY K, YOUNG K, JENNINGS S, TRIVET T J, BRUSCO T

Good Life with osteoarthritis in Denmark (GLA:D) is an evidence-based physiotherapy program involving education and exercise for people with hip or knee osteoarthritis. This program has been recently implemented at Cabrini Health, but the uptake and acceptability has not been established. This project aims to determine the barriers and enablers for medical and surgical practitioners to refer and for those with hip or knee osteoarthritis to participate.

Other Projects •

• • •

•

Feasibility of a physiotherapy program ‘Good Living with Osteoarthritis from Denmark’ PLUS additional multidisciplinary interventions for people with hip and knee osteoarthritis, in a private hospital rehabilitation setting. Evaluation of five-day emergency department physiotherapy pilot trial. Investigating malnutrition in Victorian cancer services: malnutrition prevalence study 2018. EViTAH: The success of research implementation strategies on evidence-based decision-making by allied health managers: a randomised controlled trial. Traffic light healthy eating. Implementation of massage therapy to Cabrini inpatient palliative care services. Development and evaluation of a nursing manual handling program for patients with a stroke and other conditions affecting mobility: Stroke Safe Moves program. Effect of staff e-learning and simulation training for a dysphagia screening tool on time from patient admission to dysphasia screening and incidence of pneumonia (ASSIST).

Physiotherapist, Conor O’Flaherty, working with patient Margaret Barrow.

PAG E 3 5

Dr Tash Brusco, Honorary Research Fellow in CAHRE.

John Pierce, senior subacute speech pathologist at Cabrini rehabilitation and the coordinator of the Cabrini Parkinson’s Program.

•

Do post-operative sitting and activity restrictions impact on the outcome following elective lumbar micro discectomy? Telephone or electronic nutrition care delivery (TEND) to upper GI cancer patients: a randomised controlled trial. Reducing the impact of aphasia in stroke patients and their caregivers a year post onset via a brief early intervention: a cluster randomised control trial of the Action Success Knowledge (ASK) program.

• • • •

The feasibility of increasing inpatient rehabilitation duration by implementing an additional self-directed independent exercise program: My Therapy. Implementation of stroke clinical practice guidelines at Cabrini. A multidisciplinary rehabilitation program for patients following surgery for abdomino-pelvic cancer. Ambassador Model project. Case study: chronic disease program (cardiac & GLA:D).

NEW TALENT Cabrini Institute was pleased to announce the appointment of Dr Annemarie Lee to the Senior Consultant in Allied Health Research position in May 2019. Annemarie has had previous clinical experience in acute cardiorespiratory physiotherapy and pulmonary rehabilitation. Since completing her PhD in 2009, she has explored research in the field of physiotherapy for bronchiectasis and adjuncts to pulmonary rehabilitation for chronic respiratory disease. She completed a two-year international postdoctoral fellowship in Toronto and is currently also based at Monash University as cardiorespiratory teaching lead. Her research interest areas include music therapy and singing in chronic conditions, adjuncts to pulmonary rehabilitation, breathing pattern disorders and the prevalence of comorbidities and their management in chronic respiratory conditions. In commencing at Cabrini, Annemarie looks forward to working with clinicians in collaborative, cross-discipline research projects and exploring options for clinical education research, including simulation.

PAG E 3 6

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

Publications, Books, Book Chapters, Reports • Benjamin DR, Frawley HC, Shields N, van de Water ATM, Taylor NF. (2019) Relationship between diastasis recti of the abdominal muscles (DRAM) and musculoskeletal dysfunctions, pain and quality of life: a systematic review. Physiotherapy. 105(1):24-34. • Bo K, Frawley HC, Haylen BT, Morin M, Shelly E. (2018) Response to comment on the IUGA/ICS joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. Neurourology and Urodynamics. 37(2):877-878. • Brusco NK, Frawley HC. (2019) Program evaluation within the research translation framework. Journal of Physiotherapy. 65(2):63-64. • Denneny D, Frawley HC, Petersen K, McLoughlin R, Brook S, Hassan S, Williams AC. (2019) Trigger Point Manual Therapy for the Treatment of Chronic Noncancer Pain in Adults: A Systematic Review and Meta-analysis. Archives of Physical Medicine and Rehabilitation. 100(3):562-577. • Harrison AL, Taylor NF, Frawley HC, Shields N. (2019) Women with gestational diabetes mellitus want clear and practical messages from credible sources about physical activity during pregnancy: a qualitative study. Journal of Physiotherapy. 65(1):37-42. • Krikheli L, Carey L, Mathisen B, Erickson S, Carey-Sargeant C. (2018) Speech-language pathologists in paediatric palliative care: a Delphi study protocol. BMJ Supportive & Palliative Care. doi:10.1136/ bmjspcare-2018-001667. • Lin K-Y, Denehy L, Granger CL, Frawley HC. (2019) Pelvic floor outcomes in patients who have undergone general rehabilitation following surgery for colorectal cancer: A pilot study. Physiotherapy Theory and Practice. 35(3):206-218. • Lin KY, Edbrooke L, Granger CL, Denehy L, Frawley HC. (2019) The impact of gynaecological cancer treatment on physical activity levels: a systematic review of observational studies. Brazilian Journal of Physical Therapy. 23(2):79-92. • Peiris CL, Shields N, Brusco NK, Watts JJ, Taylor NF. (2019) Commentary. Annals of Internal Medicine. 170: JC33. • Peiris CL, Taylor NF, Watts JJ, Shields N, Brusco NK, Mortimer D. (2019) Mapping the functional independence measure to a multi-attribute utility instrument for economic evaluations in rehabilitation: a secondary analysis of randomised controlled trial data. Disability and Rehabilitation. 23:1-9.

C E N T R E F O R A L L I E D H E A LT H R E S E A R C H A N D E D U C AT I O N (C A H R E )

• Pierce JE, O’Halloran R, Togher L, Rose M. (2019) What Is Meant by “Multimodal Therapy” for Aphasia? American Journal of Speech-Language Pathology. 28(2):706-716. • Slade SC, Hay-Smith J, Mastwyk S, Morris ME, Frawley H. (2019) Attributes of physiotherapy continence clinicians: a qualitative perspective. Physiotherapy. doi. org/10.1016/j.physio.2019.01.018. • Taylor NF, Lawler K, Brusco NK, Peiris CL, Harding KE, Scroggie G, Boyd N, Wilton AM, Coker F, Ferraro J, Shields N. (2019) Saturday allied health services for geriatric evaluation and management: A controlled before and after trial. Australasian Journal on Aging. doi: 10.1111/ajag.12669. • Winiker K, Gillman A, Hernandez E, Huckabee M, Gozdzikowska K. (2019) A systematic review of current methodology of high resolution pharyngeal manometry with and without impedance. European Archives of OtoRhino-Laryngology. 276(3):631-645.

Grants Held • Cabrini Foundation Clinical Grant Round. ‘Barriers and enablers for referrals and participation in Cabrini’s new evidence-based osteoarthritis management program: Capturing referrer and patient perspectives’. (2017-2019), $30,000, Wallis J. • Cabrini Foundation Clinical Grant Round and Monash University Funding. ‘Do post-operative sitting and activity restrictions impact on the outcome following elective lumbar micro discectomy?’ (2016-2019), $45,000, Goldschlager T, Risbey P, Jennings S. • Cabrini Foundation Clinical Grant Round. ‘Is spontaneous swallowing reduced in Parkinson’s compared to healthy controls?’ (2019-2020), $20,000, Pierce J, Vogel A, Cormick M, Lawson N. • Cabrini Foundation Clinical Grant Round. ‘The development and implementation of a pictorial hospital food menu’. (2019-2020) $15,000, Matthews C, Coletti S, Kelaart A, Lawson N, Dowd J. • Cardiac Care Quality Improvement Grant, Cabrini Foundation Clinical Grant Round. ‘Cardiorespiratory parameters during mobilisation following cardiac surgery’. (2019-2020), $15,000, Lee A, Gaudin J, Jennings S, Driver A.

PAG E 3 7

MONASH DEPARTMENT OF CLINICAL EPIDEMIOLOGY – CABRINI HEAD: PROFESSOR RACHELLE BUCHBINDER

We conduct high-quality clinical research and drive translation of research knowledge into practice and policy change for improved healthcare.

$42M+

in grant funding

publications

Our work strives to reduce low-value care arising from overdiagnosis and over-treatment, and identify ways to create a more sustainable healthcare system able to support future generations. We engage consumers as advisors, partners and participants in our research.

Highlights There was considerable attention for Wiser Healthcare. Rachelle Buchbinder and colleagues from Wiser Healthcare, a national research collaboration that aims to reduce overdiagnosis and overtreatment, published a perspective in MJA to highlight Wiser Healthcare’s National Action Plan to Prevent Overdiagnosis and Overtreatment in Australia. This Action Plan has been publicly endorsed by some of Australia’s most influential health care organisations. In September 2018, Professor Rachelle Buchbinder and Dr Denise O’Connor, along with their colleague Professor Ian Harris (UNSW), also wrote an article in The Conversation that highlighted the needless and wasteful practice PAG E 3 8

presentations

active clinical trials

of arthroscopic surgery being performed for knee osteoarthritis. Professor Rachelle Buchbinder is on the 2018 Highly Cited Researchers list from Clarivate Analytics. This list recognises world-class researchers selected for their exceptional research performance, demonstrated by the production of multiple highly cited papers that rank in the top 1% by citations for a given field in the last decade in Web of Science. Rachelle’s field is “cross field”, meaning across more than one field. Dr Denise O’Connor was awarded an NHMRC Translating Research into Practice (TRIP) Fellowship, which provides support for health researchers to translate evidence into healthcare and public health improvements. This funding for two years will support the design, piloting and evaluation of a patient decision aid for people with degenerative knee disease considering arthroscopic surgery. Patient decision aids have been shown to increase knowledge and accuracy of perceptions about the benefits and harms of treatment options. This research translation

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

Dr Romi Haas, Postdoctoral Research Fellow in the Monash Department of Clinical Epidemiology at Cabrini.

Professor Rachelle Buchbinder, Director and NHMRC Senior Principal Research Fellow of the Monash Department of Clinical Epidemiology at Cabrini.

intervention is designed to target misconceptions about arthroscopy and support shared decision-making. The Department continued to expand, welcoming several new researchers. We welcomed one part-time and four full-time Research Fellows. With their clinical and public health research backgrounds, they will be contributing to the department’s work on the NHMRC-funded Wiser Healthcare, ANZMUSC and Partnership Centre for Health System Sustainability research projects.

‘living’ recommendations in Therapeutic Guidelines Ltd: Rheumatology.

Our Research Identifying and prioritising alternative delivery models to increase value and sustainability of healthcare – NHMRC Partnership Centre for Health System Sustainability RESEARCHERS: BUCHBINDER R, O’CONNOR DA , PUTRIK P, JESSUP R AND COLL ABORATORS

Sustainability is a key challenge for healthcare systems worldwide. A research grant from the Australian National Health and Medical Research Council (NHMRC) and other partners is being used to explore the critical issues impacting the sustainability of the healthcare system and to investigate and create implementable interventions to improve its performance so that it delivers care efficiently and effectively over the long-term. A core set of promising alternative ways of delivering healthcare services that have been shown to deliver equal or better outcomes than usual care have been identified in a review of more than 500 systematic reviews. Implementation planning for the most promising models is currently underway. ANZMUSC living evidence RESEARCHERS: WHIT TLE S, JOHNSTON R, BUCHBINDER R

Living Systematic Reviews and Living Guidelines aim to update available information as new research comes to light. Funding from the NHRMC Centre for Research Excellence is being used to generate Cochrane Living Systematic reviews on two key musculoskeletal research priorities; platelet rich plasma and stem cell injections for knee osteoarthritis. These reviews in turn will be used to continuously update M O N A S H D E PA RTM E N T O F C L I N I C A L E P I D E M I O LO GY – C A B R I N I

Priority Setting and Priority setting tool development – ANZMUSC RESEARCHERS: TAYLOR W, BUCHBINDER R AND ANZMUSC COLLABORATORS

A key criteria for obtaining ANZMUSC endorsement is that a musculoskeletal research proposal be focused on a topic that is a high priority for all stakeholders. ANZMUSC is generating its own multi-attribute decision-making tool, instead of using methods that may result in developing lists that are not dynamic and potentially biased by participants involved in the task. This multi-step process has involved: a literature review of priority-setting projects for musculoskeletal trials to identify attributes previous groups have considered as being most relevant; and a group ranking survey and workshop to identify the key attributes of research projects that make it important. Having now identified these attributes and the criteria for each, ANZMUSC is in the process of verifying the consistency of the framework in preparation for a weighting survey. This final step will assign scores to each criteria to generate cut-off thresholds between low and high priorities and ultimately allow the network to generate a dynamic list of musculoskeletal research priorities. Comparative effectiveness of ultrasound-guided injection with either autologous platelet rich plasma or glucocorticoid injection for ultrasound-proven lateral epicondylitis: a three arm randomised placebo-controlled trial RESEARCHERS: BUCHBINDER R AND COLLABORATORS

The effectiveness of platelet rich-plasma injections for the treatment of tennis elbow is currently unknown. The purpose of this project is to see whether a single ultrasound-guided injection of autologous platelet rich plasma, a glucocorticoid injection or a placebo injection is more effective in relieving pain and disability from lateral epicondylitis (tennis elbow). The project has now finished recruitment and analysis will begin at the end of the year. PAG E 3 9

All Projects • • •

• • • • • • •

• • •

•

NHMRC Program Grant and NHMRC Centre of Research Excellence – Wiser Healthcare NHMRC Partnership Centre in Health System Sustainability NHMRC Centre of Research Excellence for the Australia & New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network The Australian Rheumatology Association Database (ARAD) Cochrane Musculoskeletal Australasian Satellite of Cochrane Effective Practice and Organisation of Care (EPOC) Group ANZMUSC Living Evidence Development of a tool for setting priorities for trials in the musculoskeletal field Identifying and prioritising alternative delivery models to increase value and sustainability of healthcare Clinician, patient and general public beliefs about diagnostic imaging for low back pain: Qualitative evidence synthesis Consumer understanding of terms used in imaging reports requested for low back pain Experiences and perceptions of people living with shoulder pain: A qualitative evidence synthesis Perceived barriers and facilitators to reducing inappropriate use of imaging in people with shoulder pain Scoping review of the volume and scope of implementation research conducted in knee osteoarthritis Comparative effectiveness of ultrasound-guided injection with either autologous platelet rich plasma or glucocorticoid for ultrasound-proven lateral epicondylitis: a three-arm randomised placebocontrolled trial SUcceSS: SUrgery for Spinal Stenosis – a randomised placebo-controlled trial

•

• • •

•

• • • •

• •

•

Effectiveness of an electronic patient-centred self-management tool for gout sufferers: a cluster randomised controlled trial Hype or Hope? platelet-rich plasma as a symptom- and disease-modifying treatment for knee osteoarthritis – the RESTORE trial CROSSFIRE: Combined Randomised and Observational Study of Surgery for Fractures In the distal Radius in the Elderly CRISTAL: Cluster Randomised Trial of Aspirin versus Low molecular weight heparin for venous thromboembolism prophylaxis in joint replacement surgery, a registry-nested study TOPS: Trial Of Prevention Strategies for back pain OPAL: First placebo-controlled trial of opioid analgesia for acute spinal pain Development of a decision support tool for patients considering arthroscopic treatment for degenerative knee disease (osteoarthritis, degenerative meniscal tears) Understanding general practitioner and patient expectations for imaging requests and reports of the lumbar spine in people with acute low back pain: A qualitative study Complementary medicine use in people with inflammatory arthritis Acute low back pain presenting to the Emergency Department: The patient journey Development of a core set of outcomes for shoulder trials, part of the OMERACT initiative. Barriers and enablers to monitoring and deprescribing opioid analgesics for chronic non-cancer pain: a qualitative evidence synthesis Implementation of the Clinical Care Standards for Osteoarthritis of the Knee Obstacles, enablers and acceptability of home-based rehabilitation following hip and knee replacement at Cabrini: A qualitative study Communicating overdiagnosis to the public

Publications, Books, Book Chapters, Reports • Amundsen PA, Evans DW, Rajendran D, Bright P, Bjørkli T, Eldridge S, Buchbinder R, Underwood M, Froud R. (2018) Inclusion and exclusion criteria used in non-specific low back pain trials: a review of randomized controlled trials published between 2006 and 2012. BMC Musculoskelet Disord. 19(1):113. • Anderson DB, Ferreira ML, Harris IA, Davis GA, Stanford R, Beard D, Li Q, Jan S, Mobbs R, Maher CG, Latimer J, Buchbinder R. (2019) SUcceSS: Surgery for Spinal Stenosis – protocol of a randomised, placebo-controlled trial. BMJ Open. 0:e024944. • Anderson DB, Mobbs R, Eyles J, Meyer E, Machado GC, Davis G, Harris I, Buchbinder R, Ferreira ML. (2019) Barriers

PAG E 4 0

to participation in placebo surgery for lumbar spinal stenosis. Heliyon. 5(5):e01683. • Bell KJ, Doust J, Glasziou P, Cullen L, Harris I, Smith L, Buchbinder R, Barratt A. (2019) Recognizing the potential for overdiagnosis: Are high-sensitivity cardiac troponin assays an example? Ann Intern Med. 170(4):1-4. • Bosch M, McKenzie JE, Ponsford JL, Turner S, Chau M, Tavender EJ, Knott JC, Gruen RL, Francis JJ, Brennan SE, Pearce A, O’Connor DA, Mortimer D, Grimshaw JM, Rosenfeld JV, Meares S, Smyth T, Michie S, Green SE. (2019) Evaluation of a targeted, theory-informed implementation intervention designed to increase uptake of emergency management recommendations regarding adult patients

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

with mild traumatic brain injury: results of the NET cluster randomised trial. Implement Sci. 14(1):4. • O’Connor DA, Buchbinder R. (2019) More signals that overuse of healthcare is a pervasive problem contributing to health system waste. Intern Med J. 49(7):815-7. • Bourne AM, Johnston RV, Cyril S, Briggs A, Clavisi O, Duque G, Harris I, Hill C, Hiller C, Latimer J, Lawson A, Lin C, Maher C, Perriman D, Richards B, Smitham P, Taylor WJ, Whittle S, Buchbinder R. (2018) A scoping review of prioritysetting of research topics for musculoskeletal conditions. BMJ Open. 8(12):e023962. • Bourne A, Peerbux S, Jessup R, Staples M, Beauchamp A, Buchbinder R. (2018) Health literacy profile of recently hospitalised patients in the private hospital setting: a cross sectional survey using the Healthy Literacy Questionnaire (HLQ). BMC Health Serv Res. 18(1):877. • Buchbinder R, Bourne A, Harris I, Latimer J, Taylor W, Whittle S, Richards B, Clavisi O, Green S, Hinman RS, March L, Day R, Ferreira ML, Billot L, Maher C, on behalf of the ANZMUSC Clinical Trials Network. (2018) Early development of the Australia & New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network. Intern Med J. doi.org/10.1111/imj.14191 • Busija L, Osborne RH, Tatangelo G, Niutta S, Buchbinder R. (2019) Psychometric evaluation supported construct validity, temporal stability, and responsiveness of the Osteoarthritis Questionnaire (OA-Quest). J Clin Epidemiol. 114:11-21. • Domingues LMA, Cruz E, dos Santos FP, Ramiro S, Donato H, Manica SR, Hayden J, Buchbinder R, Branco JC. (2018) Prognostic factors for recovery in patients with nonspecific neck pain – a protocol for a systematic literature review. BMJ Open. 8(11):e023356. • Domingues L, Cruz EB, Pimentel-Santos FM, Ramiro S, Donato H, Manica SR, Hayden JA, Buchbinder R, Branco JC. (2018) Prognostic factors for recovery and non-recovery in patients with non-specific neck pain: a protocol for a systematic literature review. BMJ Open. 8(11):e023356. • Downie A, Hancock M, Jenkins H, Buchbinder R, Harris I, Underwood M, Goergen S, Maher CG. (2019) How common is imaging for low back pain in primary and emergency care? Systematic review and meta-analysis of over 4 million imaging requests across 21 years. Br J Sports Med. doi: 10.1136/bjsports-2018-100087 • Dwyer KM, Tai A, Smith P, Buchbinder R. (2019) A real pain in the neck: Giant cell arteritis presenting with non-necrotizing fasciitis and fever. Int Med J. 49(6):802-4. • Ebeling P, Akesson K, Bauer D, Buchbinder R, Eastell R, ink H, Giangregorio L, Guanabens N, Kado D, Kallmes D, Katzman W, Rodriquez A, Sinaki M, Wermers R, Wilson H, Bouxsein M. (2019) The efficacy and safety of vertebral augmentation: A second ASBMR Task Force Report. J Bone Min Res. 34(1):3-21. • Ferreira G, Costa LM, Stein A, Hartvigsen J, Buchbinder R, Maher R. (2019) Tackling low back pain in Brazil: a wake-up call (invited for Masterclass series). Braz J Phys Ther. 23(3):189-95. • Gilmartin-Thomas JF, Bell S, Liew D, Arnold C, Buchbinder R, Chapman C, Cicuttini F, Dobbin M, Gibson S, Giummarra M, Gowan J, Katz B, Lubman D, McCrone M, Pilgrim J, Synnot A, van Dyk E, Workman B, McNeil JJ. (2019)

M O N A S H D E PA RTM E N T O F C L I N I C A L E P I D E M I O LO GY – C A B R I N I

Commentary: Chronic pain medication management of older populations: key points from a national conference and innovative opportunities for pharmacy practice. Res Social Admin Pharm. 15(2):207-13. • Haas R, O’Brien L, Bowles KA, Haines T. (2018) Effectiveness of a weekend physiotherapy service on short-term outcomes following hip and knee joint replacement surgery: a quasi-experimental study. Clin Rehabil. 32(11):1493-1508. • Haas R, O’Brien L, Bowles KA, Haines T. (2018) Health professionals’ perceptions of the allied health role in the acute setting following hip and knee joint replacement surgery: a qualitative study. Disabil Rehabil. doi: 10.1080/09638288.2018.1493542 • Harris IA, Traeger A, Stanford R, Maher CG, Buchbinder R. (2018) Lumbar spine fusion: What is the evidence? Intern Med J. 48(12):1430-4. • Hosking SM, Brennan-Olsen SL, Beauchamp A, Buchbinder R, Williams LJ, Pasco JA. (2018) Health literacy in a population-based sample of Australian women: a crosssectional profile of the Geelong Osteoporosis Study. BMC Public Health. 18(1):876. • Hoy DG, Raikoti T, Smith E, Tuzakana A, Gill T, Matikarai K, Tako J, Jorari A, Blyth F, Pitaboe A, Buchbinder R, Kalauma I, Brooks P, Lepers C, Woolf A, Briggs A, March L. (2018) Use of The Global Alliance for Musculoskeletal Health survey module for estimating the population prevalence of musculoskeletal pain: findings from the Solomon Islands. BMC Musculoskelet Disord. 19(1):292. • Jessup RL, Buchbinder R. (2018) What if I cannot choose wisely? Addressing suboptimal health literacy in our patients to reduce over-diagnosis and overtreatment. Intern Med J. 48(9):1154-57. • Jessup RL, O’Connor DA, Putrik P, Rischin K, Nezon J, Cyril S, Shepperd S, Buchbinder R. (2019) Alternative service models for delivery of healthcare services in high-income countries: a scoping review of systematic reviews. (Protocol) BMJ Open. 9:e024385. • Jessup RL, Osborne RH, Buchbinder R, Beauchamp A. (2018) Using co-design to develop interventions to address health literacy needs in a hospitalised population. BMC Health Serv Res. 18(1):989. • Lähdeoja T, Karjalainen TV, Jokihaara J, Kavaja L, Salamh P, Agarwal A, Winters M, Buchbinder R, Vandvik PO, Arden C. (2019) Subacromial decompression surgery for adults with shoulder pain – a systematic review with meta-analysis. Br J Sports Med. 0:1–10. • Lee JL, Sinnathurai P, Buchbinder R, Hill C, Lassere M, March L. (2018) Biologics and cardiovascular events in inflammatory arthritis: a prospective national cohort study. Arthritis Res Ther. 20(1):171. • Lenza M, Buchbinder R, Johnston RV, Ferrari BAS, Faloppa F. (2019) Surgical versus conservative interventions for treating fractures of the middle third of the clavicle. Cochrane Database of Systematic Reviews. (1):CD009363. • Karjalainen TV, Jain NB, Page CM, Johnston R, Salamh P, Kavaja L, Arden C, Agarwal A, Vandvik PO, Buchbinder R. (2019) Subacromial decompression surgery for rotator cuff disease. (Update) Cochrane Database of Systematic Reviews. (1):CD005619.

PAG E 41

• Karjalainen T, Jokinen K, Sebastin SJ, Luokkala T, Kangasniemi OP, Reito A. (2019) Correlations Among Objectively Measured Impairment, Outcome Classification Systems, and Subjectively Perceived Disability After Flexor Tendon Repair. J Hand Surg Am. 44(5):361-5. • Karjalainen T, Pamilo K, Reito A. (2018) Implant Failure After Motec Wrist Joint Prosthesis Due to Failure of Ball and Socket-Type Articulation—Two Patients With Adverse Reaction to Metal Debris and Polyether Ether Keton. J Hand Surg Am. 43(11):1044.e1-e4. • Page MJ, O’Connor DA, Malek M, Haas R, Beaton D, Huang H, Ramiro S, Richards P, Voshaar MJH, Shea B, Verhagen AP, Whittle SL, van der Windt DA, Gagnier JJ, Buchbinder R, for the OMERACT Shoulder Core Set Working Group. (2019) Patients’ experience of shoulder disorders: a systematic review of qualitative studies for the OMERACT Shoulder Core Domain Set. Rheumatology (Oxford). doi:10.1093/rheumatology/kez046 • Paterson K, Hunter DJ, Metcalf BR, Eyles J, Duong V, Kazsa J, Wang Y, Buchbinder R, Cicuttini F, Forbes A, Harris A, Yu SP, Wang BH, Connell D, Linklater J, Bennell KL. (2018) Efficacy of intra-articular injections of platelet-rich plasma as a symptom- and disease-modifying treatment for knee osteoarthritis – the RESTORE trial protocol. BMC Musculoskelet Disord. 19(1):272. • Ramiro S, Whittle SL, Page MJ, Huang H, Verhagen AP, Beaton D, Richards P, Scholte-Voshaar M, Shea B, van der Windt D, Kopkow C, Lenza M, Jain N, Richards B, Hill C, Gill T, Koes B, Foster N, Conaghan P, Smith T, Malliaras P, Røe Y, Gagnier JJ, Buchbinder R. (2019) The OMERACT core domain set for clinical trials of shoulder disorders. J Rheumatol. doi.org/10.3899/jrheum.181070 • Shokraneh F, Adams CE, Clarke M, Amato L, Bastian H, Beller E, Brassey J, Buchbinder R, Davoli M, Del Mar C, Glasziou P, Gluud C, Heneghan C, Hoffmann T, Ioannidis JP, Jayaram M, Kwong J, Moher D, Ota E, Sheriff RS, Vale L, Goldacre B. (2018) Why Cochrane should prioritise sharing data. BMJ. 362:k3229. • Shrubsole K, Worrall L, Power E, O’Connor DA. (2018) The Acute Aphasia Implementation Study (AAIMS): a pilot cluster randomized controlled trial. Int J Commun Disord. 53(5):1021-56. • Sinnathurai P, Bartlett SJ, Halls S, Hewlett S, Orbai AM, Buchbinder R, Henderson L, Hill C, Lassere M, March L. (2019) Exploring dimensions of stiffness in rheumatoid arthritis and psoriatic arthritis: The Australian Rheumatology Association Database (ARAD) and OMERACT Stiffness Special Interest Group collaboration. J Rheumatol. doi: 10.3899/jrheum.181251 • Sinnathurai P, Buchbinder R, Hill C, Lassere M, March L. (2018) Comorbidity in psoriatic arthritis and rheumatoid arthritis. Intern Med J. 48(11):1360-8. • Sinnathurai P, Capon A, Buchbinder R, Chang V, Henderson L, Lassere M, March L. (2018) Cardiovascular risk management in rheumatoid and psoriatic arthritis: online survey results from a national cohort study. BMC Rheumatology. 2:25. • Slade SC, Finnegan S, Dionne CE, Underwood M, Buchbinder R. (2018) The Consensus on Exercise Reporting Template (CERT) applied to exercise interventions in

PAG E 4 2

musculoskeletal trials demonstrated food rater agreement and incomplete reporting. J Clin Epidemiol. 103:120-30. • Staples M, March L, Hill C, Lassere M, Buchbinder R. (2019) Malignancy risk in Australian rheumatoid arthritis patients treated with anti-tumour necrosis factor therapy: an update from the Australian Rheumatology Association Database (ARAD) prospective cohort study. BMC Rheumatol. 3:1. • Taylor NF, Bunzli S, Wallis JA, Shields N. 2019. Qualitative research and Osteoarthritis of the Knee (Chapter 8). Book Chapter in Hayre CM, Muller DJ, editors. Enhancing Healthcare and Rehabilitation: The Impact of Qualitative Research. CRC Press. • Taylor NF, Harding KE, Porter J, Horne-Thompson A, Wallis JA, Kerridge G, Wilby A, Joy A, Kaminski MR, Sheats J, Wilson E. (2019) Evaluating the introduction of an allied health clinical research office at a health service on research participation, interest and experience of allied health professionals. Journal of Allied Health. 48(1):46-53. • Traeger A, Buchbinder R, Elshaug A, Croft P, Maher C. (2019) Guideline care for low back pain: Can health systems deliver? Bulletin WHO. 97:423–33. • Traeger A, Buchbinder R, Harris I, Clavisi O, Maher C. (2019) Change Page: Avoid routinely prescribing medicines for non-specific low back pain. Br J Sports Med. 53(3):196-9. • Van Ginckel A, Hinman RS, Wrigley TV, Hunter DJ, Marshall CJ, Duryea J, Melo L, Simic M, Kasza J, Robbins SR, Wallis JA. Bennell KL. (2019) Effect of cane use on bone marrow lesion volume in people with medial tibiofemoral knee osteoarthritis: randomized clinical trial. Osteoarthritis and cartilage. doi: 10.1016/j.joca.2019.05.004 • Vandvik PO, Lähdeoja T, Ardern C, Buchbinder R, Moro J, Brox JI, Burgers J, Hao Q, Karjalainen T, van den Bekerom M, Noorduyn J, Lytvyn L, Siemieniuk RAC, Albin A, Chua S, Fisch F, Proulx L, Guyatt G, Agoritsas T, Poolman RW. (2019) Subacromial decompression surgery for adults with shoulder pain: a clinical practice guideline. BMJ. 364:l294. • Whittle SL, Johnston RV, McDonald S, Paterson KL, Buchbinder R. (2019) Autologous blood product injections including platelet rich plasma for osteoarthritis of the knee. (Protocol) Cochrane Database of Systematic Reviews. (5):CD013341. • Whittle SL, Johnston RV, McDonald S, Worthley D, Campbell TM, Buchbinder R. (2019) Stem cell therapy for osteoarthritis of the knee. (Protocol) Cochrane Database of Systematic Reviews. (5):CD013342.

Grants Held • Cabrini Foundation Clinical Research Grant. ‘Barriers and enablers for referrals and participation in Cabrini’s new osteoarthritis management program – Good Living with Osteoarthritis from Denmark (GLA:D Australia): Capturing referrer and patient perspectives’. (2017-2019) $30,000, Wallis J. • NHMRC Senior Principal Research Fellowship. (20152019), $911,915, Buchbinder R. • NHMRC Translating Research into Practice Fellowship. (2019-2020), $181,066, O’Connor DA.

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

• NHMRC Centre of Research Excellence in Translation of Research into Improved OUtcomes in Musculoskeletal Pain & Health (CRE TRIUMPH). (2015-2019), $2,500,000, Bennell K, Hunter D, Hodges P, Buchbinder R, Pirotta M, Hinman R, Harris A, Foster N, Michie S, Vicenzino B • NHMRC Program Grant. ‘Musculoskeletal pain and disability: improving outcomes through conservative interventions’. (2016-2020), $8,268,140, Hodges P, Bennell K, et al. Buchbinder R (AI). • NHMRC Partnership Grant. ‘Patient-centred eHealth approach to improving outcomes for gout sufferers’. (20162020), $660,656, Day R, et al. Buchbinder R (AI). • NHMRC Project Grant. ‘Hype or Hope? platelet-Rich plasma as a symptom- and disEaSe-modifying Treatment fOR knee ostEoarthritis - the RESTORE trial’. (2016-2019), $1,400,359, Bennell K, Buchbinder R, Wang Y, Forbes A. • NHMRC Project Grant. ‘CROSSFIRE: Combined Randomised and Observational Study of Surgery for Fractures in the Distal Radius in the Elderly’. (2016-2019), $511,076, Harris I, Buchbinder R, Ivers R, Naylor J, Baloh Z, Smith P. • NHMRC Program Grant. ‘Using healthcare wisely: reducing inappropriate use of tests and treatments’. (2017-2021), $9,578,895, Glasziou P, Buchbinder R, Maher C, McCaffery K. • NHMRC Partnership Centre in Health System Sustainability. (2017-2022), $10,700,000 (NHMRC $5,250,000; Partners: Bupa Health Foundation, NSW Health, Telstra and the University of Notre Dame Australia), Braithwaite J, Ward RL, Anderson T, Teede H, Wells L, Gray LC, Yeend T, Coiera E, Westbrook J, Glasziou P, Scott A, Karnon JD, Buchbinder R. • NHMRC Project Grant. ‘SUcceSS: Surgery for Spinal Stenosis – a randomized placebo-controlled trial. (2017-

M O N A S H D E PA RTM E N T O F C L I N I C A L E P I D E M I O LO GY – C A B R I N I

2021), $2,300,000, Ferreira M, Harris I, Davis G, Latimer J, Beard D, Li Q, Mobbs R, Buchbinder R (AI). • NHMRC The Cochrane Collaboration Round 7 Funding Program. ‘Cochrane Musculoskeletal Review Group, Australian Editorial Base’. (2017-2020), $368,086, Buchbinder R, O’Connor D, Winzenberg T, Johnston R. • NHMRC Centre of Research Excellence. ‘ANZMUSC – Australia and New Zealand Musculoskeletal Clinical Trials Network’. (2018-2022), $2,497,653, Buchbinder R (CI), Maher C, March L, Day R, Hinman R, Harris I, Ferreira M, Glasziou P, Green S, Billot L. • NHMRC Medical Research Future Fund Research Grant. ‘CRISTAL: Cluster Randomised Trial of Aspirin versus Low molecular weight heparin for venous thromboembolism prophylaxis in joint replacement surgery, a registry-nested study’. (2018-2022), $910,700, Harris I, Graves S, Buchbinder R, Naylor J, Pratt N, de Steiger R, Chong B, Ackerman I, Harris A. • Cabrini Foundation Clinical Research Grant. ‘The Back Pain Quest: Understanding beliefs about low back pain’. (2018-2019), $30,000, Buchbinder R, Hawkins M, Osborne R. • RACGP Foundation – HCF Grant. ‘OCEAn - NETs (Occasions of Care Explained and Analysed - nominated extra topics).’ (2018-2019), $60,000, Harrison C, Poon S, Gorji N, Gordon J, Bonner C, Bayram C, Maher C, Buchbinder R. • NHMRC Project Grant. ‘Trial of glucocorticoids in acute sciatica’. (2019-2022), $1,142,038, Lin CWC, McLachlan A, Latimer J, Abdel Shaheed C, Li Q, Buchbinder R (AI). • Arthritis Australia Project Grant. ‘Patterns of management for low back, knee and shoulder conditions by general practitioners in Victoria, Australia’. (2019), $31,000, Haas R, Buchbinder R.

PAG E 4 3

CABRINI MONASH UNIVERSITY DEPARTMENT OF MEDICAL ONCOLOGY – THE SZALMUK FAMILY DEPARTMENT OF MEDICAL ONCOLOGY HEAD: PROFESSOR GARY RICHARDSON OAM

$305K

in grant funding

publications

The department’s main research focus is on clinical trials of new anti-cancer agents. This involves participation in phase I to phase IV studies to determine the efficacy of new drugs or combinations of drugs in the treatment of various cancers. Through the research program, our patients are able to access potentially active treatments well before they become approved for general usage. It allows them the opportunity to try better and less toxic therapies. It gives our staff (doctors, nurses, and pharmacists) advanced training in the use of new agents, creating better and safer health practices. The research of the department supports the strategic goals of Cabrini. It supports vulnerable cancer patients and improves their lives, all by advancing precision medicine. All research services are oriented around the patients involved and allows the development of new treatments and services. The clinical trial program allows for recruitment of patients from all areas of Melbourne, across Victoria, and other states.

PAG E 4 4

presentations

active clinical trials

Consumers are involved in all levels of clinical research in the department, including the development of the protocols, approval by the HREC, and participation in the trials.

Highlights Dr Yoland Antill delivered the results of the important PHAEDRA study at the American Society of Clinical Oncology annual meeting in June 2019. This study looked at the activity of durvalumab, a novel immunotherapy agent, in advanced endometrial cancer. It was a multicentre phase II study sponsored by the Australian New Zealand Gynaecologic Oncology Group. Durvalumab monotherapy showed promising activity and safety in patients with endometrial cancer with deficient DNA mismatch repair (dMMR). We have been developing and beta-testing an electronic patient-reported outcomes (PROMs) tool

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

to report the toxicity of chemotherapy in real time. Patients receiving chemotherapy enter scores for nine chemotherapy toxicities. They receive advice from the system regarding management, and any serious toxicity is reported immediately to the treating staff. The aim is to improve timeliness of toxicity management and therefore overall patient outcomes. The department has been successfully collecting and processing breast tumour samples to create organoids. These are 3-dimensional clusters of tumour cells (minitumours) grown in specific media. This project aims to develop novel platforms for the rapid determination of drug sensitivity in individual patients with breast cancer and high-grade ovarian cancers. Overall this is a complicated process that involves the acquisition of tumour by the surgeons, dissection of tumour cells by the pathologist, and then creation of the organoids by our collaborators at the Monash Biomedicine Discovery Institute Department of Anatomy and Developmental Biology.

intravenously every 2 weeks. The dose limiting toxicity (DLT) evaluation period was 28 days. The planned dose levels (DL) were 0.3, 1, 3, 5 and 10 mg/kg. Cabrini hospital has currently recruited the most patients in the world into this study. Breast Cancer Database RESEARCHERS: VEREKER M, RICHARDSON G, MORGAN J, TAYLOR K

The Breast Cancer Service provides patient-centred, best practice breast cancer care and treatment. We have developed the Breast Cancer Database (BCD) to monitor our cancer services and ensure we provide timely, safe, appropriate and effective treatment. The BCD is also a valuable resource for epidemiological studies, clinical research and clinical trials. Since its inception in 2016, data has been collected for 1,130 patients receiving treatment at Cabrini. The database also supports management of multidisciplinary team (MDT) meetings, decision-making, cancer staging and patient treatment recommendations in line with Victorian Cancer Service performance indicators.

Our Research A Phase 1a trial that evaluates the safety, tolerability, pharmacokinetics, and immunogenicity of KN046 in patients with advanced solid tumours RESEARCHERS: RICHARDSON G, GATELY L , BRADY B

KN046 is a novel bispecific antibody that blocks both PD-L1 interaction with PD1 and CTLA-4 interaction with CD80/CD86. KN046 has a wild type IgG1 Fc portion that preserves intact effector functions, such as depletion of Regulatory T cells (Tregs) in tumor microenvironments. This first-in-human study is evaluating the safety, tolerability, pharmacokinetics and preliminary efficacy of KN046 in patients with advanced solid tumors. This traditional “3+3” dose-escalation design study enrolled patients with advanced unresectable or metastatic solid tumors refractory or intolerant to standard therapies. KN046 was administered

Studies performing circulating tumour DNA analyses to inform prognosis and treatment options in colorectal, pancreatic, rectal, endometrial and ovarian cancers RESEARCHERS: SHAPIRO J, LIPTON L , HAYDON A , RICHARDSON G

Sequencing of DNA from cancers has identified several genes that are recurrently somatically mutated. These tumour-specific DNA mutations can be detected in the cell-free component of peripheral blood as circulating tumour DNA (ctDNA) in patients with metastatic disease. ctDNA is a useful dynamic marker of tumour bulk, with early decreases in ctDNA amounts reflecting treatment responses that are later confirmed by conventional imaging. These studies are looking at the presence of ctDNA in patients with various tumours to determine prognosis, and possible early treatment options. They will potentially change management of patients and improve overall survival.

Publications, Books, Book Chapters, Reports • Burge M, Semira C, Lee B, Lee M, Kosminder S, Shapiro J, Steel S, Gibbs P. (2018) Previous Bevacizumab and Efficacy of Later Anti–Epidermal Growth Factor Receptor Antibodies in Metastatic Colorectal Cancer: Results From a Large International Registry. Clin Colorectal Cancer. 17(3):e593-e599. • Chin-Lenn L, De Boer RH, Segelov E, Marx GM, Hughes TM, McCarthy NJ, White SC, Foo SS, Rutovitz JJ, Della-Fiorentina S, Jennens R, Antill YC, Tsoi D, Cronk MF, Lombard JM, Kiely BE, Chirgwin JH, Gorelik A, Mann GB. (2018) The impact and indications for Oncotype DX on adjuvant treatment recommendations when third-party funding is unavailable. Asia Pac J Clin Oncol. 14(6):410-416.

• Eggermont AMM, Blank CU, Mandala M, Long GV, Atkinson VG, Dalle S, Haydon A, Lichinitser M, Khattak A, Carlino MS, Sandhu S, Larkin J, Puig S, Ascierto PA, Rutkowski P, Schadendorf D, Koornstra R, HernandezAya L, Di Giacomo AM, van den Eertwegh AJ, Grob JJ, Gutzmer R, Jamal R, Lorigan PC, Lupinacci R, Krepler C, Ibrahim N, Kicinski M, Marreaud S, van Akkooi AC, Suciu S, Robert C. (2019) Prognostic and predictive value of AJCC-8 staging in the phase III EORTC1325/KEYNOTE-054 trial of pembrolizumab vs placebo in resected high-risk stage III melanoma. Eur J Cancer. 116:148-157. • Foulkes SJ, Howden EJ, Bigaran A, Janssens K, Antill Y, Loi S, Claus P, Haykowsky MJ, Daly RM, Fraser SF,

C A B R I N I M O N A S H U N I V E R S I T Y D E PA RTM E N T O F M E D I C A L O N C O LO GY – T H E S Z A L M U K FA M I LY D E PA RTM E N T O F M E D I C A L O N C O LO GY

PAG E 4 5

LA Gerche A. (2019) Persistent Impairment in Cardiopulmonary Fitness after Breast Cancer Chemotherapy. Med Sci Sports Exerc. 51(8):1573-1581. • Gulley JL, Borre M, Vogelzang NJ, Ng S, Agarwal N, Parker CC, Pook DW, Rathenborg P, Flaig TW, Carles J, Saad F, Shore ND, Chen L, Heery CR, Gerritsen WR, Priou F, Langkilde NC, Novikov A, Kantoff PW. (2019) Phase III Trial of PROSTVAC in Asymptomatic or Minimally Symptomatic Metastatic Castration-Resistant Prostate Cancer. J Clin Oncol. 37(13):1051-1061. • Ha FJ, Spain L, Dowling A, Kwan EM, Pezaro C, Day D, Chia PL, Tran B, Pook D, Weickhardt AJ. (2019) Timing of brain metastases development in metastatic renal cell cancer patients treated with targeted therapies and survival outcomes: An Australian multicenter study. Asia Pac J Clin Oncol. doi: 10.1111/ajco.13109. • Hauschild A, Dummer R, Schadendorf D, Santinami M, Atkinson V, Mandalà M, Chiarion-Sileni V, Larkin J, Nyakas M, Dutriaux C, Haydon A, Robert C, Mortier L, Schachter J, Lesimple T, Plummer R, Dasgupta K, Haas T, Shilkrut M, Gasal E, Kefford R, Kirkwood JM, Long GV. (2018) Longer Follow-Up Confirms Relapse-Free Survival Benefit With Adjuvant Dabrafenib Plus Trametinib in Patients With Resected BRAF V600-Mutant Stage III Melanoma. J Clin Oncol. 36(35):3441-3449. • Horvath N, Spencer A, Kenealy M, Joshua D, Campbell PJ, Lee JJ, Hou J, Qiu L, Kalff A, Khong T, Londhe A, Siggins S, van Kooten Losio M, Eisbacher M, Prince HM. (2019) Phase 3 study of subcutaneous bortezomib, thalidomide, and prednisolone consolidation after subcutaneous bortezomib-based induction and autologous stem cell transplantation in patients with previously untreated multiple myeloma: the VCAT study. Leuk Lymphoma. 19:1-12. • Howden EJ, Bigaran A, Beaudry R, Fraser S, Selig S, Foulkes S, Antill Y, Nightingale S, Loi S, Haykowsky MJ, La Gerche A. (2019) Exercise as a diagnostic and therapeutic tool for the prevention of cardiovascular dysfunction in breast cancer patients. Eur J Prev Cardiol. 26(3):305-315. • Kenealy M, Hertzberg M, Benson W, Taylor K, Cunningham I, Stevenson W, Hiwase D, Eek R, Zantomio D, Jong S, Wall M, Blombery P, Gerber T, Debrincat M, Zannino D, Seymour JF. (2018) Azacitidine with or without lenalidomide in higher risk myelodysplastic syndrome & low blast acute myeloid leukemia. Haematologica. 104(4):700-709. • Kissane D, Lethberg C, Brooker J, Hempton C, Shapiro J. (2019) Meaning and Purpose (MaP) therapy II: Feasibility and acceptability from a pilot study in advanced cancer. Palliative and Supportive Care. 17(1):21-28. • Kok PS, Beale P, O’Connell RL, Grant P, Bonaventura T, Scurry J, Antill Y, Goh J, Sjoquist K, DeFazio A, Mapagu C, Amant F, Friedlander M; PARAGON Investigators. (2019) PARAGON (ANZGOG-0903): a phase 2 study of anastrozole in asymptomatic patients with estrogen and progesterone receptor-positive recurrent ovarian cancer and CA125 progression. J Gynecol Oncol. 30(5):e86. • Kwan EM, Fettke H, Docanto MM, To SQ, Bukczynska P, Mant A, Pook D, Ng N, Graham LK, Mangiola S, Segelov E, Mahon K, Davis ID, Parente P, Pezaro C, Todenhöfer T, Horvath LG, Azad AA. (2019) Prognostic Utility of a

PAG E 4 6

Whole-blood Androgen Receptor-based Gene Signature in Metastatic Castration-resistant Prostate Cancer. Eur Urol Focus. doi.org/10.1016/j.euf.2019.04.020. • Lawrence MG, Obinata D, Sandhu S, Selth LA, Wong SQ, Porter LH, Lister N, Pook D, Pezaro CJ, Goode DL, Rebello RJ, Clark AK, Papargiris M, Van Gramberg J, Hanson AR, Banks P, Wang H, Niranjan B, Keerthikumar S, Hedwards S, Huglo A, Yang R, Henzler C, Li Y, Lopez-Campos F, Castro E, Toivanen R, Azad A, Bolton D, Goad J, Grummet J, Harewood L, Kourambas J, Lawrentschuk N, Moon D, Murphy DG, Sengupta S, Snow R, Thorne H, Mitchell C, Pedersen J, Clouston D, Norden S, Ryan A, Dehm SM, Tilley WD, Pearson RB, Hannan RD, Frydenberg M, Furic L, Taylor RA, Risbridger GP. (2018) Patient-derived Models of Abiraterone- and Enzalutamide-resistant Prostate Cancer Reveal Sensitivity to Ribosome-directed Therapy. Eur Urol. 74(5):562-572. • Lee B, Lipton L, Cohen J, Tie J, Javed AA, Li L, Goldstein D, Burge M, Cooray P, Nagrial A, Tebbutt NC, Thomson B, Nikfarjam M, Harris M, Haydon A, Lawrence B, Wm Tai D, Simons K, Lennon AM, Wolfgang CL, Tomasetti C, Papadopoulos N, Kinzler KW, Vogelstein B, Gibbs P. (2019) Circulating tumor DNA as a potential marker of adjuvant chemotherapy benefit following surgery for localised pancreatic cancer. Ann Oncol. doi: 10.1093/annonc/mdz200. • Li N, McInerny S, Zethoven M, Cheasley D, Lim BWX, Rowley SM, Devereux L, Grewal N, Ahmadloo S, Byrne D, Lee JEA, Li J, Fox SB, John T, Antill Y, Gorringe KL, James PA, Campbell IG. (2019) Combined tumor sequencing and case/ control analyses of RAD51C in breast cancer. J Natl Cancer Inst. doi: 10.1093/jnci/djz045. • Lin E, Vincent FB, Sahhar J, Ngian GS, KandaneRathnayake R, Mende R, Morand EF, Lang T, Harris J. (2019) Analysis of serum interleukin(IL)-1α, IL-1β and IL-18 in patients with systemic sclerosis. Clin Transl Immunology. 8(4):e1045. • Liu G, Tu D, Karapetis C, O’Callaghan C, Siu L, Price T, Shapiro J, Simes J, Tebbutt N, Jonker D. (2019) Outcomes of Older Patients Treated with Targeted Therapy Treatment in Metastatic Chemo-refractory Colorectal Cancer: An Analysis of NCIC CTG CO.17 and CO.20. Clinical Colorectal Cancer. 18(1):e140-e149. • Long GV, Dummer R, Schadendorf D, Santinami M, Atkinson V, Mandalà M, Chiarion-Sileni V, Larkin J, Nyakas M, Dutriaux C, Haydon A, Robert C, Mortier L, Schachter J, Lesimple T, Plummer R, Dasgupta K, Haas T, Shilkrut M, Gasal E, Kefford R, Kirkwood JM, Hauschild A. (2019) Reply to E. Hindié and K.R. Hess. J Clin Oncol. 37(15):1356-1358. • Maharaj AD, Ioannou L, Croagh D, Zalcberg J, Neale RE, Goldstein D, Merrett N, Kench JG, White K, Pilgrim CHC, Chantrill L, Cosman P, Kneebone A, Lipton L, Nikfarjam M, Philip J, Sandroussi C, Tagkalidis P, Chye R, Haghighi KS, Samra J, Evans SM. (2019) Monitoring quality of care for patients with pancreatic cancer: a modified Delphi consensus. HPB (Oxford). 21(4):444-455. • McLean L, Soon JA, Haydon A. (2018) Immunotherapy induced pyrexia and the role of PET/CT. International Journal of Case Reports. 2:29. • Meiser B, Quinn VF, Mitchell G, Tucker K, Watts KJ, Rahman B, Peate M, Saunders C, Geelhoed E, Gleeson M,

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

Barlow-Stewart K, Field M, Harris M, Antill YC, Susman R, Bowen MT, Mills L, Kirk J; TFGT Collaborative Group. (2018) Psychological outcomes and surgical decisions after genetic testing in women newly diagnosed with breast cancer with and without a family history. Eur J Hum Genet. 26(7):972-983. • Mendis S, Beck S, Lee B, Lee M, Wong R, Kosmider S, Shapiro J, Yip D, Steel S, Nott L, Jennens R, Lipton L, Burge M, Field K, Ananda S, Wong HL, Gibbs P. (2019) Right versus left sided metastatic colorectal cancer: Teasing out clinicopathologic drivers of disparity in survival. Asia Pac J Clin Oncol. 15(3):136-143. • Michael N, Beale G, O Callaghan C, Melia A, Costa D, Kissane D, Shapiro J. (2019) Timing of palliative care referral and aggressive cancer care toward the end-oflife in pancreatic cancer: a retrospective, single-center observational study. BMC Palliative Care. 18(1):13. • Prasanna T, Karapetis CS, Roder D, Tie J, Padbury R, Price T, Wong R, Shapiro J, Nott L, Lee M, Chua YJ, Craft P, Piantadosi C, Sorich M, Gibbs P, Yip D. (2018) The survival outcome of patients with metastatic colorectal cancer based on the site of metastases and the impact of molecular markers and site of primary cancer on metastatic pattern. Acta Oncologica. 57(11):1438-1444. • Price T, Tang M, Gibbs P, Haller D, Peeters M, Arnold D, Segelov E, Roy A, Tebbutt N, Pavlakis N, Karapetis C, Burge M, Shapiro J. (2018) Targeted therapy for metastatic colorectal cancer. Expert Review of Anticancer Therapy. 18(10):991-1006. • Rischin A, Brady B, McLean C, Ostor AJK. (2018) Immune checkpoint inhibitor-induced lymphocytic fasciitis. Intern Med J. 48(12):1550-1552. • Schadendorf D, Hauschild A, Santinami M, Atkinson V, Mandalà M, Chiarion-Sileni V, Larkin J, Nyakas M, Dutriaux C, Haydon A, Robert C, Mortier L, Lesimple T, Plummer R, Schachter J, Dasgupta K, Manson S, Koruth R, Mookerjee B, Kefford R, Dummer R, Kirkwood JM, Long GV. (2019) Patient-reported outcomes in patients with resected, high-risk melanoma with BRAFV600E or BRAFV600K mutations treated with adjuvant dabrafenib plus trametinib (COMBI-AD): a randomised, placebo-controlled, phase 3 trial. Lancet Oncol. 20(5):701-710. • Semira C, Wong HL, Field K, Lee M, Lee B, Nott L, Shapiro J, Wong R, Tie J, Tran B, Richardson G, Zimet A, Lipton L, Tamjid B, Burge M, Ma B, Johns J, Harold M, Gibbs P. (2019) Chemotherapy and biologic use in the routine management of metastatic colorectal cancer in Australia: is clinical practice following the evidence? Intern Med J. 49(4):446-454. • Shapiro JD, Thavaneswaran S, Underhill CR, Robledo KP, Karapetis CS, Day FL, Nott LM, Jefford M, Chantrill LA, Pavlakis N, Tebbutt NC, Price TJ, Khasraw M, Van Hazel GA, Waring PM, Tejpar S, Simes J, Gebski VJ, Desai J, Segelov E. (2018) Cetuximab Alone or With Irinotecan for Resistant KRAS-, NRAS-, BRAF- and PIK3CAwild-type Metastatic Colorectal Cancer: The AGITG Randomized Phase II ICECREAM Study. Clin Colorectal Cancer. 17(4):313-319. • Shepshelovich D, Townsend AR, Espin-Garcia O, Latifovic L, O’Callaghan CJ, Jonker DJ, Tu D, Chen E, Morgen E, Price TJ, Shapiro J, Siu LL, Kubo M, Dobrovic

A, Ratain MJ, Xu W, Mushiroda T, Liu G. (2018) Fc-Gamma Receptor Polymorphisms, Cetuximab Therapy, and Overall Survival in the CCTG CO.20 Trial of Metastatic Colorectal Cancer in Cancer Medicine. Cancer Medicine. 7(11): 5478-5487. • Sud S, O’Callaghan C, Jonker C, Karapetis C, Price T, Tebbutt N, Shapiro J, Van Hazel G, Pavlakis N, Gibbs P, Jeffrey M, Siu L, Gill S, Wong R, Jonker D, Tu D, Goodwin R. (2018) Hypertension as a predictor of advanced colorectal cancer outcome and cetuximab treatment response. Current Oncology. 25(6):e516–e526. • Tan L, Sandhu S, Lee RJ, Li J, Callahan J, Ftouni S, Dhomen N, Middlehurst P, Wallace A, Raleigh J, Hatzimihalis A, Henderson MA, Shackleton M, Haydon A, Mar V, Gyorki DE, Oudit D, Dawson MA, Hicks RJ, Lorigan P, McArthur GA, Marais R, Wong SQ, Dawson SJ. (2019) Prediction and monitoring of relapse in stage III melanoma using circulating tumor DNA. Ann Oncol. 30(5):804-814. • Tang M, O’Connell RL, Amant F, Beale P, McNally O, Sjoquist KM, Grant P, Davis A, Sykes P, Mileshkin L, Moujaber T, Kennedy CJ, deFazio A, Tan K, Antill Y, Goh J, Bonaventura T, Scurry J, Friedlander M. (2019) PARAGON: A Phase II study of anastrozole in patients with estrogen receptor-positive recurrent/metastatic low-grade ovarian cancers and serous borderline ovarian tumors. Gynecol Oncol. doi: 10.1016/j.ygyno.2019.06.011. • Vincent FB, Lang T, Kandane-Rathnayake R, DownieDoyle S, Morand EF, Rischmueller M. (2019) Serum and urinary macrophage migration inhibitory factor (MIF) in primary Sjögren’s syndrome. Joint Bone Spine. 86(3):393-395. • Vincent FB, Lin E, Sahhar J, Ngian GS, KandaneRathnayake R, Mende R, Hoi AY, Morand EF, Lang T, Harris J. (2018) Analysis of serum macrophage migration inhibitory factor and D-dopachrome tautomerase in systemic sclerosis. Clin Transl Immunology. 7(12):e1042.

Grants Held • Telematics Trust. ‘Patient-Self Reporting Outcomes of Chemotherapy App’. (2018–2019) $50,000, Richardson G, Lang T. • Peter Meese Memorial Oncology Nursing Research Grant. ‘Patient-Self Reported Outcomes of Toxicity Experienced During Chemotherapy’. (2018 – 2019) $15,000, Hastings J, Lang T, Richardson G. • Beverley Barlow Genetic Cancer Research Grant. ‘Modelling Human Breast Cancer Disease Using an Experimental in-vitro Organoid Culture System’. (2018 – 2019) $100,000, Richardson G. • Cabrini Foundation Grant Round ‘Validation of Cabrini‘s new chemotherapy app’. (2019-2020) $25,000 Richardson G, Lang T, Seletto K, Hastings J. • Cabrini Foundation Quality Improvement Grant ‘Combatting Compassion Fatigue and Burnout of Oncology Nurses Through Wellness Activities’. $15,000 (2019- 2020) Seletto K, Lang T. • John Sutherland Hamling Breast Cancer Research Grant ‘Dietary Intervention in Patients Receiving Adjuvant Chemotherapy for Early Stage Breast Cancer’ (2016-2018) $100,000 Richardson G, Nieron Z.

C A B R I N I M O N A S H U N I V E R S I T Y D E PA RTM E N T O F M E D I C A L O N C O LO GY – T H E S Z A L M U K FA M I LY D E PA RTM E N T O F M E D I C A L O N C O LO GY

PAG E 4 7

CABRINI MONASH UNIVERSITY DEPARTMENT OF SURGERY, THE FRĂ&#x2013;HLICH WEST CHAIR OF SURGERY HEAD: ASSOCIATE PROFESSOR PAUL MCMURRICK

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

$3.6M+

in grant funding

publications

A large number of clinical research projects are carried out using the colorectal neoplasia database which forms the cornerstone of all our research. Research projects investigate which patients are at most risk of developing complication after surgery, which patients might have a relapse of their cancer, and how we can improve cancer care for improved patient outcomes. In conjunction with clinical governance at Cabrini Hospital we have a quarterly quality assurance loop to ensure that not only are the overall results for the treatment of bowel cancer at Cabrini at an international standard but also the individual outcomes of every surgeon are scrutinised and reported. Through our three main collaborative projects of organoids, tissue microarray and the new tissue-slice assay, we are able to match individual tumour response to drug treatment, gene expression, and immune response to patient clinical outcomes and the success of their treatment. PAG E 4 8

presentations

active clinical trials

These combined projects have the potential to individualise or personalise treatment for each bowel cancer patient in the future.

Highlights Colorectal organoids are three-dimensional cultures of cells derived from healthy patient tissues and tumours. We have established tumour-derived organoids from colorectal cancer patients for the development of assays to test routine cancer therapies such as chemotherapy and radiotherapy. Ultimately, this project aims to develop a pre-clinical assay to predict treatment outcomes for colorectal cancer patients before they undergo therapy. We (Dr Rebekah Engel, Associate Professor Paul McMurrick and collaborator Associate Professor Helan Abud) were awarded a $30,000 Cabrini Foundation Clinical Research Grant in 2018 for C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

Dr Rebekah Engel is a Postdoctoral Research Fellow with the Cabrini Monash University Department of Surgery. She is pictured observing colorectal organoid cultures under the microscope.

Microscope photograph of a patient derived colorectal tumour organoid labelled with fluorescent dyes to visualise living cells (Hoescht;blue colour) and dead cells (Propidium Iodide; red colour).

‘Using patient-derived organoids to guide the ‘watch and wait’ nonsurgical approach for rectal cancer’ as part of the organoid program. Tissue microarray is a pathological technique that allows high-throughput analyses by assembling samples of many different patients onto a single slide. In our study, slides have been analysed for prognostic and predictive biomarkers of colorectal cancer and the data compared to clinical outcomes stored in the colorectal neoplasia database. At the 2018 Cabrini Research Week, research from this program led by Dr Christine Koulis, took out the Best Cancer Poster award and People’s Choice for Best Poster award for ‘The predictive and prognostic role of p53, GLUT1 and TRAP1 in Stage IV colon cancer’. Dr Koulis was also selected to give a podium presentation of this research at the Royal Australasian College of Surgeons 88th Annual Scientific Congress, held in Bangkok, Thailand in May 2019. Dr Koulis presented on ‘Prognostic biomarkers in Stage IV colon-cancer: An immunohistochemistry-based study using tissue microarray’. The aim of the ‘When to resect?’ study was to assess the overall survival of patients detected with a malignancy after a polypectomy where major surgery was subsequently undertaken as definitive treatment. At the 2018 Cabrini Research Week, the research presented by Karen Oliva, took out the Best Poster Award for ‘When to resect? Management of patients with adverse histopathological features post colonoscopic polypectomy’. Dr Gemma Solon was also selected to give a podium presentation of this research at the Royal Australasian College of Surgeons 88th Annual Scientific Congress, held in Bangkok, Thailand in May 2019.

1. 2.

Our Research The Department is involved in a wide range of research projects on all aspects of colorectal cancer from clinical database projects to translational laboratory projects with partner universities. There are four main areas of clinical research undertaken in the Department:

3. 4.

Screening and prevention for bowel cancer Peri-operative care (including surgical techniques) of bowel cancer Patient outcomes following treatment for bowel cancer Collaborative research projects with external organisations

Screening and prevention: Analysis of colorectal cancer in the under 50s in Australia RESEARCHERS: WILKINS S, RUGGIERO B, OLIVA K, MCMURRICK P

Bowel cancer screening is recommended for people aged over 50, however recent studies have shown an increase in incidence in people under 50 years of age. This project will analyse the incidence of bowel cancer in people under 50 in our Cabrini Monash Colorectal Neoplasia Database and from other databases and registries across Australia, and conduct a cost-benefit analysis of under 50s bowel cancer screening and identify whether an expansion of the screening ages to include patients aged 40-50 is warranted. Peri-operative care: Oversewing staple lines and the relationship to anastomotic complications in colorectal cancer RESEARCHERS: BAQAR A , WILKINS S, OLIVA K, MCMURRICK P

During bowel cancer surgery an anastomosis can be formed with a surgical stapler or hand sewn. This project aims to examine whether oversewing staples lines reduces postsurgical complications for patients. Patient outcomes: The impact of renal impairment on the perioperative outcomes of colorectal cancer surgery patients RESEARCHERS: WILKINS S, OLIVA K, KOULIS C, MCMURRICK P

Investigation into the effects of renal impairment and other renal issues on the short and long-term outcomes of colorectal cancer patients.

C A B R I N I M O N A S H U N I V E R S I T Y D E PA RTM E N T O F S U R G E RY, T H E F R Ö H L I C H W E S T C H A I R O F S U R G E RY

PAG E 49

Collaborative research projects: Development of a colorectal cancer tissue microarray RESEARCHERS: KOULIS C, OLIVA K, WILKINS S, ENGEL R, QUEIROS J, NICKLESS D, DOWNEY B, COHEN C, MCMURRICK P

This project proposes the transfer of 2000 tumour and normal tissue specimens to tissue microarray (TMA) blocks of patients who have undergone colorectal cancer surgery. TMA blocks will be tested in collaboration with university partners. This project is partly funded by a VCA Grant awarded in 2016 ($2 million) and the Margaret Walkom Trust ($30,000 in 2017 and $30,000 in 2018).

Selection of other projects: • • •

•

• •

Factors affecting the short- and long-term outcomes from colorectal cancer surgery in older patients Patient reported outcome measures Recalibration of the ACPGBI risk prediction models for 30-day mortality after surgery for colorectal cancer: is it predictive in Australia? Preoperative glycated haemoglobin and insulin treatment: Risk factors for patients with type 2 diabetes undergoing colorectal cancer surgery Molecular signature of interleukin-22 in colon carcinoma cells and organoid models Defining the T cell-suppressive mechanisms and phenotypic identity of cancer-associated fibroblasts

Publications, Books, Book Chapters, Reports • Baqar AR, Wilkins S, Staples M, Lee CHA, Oliva K, McMurrick PJ. (2019) The role of preoperative CEA in the management of colorectal cancer: a cohort study from two cancer centres. International Journal of Surgery 64:10-15. • Bell S. (2019) “Critical Anatomical Landmarks in Transanal Total Mesorectal Excision (taTME)”. Transanal Minimally Invasive Surgery (TAMIS) and Transanal Total Mesorectal Excision (taTME) Ed. Sam Atallah. Springer Publishing. • Bell S, Kong JC, Carne P, Chin M, Simpson P, Farmer C, Warrier S. (2019) Oncological safety of laparoscopic versus open colorectal cancer surgery in obesity: a systematic review and meta-analysis. ANZ Journal of Surgery. doi: 10.1111/ans.14845. • Lee CHA, Wilkins S, Oliva K, Staples M, McMurrick PJ. (2018) The role of lymph node yield and lymph node ratio in predicting outcomes in non-metastatic colorectal cancer. BJS Open. 3(1):95-105. • McCombie AM, Frizelle F, Bagshaw PF, Frampton CM, Hewett PJ, McMurrick PJ, Rieger N, Solomon MJ, Stevenson AR, ALCCaS Trial group (2018) The ALCCaS Trial: A Randomized controlled trial comparing quality of life following laparoscopic versus open colectomy for colon cancer. Diseases of the Colon & Rectum. 61:1156-1162. • Wilkins S, Yap R, Loon K, Staples M, Oliva K, Ruggiero B, McMurrick PJ, Carne P. (2018) Surgical outcome after standard abdominoperineal resection: A 15-year cohort study from a single cancer centre. Annals of Medicine and Surgery. 36:83-89. • Yeoh A, Bell S, Farmer C, Carne P, Skinner S, Chin M, Warrier S. (2019) Clinical evaluation of anal intraepithelial neoplasia: are we missing the boat? ANZ Journal of Surgery. 89: E1-E4.

Grants Held • Alan, Ada and Eva Selwyn Clinical Research Grant. ‘Personalised medicine for colorectal cancer patients:

PAG E 5 0

Utilisation of Organoid Technology, Tissue microarrays and Consensus Molecular Subtypes’. (2019-2020) $30,000, Koulis C, Engel R, McMurrick P. • Cabrini Foundation Research Grant. ‘Developing a new tissue-slice assay for modelling colorectal cancer tumours’. (2019-2020) $30,000, Wilkins S, Fletcher A, Knoblich K, McMurrick P. • Cabrini Foundation Research Grant. ‘Using patientderived organoids to guide the “watch and wait” nonsurgical approach for rectal cancer’. (2018-2019) $30,000, Engel R, McMurrick P, Abud, H. • Collie Foundation. ‘Patient reported outcome measures’. (2017-2019) $40,000, Wilkins S, McMurrick P. • Collie Foundation. ‘Human Organoids’. (2017-2019) $300,000, Wilkins S, McMurrick P. • Urquhart Charitable Fund. ‘Patient education with a view to expanding uptake of the National Bowel Cancer Screening program’. (2017-2018) $14,490, McMurrick P. • Victorian Cancer Agency. ‘Super enhancer templated RNAs as predicitive biomarkers of BET inhibitor sensitivity in prostate and colorectal cancer’. (2016-2018) $2,000,000, Firestein R, Azad A, Abud H, McMurrick P, Risbridger G, Wilkins S. • Cancer Australia. ‘Translating colorectal cancer organoids into patient care’. (2018-2020) $597,557, Abud H, Worthley D, Burgess A, McMurrick P, Firestein R, Gibbs P, Clevers H, Price T, Padbury R, Hewett P. • NHMRC Project Grant. ‘Role of Snail proteins in mediating intestinal stem cell identity’. (2016-2019) $646,698, Abud H, Hime G, Jones L, McMurrick P. • Monash Faculty of Medicine Platform Access Grant. ‘Characterisation of transcriptional alterations controlling colorectal cancer stem cell maintenance’. (2018) $11,500, Jarde T, Abud H, McMurrick P. • Margaret Walkom Trust. ‘Genetic Testing of colorectal cancer’. (2018-2019) $30,000, Koulis C, Wilkins S, McMurrick P.

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

Participants in the LBBC Golf Classic.

LET’S BEAT BOWEL CANCER Let’s Beat Bowel Cancer (LBBC) is a health promotion initiative of Cabrini. Our mission is to significantly lower deaths related to bowel cancer through prevention and research. Bowel Cancer, also known as colorectal cancer, is a leading cause of cancer death in Australia and has one of the highest (and increasing) incidence rates in the world. It is estimated in Australia in 2018 there were 17,004 new cases of bowel cancer diagnosed, and that globally the incidence of bowel cancer will increase by 60% by 2035. Approximately 90% of bowel cancer cases can be treated successfully if found early, however fewer than 50% are detected early. Our work mitigates suffering and ultimately, we hope, will help find a cure for bowel cancer. Through the LBBC initiative, we are campaigning for awareness, prevention and cure of bowel cancer.

L E T ’ S B E AT B OW E L C A N C E R

PAG E 5 1

Visiting Professorship 2018 The annual AL Polglase Visiting Professorship program hosted by the Cabrini Monash Department of Surgery was held 11-13 November 2018. Our Visiting Professor for 2018 was Professor Antonio de Lacy. Antonio is the head of the Gastrointestinal Surgery Service and Chief of the Minimally Invasive Surgery Department at the Hospital Clinic in Barcelona, and is regarded worldwide as a pioneer in the field of general surgery. The first day began with a hospital tour of Cabrini Malvern, showcasing the important features of the hospital, as well as the new improvements and developments. This was followed by an in-depth colorectal case discussion where details of complex surgical cases were presented by the Cabrini surgeons. Antonio shared his knowledge and experience, providing insight that will help to further develop our team here in the Department of Surgery. The entire team, including research fellows and surgeons, found it incredibly interesting and educational. The research team were then able to have a discussion over lunch with Antonio to present the research projects currently being undertaken in our program here at the Cabrini Institute. Database-related projects were discussed as well as our feature research programs such as the organoid project and the tissue microarray project. Antonio was very impressed with the efforts of the research team and was interested in learning of the progress and achievements of each projects. Antonio is in the process of capturing Patient Reported Outcome Measurements (PROMS) similar to the measurements being captured by our researcher Dr Christine Koulis, with potential collaboration in the future. An afternoon meeting with Antonio saw the research team and surgeons review the data captured on the colorectal neoplasia database over the 2017-18 financial year. This created a robust discussion that focused on data mining and research, prompting new potential research projects that the team will be investigating in 2019. The afternoon was then followed by a dinner at L’Hotel Gitan where surgeons from all over Melbourne were invited to hear Antonio present a lecture about the history of natural orifice surgical techniques. This technique has been gathering

Professor Antonio de Lacy delivering his keynote presentation.

PAG E 5 2

interest amongst the surgical community of late as it is suggested that these techniques have better patient outcomes in recovery. On the second day, Antonio was invited to visit our surgeons at work, where he could view the Cabrini operating theatre in action. The surgeons found this a fantastic way to interact with Antonio as he was able to view a live robotic surgery case sharing with us his expertise obtained from many years’ experience. To conclude the visit, Antonio presented an insightful and entertaining lecture on the future of education in surgery and how technology will change how our medical staff interact and learn in the future. It was amazing to learn of the exciting progress in this field, from fostering partnerships with large tech companies to the implementation of artificial intelligence and virtual reality for the innovation of education in surgery. The visit was an extremely successful one and made a great contribution to the ongoing professional development of Cabrini’s colorectal surgeons. The visit would not have been possible without the support of our major sponsor Medtronic.

Annual Golf Classic 2018 Last year’s LBBC Golf Classic was an outstanding success raising much needed funds for LBBC’s public awareness and research programs. The event continues to receive exceptional support from our loyal and committed sponsor group with 23 teams enjoying a round of 18 holes at the impeccable Kingston Heath Golf Club. The LBBC Fundraising and Golf Committees were thrilled to have Deague Group and Natural Selection Group return as our Platinum Partners together with our gold sponsors Anderson Partners, BDA Planning, Commonwealth Bank, Crestone Wealth Management, Fitzpatrick Insurance Brokers, Identity Matters, K2 Asset Management, Kay & Burton, Logical Staffing Solutions, Mercedes-Benz Berwick, Morgan & Griffin, Nike, Parklea, RMBL and our silver sponsors Bendigo Bank Dingley Village, Cevol Industries, Clinical Genomics, EnergyLease Australia, Florrie’s All Stars, Gibson Property Corporation, GolfSelect, Proclaim,

Andrew Gill with research scientists Dr Christine Koulis (middle) and Dr Rebekah Engel (right), discussing the Tissue Microarray research project at the annual LBBC Golf Classic.

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

ShineWing and SJB Planning. Without these sponsors the day wouldn’t be possible. Feedback has been overwhelmingly positive which is a tremendous outcome given the event is now in its 14th year. Research scientists Dr Christine Koulis and Dr Rebekah Engel attended on the day to present research from the Colorectal Tissue Microarray (TMA project). The Committee acknowledged the passing of LBBC’s golf patron Peter Thomson AO CBE, and Associate Professor Paul McMurrick paid tribute to LBBC’s retiring patron and founder Emeritus Professor Adrian Polglase.

June was bowel cancer awareness month and LBBC used this opportunity to raise awareness and fundraise for the Organoid Research project.

Let’s Beat Bowel Cancer Women’s Breakfast June was bowel cancer awareness month and LBBC used this opportunity to raise awareness and fundraise for the Organoid Research project. Currently we are trying to raise money to employ a new research assistant and buy new laboratory equipment to accelerate new organoid research. The breakfast brought together 60 successful women, including the brilliant women in our research team. The breakfast was held at Syracuse restaurant with special guest speaker the Honorable Lord Mayor, Sally Capp, who gave a heartfelt speech about her own brush with cancer. We had amazing support from our sponsors with the likes of Mars confectionary, Ark Clothing, Rutherford’s Jewellery, Specsavers and Red Rock Venues, as well as Basketcase who generously donated hampers towards what was a very successful raffle.

Supporting Men of Malvern As part of bowel cancer awareness month, we supported the Men of Malvern’s Men’s Health Expo called “Check the Male” held on 13 June 2019. Let’s Beat Bowel Cancer and Cabrini Health were there on the day to raise awareness of Bowel Cancer Screening and raise money for Bowel Cancer research. It was a great day with observers asking genuine questions about bowel cancer and bowel cancer tests and showing great interest in our research.

The Honorable Lord Mayor, Sally Capp (pictured centre back), with women at the LBBC Women’s Breakfast.

L E T ’ S B E AT B OW E L C A N C E R

PAG E 5 3

SZALMUK FAMILY PSYCHO-ONCOLOGY RESEARCH UNIT HEAD: PROFESSOR DAVID KISSANE AC

Our research interests cover the full trajectory of cancer experiences, including diagnosis, treatment decisionmaking, psychosocial factors that influence adjustment to cancer, unmet needs of cancer patients and their families, psychosocial interventions for people affected by cancer and psychosocial factors in the supportive care of cancer patients across the disease continuum.

$400K

in grant funding

publications

We have Dr Catherine Milvain as a consumer advisor to our collaborative care in treating depression where she serves on our steering committee.

Highlights One domain of particular study is the phenomena and experience of demoralisation wherein patient morale is lowered and their coping potentially challenged by the stress of their cancer diagnosis and treatment. We have validated a question and answer measure of demoralisation (known as a quantitative scale) and are now validating a clinical interview to facilitate making this diagnosis in the clinic. Our work has shown that patients are at risk of becoming demoralised when they feel trapped by what is PAG E 5 4

presentations

active clinical trials

happening to their illness. The demoralisation can occur as a stand-alone psychological state of distressed coping or it can develop into a co-morbid clinical depression. In both states, when patients feel hopeless and helpless, they may begin to wonder about the value and point of their life, with the risk that they give up prematurely in striving to have their illness treated. In parallel with this observational and diagnostic work on demoralization, we are undertaking a randomized controlled trial of a six session psychological treatment to restore hope, morale and meaning to the life of the patient. We call this therapy â&#x20AC;&#x153;Meaning and Purpose Therapyâ&#x20AC;? because it has the primary aim of restoring meaning to the life of the person, empowering them to live out their life as fully as possible, despite any disability resultant from their illness. Our earlier pilot work showed great promise C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

from this intervention, allowing us to proceed with a formal efficacy trial to confirm its genuine patient benefit. Such trials are labour intensive as they involve the training, supervision and fidelity maintenance of the therapy as it is delivered across several weeks by a number of psychologists. We are running the study across two sites (Cabrini and St Vincent’s Sydney) to help us get through this volume of work. With support from the Victorian Department of Health and Human Services (DHHS), we have also been running a collaborative care trial of oncology patients with depression, using a manualised cognitive-coping model of therapy. We train and supervise community psychologists to deliver this therapy, linking them to their GPs as needed for antidepressant medications, and thus building up a team of community psychologists better able to work with patients with cancer. This work has focused on Peninsula Hospital, Moorabbin Hospital and Cabrini Brighton, as there has been a relative paucity of psychology support in these suburbs. This is a demonstration project for the DHHS, whose evaluation will lead to the development of a larger proposal that could be implemented across Victoria. Our Cabrini Oncology Specialists have contributed videorecorded educational presentations aimed to help the community psychologists to better understand cancer and its treatment, thus increasing their comfort in delivering care to this clinical population. Such work can continue under Commonwealth-funded mental healthcare plans, coordinated by primary care physicians, once community psychologists increase their knowledge and confidence in working with patients with cancer. Over the last couple of years, Dr Clare O’Callaghan has led us in a qualitative and quantitative (mixed methods) study of spirituality in advanced cancer care. We have built up a data set and are analysing a spiritual concerns checklist to evaluate its utility in helping recognise patients who may be carrying unrecognized spiritual concerns as they journey with their illness. We have welcomed Associate Professor Seon Young Kim, an academic psychiatrist and psycho-oncology researcher from South Korea, who has been undertaking a

sabbatical with our research group to study Meaning and Purpose Therapy, with the intent of conducting a similar trial on her return to South Korea. We farewelled Dr Joanne Brooker who had worked with the unit for several years and moved across to a new position with the Monash Department of Epidemiology.

Our Research Development of a spiritual concerns checklist RESEARCHERS: O’CALLAGHAN C (PI), MICHAEL N, KISSANE DW

A spiritual concerns checklist will help identify patients with advanced cancer who may hold unrecognised spiritual concerns that could be readily addressed. Validation of a clinical interview for demoralization RESEARCHERS: BOBEVSKI I (PI), KISSANE DW, MICHAEL N

A structured set of questions that can be asked in a clinical interview to assist in the diagnosis of the mental state of demoralisation. Implementation of collaborative depression care in oncology RESEARCHERS: KISSANE DW, WONG Z , RICHARDSON G, O’CALLAGHAN C

Training and supervision of a team of community psychologists to deliver a psychological intervention to cancer patients with depression who might otherwise be unable to access this form of psychological help in their cancer care. Meaning & Purpose Therapy Randomized Controlled Trial RESEARCHERS: KISSANE DW (PI), LETHBORG C, BOBEVSKI I, MICHAEL N

A formal randomised controlled trial of a manualised psychological intervention delivered over six sessions to help restore morale and a sense of the value and meaning of the person’s life. Video tools to assist with advance care planning in cancer RESEARCHERS: MICHAEL N (PI), KISSANE DW, JIWA M, BURKE A

A video tool shown to patients and their carers in the advanced cancer setting to help them talk about advance care planning and assess whether this helps them complete a personal advance care plan.

Professor David Kissane AC, Head of the Szalmuk Family Psycho-Oncology Research Unit.

S Z A L M U K FA M I LY P SYC H O - O N C O LO GY R E S E A R C H U N I T

PAG E 5 5

Publications, Books, Book Chapters, Reports • Bobevski I, Kissane DW, Vehling S, McKenzie D, Glaesmer H, Mehnert A. (2018) Latent class analysis differentiation of adjustment disorder and demoralisation, more severe depressive-anxiety disorders, and somatic symptoms in a cohort of patients with cancer. PsychoOncology. 27(11), 2623-2630. • Bobevski I, McKenzie DP, Rowe H, Kissane DW, Clarke DM, Fisher J. (2018) Measuring postnatal demoralisation: adaptation of the Demoralisation Scale-II (DS-II) for postnatal use. J Reprod Infant Psychol. 36(5):561-577. • Chau R, Davison T, Kissane DW. (2019). Risk Factors for Depression in Long-Term Care: A Prospective Observational Cohort Study. Clinical Gerontologist. doi: 10.1080/07317115.2019.1635548 • Chau R, Kissane DW, Davison TE. (2019) Risk factors for depression in long-term care: A systematic review. Clinical Gerontologist. 42(3): 224-237. • Creighton AS, Davison TE, Kissane DW. (2019) The psychometric properties, sensitivity and specificity of the geriatric anxiety inventory, hospital anxiety and depression scale, and rating anxiety in dementia scale in aged care residents. Aging Ment Health. 23(5):633-642. • Hartung TJ, Kissane D, Mehnert A. (2018) COMSKIL Communication Training in Oncology-Adaptation to German Cancer Care Settings. Recent Results Cancer Res. 210:191-205. • Kaur R, Meiser B, Zilliacus E, Wong WKT, Woodland L, Watts K, Tomkins S, Kissane D, Girgis A, Butow P, Hale S, Perry A, Aranda SK, Shaw T, Tebble H, Norris C, Goldstein D. (2019) Evaluation of an online communication skills training programme for oncology nurses working with patients from minority backgrounds. Supportive Care in Cancer. 27:1951-1960. • Kissane DW. (2018) Dr Jimmie C. Holland, MD (19282017): A remarkable woman in medicine and cancer care. Psycho-Oncology. 27(5):1377-1378. • Kissane DW (2019) Terminal illness and Dorothy Ewing: Working with the Family. In JW Barnhill, Ed. Approach to the Psychiatric Patient. Case-Based Essays. Second Edition. Pp. 200-204. American Psychiatric Association Publishing, Washington, DC. • Kissane DW, Lethborg C, Brooker J, Hempton C, Burney S, Michael N, Staples M, Osicka T, Sulistio M, Hiscock H. (2019) Meaning and Purpose (MAP) Therapy II: Feasibility, acceptability from a pilot study in advanced cancer. Palliative and Supportive Care. 17(1): 21-28. • Lichtenthal WG, Catarozoli C, Masterson M, Slivjak E, Schofield E, Roberts KE, Neimeyer RA, Wiener L, Prigerson HG, Kissane DW, Li Y, Breitbart W. (2019) An open trial of meaning-centered grief therapy: Rationale and preliminary evaluation. Palliative Supportive Care. 17(1):2-12. • Lichtenthal WG, Maciejewski PK, Craig Demirjian C, Roberts KE, First MB, Kissane DW, Neimeyer RA, Breitbart W, Slivjak E, Jankauskaite G, Napolitano S, Maercker A, Prigerson HG. (2018) Evidence of the clinical utility of a

PAG E 5 6

prolonged grief disorder diagnosis. World Psychiatry. 17(3):364-365. • Lethborg C, Kissane DW, Schofield, P. (2019) Meaning and Purpose (MAP) Therapy I: Therapeutic processes and themes in advanced cancer. Palliative and Supportive Care. 17(1): 13-20. • Loughland C, Ditton-Phare P, Kissane DW. (2019) Communication and Relational Skills In Medicine. In L. Grassi, MB Riba, T Wise, Eds. Person Centered Approach to Recovery in Medicine. Insights from Psychosomatic Medicine and Consultation-Liaison Psychiatry. Pp. 163-176. Springer, Switzerland. • Manne S L, Kashy DA, Virtue S, Criswell KR, Kissane DW, Ozga M, Heckman C J, Stapleton J, Rodriguez L. (2018). Acceptance, social support, benefit-finding, and depression in women with gynaecological cancer. Quality of Life Research. 27(11):2991-3002. • Manne SL, Kashy DA, Zaider T, Kissane D, Lee D, Kim IY, Heckman CJ, Penedo FJ, Murphy E, Virtue, SM. (2019) Couple-focused interventions for men with localised prostate cancer and their spouses: A randomised clinical trial. British Journal of Health Psychology. 24(2): 396-418. • Michael N, Beale G, O’Callaghan C, Melia A, DeSilva W, Costa D, Kissane D, Shapiro J, Hiscock R. (2019) Timing of palliative care referral and aggressive cancer care toward the end-of-life in pancreatic cancer: a retrospective, singlecenter observational study. BMC Palliative Care. 18(1):13. • Moon F, McDermott F, Kissane D. (2018) Systematic review for the quality of end-of-life care for patients with dementia in the hospital setting. American Journal of Hospice and Palliative Medicine. 35(12):1572-1583. • Nanni MG, Caruso R, Travado L, Ventura C, Palma A, Berardi AM, Meggiolaro E, Ruffilli F, Martins C, Kissane D, Grassi L. (2018) Relationship of demoralization with anxiety, depression, and quality of life: A Southern European study of Italian and Portuguese cancer patients. Psycho-Oncology. 27(11):2616-2622. • Parker PA, Banerjee SC, Matasar MJ, Bylund CL, Rogers M, Franco K, Schofield E, Li Y, Levin TT, Jacobsen PB, Astrow AB, Leventhal H, Horwitz S, Kissane D. (2018) Efficacy of a survivorship-focused consultation versus a time-controlled rehabilitation consultation in patients with lymphoma: A cluster randomised controlled trial. Cancer. 124(23):4567-4576. • Pene CTH, Kissane D. (2019) Communication in cancer: its impact on the experience of cancer care: communicating with the angry patient and the patient in denial. Current Opinion in Supportive Palliative Care. 13(1):46-52. • Sanjida S, Janda M, McPhail SM, Kissane D, Couper J. (2019) How many patients enter endometrial cancer surgery with psychotropic medication prescriptions, and how many receive a new prescription perioperatively? Gynecologic Oncology. 152: 339-345. • Sanjida S, McPhail SM, Shaw J, Couper J, Kissane D, Price MA, Janda M. (2018) Are psychological interventions effective on anxiety in cancer patients? A systematic review and meta-analyses. Psycho-Oncology. 27(9): 2063-2076.

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

• Shaw J, Sethi S, Vaccaro L, Beatty L, Kirsten L, Kissane D, Kelly B, Mitchell G, Sherman K, Turner J. (2019) Is care really shared? A systematic review of collaborative care (shared care) interventions for adult cancer patients with depression. BMC Health Serv Res. 19(1):120. • Vehling S, Kissane D. (2018) Existential distress in cancer: Alleviating suffering from fundamental loss and change. Psycho-Oncology. 27(11):2525-2530. • Virtue SM, Manne SL, Criswell K, Kissane D, Heckman CJ, Rotter D. (2019). Levels of emotional awareness during psychotherapy among gynecologic cancer patients. Palliative and Supportive Care. 17(1):87-94.

Grants Held • Bethlehem Griffiths Research Foundation. ‘Validation of a clinical interview for demoralization’. (2019-2020) $50,000 Bobevski I, Kissane DW, Michael N.

S Z A L M U K FA M I LY P SYC H O - O N C O LO GY R E S E A R C H U N I T

• Cabrini Foundation Clinical Research Grant. ‘Validation of a clinical interview for demoralisation’. (2019-2020) $30,000 Bobevski I, Kissane DW, Michael N. • Victorian Department of Health & Human Services, Monash Partners Comprehensive Cancer Centre. ‘Implementation of collaborative depression care in oncology’. (2018-2019) $224,804 Kissane DW, Wong Z, Richardson G, O’Callahan C. • Cabrini Foundation Clinical Research Grant. Doreen Johnson Oncology Research Grant ‘Meaning & Purpose Therapy Randomized Controlled Trial’. (2018-2019) $50,000 Kissane DW, Michael N, Shapiro J, Brady B, Seah D, Brooker J, Bobevski I. • Cabrini Foundation Clinical Research Grant. ‘A pilot randomised control trial of a video decision support tool (VDST) for advanced care planning in cancer patient caregiver dyads’. (2019-2020) $45,000 Michael N, Kissane DW, Jiwa M, Burke A.

PAG E 5 7

VICTORIAN GOVERNMENT FUNDS A PILOT PROGRAM TO EXAMINE A COORDINATED SYSTEM OF CARE FOR CANCER PATIENTS SUFFERING FROM DEPRESSION Cabrini is celebrating the recent funding success for Professor David Kissane AC, Head of the Szalmuk Family Psycho-oncology Research Unit at Cabrini, who is leading a collaborative pilot project to assess the efficacy of implementing a sharedcare model for cancer-related depression.

Above: Team members of the shared care model for cancer-related depression project being run by the Szalmuk Family Psycho-Oncology Research Unit. From left to right, Genevieve Murphy, Oncology Research Nurse, Professor David Kissane AC, Head of the Szalmuk Family Psycho-Oncology Research Unit, Anne Loupis, Project Manager. PAG E 5 8

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

There is a significant shortage in the number of hospitalbased psychiatrists and psycho-oncologists practicing across hospitals, and thus there is an urgent need to increase the workforce capacity and improve access to consistent, high-quality psycho-oncology care for cancer patients.

Clinical depression is highly prevalent in cancer patients and survivors but is poorly recognised and treated in the cancer setting. International studies have determined that around 73% of cases go undetected, resulting in significant distress and reduced quality of life for patients. There is a significant shortage in the number of hospital-based psychiatrists and psycho-oncologists practicing across hospitals, and thus there is an urgent need to increase the workforce capacity and improve access to consistent, high quality psycho-oncology care for cancer patients. Shared care is a model that holds potential to relieve the care burden on acute hospital settings and to provide affordable services for patients and their families, close to where they live. Shared care is based on a teamdriven approach, in which a multidisciplinary group of healthcare professionals work in a co-ordinated fashion and are empowered to maximise the care of an individual patient. This patient-centric model focusses on healthcare quality, accessibility and value. The shared care cancer-related depression pilot model involves hospital-based oncologists and psycho-oncologists, specialty-trained community-based psychologists and general practitioners (GPs), working together to provide a coordinated system of care. The study will evaluate the feasibility and effectiveness of this shared care approach. The pilot is being conducted across a number of member hospitals, part of the Monash Partners Comprehensive Cancer Consortium (MPCCC) including Cabrini Health (Brighton), Monash Cancer Centre, Monash Health (Moorabbin) and Peninsula Health (Frankston).

of antidepressant medication based on provided algorithms. The project team liaise regularly with participating GPs to ensure communication of their patient’s progress and provide results of the cognitive therapy undertaken. The final phase of this project will involve evaluation of the patient data and the shared-care model.

Progress & Results

Making an impact

Twelve participating community-based psychologists, three clinical supervisors including psychiatrists, have attended training sessions led by Professor David Kissane AC. The full-day workshops (one per catchment area), focused on understanding cancer and the existential distress it causes, as well as familiarisation with the methodology and protocols applied in the pilot study. Oncology teams working at the three pilot hospitals routinely screen cancer patients using what is known as a ‘distress thermometer’ and refer those with symptoms of depression for further diagnosis and consent. Overall 22 patients have been recruited to the study. Over 100 individual therapy sessions have been completed by the trainee community psychologists (6-8 sessions per patient). Sessions are recorded and reviewed to ensure adherence with the study protocol. Regular supervision meetings are convened with participating psychologists to offer feedback and support. Each patient’s progress is carefully measured and monitored. To date, results show that patients have recorded an overall reduction in their Patient Health Questionnaire baseline score for depression. General Practitioners (GPs) have also been part of the pilot. They assist with prescription

The project is expected to have impact on several levels. Participating cancer patients suffering with clinical depression will benefit from access to coordinated supportive care teams that enable timely, affordable access to high-quality, cancer-specialised psychology services across three hospital sites, close to where they live. Hospitals will benefit from improved workforce capacity, new patient referral pathways and reduced waiting times as they build relationships with the participating community psychologists. Community based-providers will benefit from specialist training and expanded professional networks. Evaluation of this pilot study will also contribute higher learnings for the implementation of models of shared care that could be readily applied to other healthcare initiatives involving a multidisciplinary team that is spread across hospital and community healthcare providers. The shared care cancer-related depression project is being delivered through a collaborative effort across the Monash Partners Comprehensive Cancer Consortium (MPCCC). Professor Kissane is supported by the Cabrini project team members Anne Loupis, Anna Maciejewska and Genevieve Murphy.

FUNDING SUCCESS

PAG E 5 9

PALLIATIVE AND SUPPORTIVE CARE RESEARCH UNIT HEAD: ASSOCIATE PROFESSOR NATASHA MICHAEL

Palliative and supportive care promotes dignity in care by helping patients and families find comfort and meaning in their living. We strive to further research, develop robust evaluations and interventions, and partner collaboratively to ensure benefit to those who deserve the best care possible as they face their illness.

$125K

in grant funding

publications

Our research on pancreatic cancer has provided valuable knowledge on the current management of patients with this disease at Cabrini and identified areas for service improvement and development. The findings of our spirituality study have demonstrated the need to improve spiritual support for caregivers and highlighted the importance of the experience of hospitality, aesthetics and tone of care in the experience of spiritual care within our organisations.

Highlights We have strengthened our research capacity with the appointment of Professor David Kissane as Head of Palliative Care Research at the University of Notre Dame; fostered multisite collaborations, strengthening our relationships with St Vincentâ&#x20AC;&#x2122;s Health Sydney, Eastern Palliative Care,

PAG E 6 0

presentations

active clinical trials

and The University of Notre Dame and Hammond Care. We continue to invest in teaching and training of students from the University of Notre Dame and Monash University as well as advance trainees in Palliative Medicine and Geriatrics. We are participating in assessments and examinations, working closely with training bodies and specialist colleges.

Our Research Exploring the knowledge and attitudes of euthanasia and physician-assisted dying (EPAD) among ethnic minority groups RESEARCHERS: MICHAEL N (PI), NG A , Oâ&#x20AC;&#x2122;CALLAGHAN C, KISSANE D, MENDZ G.

Our research has demonstrated that despite patients from an East Asian background stating that they support EPAD,

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

Dr Clare O’Callaghan AM, Senior Research Associate with the Palliative and Supportive Care Research Unit.

Associate Professor Natasha Michael, Head of the Palliative and Supportive Care Research Unit.

many have a limited understanding of EPAD and consider withdrawal of fluid and antibiotics as constituting EPAD. We continue to explore the knowledge and attitudes of the Greek and Italian communities through engagement with local community groups.

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

Timing of palliative care referral and aggressive end-of-life care in pancreatic cancer. A retrospective, single-centre observational study RESEARCHERS: MICHAEL N, SHAPIRO J, BEALE G, O’CALLAGHAN C, DE SILVA W, HISCOCK R

Pancreatic cancer is a diagnosis associated with a poor prognosis. We completed a retrospective cohort analysis of end-of-life care outcomes of patients with pancreatic cancer who died between 2012 and 2016, benchmarking against key indicators of aggressive care in the last 30 days of life. Of the 278 eligible deaths, 67.3% were categorised as receiving a late referral to palliative care (<3 months before death). Those with late referrals were more likely to present to the emergency department and acute hospital particularly for symptom management and complications of cancer. Over half of the patients died in an inpatient palliative care unit. Understanding spiritual encounters and requirements of patients and caregivers with an incurable, serious illness RESEARCHERS: O’CALLAGHAN C, BROOKER J, DE SILVA W, CL AY TON J, WELTZ M, HISCOCK R, SEAH D, MICHAEL N

Our caregiver studies have been accepted for publication and have demonstrated the need for additional spiritual support. The study will be the first Australian study examining the spiritual wellbeing, concerns, and requirements of patients with incurable, serious illnesses, and their views about spiritual and/or religious support received in healthcare. Findings, based on what matters to patients, will be used to maintain and/or improve Cabrini’s spiritual care and religious activity, including determining whether any specific religious or no religious subgroup requires additional support.

PA L L I AT I V E A N D S U P P O RT I V E C A R E R E S E A R C H U N I T

RESEARCHERS: MICHAEL , N, O’CALLAGHAN C, MELIA A , MORTON N

This study will examine the feasibility of developing and implementing Schwartz Rounds at Cabrini Health. Schwartz Rounds are a unique, multidisciplinary forum where clinical caregivers discuss and process difficult emotional and social issues that arise when caring for patients and their families. Other institutions have shown the Schwartz rounds to have a unique and profound impact on participants. Participants have reported decreased feelings of stress and isolation, better insight into emotional and social aspects of patient care, an increased ability to feel and demonstrate compassion towards patients and overall increased readiness to respond to patients and families’ needs. Video tools to assist with advance care planning in cancer RESEARCHERS: MICHAEL N (PI), KISSANE DW, JIWA M, BURKE A

This pilot randomised control trial of a video decision support tool (VDST) for advanced care planning in cancer patient caregiver dyads has now recruited over 100 patientcaregiver dyads. Preliminary findings demonstrate that only a third of those offered the opportunity to complete an ACP are doing so with a further third deteriorating before an ACP is completed. We aim to recruit up to 15 patient-caregiver dyads for this study. Meaning & Purpose Therapy Randomized Controlled Trial RESEARCHERS: KISSANE DW (PI), LETHBORG C, BOBEVSKI I, MICHAEL N

A formal randomised controlled trial of a manualised psychological intervention delivered over six sessions to help restore morale and a sense of the value and meaning of the person’s life.

PAG E 61

Validation of a clinical interview for demoralisation RESEARCHERS: BOBEVSKI I (PI), KISSANE DW, MICHAEL N

A structured set of questions that can be asked in a clinical interview to assist in the diagnosis of the mental state of demoralisation. Professional and caregiver delivered massage therapy options in inpatient palliative care: a mixed method exploratory study

A retrospective review of methadone in the treatment of cancer induced bone pain RESEARCHERS: SULISTIO M, KWOK J, KEY S, WOJNAR R, MICHAEL N

This study examined the use of methadone in 107 Cabrini patients rotated to methadone for cancer-induced bone pain. It demonstrated a reduction in pain scores and overall opioid load post rotation.

RESEARCHERS: PRYDE K, BRUSCO N, O’CALLAGHAN C, WHITE J, MICHAEL N

This study explored the uptake of professional delivered massage with caregiver delivered massage, demonstrating patient preference for professional delivered massage.

Publications, Books, Book Chapters, Reports • Bailey, C, Doyle Z, Dearin J, Michael N, Kissane D. (2019) Demoralization and chronic illness in rural Australia: A crosssectional survey. Accepted Palliative and Supportive Care. • Brant JM, Fink RM, Thompson C, Li YH, Rassouli M, Majima T, Osuka T, Gafer N, Ayden A, Khader K, Lascar E, Tang L, Nestoros S, Abdullah M, Michael N, Cerruti J, Ngaho E, Kadig Y, Hablas M, Istambouli R, Muckaden MA, Ali MN, Aligolshvili B, Obeidat R, Kunirova G, Al-Omari M, Qadire M, Omran S, Mouhawej MC, Zouak M, Ghrayeb I, Manasrah N, Youssef A, Ortega PF, Tuncel Oguz G, Cajucona LA, Leaphart K, Day A, Silbermann M. (2019) Global Survey of the Roles, Satisfaction, and Barriers of Home Health Care Nurses on the Provision of Palliative Care. J Palliat Med. 22(8):945-960. • Kissane DW, Lethborg C, Brooker J, Hempton C, Burney S, Michael N, Staples M. Osicka T, Sulistio M, Hiscock H. (2019) Meaning and Purpose (MAP) Therapy II: Feasibility, acceptability from a pilot study in advanced cancer. Palliative and Supportive Care. 17(1): 21-28. • Michael N, Beale G, O’Callaghan C, Melia A, DeSilva W, Costa D, Kissane D, Shapiro J, Hiscock R. (2019) Timing of palliative care referral and aggressive cancer care toward the end-of-life in pancreatic cancer: a retrospective, singlecenter observational study. BMC Palliative Care. 18(1):13. • O’Callaghan C, Brooker J, deSilva W, Glenister D, Cert AM 4th, Symons X, Kissane D, Michael N. (2019) Patients’ and caregivers’ contested perspectives on spiritual care for those affected by advanced illnesses: a qualitative

PAG E 6 2

descriptive study. J Pain Symptom Manage. doi:10.1016/j. jpainsymman.2019.08.004. • O’Callaghan C, Michael N. (2019) Palliative caregivers’ spirituality, views about spiritual care, and associations with spiritual wellbeing: a mixed method study. Accepted American Journal of Hospice and Palliative Medicine. • Sulistio M, Wojnar R, Michael N. (2019) Propofol for Palliative Sedation. Accepted BMJ Palliative and Supportive Care.

Grants Held • Doreen Johnson Oncology Research Grant, Cabrini Foundation Clinical Grant Round ‘Meaning and Purpose (MaP) Therapy in Advanced Cancer Patients: A Multi-site Randomised Controlled Trial’ (2018-19) $50,000 Kissane D, Michael N. • Medical Oncology Research Grant, Cabrini Foundation Grant Round ‘A pilot randomised control trial of a video decision support tool (VDST) for advanced care planning in cancer patient caregiver dyads’ (2019-20) $45,000 Michael N. • Cabrini Foundation Clinical Grant Round ‘Using the modified Delphi method to establish expert consensus on optimising the applicability of The Code of Ethical Standards for Catholic Health and Aged Care Services in the clinical setting’ (2018-2019) $30,000 O’Callaghan C, Michael N, Fleming D, Symons X, Lynch S, Garner C, Kissane D.

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

Adelaide Melia, research team member in the Palliative and Supportive Care Research Unit

The findings of our spirituality study have demonstrated the need to improve spiritual support for caregivers and highlighted the importance of the experience of hospitality, aesthetics and tone of care in the experience of spiritual care within our organisations.

PA L L I AT I V E A N D S U P P O RT I V E C A R E R E S E A R C H U N I T

PAG E 6 3

ALAN, ADA AND EVA SELWYN EMERGENCY DEPARTMENT HEAD: ASSOCIATE PROFESSOR KATIE WALKER

Cabriniâ&#x20AC;&#x2122;s emergency medicine research program aims to evaluate innovative ideas that have the potential to be adopted nationally and internationally, particularly those that are patientoutcome and patient-experience focused.

$660K+

in grant funding

publications

This year we have shown how a cost-effective intervention can extend the reach of the emergency physician to 16% more patients for every shift worked, whilst moving patients through their emergency evaluation faster. We have tested communication-training workshops to improve medical communication skills and we have supported Monash engineers in testing a new, miniature wearable blood pressure device that may let us throw away uncomfortable blood pressure cuffs and invasive arterial lines. We have a patient-centered focus and partner with consumers in all our projects.

Highlights This year we are proud to highlight our scribe paper, which was the final manuscript in a series of publications that looked at whether providing an emergency physician with a scribe (clerical assistant) was a good idea. We published our

PAG E 6 4

presentations

active clinical trials

work in the British Medical Journal and were delighted with the international interest in the concept. Over 1.2 million people heard about the paper via Twitter and we achieved the highest multi-channel media exposure for emergency medicine research this year. We are excited to be starting some innovative projects. We have been awarded grants that will allow us to investigate whether using virtual reality tools can calm older patients who are distressed, hence reducing the rate of chemical sedation and physical restraints applied in emergency departments. We also have funding to evaluate the value of providing patients with accurate estimates of how long they have to wait to see a clinician when they visit an emergency department. In addition, we welcomed our first emergency medicine medical research trainee. We have the ability now to teach clinical research skills to our junior doctors and are happy to have this opportunity.

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

Our Research Emergency department wait time visibility project Emergency medicine looks after 8 million patients per annum in Australia. Almost everyone attending Emergency has to wait to see a clinician. A Monash Partners $250,000 research grant from the Medical Research and Futures Fund will be used to determine what wait-time information is important to patients whilst they are waiting and how to present information safely. We will use this communitycentered information to guide the design and evaluation of real-time predictive analytics, with an eventual aim of streaming waiting times to waiting rooms, patient phones and ambulance paramedics. Diverting public ambulance patients to private emergency departments during disasters Helping our community during disasters is important to Cabrini. During the Thunderstorm asthma event and the 2017 influenza outbreak, public hospitals were overwhelmed and unable to safely accept new patients. Cabrini emergency department opened its doors to public ambulance patients after partnering with the Department of Health and Human Services and Ambulance Victoria, to help get patients treated sooner and ambulances back on the road. We undertook a project to evaluate how this went from a patient, paramedic and emergency staff perspective. We

learnt what went well, what could be improved and have formal processes in place now, should the state need our help again. Epidemiological descriptions about emergency medicine patients and their outcomes Relatively little is known about which patients are treated in emergency departments across Australia and New Zealand and how this goes for the patients. For the first time, Cabrini emergency department has contributed data to two large international studies; ensuring private patients are represented in epidemiological work. We observed patients with septic shock for an ARISE study and patients presenting with a headache for the HEAD study. We are pleased to be able to contribute to large-scale, multi-centre research. Goals of care conversations in emergency medicine for patients approaching their end-of-life Patients may arrive critically unwell to emergency departments. We undertook a body of work to understand how emergency physicians should have conversations with patients about what care the patient would like to receive as they approach their end-of-life. Enabling shared decision making at end-of-life is likely to reduce burdensome and unwanted interventions for patients, reduce the stress levels and trauma experienced by patients and their families whilst also reducing the stress levels of healthcare workers.

Publications, Books, Book Chapters, Reports • Hanning J, Walker KJ, Horrigan D, Levinson M, Mills A. (2019) Review article: Goals-of-care discussions for adult patients nearing end of life in emergency departments: A systematic review. Emergency Medicine Australasia. 31(4):525-532. • Levinson M, Walker K, Hanning J, Dunlop W, Cheong E, Mills A. (2019) Medical perspectives regarding goals-of-care consultations in Emergency Departments. Psychology, Health & Medicine: 24(9):1137-1147. • Makinen M, Castren M, Huttunen K, Sundell S, Kaartinen J, Ben-Meir M, Renholm M. (2018) Assessing the discharge instructing in the emergency department: Patient perspective. International Emergency Nursing. 43:40-44. • Walker K, Ben-Meir M, Dunlop W, Rosler R, West A, O’Connor G, Chan T, Badcock D, Putland M, Hansen K, Crock C, Liew D, Taylor D, Staples M. (2019) Impact of scribes on emergency medicine doctors’ productivity and patient throughput: multicentre randomised trial. British Medical Journal. 364:l121. • Walker K, Johnson M, Dunlop W, Staples M, Rodda H, Turner I, Ben-Meir M. (2018) Feasibility evaluation of a pilot scribe-training program in an Australian emergency department. Australian Health Review 42(2): 210-217. • Walker K, Stephenson M, Dunlop W, Cheong E, Ben-Meir M. (2019) Australian private Emergency

A L A N , A DA A N D E VA S E LW Y N E M E R G E N C Y D E PA RTM E N T

Departments can assist Ambulance services by taking public emergency patients during surge and disasters: preliminary proof-of-concept. Emergency Medicine Australasia. doi: 10.1111/1742-6723.13328.

Grants Held • Australian Research Council Grant. ‘Wearable device design with continuous cuffless blood pressure measurement’. (2017-2019) $447,000, Joe K. • Telematics Trust. ‘Development of IT software to support next-day nurse follow up phone calls to patients discharged from the emergency department’. (2018-19) $50,000, Ben-Meir M, Joe K (AI), Walker K (AI). • Specialist Training Program Grant (Private Infrastructure and Clinical Supervision (PICS) program). ‘Cabrini Health practice ACEM (Australian College of Emergency Medicine) fellowship objective structured clinical examination’. (201718) $20,000, Horsfall D. • Auric Innovation Grant, Cabrini Health. ‘Development of customised distraction techniques for managing acute behavioural disturbance of elderly patients in the emergency department setting to limit use of chemical and physical restraint’. (2019-20) $146,993, Blecher G, Walker K, Joe K, Russo P, Kuhn L, Flynn D, Page R, Peisah C.

PAG E 6 5

INTENSIVE CARE RESEARCH UNIT HEAD: ASSOCIATE PROFESSOR VINEET SARODE

The Cabrini Intensive Care Unit (ICU) admits approximately 1570 patients per year following procedures such as cardiothoracic and abdominal surgery as well as medical admissions requiring multiple organ support. The average length of stay in our unit is 48 hours.

publications

presentations

Research in the ICU centres on questioning current practices and determining how we can get the best outcomes for our patients based on the evidence found. ICU research is increasingly trending towards examining patient outcomes post ICU discharge by following up patients for extended time periods to determine quality of life and disability as well as the standard outcome measures such as morbidity and mortality. Through this extended follow up of patients we hope to ascertain the long-term impact an Intensive Care admission can have on both patients and their families â&#x20AC;&#x201C; emotionally, physically, financially and socially. This would ultimately lead to standard practices and procedures possibly being changed or modified to ensure beneficial long term outcomes for our patients.

Highlights Cabrini is a part of a thriving ICU research community led by the Australia New Zealand Intensive Care Society Clinical PAG E 6 6

active clinical trials

Trials Group (ANZICS CTG). Our research team collaborates with multiple sites including Monash Partners, the Australia New Zealand Intensive Care Society Research Centre (ANZICS RC), Sunnybrook Research Centre in Toronto and the Medical Research Institute of New Zealand. Together with the Cabrini Physiotherapy team, we have commenced participating in a study investigating early mobilisation vs standard in the mechanically ventilated cohort of ICU patients. This again will aim to improve our patient outcomes for their ICU stay and beyond. We are also proud to have Associate Professor David Brewsterâ&#x20AC;&#x2122;s research surrounding collegiality amongst colleagues published. David has tried to encourage kindness amongst doctors to help with the reported issues of harassment and mental health concerns amongst the Australian medical workforce. Working with the Medical Journal of Australia and Associate Professor Bruce Waxman from the Royal Australian College of Surgeons, he has introduced the new handover acronym k-ISBAR (Kindness, C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

Associate Professor Vineet Sarode, Director of the Cabrini Intensive Care Unit.

Members of the Intensive Care Research Unit (left to right) Associate Professor Vineet Sarode, Director of the Cabrini Intensive Care Unit, Wendy Lake , ICU Nurse, Associate Professor David Brewster, Deputy Director Intensive Care Unit and Head of ICU Research, Dr Steve Philpot, Intensive Care Physician and researcher.

Introduction, Situation, Background, Assessment and Recommendation) which incorporates kindness into the standard handover process. We hope this will help the broader process of improving collegiality amongst medical staff in all hospitals and across specialties. Our staff were invited to speak at a number of conferences this year. Associate Professor David Brewster was invited to present the INTUBE study at the ANZICSCTG winter meeting held in Sydney. Associate Professor Vineet Sarode was invited to Chair the Critical Care Clinical Network Strategy session at a Safer Care Victoria day this year, and was an invited panel member at the Cabrini Q&A session on “Is frailty a better determinant of risk for surgery than age?” held in June. Professor Warwick Butt represented the team with poster presentations at the 2019 International Society on Thrombosis and Haemostasis Congress.

ultimately be treated with a shorter duration of antibiotics. We are currently in the recruitment phase of this study.

Our Research ANZ-CODE (Australia and New Zealand cardiac arrest Outcome Determinants and ECMO suitability study) RESEARCHERS: BREWSTER D, SIMPSON S

All code blue calls on the wards which are screened and those requiring cardio pulmonary resuscitation (CPR) reviews are then further screened for admission details, details of the cardiac arrest and outcome. Survivors of the initial cardiac arrest are then followed up in six months and are interviewed to determine survival status, functional status and quality of life. Analysis of the data for ANZ-CODE is currently being undertaken.

PREDICT (A registry of critically ill patients to determine predictors of disability free survival) RESEARCHERS: PHILPOT S, SIMPSON S

ICU patients who were mechanically ventilated for more than 24 hours will be contacted and consented after hospital discharge. The aims of the study are to: 1. Identify epidemiology of disability-free survival 2. Build a risk prediction model for disability 3. Measure long-term outcomes and economic consequences of critical illness for ICU patients ventilated over more than 24 hours, at six months after admission. The objectives are to measure and describe the longterm outcomes of critically ill patients in order to identify effectiveness of care in the wider community and costs associated with the burden on the community. PREDICT has now completed the data collection for the enrolled patients and we await analyses of the results. TRICS III EXTENSION STUDY (A follow up of patients who participated in the TRICS III study whilst undergoing cardiac surgery) RESEARCHERS: BREWSTER D, SIMPSON S

We are following up patients at 12, 18 and 24 months postsurgery, looking at any hospital readmissions as well as completing a quality of life survey. We have now completed follow up of these patients and are awaiting results.

BALANCE (Bacteraemia length actually needed for clinical effectiveness study)

SIQ

RESEARCHERS: SARODE V, BREWSTER D, MURPHY D, SIMPSON S

This study is a multicentre survey of the sources of health information used by surrogate decision-makers of patients admitted to the ICU. This study concluded in December 2018 and we are awaiting publication of results.

Upon confirmation of positive blood culture in the ICU, patients are randomised to receive seven days compared to 14 days of appropriate antibiotic. The purpose is to determine survival rates at 90 days and whether patients can INTENSIVE CARE RESEARCH UNIT

RESEARCHERS: SARODE V, SIMPSON S

PAG E 6 7

ICU ROX TRIPS (Standard versus intervention use of oxygen in mechanically ventilated patients, translating research into practice (TRIPS) study) RESEARCHERS: BREWSTER D, SIMPSON S

With the ICU ROX study now having completed recruitment, the focus shifts to translating research into practice. Do we change our practice in line with recommendations from research? Practice of clinicians was examined pre commencement of ICU ROX and will be looked at further now recruitment has finished and also after ICU ROX TRIPS has been published. TEAM (Treatment of invasively ventilated adults with early activity and mobilisation study)

with standard care in invasively ventilated patients in intensive care. We are currently in the recruitment phase for this study working in partnership with Allied Health including the physiotherapists and dietitians. INTUBE (International observational study to understand the impact and best practices of airway management in critically ill patients) RESEARCHERS: BREWSTER D, SIMPSON S

Cabrini ICU was the lead site for Australia and New Zealand in this study, collecting real time data when patients were intubated in the ICU or Emergency Department. INTUBE concluded enrolment in April 2019 with over 3000 patients enrolled worldwide. Analysis of results is currently underway.

RESEARCHERS: MURPHY D, SARODE V, BREWSTER D, PHILPOT S, SIMPSON S

This is a prospective multicentre phase III randomised controlled trial of early activity and mobilisation compared

Publications, Books, Book Chapters, Reports • Brewster DJ, Butt WW. (2019) Tracheal intubation in PICU: making it safe. Pediatric Crit Care Med. 20(1):79-81. • Brewster DJ, Waxman BP. (2018) Adding kindness at handover to improve our collegiality – the K-ISBAR tool. Med J Aust. 209(11):482-484. • Brewster DJ, Waxman BP. (2019) Letter to the editor (response). Adding kindness at handover to improve our collegiality – the K-ISBAR tool. Med J Aust. 211(2):93. • Clark M, Brewster DJ. (2019) Can doctors learn from super chickens? MJA InSight. https://insightplus.mja.com.au • Darvall JN, Durie M, Pilcher D, Wigmore G, French C, Karalapillai D, McGain F, Newbigin E, Byrne T, Sarode V, Gelbart B, Casamento A, Dyett J, Crosswell A, Vetro J, McCaffrey J, Taori G, Subramaniam A, MacIsaac C, Cross A, Ku D, Bellomo R. (2018) Intensive care implications of epidemic thunderstorm asthma. Crit Care Resusc. 20(4):294-303. • Edelman DA, Perkins EJ, Brewster DJ. (2019) Difficult airway management algorithms: a directed review. Anaesthesia. doi: 10.1111/anae.14779. • Low XM, Horrigan D, Brewster DJ. (2018) The clinical effects of team-training in intensive care medicine: a narrative review. Journal of Critical Care. 48:283-289. • McIlroy D, Murphy D, Kasza J. (2019) Association of postoperative blood pressure and bleeding after cardiac surgery. Journal of Thoracic and Cardiovascular Surgery. doi: 10.1016/j.jtcvs.2019.01.063. • Pereira-Salgado A, Philpot S, Schlieff J, O’Driscoll L, Mills A. (2019) Advance Care Planning Simulation-Based Learning for Nurses: Mixed Methods Pilot Study. Clinical Simulation in Nursing. (29):1-8.

PAG E 6 8

• Philpot SJ. (2018) Organ Donation after circulatory death following voluntary assisted dying: Practical and ethical considerations for Victoria. Critical Care and Resuscitation. 20(4):254-257. • Philpot SJ. (2019) Should an Advance Care Directive Refusing Life-Sustaining Treatment Be Respected after an Attempted Suicide? Development of an Algorithm to Aid Health Care Workers. Journal Law and Medicine. 26(3):557-570. • Philpot SJ. (2019) The Importance of Shared Decision Making: A personal experience. MJA Insight. https:// insightplus.mja.com.au • Sarode VV, Hawker FH. (2019) Design and organisation of intensive care units. In Bersten A, Handy J, Eds. Oh’s Intensive Care Manual. Eighth Edition. Pp. 3-10. Elsevier, China. • Soquet J, Chiletti R, Horton S, Konstantinov IE, Brink J, Brizard CP, Butt W, d’Udekem Y. (2019) Dismal Outcomes of Second-Run Extracorporeal Life Support in the Paediatric Population. Heart, Lung & Circulation. 28(3):450-454. • Tan SI, Brewster DJ, Horrigan D, Sarode V. (2019) Pharmacological and non-surgical renal protective strategies for cardiac surgery patients undergoing cardiopulmonary bypass: a systematic review. ANZ J Surg. 89(4):296-302. • Taylor A, Sarode V, Brewster DJ. (2018) Functional assessment tools in the intensive care unit: are we comparing apples and oranges? Anaesth Intensive Care. 46(6):627-6283.

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

Associate Professor David Brewster, Deputy Director Intensive Care Unit and Head of ICU Research.

Cabrini is part of a thriving ICU research community led by the Australian New Zealand Intensive Care Society Clinical Trials Group (ANZICS CTG). Our research team collaborates with multiple sites including Monash Partners, the Australian New Zealand Intensive Care Society Research Centre (ANZICS RC), Sunnybrook Research Centre in Toronto, and the Medical Research Institute of New Zealand.

INTENSIVE CARE RESEARCH UNIT

PAG E 6 9

CLINICAL DATABASE REGISTRIES Without some form of clinical audit, it is difficult to know if healthcare is being delivered efficiently or effectively and even more difficult to demonstrate to others. CABRINI MONASH COLORECTAL NEOPLASIA DATABASE

AUSTRALIAN RHEUMATOLOGY ASSOCIATION DATABASE (ARAD)

BRIGHTWAYS: A CABRINI BREAST CANCER SERVICE DATABASE

Data on almost

6523

Data for

4500

patients in database

bowel cancer patients has been collected from Monash affiliated hospitals Almost

Mean follow up time of each patient

bowel cancer patients are under the age of 50

5.27 years

1 in 10

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

Brightways: A Cabrini Breast Cancer Service Database Breast cancer is the most common cancer among Australian PAG E 70

1130

patients receiving treatment at Cabrini has been collected Information has been collected for

1570

patients referred to the breast MDT meetings at Cabrini

women and is the second leading cause of cancer related death in Australian women, after lung cancer. One in eight Australian women will be diagnosed with breast cancer in their lifetime. The rate of mortality is decreasing due to earlier detection by screening mammography and advances in treatment. Using the Brightways Breast Cancer Service database, we aim to monitor and improve the quality of breast cancer treatment and outcomes at Cabrini. The information is used to: â&#x20AC;˘ Compare variations in care and outcomes with clinical quality indicators â&#x20AC;˘ Provide feedback to participating clinicians C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

Karen Oliva, Database Manager of the Cabrini Monash Colorectal Neoplasia Database.

Ashley Fletcher, Project Officer for the Australian Rheumatology Association Database (ARAD).

• • •

Cabrini Monash Colorectal Neoplasia Database

Promote compliance with breast cancer guidelines Reduce unfavourable variation Support epidemiological studies and translational research The registry was established in November 2016 and data has been collected for 1130 patients receiving treatment at Cabrini. This database supports management of multidisciplinary team (MDT) meetings, decision-making, cancer staging and patient treatment recommendations in line with Victorian Cancer Service performance indicators. Clinicians receive patient clinical and treatment summaries prior to the weekly MDT meetings. The recommended care plan and staging are recorded at the meeting and the care team receives a record of their patient’s care plan. Data for 1570 patients referred to the breast MDT meetings at Cabrini has been captured. An audit has been conducted to compare hospital admissions data with our database to ensure all patients, treatment and outcomes are captured. In 2018, 99.8% of patients with a first diagnosis of early invasive breast cancer were referred for discussion at a breast MDT meeting. The database is a powerful tool for translational bioinformatics. Unlike other cancer databases, this database has been specifically designed to capture complexity and variation in tumour heterogeneity and hormone-receptor expression for core biopsies of primary and metastatic tumours. The database also collects vital outcome information including treatment modification, response to therapy, toxicity, disease progression, recurrence and cancer status at death. The information in our database will be integrated with research findings to identify new biomarkers for prognosis, improve our understanding of tumour behaviour and heterogeneity, rapidly evaluate the effectiveness of anti-cancer agents for specific tumour molecular subtypes and identify molecular subtypes and variation in hormone receptor expression, which may lead to a poorer response or drug resistance. C L I N I C A L DATA B A S E R E G I S T R I E S

Bowel cancer is a major cause of illness, disability and death worldwide. Complete and accurate data remain the key requirement to describe processes and outcomes of care for all patients with bowel cancer. The Colorectal Database Registry was established in February 2010 to capture data on patients who have undergone treatment for either bowel cancer or benign bowel neoplasia at Cabrini Health and the Alfred Hospital, as well as other Monash affiliated hospitals, including Peninsula Health and Monash Health, Dandenong. This initiative has been entirely driven and funded by Cabrini Monash University Department of Surgery. In 2013, the Colorectal Surgical Society of Australia and New Zealand (CSSANZ) was encouraged by the success of our database and developed the Bi-National Colorectal Cancer Audit (BCCA), a minimally scaled duplicate version, with participation from over 93 sites across Australia and New Zealand and now contains data on over 33,000 patients. Registries play a critical role in cancer surveillance allowing us to evaluate survival, new cases and deaths. The primary purpose of this surgical audit is to monitor outcomes and report on quality of care and report this back to the treating clinicians. Clinicians, researchers and others use audit data to answer questions like, “Are more or fewer people getting colorectal cancer this year compared to last year?”, “Is it safe to perform surgery on patients aged over 90 years of age?” and “Is there a relationship between obesity, diabetes and bowel cancer?” The role of the database manager is to also inform patients of the leading-edge research we are conducting in collaboration with laboratories at Monash Biomedicine Discovery Institute, Department of Anatomy and Developmental Biology. Patients willing to provide consent allow us to collect valuable clinical samples such as tumour and normal tissue, enabling us to undertake research projects as follows:

PAG E 7 1

Development of Tissue microarray (TMA) TMA is a powerful tool in translational research as it utilises high throughput technology to allow us to identify possible protein markers of colorectal cancer development and expression. TMAs allow multiple sources of tissue to be analysed simultaneously to enable the rapid identification of prognostic and predictive biomarkers resulting in improved patient management.

Sankey plot representing data from the Australian Rheumatology Association Database (ARAD)

Development of Organoids Organoids are miniature replicas of both cancer and normal tissue, grown in the laboratory, providing scientists with model systems to assist researchers to quickly identify and optimize targeted anticancer therapies. The impact of this research will enable clinicians, surgeons and patients to make informed choices on their treatment, helping patients to get the best possible outcomes, while sparing others from receiving costly and unnecessary treatment. A ‘personalised approach’ would transform the treatment and management of disease. Development of an innovative human tissue-slice assay This represents an exciting new model for studying the development of colorectal cancer, the tumour microenvironment and treatment resistance, and will be a novel platform for testing new drugs and immunotherapies. This again enables us to continue moving forward towards personalised medicine for colorectal cancer patients. A further highlight of this year: In September 2018, assessment of individual surgeon outcome data from the Cabrini Monash Colorectal Neoplasia database was initiated, reviewing the following parameters on a quarterly basis: 1. 30-day mortality 2. Re-admission rate 3. Return to theatre rate 4. Anastomotic leak rate The results demonstrated that rates remain acceptably low and stable for all four parameters with no surgeon falling outside 99.8% confidence intervals, representing a great achievement in surgical care.

Australian Rheumatology Association Database (ARAD) The Australian Rheumatology Association Database (ARAD) collects long-term observational data about the outcomes of Australians with inflammatory arthritis (rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and juvenile idiopathic arthritis). Its primary aim is to determine the long-term safety and effectiveness of biologic disease modifying antirheumatic drugs (bDMARDs).

PAG E 7 2

The graph demonstrates for each biological disease modifying antirheumatic drug (bDMARD), the percentage of patients who continue to take their bDMARD (50%), those that switch to another bDMARD (30%) and those that stop taking any bDMARD (20%).

Highlights over the year: In the last year we have presented data from ARAD at the American College of Rheumatology 2018 Annual Meeting (ACR 2018): Socioeconomic differences in opioid use; and the Asia Pacific League of Associations for Rheumatology/ Australian Rheumatology Association 2019 Congress (APLAR/ARA 2019): Attitudes and beliefs regarding methotrexate at ACR 2018, and cardiovascular risk using the Expanded Risk Score in Rheumatoid Arthritis (ERS-RA) calculator in Australian rheumatoid arthritis patients. ARAD supports 3 PhD students, 2 Rheumatology Advanced Trainees, 1 MD student and 1 Masters student. ARAD is also currently collaborating with the Australian Arthritis and Autoimmune Biobank Collaborative (A3BC), a large network of clinicians, researchers and scientists from across Australia who are working together to develop a national, data-linked, open-access biobanking network to integrate with the established ARAD questionnaire and data linkage framework. The primary objective of the A3BC is to expand the scope of the ARAD through updated questionnaires, an expanded disease focus, extended data-linkage capability and by collecting, processing and storing a broad range of high-quality biospecimens (e.g. blood, saliva, faeces) from existing and future ARAD participants to build Australia’s capacity to conduct powerful longitudinal, ‘multi-omic’, bigdata analytics-driven rheumatology research.

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

PROVIDING BEST CANCER MANAGEMENT FOR OUR PATIENTS – MULTIDISCIPLINARY TEAM MEETINGS Cabrini is committed to providing best practice management of patients with cancer. We provide personalised multidisciplinary care, from diagnosis to treatment, rehabilitation and recovery. Multidisciplinary team (MDT) meetings are a vital part of treatment planning and effective management of cancer at Cabrini. The following multidisciplinary team meetings are held at Cabrini: Cancer stream

Frequency

Breast Weekly Colorectal Fortnightly Haematology Fortnightly Lung Fortnightly Melanoma/skin Fortnightly Neuro-oncology Bi-monthly Upper GI

Fortnightly

The benefits of multidisciplinary care include: • Shorter timeframes from diagnosis to treatment • Improved coordination of care • Improved treatment planning • Improved communication and sharing of information • Identification of patient supportive care needs and other factors which may impact treatment and care • Recruitment for clinical trials and cancer research projects • Clinical data captured during MDT meetings is used for clinical audit and quality improvement • Educational opportunities for health care professionals At Cabrini, we strive to deliver a high standard of care by continuously measuring, evaluating and improving the quality of care. In 2019, our team of healthcare professionals participated in a multidisciplinary team meeting audit conducted by the Victorian Department of Health and Human Services. The aim of the audit is to monitor, enhance and support the quality, effectiveness and consistency of cancer multidisciplinary team meetings in Victoria. The breast cancer MDT is currently the highest subscribed meeting at Cabrini. Statistics show: Average number of patients referred per meeting

Minimum number of patients referred per meeting

Maximum number of patients referred per meeting 59 Total number of patients referred in 2017

658

Total number of patients referred in 2018

775

Our dedicated team of health professionals – surgeons, diagnostic experts, medical and radiation oncologists, breast care nurses, physiotherapists and counsellors - work together through breast MDT meetings to determine the best, individualised treatment and care plan for every patient. Our decision making is guided by our patients and their individual needs and preferences. Our collaborative team approach to cancer treatment ensures continuity of care throughout the patient’s cancer journey.

M U LT I D I S C I P L I N A RY C A R E

PAG E 7 3

Jess Radin, Deterioration and Resuscitation Clinical Educator with the Clinical Education Department. PAG E 74

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

SUPPORT SERVICES & EDUCA TION S U P P O RT S E RV I C E S & E D U C AT I O N

PAG E 75

CLINICAL EDUCATION DEPARTMENT The Clinical Education department has a centralised model of education with a core curriculum informed by organisational risk, workforce requirements and Cabrini’s customers.

11,710

student placement days offered in (FY) 18/19

graduate nursing positions offered in 2019

Our department develops resources and training programs for Nursing, Midwifery and Allied Health staff, ensuring quality standards are maintained throughout our organisation. Our focus is to provide educational opportunities that build a smart, change enabled workforce inspiring confidence, professionalism, expertise and excellence in clinical care.

Highlights Undergraduate Program Cabrini is a teaching hospital, providing clinical training opportunities for our future health professionals. Over the 2018-19 year, Cabrini provided 11,710 clinical placement days for nursing and midwifery students. We have strong primary partnerships for nursing and PAG E 76

6923

Basic Life Support Program recorded activity completions

143

courses and workshops to support professional development

midwifery with Monash University, Australian Catholic University (ACU) and ACU College. These partnerships are designed to support our workforce requirements and promote our nursing model of care across the organisation. A recent outcome of Cabrini partnerships is what has been affectionately called the ‘ACCENT program’, which stands for ‘ACU College and Cabrini educating nurses together’. This is indicative of our commitment to work together in partnership to shape the future of our nursing workforce. Collaborating with ACU College enables us to continue developing our enrolled nursing workforce, which supports our strategic direction and aligns with our organisational heritage and culture. The Diploma of Nursing qualification provides education and training at Melbourne’s ACU College campus and a unique opportunity for students to learn valuable practical skills through their clinical placements at Cabrini. In October 2018, we commenced our first program

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

Sarah Mann (left), Clinical Placement Facilitator with the Clinical Education Department, and ACU college student.

Interprofessional learning event.

intake with 15 students. These students have recently completed their three week aged care placement at our Ashwood campus. The Cabrini ACU Teaching, Learning and Research Collaborative continues to support our Clinical School for Registered Nurses. This collaboration assists students to maximise their learning potential and creates opportunities for staff to embed the students within Cabrini’s culture.

has offered transition programs for perioperative, cardiac, intensive care, respiratory and emergency nursing.

Transition to Professional Practice Program (Graduate Program) Our Transition to Professional Practice (TTPP) program for newly registered nurses, enrolled nurses and midwives is designed to ease the transition into the workforce. The program facilitates consolidation of clinical skills whilst enhancing critical thinking and clinical reasoning in a supported learning environment. The program incorporates simulation scenarios derived from Cabrini’s risk data, which focus on patient deterioration, communication skills and cognitive impairment. Our team provides learning opportunities and clinical support to over 50 graduates. In 2019, our graduate education team introduced midwifery specific study days to support our graduate midwives to develop speciality clinical skills and transition within Cabrini’s maternity service. On May 16 this year, Cabrini Institute welcomed over 200 prospective graduates at the 2020 Graduate Information evening. Cabrini’s clinical teams supported the event, showcasing their clinical specialities and what Cabrini has to offer for graduates. Transition to Speciality Practice Program Transition to Speciality Practice Programs enable Cabrini to extend opportunities for staff to gain employment within speciality areas such as our Perioperative and Emergency Departments in a structured and supportive program. Our dedicated Clinical Support Nurses facilitate these programs aiding staff to apply their new knowledge and skills in a safe learning environment. Over the past 12 months, Cabrini C L I N I C A L E D U C AT I O N D E PA RTM E N T

Transition to Respiratory Nursing Program The opening of Cabrini’s respiratory service in the Gandel Wing provided an opportunity for our education team to develop and implement a respiratory transition program to support our nurses. The eight-week program generated a unique learning opportunity for respiratory service staff through the provision of theoretical and practical learning opportunities that complement practice in the respiratory setting. Participants reported high levels of satisfaction with the program and identified their preparedness to succeed in their new roles. Postgraduate Programs Cabrini offers several postgraduate programs to support nurses to expand their scope of practice and pursue their personal and professional development goals. We offer courses in Cancer and Palliative Care (University of Melbourne), Emergency Nursing (Monash University), Intensive Care Nursing (Monash University), Perioperative Nursing (Monash University) and Cardiac Nursing (La Trobe University). We have dedicated Clinical Support Nurses who provide clinical learning opportunities to assist course participants to contextualise their academic learning. Clinical Support Nurses We have seven Clinical Support Nurse (CSN) roles across Cabrini designed to support novices, postgraduates and clinical staff. In addition to this we have a clinical facilitation team who provide support to our undergraduate students and their preceptors. Our Clinical Deterioration and Neurology and Cognition CSNs provide just-in-time training to clinical staff at the bedside in collaboration with our customers. CSNs utilise a customer’s clinical presentations to guide the content of the education session. This ensures staff PAG E 7 7

Alice Wandke, Neurology and Cognition Clinical Support Nurse with the Clinical Education Department, with prospective graduates.

Anie Abraham (left), Clinical Placement Facilitator with the Clinical Education Department, with ACCENT student (right) and patient.

receive the right education at the right time and can directly apply their learning. These roles have recorded over 1200 encounters with clinical staff across the Malvern, Brighton and Rehabilitation campuses. On 13 March 2019, our Neurology and Cognition CSN facilitated an interactive stand at our Malvern campus for World Delirium Awareness day. The stand raised awareness on how Cabrini staff can contribute to improving care for our patients with delirium and other cognitive impairments. Numerous staff and visitors engaged with the interactive stand enabling our CSN to support their learning needs.

Cabrini’s emergency response teams participate in immersive simulation scenarios to expand their clinical skills. This year we have introduced a new program structure that incorporates full-day and half-day refresher training to align with our workforce needs. The Basic Life Support program utilises the Laerdal Resuscitation Quality Improvement (RQI) simulation program to assess staff competence in basic life support skills. The program provides staff with objective, real-time feedback through verbal prompting and performance analysis. The resuscitation and deterioration educators ensure clinical staff have access to local clinical leaders for coaching, support and assessment. The Transition to Professional Practice Program provides a series of study days that incorporate simulation based training. The study day scenarios are developed using Cabrini’s risk and Clinical Support Nurse data in collaboration with our customer representatives. Our graduate educators receive overwhelmingly positive feedback about the benefits of these study days in equipping graduates with the skills they require to care for Cabrini’s customers. Our third and fourth year medical students regularly utilise the simulation centre to practice and refine their skills on the mannequins and part-task trainers before advancing to direct patient care.

Interprofessional Learning Our education team continues to refine our interprofessional learning program titled Medical Mystery. The program applies a problem-based learning approach using a three-stage evolving case study that reflects our customer demographic. Participants are required to determine care priorities and develop a plan of care that reflects interprofessional collaboration and customer partnership. This program’s point of difference is the active involvement of Cabrini’s Consumer Advisory Committee members. Our evaluation data shows 93% of participants believed involving the customer enhanced their learning experience, health literacy and communication. Participant satisfaction and self-perceived confidence benefits have also been demonstrated in the evaluation. Simulation Centre Cabrini’s simulation activities provide engaging learning opportunities, ultimately promoting the delivery of safe and high quality patient care. Staff and students have the opportunity to practice their skills in a safe learning environment prior to performing these clinically. Our simulation centre provides a training space for our adult, paediatric and neonatal advanced life support programs. As part of these programs staff working within

PAG E 78

Just-in-time recognising and responding to clinical deterioration Rick Peebles, our Curriculum Developer for Quality and Safety Education, presented his work on ‘Just-in-time’ training: an innovative education approach to recognising and responding to clinical deterioration’ at the Catholic Health Australia Nursing and Midwifery Symposium held in Melbourne in October, and at the Australian and New Zealand Association for Health Professional Educators (ANZAHPE) Conference held in July in Hobart.

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

TRAINING OUR NEXT GENERATION OF MEDICAL SPECIALISTS In 2018 Sarah Brazel, as a University of Notre Dame (UND) final year medical student, completed three rotations at Cabrini – Cardiology, Obstetrics & Gynaecology and Palliative care. Sarah was also our Cabrini/Notre Dame student representative and did a wonderful job of providing an open line of communication between Cabrini and the students. Sarah was the recipient of the Vice Chancellor’s Medal for 2017, first place Melbourne clinical school 2018 and University Medal 2018 – excellence for community service to the Notre Dame family for 4th year. Cabrini Institute would like to recognise Sarah’s achievements and thank her publicly for her contribution to Cabrini and the UND relationship. About Sarah “I grew up just outside of Tamworth, in regional NSW. I took a gap year after high school to work and travel as a pool lifeguard at a boarding school in the UK, before deciding that a Bachelor of Commerce at the University of Sydney majoring in Marketing would be the right fit for me – only slightly different to my eventual career choice! The road to medicine and UND As clichéd as it sounds, it was a volunteering trip that made me re-evaluate my career choices. I was travelling with a group of friends who were teachers and envied their practical, applicable skill set that could be of more help than mine. I had always thought I would enjoy Medicine, both the intensely human and privileged nature of the work and the constant learning. I am fascinated by why and how things work, but having done no science subjects in high school I always put it to the back of my mind as something unachievable for me. An older cousin of mine began Medicine at Uuniversity of Notre Dame after completing an Arts degree and, upon seeing her flourish in the environment, I set my own plans into motion. I was lucky to have been supported by the University and my teachers who valued me for the other things I could bring to the table apart from a science degree, and strong friendships with people with useful scientific and allied health skillsets and knowledge, who were patient with me and supported my learning in the early years. They created a positive environment for me to be passionate about what I was studying, and set me up for successes in later years.

T R A I N I N G O U R N E X T G E N E R AT I O N O F M E D I C A L S P E C I A L I S T S

The experience of studying at Cabrini On arrival at Cabrini, all medical students learn about the history, the mission and values of the hospital. This was unique to Cabrini in my experience, and a testament to the commitment of all staff to these values. As a student, some of my most impactful learning was done here, and the communication and clinical skills I learnt from my teachers I will take with me into my career. Overwhelmingly, in my three rotations with Cabrini, I witnessed and was part of compassionate, respectful patient care. In particular, my experience of Palliative Care was humbling and somewhere I could truly see patients at the forefront of healthcare decisions. As the UND student representative at Cabrini, I was privy to the collective experiences of the senior cohort who mostly had similar things to share. I was encouraged to be honest and speak plainly about the student experience. On the few occasions that there was any negative feedback I found it was received openly and managed proactively. It gave me confidence that Cabrini is a centre putting themselves at the forefront of a positive culture shift in our profession. After Cabrini and her future career I am currently over halfway through my Intern Year at St Vincent’s Hospital Melbourne. It has been an overwhelmingly positive experience so far- although I am currently finishing my 5th week of nightshift so those who live at home with me may not say the same! I am enjoying the additional responsibility and ability to make more meaningful contributions to patient care. I have felt supported by my colleagues and humbled by how much more there is to learn. I am hoping to pursue Physician Training and continue to unpack how things work and fit together as disease processes while always being aware of the patient as a person first, deserving of compassion, dignity, respect and simple kindness.”

PAG E 7 9

MEDICAL EDUCATION Medical education is thriving at Cabrini. Complementing a long-standing and successful Monash University undergraduate program, Cabrini has clinical rotations for medical students from the University of Notre Dame, multiple teaching programs for junior medical staff and targeted educational sessions for specialists.

registrars involved in the STP program

260+

medical students undertook clinical rotations in 2018

Our dedication to medical education aligns with the values and mission of Cabrini and creates a safe environment for education and the enrichment of the minds of our next generation of medical specialists at Cabrini. Monash University undergraduates As a member of the Central Clinical School for Monash University, Cabrini provides high quality clinical placements for students from Monash University’s Bachelor of Medicine and Bachelor of Surgery (MBBS) course. Associate Professor David Brewster and Jennie McInerney continue to develop and oversee the undergraduate educational program at Cabrini. Our excellence in education at Cabrini has seen outstanding undergraduate examination results for our students in the past few years, as well as fantastic clinician engagement from the dedicated specialists at Cabrini who give their time to teaching the students and welcome them into their consulting rooms, wards and operating theatres PAG E 8 0

to further their learning. We have a successful Cabrini Senior Medical Staff Association Student Research Scholarship program, which has seen over 20 Monash University students awarded scholarships in the past two years achieving numerous publications in peer reviewed medical journals. During 2018, approximately 260 Monash University students attended Cabrini for clinical rotations. Third-year program Up to 29 medical students simultaneously were placed at Cabrini for six-week rotations in various specialties of medicine and surgery at Cabrini Malvern in 2018. They had additional learning through a “Problem-Based Learning” program at The Alfred Hospital and an extremely popular Curriculum Enhancement program at Cabrini. Our Cabrini specialists donated their time and efforts to run a Local Lectures Series throughout the year. Naomi Snowden also ran procedural skills training and simulation teaching to C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

further complement their development. Students received a weekly bedside teaching session from their tutors and can apply for summer research grants. Fourth-year program Thirty two fourth-year students experienced a four-week paediatric rotation at Cabrini Health under the supervision of Dr Debbie Kipen in 2018. Approximately 70 students experienced a Women’s Health Mentor Week at Cabrini where they spent a week shadowing a Cabrini specialist. Fifth-year program Throughout the year, approximately 80 fifth-year students completed a six-week pre-intern rotation at Cabrini. These placements occurred in many medical specialties and general surgery. Our registrars and supervising specialists provided valuable guidance and preparation to these students. The students form a valuable part of the clinical team and contribute to patient care. They engage in multiple education programs (weekly case discussions, radiology sessions and registrar teaching programs) and learn how to function in inter-professional working environments. University of Notre Dame The University of Notre Dame medicine program is limited to post graduate students. This brings a wide range of experience and a more mature cohort to our student population. These students undertake their first two years of academic study at the University’s Sydney campus and then come to Melbourne for their two clinical years. Clinical placements continued in gynaecology/obstetrics, orthopaedics/rehabilitation, cardiology and palliative care medicine. The teaching by clinicians who volunteer to participate in these rotations is greatly appreciated by Cabrini, the University and the students. We ask students to vote for the “Student Choice Award for Distinguished Teaching at Cabrini” each year and the 2018 winners were Dr Meroula Richardson (winner in 2017) and Associate Professor Natasha Michael.

Junior Medical Staff Education - Specialist Training Program (STP) Cabrini continues to offer specialist training to Advanced Trainees across many areas of Cabrini including Intensive Care; Palliative Care; Emergency Medicine; Anaesthetics; Haematology; Medical Oncology; General Medicine; Geriatrics and Pathology. This program attracts a federal government grant towards the cost of the trainee salaries. Trainees rotate from the public sector for a semester at Cabrini where they have an opportunity to work in a private health environment. These trainees provide service to our patients and are an integral part of the care team. Most of the trainees are required to undertake a research project as part of their training and this gives them the opportunity to explore clinical questions related to Cabrini patients. The trainees teach our Monash University medical students. They are an important part of Cabrini’s culture and support our imperative to be a teaching and learning environment with a strong academic and research focus. We offer grants to supervisors each year to support the development of education programs tailored specifically to registrars. Dr Dane Horsfall has developed an education package to assist Emergency Department trainees’ success at practical examinations. Associate Professor Natasha Michael has supported the introduction of Schwartz rounds at Cabrini (giving structured debriefing opportunities for the clinical workforce). Dr Steve Philpot has developed and delivered communications workshops. Dr Tim Gray conducts a program entitled “transition to consultant” where he supports registrars to develop professional skills and sustainable models of practice. Senior Medical Staff Education – Quick Clinical Updates The Quick Clinical Updates series aims to provide education to our clinical workforce, particularly specialist trainees, about the translation of new research into practice across the specialties. We are grateful to the local Cabrini expert clinicians who deliver these excellent sessions. Sessions this year have included: • Using the immune system to kill cancer cells (Professor Gary Richardson OAM) • What’s new in radiotherapy? (Dr Ian Porter) • What’s new in rheumatology? (Professor Stephen Hall) • Asthma management in 2018 (Dr Ryan Hoy) • Contemporary multidisciplinary treatment of colorectal cancer (Associate Professor Paul McMurrick) • Voluntary assisted dying in Victoria: It’s coming but what do I say or do? (Associate Professor Natasha Michael) • CT cardiac angiogram (Dr Nathan Better) • Code grey (Dr Fergus Kerr) • Shared decision-making (Dr Steve Philpot)

(L-R) Donna Zhuang, Kit Foo and Yi May Cheah, medical students and recipients of Medical Staff Student Research Scholarships and poster prize winners at Research Week 2018.

M E D I C A L E D U C AT I O N

PAG E 8 1

PROVIDING EDUCATIONAL LESSONS AND RESOURCES FOR OUR STAFF AND WIDER COMMUNITY Cabrini is a strong supporter of education in healthcare and strives to provide resources and learning opportunities for our staff and our community.

13,097

full text articles downloaded from library

68,453

GP Lectures held

database searches accessed from library

The Lee & Brian Johnstone Library Providing a comprehensive and valued library and information service for Cabrini staff with patient care and research needs is the key priority of the operations of The Lee & Brian Johnstone Library. This year has been one of its busiest for the library, with increased usage, increased engagement with key stakeholders and increased attendance of staff at library training sessions. Highlights include: •

Research Skills Training – 13 Medical students who have successfully applied for the 2019 Cabrini Medical Staff Association Scholarships attended a two-hour workshop led by Associate Professor David Brewster and Librarian Di Horrigan. This workshop consisted of providing advice and skills required from planning and searching databases, Endnote Skills, using COVIDENCE software and finishing with the perils of publishing. Critical Appraisal Workshops were also well attended by Cabrini staff providing hands on exercises in using

PAG E 8 2

•

Q&A sessions held

various checklists and tools to appraise journal articles, websites and guidelines. Publication Output – The librarian has provided search strategies and expert advice to researchers and medical students which has resulted in the librarian being acknowledged as co-author of three published works.

Tan SI, Brewster DJ, Horrigan D, Sarode V. (2019) Pharmacological and non-surgical renal protective strategies for cardiac surgery patients undergoing cardiopulmonary bypass: a systematic review. ANZ J Surg. 89(4):296-302. Low XM, Horrigan D, Brewster DJ. (2018) The clinical effects of team-training in intensive care medicine: a narrative review. Journal of Critical Care. 48:283-289. Hanning J, Walker KJ, Horrigan D, Levinson M, Mills A. (2019) Review article: Goals-of-care discussions for adult patients nearing end of life in emergency departments: A systematic review. Emergency Medicine Australasia. 31(4):525-532. C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

Di Horrigan, Manager of Library Services for the Lee & Brian Johnstone Cabrini Library.

•

New Library Platform (Discovery) – With support from the Lee & Brian Johnstone Fund, the library has purchased a search engine (Discovery) that allows staff to search across all resources (databases, eBooks, websites, ejournals) from the one search portal. This has meant staff can quickly gather information to inform their clinical decision-making and research from one interface. Statistics are already demonstrating a great uptake on using this resource from all staff.

physiotherapist Dr Jason Wallis; “Arrythmias – an update” presented by Professor Peter Kistler; and “Abnormal LFT and cirrhosis” presented by Dr Dilip Ratnam. We are most grateful to all clinicians who give generously of their time and talents to share their knowledge with others in the Cabrini community. We have also commenced education sessions at some larger GP clinics and will evaluate this activity at the end of 2019.

GP Series

Q&A Program

We value our relationship with GPs who are the primary clinicians for Cabrini patients. We strive to ensure that Cabrini patients receive well-coordinated care as they transition from Cabrini care back to the community. One way we can strengthen these relationships is to offer RACGP accredited education to meet the needs of our GP referrers, helping them stay up to date with latest research and clinical practice. We record these sessions and upload them to Praxhub – a free online GP education platform. Sessions this year that drew the most interest from GPs included “Good living with Osteoarthritis from Denmark (the GLAD physiotherapy program)” presented by

Our Q&A program is designed to include the whole Cabrini community with education relating to the National Standards including the patient experience relating to all topics. The format usually begins with small presentations from an expert panel followed by questions and answers and conversation from all attendees. These sessions are recorded and available later to those who are unable to attend the session. The greatest audience numbers attended “Margin vs Mission – getting the balance right” in October 2018 and “What is Digital Health?” in April 2019. The Margin vs Mission question was led by our CEO Dr Michael Walsh and produced a lively and entertaining conversation.

P R OV I D I N G E D U C AT I O N A L L E S S O N S A N D R E S O U R C E S F O R O U R S TA F F A N D W I D E R C O M M U N I T Y

PAG E 8 3

IMPROVING HOW WE PREPARE FOR AND MANAGE HEALTH DISASTERS Diana Wong is an experienced emergency nurse with over 30 yearsâ&#x20AC;&#x2122; experience in emergency and disaster health. With an extensive career in emergency health and as the daughter of migrants impacted by World War II, she feels very strongly about making a difference to those suffering now and those who may suffer in the future as a result of disasters and conflict. This has driven her doctoral research which was aimed at improving the way in which disaster evaluations are undertaken and reported nationally and internationally, with the aim of reducing preventable mortality and morbidity in future events.

Above: Participants in a mock health emergency disaster conducted at Cabrini Health. PAG E 8 4

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

The risk of disasters resulting in mass casualties and affecting the lives of many communities continues to increase, as does the scale, frequency and impact of crises that demand international humanitarian response. Diana’s research will assist in reducing disaster risk to the international community by providing a standardised and comprehensive framework to structure disaster evaluations. Diana’s early work identified that some evaluation frameworks existed in the disaster setting, however they were mainly fragmented, uni-focused and not validated at an international level and not used to structure disaster evaluations and research. Her PhD research has subsequently led to the development and international validation of a comprehensive framework that would effectively inform disaster evaluations by providing structure, consistent terminology and standards for reporting to allow comparability of evaluations. The framework was developed with a health emergency lens, however it will provide benefits for the disaster, humanitarian and development sectors at an international level. Diana’s work emphasises the importance to evaluate the whole trajectory of a disaster. Far too often, the focus is only on the impact after the disaster, where after action reviews and root cause analyses are conducted. What many evaluations fail to look at is the entire timeline of a disaster, the whole disaster picture, including pre-disaster, disaster, and post-disaster. For example, baseline information predisaster (e.g. what populations are immunised for influenza) can inform post-disaster efforts (e.g. The highest casualty rates in the influenza outbreak were in nursing homes. We need to focus efforts on achieving a higher rate of influenza immunisation in nursing homes to potentially prevent higher casualty rates next time). Diana’s research has led to the development of a focused approach to comprehensively evaluate a disaster timeline which will assist in reducing the devastating losses that communities face each year as a result of disaster events. Diana is passionate about ensuring whatever we do in health is evidence based. Our healthcare system continues to surge with a population of patients who are sicker, placing increasing pressures on resources and time, meaning we need new ways to be efficient and effective in everything we do. When she is asked if she wants to be an academic or a practitioner, Diana’s response is she wants to be a “Pracademic”, someone who ultimately combines the practice and delivery of healthcare with academic processes to ensure we legitimise and provide evidence for best healthcare delivery. She wants to bridge the gap between research and what occurs in practice. Diana is currently a member of the operational emergency management team and an emergency nurse at Liverpool Hospital in Sydney, the second largest hospital in NSW and one of the leading trauma centres in Australia. Her aim is to build a career in disaster evaluation, such as post disaster needs assessments after large events. Diana volunteers with Team Rubicon Australia as the clinical lead for emergency medical team capability. Team Rubicon Australia brings together military veterans, emergency responders and motivated civilians to provide help and services to survivors and communities in need following disasters. They deploy both domestically and internationally to assist in disaster areas. Her aim is to combine her career as a practicing emergency nurse with formal positions such I M P R OV I N G H OW W E P R E PA R E F O R A N D M A N AG E H E A LT H D I S A S T E R S

What many evaluations fail to look at is the entire timeline of a disaster, the whole disaster picture, including pre-disaster, disaster and post-disaster.

as within government agencies to conduct official post disaster needs assessments nationally and internationally. She would also love to be involved in the World Health Organisation (WHO) Joint External Evaluations (JEE) that are being conducted around the world. The JEE is based on evaluating a country’s implementation of the International Health Regulations (IHR) and is a monitoring and evaluation framework. Australia’s most recent JEE of IHR compliance took place throughout 2017. Diana is very committed to disseminating and promoting her research findings to national and international agencies, and she has made her thesis open access to assist in promoting the framework https:// monash.figshare.com/articles/Development_and_ Validation_of_a_Comprehensive_Framework_for_Disaster_ Evaluation_Typologies/7767128 Diana continues to use evaluation workshops, contacts with international health organisations, and presentations at conferences to promote the framework. She engages at an international level with WHO in Health Emergency and Disaster Risk Management (H-EDRM) and works with Team Rubicon Australia, to leverage the broad network they cover. She has previously presented at the United Nations and more recently at the World Association for Disaster in Emergency Medicine where she met European colleagues who want to work together. She is also looking at opportunities to pursue further work with the evaluation methods she devised, by publishing a book, or developing Tool Kits and How to Guides. The intention is to keep engaging and building a network that will improve how we learn and be efficient and effective, and make a difference by reducing mortality, morbidity and suffering. Diana likens it to when people say you are an overnight success but it’s actually taken you many years to get there. In 2019, Diana completed her PhD at Monash University, a challenging endeavour given she was based in Sydney. She credits her supervisors at Monash University, Emeritus Professor Frank Archer and Dr Caroline Spencer, and is extremely thankful for the opportunity to work with her Cabrini PhD supervisor, Professor Lee Boyd, who she describes as a ‘God send,’ for her practicality, her great advice and great insight. PAG E 8 5

CABRINI HUMAN RESEARCH ETHICS COMMITTEE (CHREC) AND RESEARCH GOVERNANCE OFFICE Cabrini Human Research Ethics Committee (CHREC) and Research Governance Office is responsible for reviewing research proposals before the research can be conducted at Cabrini.

317

active research projects are currently underway at Cabrini

new research projects approved by CHREC and Research Governance in FY18-19

Cabrini Human Research Ethics Committee (CHREC) and Research Governance Office is responsible for reviewing research proposals before the research can be conducted at Cabrini. This is to ensure that research protocols are in accordance with the principles set out in the National Health and Medical Research Council (NHMRC) National Statement on Ethical Conduct in Human Research and Australian Code for the Responsible Conduct of Research, so that the interests of participants, researchers, the institution and the wider community are protected. The CHREC and Research Governance Team approved 81 project during the 2018-19 financial year. The vast majority of these projects were seeking to provide new information so that quality of care can be assured or improved. Approximately 20% of project applications were for new drug trials, which may lead to new or more effective treatments. Currently, Cabrini has 317 active research projects and 21 new submissions as well as numerous project amendments under review. PAG E 8 6

20%

of project applications were for new drug trials

Revised National Guidelines Both the National Statement and Australian Code have undergone significant revisions recently, taking into account such matters as requirements for data management, developments in research involving biospecimens, and genomic research. CHREC members have been kept abreast of these revisions so that research proposals are assessed against the most recent national guidelines. Research requires regular monitoring to ensure research conduct follows approved protocols and adheres to national standards, participants are advised when relevant new information arises, and any adverse events or deviations are reported with appropriate action taken if necessary.

Highlights CHREC Twilight Seminar The CHREC Twilight Seminar was held in August 2018 as part of ongoing training opportunities for CHREC members. C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

Internationally renowned health economist and Academic Director of the Australian Centre for Health Services Innovation Professor Nick Graves gave a very interesting and informative presentation on the wise use of scarce resources for healthcare. The seminar was well attended by CHREC members, as well as Cabrini staff and interested parties from several external health organisations. With demands for the health sector increasing but budgets not increasing, key concerns were discussed. Professor Graves raised interesting points about the disparity between need and allocation of resources, particularly how some funded programs may cause harm and/or wastage while programs proven to reduce costs and improve health benefits are not funded. He talked about how change for the better is difficult to enact in Australia, where political terms are short and party focus is on re-election rather than long term benefits. Strong lobbyists, media and consumer groups can influence policy, often with negative impact. The importance of conducting robust research that provides evidence for more efficient healthcare was highlighted, with clinicians being the ones able to drive positive change. New Processes With ever-increasing preference for electronic processes, CHREC has moved to paperless submission and review. From January this year, all research proposals have been accepted electronically. This has significantly reduced paper consumption and the need for expansive storage space. Researchers, committee members and office staff are able to access relevant project information through a dedicated secure database. The online platform allows access from any location with internet provision. Reviewers are able to view applications and submit comments remotely, at their own convenience. Cabrini is a member of Monash Partners and CHREC has been piloting the review of research projects through a joint platform model that uses ethics committees of partner organisations, Alfred Health and Monash Health. The aim has been to streamline the ethics review process. Following initial concerns, particularly related to timelines, and the quality of information for research participants, focus group discussions were held and a working party has been formed to develop mutually acceptable terms. Cabrini now has a

dedicated point of contact within the Monash Health HREC office to facilitate Cabrini applications and standardised participant information requirements are being developed. At the end of 2019, we expect to transition to review through the Monash Partnersâ&#x20AC;&#x2122; shared review model giving researchers the option of review through Alfred Health HREC or Monash Health HREC. Both these HRECs will be badged as Monash Partners HREC.

CHREC Membership Name Mrs Beatrice Bastomsky Mr Nir Bruner Ms Joanne Cheah A/Prof Henry Debinski Dr Gordon Donaldson AM Ms Ganga Narayanan Dr Dane Horsfall Dr Sophie Mepham Ms Emma Patterson A/Prof Val Usatoff Dr Katherine Walker

Category Lay Person Lay Person Professional Carer Researcher Lay Person Lawyer Professional Carer Researcher Pastoral Carer Professional Carer Researcher

Gender F M F M M M M F F M

Mr Robert Wojnar

Acting Chairperson

Retirements from CHREC During more than 11 years of service, Dr Staples made a significant contribution to CHREC. She first served on the committee as an experienced researcher and then continued for over eight as Chair of the CHREC. Dr Staples brought with her an invaluable breadth of scientific knowledge and experience and chaired meetings with great poise. She was a well-respected Chair and is truly missed. Mr Gleeson QC also made significant contributions to CHREC, particularly in consideration of genetic research and research around new legislation. He served as a member for almost three-and-a-half years, providing legal counsel and would step in as Chair on the odd occasion.

C A B R I N I H U M A N R E S E A R C H E T H I C S C O M M I T T E E (C H R E C ) A N D R E S E A R C H G OV E R N A N C E O F F I C E

PAG E 8 7

CHREC Projects Approved PROJECT TITLE

PRINCIPAL INVESTIGATOR

Surgery for Spinal Stenosis - A randomised, placebo controlled trial [SUcceSS]

Professor Rachelle Buchbinder

Monash partners Comprehensive Cancer Consortium (MPCCC) Cancer Donor Program

Dr David Pook

JASPER study: Junctional Arrhythmia in Slow Pathway ablation: end points and response

Professor Peter Kistler

Food Service satisfaction comparisons and benchmarking

Claire Matthews

Circulating tumour DNA analysis informing adjuvant chemotherapy in locally advanced rectal cancer: a multicentre randomised study (DYNAMIC-Rectal) [WEHI-ctDNA-11]

Associate Professor Jeremy Shapiro

Circulating tumour DNA analysis informing adjuvant chemotherapy in early stage pancreatic cancer: a multicentre randomised study (DYNAMIC-Pancreas) [WEHI-ctDNA-09]

Associate Professor Jeremy Shapiro

The development and use of an electronic patient self-reported outcomes app for recording adverse events during systemic cancer treatment

Professor Gary Richardson

TEAM: Treatment of invasively ventilated adults with early activity and mobilisation

Dr Deirdre Murphy

A phase 1 study of HLX20, a human monoclonal antibody targeting programmed death ligand 1 (PD-L1) protein [HLX20-001]

Professor Gary Richardson

A randomised, open-label, phase II clinical trial of relatlimab (anti-LAG-3) and nivolumab in combination with chemotherapy versus nivolumab in combination with chemotherapy as first-line treatment in patients with gastric or gastroesophageal junction adenocarcinoma [CA224-060]

Associate Professor Lara Lipton

A phase 3, open-label, randomised study to compare the efficacy and safety of luspatercept (Ace-536) versus epoetin alfa for the treatment of anaemia due to Ipss-R very low, low or intermediate risk myelodysplastic syndromes (MDS) in ESA naive subjects who require red blood cell transfusions [ACE-536-MDS-002]

Associate Professor Melita Kenealy

Investigating malnutrition in Victorian cancer services: malnutrition prevalence 2018

Kellie Wright

Identifying barriers to delivering compassionate care at Cabrini

Toula Saltas

Development of a comprehensive discharge process for overnight orthopaedic surgical patients at Cabrini Brighton

Susan Hewat

INTUBE: INternational observational study To Understand the impact and BEst practices of airway management of critically ill patients

Associate Professor David Brewster

Multi-centre observational descriptive study of current practice; the Australian Resuscitation in Sepsis Evaluation: FLUid or Vasopressors In emergency Department Sepsis observational study [ARISE FLUIDS]

Associate Professor Katie Walker

A pilot study assessing the impact of a dementia education program targeted to staff at Cabrini Brighton, Melbourne

Rhianna Kemm

A phase 1b/2 study of BMS-813160 in combination with chemotherapy or Nivolumab in patients with advanced solid tumors [CV202-103]

Professor Gary Richardson

Evaluation of transition to speciality nursing practice programs

Dr Geoff White

Pressure ulcer occurrence: A comparison of data sources

Professor Lee Boyd

Evaluation of Cabriniâ&#x20AC;&#x2122;s basic life support (BLS) program

Dr Geoff White

Evaluation of Cabriniâ&#x20AC;&#x2122;s undergraduate and transition to professional practice (graduate) programs

Dr Geoff White

PAG E 8 8

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

PROJECT TITLE

PRINCIPAL INVESTIGATOR

Targeted thromboprophylaxis in ambulatory patients receiving anticancer therapies for lung or gastrointestinal cancers: an investigator-initiated, open-label, multicentre, randomised, phase 3 trial [Target-TP]

Associate Professor Melita Kenealy

A cross-sectional examination of the association between caregiver’s burden and patient’s needs

Associate Professor Natasha Michael

Using the modified Delphi method to establish expert consensus on optimising the applicability of The Code of Ethical Standards for Cabrini Health and Aged Care Services in the clinical setting

Dr Clare O’Callaghan

Contextual inquiry related to continuous flush

Professor Lee Boyd

Submuscular transposition for symptomatic ulnar neuropathy

Gavin Davis

Fat injections for basal joint arthritis – A case series

Dr John Crock

Participation in outpatient programs results in cancellation of total knee replacement for multimorbidity patient. A Case Study.

Milly Bell

Meaning and purpose (MaP) therapy in advanced cancer patients: a multi-site randomised controlled trial

Professor David Kissane

The feasibility of implementing an innovative shared care model to treat cancer related depression in the community

Professor David Kissane

Longitudinal study of high intensity focused ultrasound (HIFU) for treatment of localised prostate cancer at Cabrini Hospital from 2007 to 2017

Associate Professor Peter Royce

Survey of research capability amongst Australasian College of Emergency Medicine accredited Emergency Departments

Associate Professor Katie Walker

Identifying predictive factors of complete pathological response in rectal cancer patients

Associate Professor Paul McMurrick

Exploring culturally and linguistically diverse community leader’s views on the voluntary assisted dying bill, a qualitative study

Associate Professor Natasha Michael

Determining the significance of Corynebacterium tuberculostearicum in clinical specimens

Jenny Couper

West Nile Virus encephalitis in an immunocompromised returned traveller

Dr Naomi Whyler

Understanding diagnosis and treatment of Oesophageal cancer in Victoria: improving outcomes for Oesophageal cancer patients

Associate Professor Lara Lipton

A phase 1a/1b study of FPT155 in patients with advanced solid tumours [FPT155-001]

Professor Gary Richardson

A phase 1/1b study to evaluate the safety and tolerability of immunotherapy combinations in participants with gastrointestinal malignancies [AB928CSP0003]

Professor Gary Richardson

A phase 1/1b study to evaluate the safety and tolerability of immunotherapy combinations in participants with breast or gynaecologic malignancies [AB928CSP0002]

Professor Gary Richardson

A pilot study assessing the impact of multi-component intervention program to optimise the care of patients with dementia at Cabrini Brighton

Rhianna Kemm

A clinical evaluation of ROSA knee 1.0 robotic total knee application

Dr Adrian Trivett

Australian and New Zealand massive transfusion registry [ANZ-MTR]

Associate Professor Vineet Sarode

C A B R I N I H U M A N R E S E A R C H E T H I C S C O M M I T T E E (C H R E C ) A N D R E S E A R C H G OV E R N A N C E O F F I C E

PAG E 8 9

CHREC PROJECTS APPROVED CONTINUED

PROJECT TITLE

PRINCIPAL INVESTIGATOR

Improving the manner by which patient falls are identified, reported and responded to by piloting the Soteria Falls Detection System

Professor Lee Boyd

Headache in the emergency department (HEAD Study)

Associate Professor Katie Walker

A phase 1/1b study to evaluate the safety and tolerability of immunotherapy combinations in participants with advanced malignancies [AB928CSP0005]

Professor Gary Richardson

Patterns of care for musculoskeletal conditions by general practitioners in Victoria, Australia

Romi Haas

Defining the T-cell suppressive mechanisms and phenotypic identity of cancerassociated fibroblasts

Associate Professor Paul McMurrick

Colorectal cancer in the young: rates of adjuvant therapy in those diagnosed below the age of 50

Associate Professor Paul McMurrick

A retrospective review of methadone for the treatment of cancer induced bone pain

Dr Merlina Sulistio

A phase 3, multicenter, randomized, double-blind, parallel, placebo-controlled induction study of mirikizumab in conventional failed and biologic failed patients with moderately to severely active ulcerative colitis (LUCENT 1) [I6T-MC-AMAN]

Associate Professor Henry Debinski

A phase 3, multicenter, randomized, double-blind, parallel-arm, placebo controlled maintenance study of mirikizumab in patients with moderately to severely active ulcerative colitis (LUCENT 2) [I6T-MC-AMBG]

Associate Professor Henry Debinski

A prospective evaluation of patient needs the day after discharge from Cabrini Emergency Department as determined by nurse telephone follow-up program

Associate Professor Katie Walker

Perioperative delirium screening of elderly patients admitted for elective cardiac surgery at Cabrini Malvern

Dr Joel Aizenstros

A phase 1a/1b multicenter, open-label, dose escalation, dose expansion study evaluating the safety, pharmacokinetics and activity of GDC-9545 alone or in combination with palbociclib and/or LHRH agonist in patients with locally advanced or metastatic estrogen receptor-positive breast cancer [GO39932]

Professor Gary Richardson

Retrospective review of cardiac surgery patients at Cabrini to identify modifiable causes of acute kidney injury (AKI)

Associate Professor David Brewster

Effect of inhaled nitrous oxide during cardiopulmonary bypass surgery on kidney function post cardiopulmonary bypass surgery

Justin Negri

Intensive care unit pain agitation and delirium standardised assessment and monitoring practice project

Catherine Cross

Authorised Prescriber - ALK Abello skin prick test reagents

Associate Professor Ian Glaspole

Authorised Prescriber - Inmunotek and Stallergenes Greer skin prick test reagents

Associate Professor Ian Glaspole

A pilot study examining mobilisation alarm utilisation for hospitalised adults at risk of falling; a trial feasibility study

Professor Lee Boyd

PAG E 9 0

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

PROJECT TITLE

PRINCIPAL INVESTIGATOR

Relative toxicity of immunotherapy in the elderly

Dr Gordon Ratcliff

Elements model of local area co-ordination

Ann MacRae

Australia and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation (CORE) intensive care registries

Associate Professor Vineet Sarode

Scaphoid plate fixations: comparative analysis of outcomes of new scaphoid fixation technique

Dr Konrad Lemke

Development of a diagnostic interview for psychological adjustment and demoralisation in medically ill patients

Professor David Kissane

Australasian Cardiac Outcome Registry (ACOR) Ltd TAVI Registry

Associate Professor Dion Stub

Feasibility of a physiotherapy program “Good living with osteoarthritis from Denmark” plus additional multidisciplinary interventions for people with hip and knee osteoarthritis, in a private hospital rehabilitation setting

James Sherwood

Study of anaplastic large cell lymphoma associated with breast implants

Dr Nicholas Houseman

The impact of age and screening on survival from colorectal cancer

Associate Professor Paul McMurrick

Clinician’s survey establishing interest and attitudes to referring patients to a cancer integrative lifestyle and wellness program

Dr Despina Handolias

ANZICS Point Prevalence Program (PPP)

Associate Professor Vineet Sarode

A phase 1b, open label, multicenter study evaluating the safety and efficacy of ipatasertib in combination with rucaparib in patients with advanced breast, ovarian or prostate cancer [BO40933]

Dr David Pook

Patient attitudes and interest in integrating diet, exercise and other lifestyle measures into their standard cancer management

Dr Despina Handolias

A multicentre qualitative evaluation of the impact of advertised Emergency Department (ED) wait time on ED patients, potential patients and other stakeholders

Associate Professor Katie Walker

Propofol for Palliative Sedation

Dr Merlina Sulistio

Correlation of different mutations and rate of progression in prostate cancer

Dr Gordon Ratcliff

In Situ Simulation Program

Rick Peebles

Evaluation of 5 day emergency department physiotherapy service pilot

Sophie Jennings

Moral injury in relation to immigration detention and post-migration difficulties in asylum seekers

Professor Suresh Sundram

C A B R I N I H U M A N R E S E A R C H E T H I C S C O M M I T T E E (C H R E C ) A N D R E S E A R C H G OV E R N A N C E O F F I C E

PAG E 9 1

CABRINI INSTITUTE TEAM Group Director Nursing, Clinical Education and Research Professor Lee Boyd

Biostatistician Dr Lucy Busija

Director of Institute Infrastructure Anne Spence

Assistant Managing Editor of Cochrane Musculoskeletal Dr Sheila Cyril

Director of Research Dr Emma Baker

Postdoctoral Research Fellows Dr Emma Gearon Dr Romi Haas Dr Aislinn Lalor Dr Liesl Nicol Dr Polina Putrik Dr Jason Wallis

Institute Administration and Infrastructure Jacky Fernandez, Coordinator Infrastructure Leesa Horrigan, Coordinator Engagement and Undergraduate Education Donna Li, Coordinator Postgraduate Education Michele Tonkin, Coordinator Scholarships, Grants and Communications Claire Turner, Cabrini Institute Receptionist Institute Health Data Management Justin Lang Mr Gilbert Shardey Cabrini Human Research Ethics Committee (CHREC) Grace Wijnen, Acting Manager, CHREC and Research Governance Deb Macdonald, CHREC Administrator Lee & Brian Johnstone Cabrini Library Di Horrigan, Manager of Library Services

Monash Department of Clinical Epidemiology â&#x20AC;&#x201C; Cabrini Director and NHMRC Senior Principal Research Fellow Professor Rachelle Buchbinder Deputy Director, NHMRC Translating Research into Practice (TRIP) Fellow, Senior Research Fellow and Director of Australasian Satellite of Cochrane Effective Practice and Organisation of Care (EPOC) Dr Denise Oâ&#x20AC;&#x2122;Connor Managing Editor of Cochrane Musculoskeletal Dr Renea Johnston Executive Officer of Centre of Research Excellence for the Australia & New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network and Postdoctoral Research Fellow Dr Allison Bourne

PAG E 9 2

Research Fellows Amanda Cross Melanie Hawkins, Honorary Research Fellow Tom Rozbroj Practitioner Fellow Dr Sam Whittle Australian Rheumatology Association Database (ARAD) Vibhasha Chand, Data Manager Ashley Fletcher, Project Officer Research Assistant and Assistant Managing Editor for Cochrane EPOC Jia Xi (JC) Han Administrative Assistant Cathy Matthews PhD Students Liana Cahill, La Trobe University Michael Di Donato, Monash University Caitlin Farmer, Monash University Bethan Richards, The University of Sydney Acknowledgement of Staff who have left (2018-2019) Dr Rebecca Jessup, Postdoctoral Research Fellow Dr Emma Tavender, Managing Editor of Australasian Satellite of Cochrane EPOC Ms Christina Geros, Assistant Managing Editor of Cochrane Musculoskeletal and EPOC Dr Teemu Karjalainen, Visiting Honorary Research Fellow Dr Margaret Staples, Biostatistician

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

Cabrini Monash University Department of Medical Oncology – The Szalmuk Family Department of Medical Oncology Head of Department Professor Gary Richardson OAM (Phase I trials, Gynaecologic Cancers, Lung Cancer) Principal Investigators Dr Yoland Antill (Breast Cancer) Dr Ben Brady (Melanoma, Lung Cancer) Dr Andrew Haydon (Gastrointestinal Cancers, Melanoma) Associate Professor Melita Kenealy (Haematologic Malignancies) Associate Professor Lara Lipton (Gastrointestinal Cancers) Dr David Pook (Genitourinary Cancers) Associate Professor Jeremy Shapiro (Gastrointestinal Cancers, Genitourinary Cancers) Associate Investigators Dr Michael Dickinson Dr Lucy Gately Dr Sanjeev Gill Associate Professor Ian Haines Dr Despina Handolias Dr Henry Januszewicz Dr Sem Liew Dr Esther Lin Dr Ben Markman Miss Joanna Morgan Professor Miles Prince Dr Tess Schenberg Professor Max Schwarz Dr Gaurav Srivastava Dr Robert Stanley Dr Karen Taylor Dr Mark Voskoboynik Dr Michelle White Associate Professor Max Wolff Senior Research Fellow Dr Tali Lang Research Coordinators Li Hoon Lai (Team Leader) Daphne Antonopoulos Demis Balamatsias Lyanne Cottee Theresa Ealdama Kate Hurford Simer Khaira

CABRINI INSTITUTE TEAM

Anna Uhe Rochelle Woods CTA Ethics Specialist Dr Luz Yévenes Family Cancer Clinic Stephanie Groube Lynne McKaye Brightways Breast Cancer Program Melissa Vereker, Data Manager and MDT Meeting Coordinator Jacqui Hastings, Acting Brightways Coordinator Acknowledgement of Research Coordinator Staff who have left (2018-2019) James Baker Melissa Groom Joe Miani Aish Murali Breegini Sahayanathan

Cabrini Monash University Department of Surgery, The Fröhlich West Chair of Surgery Head of Department - Fröhlich West Chair of Surgery Associate Professor Paul McMurrick Consulting Surgeons Mr Stephen Bell – Colorectal surgeon, Senior Lecturer Mr Peter Carne – Colorectal surgeon, Senior Lecturer and Director of Colorectal Fellowship Program Mr Martin Chin – Colorectal surgeon Mr Chip Farmer – Colorectal surgeon, Senior Lecturer Emeritus Professor Adrian Polglase Mr Pravin Ranchod – Colorectal surgeon, Lecturer Mr Paul Simpson – Colorectal surgeon Dr Gemma Solon – Colorectal Fellow Senior Research Fellow Dr Simon Wilkins Postdoctoral Research Fellows Dr Rebekah Engel Dr Christine Koulis Database Manager Karen Oliva LBBC Project Manager Tanya Gutteridge

PAG E 9 3

CABRINI INSTITUTE TEAM CONTINUED

PhD Student Mr Stephen Bell, Monash University

Alan, Ada and Eva Selwyn Emergency Department Director of Emergency Medicine Associate Professor Michael Ben-Meir Director of Emergency Medicine Research Associate Professor Katie Walker Emergency Physicians Dr Gabriel Blecher Associate Professor Keith Joe, IT lead Dr Hamish Rodda

Intensive Care Research Unit Director Intensive Care Unit Associate Professor Vineet Sarode Deputy Director Intensive Care Unit, Head of ICU Research Associate Professor David Brewster Intensive Care Physicians Professor Warwick Butt Dr Deirdre Murphy Dr Steve Philpot ICU Research Coordinator Shannon Simpson

Directors of Emergency Medicine Training Dr Dane Horsfall Dr Ian Turner

Centre for Allied Health Research and Education (CAHRE)

PhD Student Troy McGee, Monash University

Senior Research Consultant, Allied Health Dr Annemarie Lee

ACEM Trainee Dr Melanie Stephenson, Monash University

Allied Health & Ambulatory Services Clinical Educator; Allied Health Research Assistant Sophie Jennings

Medical Students David Cui, Monash University Ian Shijie Tan, Monash University

Cabrini Monash University Department of Nursing Research Director Associate Professor Philip Russo Former Head of Department Professor Lee Boyd Research Assistant Julia Caissutti PhD Students Tegwyn McManamny, Monash University Shanely Miranda, Deakin University Naomi Pratt, Deakin University Mani Suleiman, RMIT Pheona van Huizen, Monash University Sue Willey, Monash University Completed PhDs Dr Louise Alexander, Deakin University (2019) Dr Diana Wong, Monash University (2019)

PAG E 94

Honorary Research Fellows Associate Professor Helena Frawley Dr Tash Brusco Dr Kuan-Yin Lin PhD Students Lillian Krikheli, La Trobe University Edwina Lamborn, La Trobe University John Pierce, La Trobe University Masters Students Sophia Cotroneo, University of Melbourne Sophie Jennings, La Trobe University Helen Kugler, La Trobe University Jo McLeod, University of Melbourne Alyssa Waanders, University of Melbourne Kellie Wright, La Trobe University

Palliative and Supportive Care Research Unit Head of Department Associate Professor Natasha Michael

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

Senior Research Associate Dr Clare O’Callaghan AM Research Team Sonia Maleki Adelaide Melia Nerida Morton Genevieve Murphy Dr Merlina Sulistio

Szalmuk Family Psycho-Oncology Research Unit Head of Department Professor David Kissane AC Project Managers Anne Loupis Anna Maciejewska Oncology Research Nurses Genevieve Murphy Adelaide Melia Qualitative Research Fellow Dr Clare O’Callaghan AM Honorary Research Fellow Dr Irene Bobevski Honorary Research Associate Dr Carrie Lethborg PhD Students Associate Professor Natasha Michael, University of Notre Dame Felicity Moon, Monash University Doctor of Philosophy (Clinical Psychology) Students Rebecca Chau, Monash University Alexandra Creighton, Monash University

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

Curriculum Developers Tanya Harding, Clinical Education Rick Peebles, Quality and Safety Education Lauren Williams, Clinical Education Clinical Educators Abby Falla, Transition to Professional Practice Kristin Hamer, Midwifery Natalie Horvath, Perioperative Sophie Jennings, Allied Health and Ambulatory Services Jess Radin, Deterioration and Resuscitation Kelly Sherman, Undergraduate and Clinical Educator Deterioration and Resuscitation Louise Suttie, Transition to Professional Practice Clinical Support Nurses Margot Dobie, Perioperative Claire Loveridge, Clinical Deterioration Madeline Marcelino, Emergency Clare McCosker, Intensive Care Andrea McDonald, Cardiac Alice Wandke, Neurology and Cognition Michelle Wigg, Perioperative Irene Zhao, Perioperative (Maternity Leave) Undergraduate Clinical Placement Facilitators Anie Abraham Stefanie Adlam-Smeele Gail Iglesia Sarah Mann Marina Necoski Jodie Patrick Lindsey Potter

Department of Medical Education Clinical Dean, Cabrini-Monash University Clinical School Associate Professor David Brewster Clinical Site Administrator Cabrini-Monash University Clinical School Jennie McInerney Clinical Educator Cabrini-Monash University Clinical School Naomi Snowden

Curriculum Administrator Barb Miles

CABRINI INSTITUTE TEAM

PAG E 9 5

CABRINI INSTITUTE COUNCIL The Cabrini Institute Council is responsible for overseeing and advising on the Cabrini Institute’s clinical education, research and health promotion strategies and governance. The group brings a broad range of clinical and managerial experience to the Cabrini Institute Council’s governance role.

Professor Meg Morris

Professor Peter Fuller AM

Jason Aquilina

Member since February 2015, Chair from January 2019

Member since June 2005, Chair from May 2014, retired November 2019

Invitee since May 2019

Professor Meg Morris is a physiotherapist and fellow of the Australian College of Physiotherapists. She is Head of the School of Allied Health at La Trobe University, an Honorary Professor at Cabrini and an Honorary Professor at Melbourne Health. She is an international expert in ageing and neurological conditions such as Parkinson’s disease and is widely published. Professor Morris is known for her work on physical activity, exercise and dancing for people with Parkinson’s disease, as well as physical activities and strength training. She has strong international research collaborations in Italy, Ireland and Singapore.

PAG E 9 6

Professor Peter Fuller AM is a National Health and Medical Research Council Senior Principal Research Fellow at Hudson Institute in Melbourne where he is Associate Director, Head of the Centre for Endocrinology and Metabolism Research Group, and Head of the Steroid Receptor Biology Group. He is Head of the Endocrinology Unit at Monash Health and Adjunct Professor in Medicine and Biochemistry and Molecular Biology at Monash University. His research interests include understanding the molecular mechanisms of adrenal steroid hormone action and the molecular pathogenesis of endocrine tumours.

As Cabrini’s Chief Financial Officer (CFO), Jason has executive responsibility for Cabrini’s patient accounts, payroll, accounts payable, management accounting, private health funds and finance and treasury functions. Before joining Cabrini in 2011, Jason worked in transport and logistics, where he held multiple finance roles including leading the accounting teams for various large infrastructure and information technology projects. Jason is a certified practising accountant and holds a Bachelor of Business degree majoring in accounting and economics.

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

Dr Emma Baker

Professor Lee Boyd

Professor Rosemary Calder AM

Invitee since July 2015

Invitee from September 2014, Member since September 2015

Member since March 2019

Dr Emma Baker joined Cabrini in May 2015 and is the Director of Research. Emma has a research background in epigenetics and preclinical testing in cancer models and is a previous recipient of National Health and Medical Research Council and Cure Cancer Australia Fellowships. Her role includes organising the annual Cabrini Research Day and undertaking activities to strengthen the reputation of the Cabrini Institute and maximise its funding opportunities. Emma works closely with the Cabrini Monash University Department of Medical Oncology, the Szalmuk Family Department of Medical Oncology, in managing the clinical trials research activity.

CABRINI INSTITUTE COUNCIL

Professor Lee Boyd leads the Cabrini Institute, having joined the Executive Committee in August 2014 as Executive Director of Nursing and Cabrini Institute. She has a clinical background in critical care and began working at Cabrini in 2012 as Director of Education and Staff Development. Professor Boyd has more than 20 yearsâ&#x20AC;&#x2122; experience in health professional education. Previously, she worked at Monash University as Director of Academic Programs (Middle East) and Head of Department Community Emergency Health and Paramedic Practice. She holds postgraduate qualifications in education and critical care from Monash University and a Master of Tertiary Education Management from the University of Melbourne.

Rosemary Calder is a respected health and social policy expert. She has held positions as a senior executive in health policy and administration in both State and Commonwealth Departments of Health and was head of the Office for the Status of Women in the Commonwealth Department of Prime Minister and Cabinet from 2000 to 2003. Rosemary has also served as Chief of Staff to a Victorian Minister for Health. Rosemary leads the Australian Health Policy Collaboration at Victoria University, a national collaboration of public health experts, clinicians and organisations, aimed at evidence based policy leadership to reduce preventable chronic diseases in the Australian population. Rosemary has also worked extensively in and with nongovernment organisations in health and social issues. She is a sociologist and began her career as a journalist with The Age.

PAG E 9 7

CABRINI INSTITUTE COUNCIL CONTINUED

Kate Dennis

Professor Alison Hutchinson

Professor Judy Lowthian

Invitee since July 2018, retired March 2019

Member since November 2017

Member since November 2018

Professor Hutchinson is Chair in Nursing, Deakin Centre for Nursing Research at Monash Health, and Professor of Nursing in the School of Nursing and Midwifery at Deakin University. She is Deputy Director of the Deakin University Centre for Quality and Patient Research. Her research interests centre on translation of research evidence into clinical practice and the care of older people.

Professor Judy Lowthian is the Head of Research and Principal Research Fellow at Bolton Clarke (formerly known as RSL Care + Royal District Nursing Service); an adjunct Professor in the Faculty of Health and Behavioural Sciences at The University of Queensland, and Associate Professor in the School of Public Health and Preventive Medicine at Monash University, and in the Institute of Future Environments, Queensland University of Technology. Bolton Clarke Research Institute is embedded within one of Australia’s largest community health and aged care service provider that supports clients through community nursing, home support and residential aged care. Her research is underpinned by a 25year career as a speech pathologist and health service manager. Judy’s specific interest is health services research that is co-designed with end-users, to improve the quality and safety of care for older people. She is recognised internationally for her research in health services use and models of care.

Kate was Cabrini’s Financial Controller from March 2018 to May 2019 and was responsible for Cabrini’s financial accounting, compliance and treasury. Previously she was the Finance Director at MacMillan Science and Education for two years, a global trade book publishing company with prominent imprints around the world.

PAG E 9 8

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

Jeremy McCarthy

Professor Robyn E O’Hehir AO

Sophie Pennington

Member since February 2007, retired May 2019

Member since September 2010

Member since March 2019

Robyn is an academic consultant physician, educator and internationally renowned medical researcher with more than 30 years of experience in adult medicine. She is Professor/Director Respiratory Medicine, Allergy and Clinical Immunology (Research), Central Clinical School, Monash University and Alfred Hospital. Robyn has honours degrees in medicine and science and a doctoral degree. She is a fellow of the Royal Australasian College of Physicians, the Australian Academy of Health and Medical Sciences and the Royal College of Pathologists. Robyn was appointed an Officer in the Order of Australia ‘for distinguished service to clinical immunology and respiratory medicine, to tertiary education and to specialist health organisations’. She is a Member of the Australian Institute of Company Directors and sits on the Health Innovation Advisory Committee of the National Health and Medical Research Council. Robyn serves as a Director of Cabrini Health.

Sophie Pennington is a partner at HWL Ebsworth and heads up the Melbourne Health Group. She has over 20 years’ experience as a litigation lawyer, specifically in the area of professional negligence in the health sector. Sophie acts for public and private hospitals, pathology and radiology clinics and individual medical practitioners in negligence claims, Coronial inquests, disciplinary matters and employment disputes. She also advises on emerging health issues including voluntary assisted dying, electronic medical records and human rights issues in the health context. Prior to returning to private practice Sophie spent seven years in house at Australia’s largest medical defence organisation.

Jeremy McCarthy is a partner at national law firm HWL Ebsworth in its mergers and acquisitions group in Melbourne. He has extensive experience in corporate governance and general commercial matters and has drafted a broad range of commercial contracts. He advises clients in a range of industries, in particular the health sector.

CABRINI INSTITUTE COUNCIL

PAG E 9 9

CABRINI INSTITUTE COUNCIL CONTINUED

Sue Parkes Invitee since July 2015 Sue Parkes, Director of the Cabrini Foundation, has more than 20 years’ experience working in not-for-profit organisations including some of Australia’s leading nongovernment organisations. Sue has held leadership roles at Melbourne City Mission, Sacred Heart Mission, Brotherhood of St Laurence and Eastern Health. She has a strong commitment to social justice and is currently on the Board of the Fitzroy Learning Network.

Associate Professor John Santamaria Member since August 1996 Associate Professor John Santamaria is the Director of St Vincent’s Hospital Melbourne’s Intensive Care Unit. He is National and State President of the Australian and New Zealand Intensive Care Society. He was a member of the Cabrini Board of Directors for many years and served as Vice Chairman from September 2005 until October 2009.

Professor Julian Smith Member since July 2015 Professor Julian Smith is Head of the Department of Cardiothoracic Surgery at Monash Health, Head of Monash University’s Department of Surgery (School of Clinical Sciences at Monash Health) and Deputy Head of the School of Clinical Sciences at Monash Health. He has served as a Councillor of the Royal Australasian College of Surgeons. He is a consultant cardiothoracic surgeon at MonashHeart and has broad basic and clinical research interests in robotic and minimally invasive surgical techniques, acute kidney injury after cardiac surgery, utilising large databases to monitor patient outcomes and in surgical education.

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

Dr Michael Walsh

Professor Neville Yeomans AM

Member since December 2008

Member since February 2010, retired September 2018

Dr Michael Walsh has been Chief Executive of Cabrini Health since 2008. He has a distinguished career in hospital and health administration in Victoria, Western Australia, the UK and the Middle East. He is a medical graduate of Monash University and holds a Master in Public Administration from the Kennedy School of Government, Harvard University. He is a Fellow of the Royal Australasian College of Medical Administrators and the Australasian College of Health Service Managers.

CABRINI INSTITUTE COUNCIL

Professor Neville Yeomans AM is Director of Research at Austin Health and Emeritus Professor of Medicine (previously Foundation Dean) in the School of Medicine, University of Western Sydney. He is a gastroenterologist and a fellow of the Royal Australasian College of Physicians, American College of Gastroenterology and American Gastroenterological Association. His research has been mainly into the biology and pathology of the gastric mucosa, pharmacology of acid-related diseases and recently, medical education.

PAG E 1 0 1

SUPPORTERS The Cabrini Foundation is grateful to our generous supporters, both those listed and those who wish to remain anonymous.

Associates Georgina Barraclough John & Liz Bate The CR Brad Foundation The Sir Wilfred Brookes Charitable Foundation David Brookman Howard & Jenny Brown Mr Richard Carter AM Ben Chapman Stephen Charles AO Nelson & Julie Cheung celebrating our 50th Anniversary Mrs Margaret Coningsby Cornelis Van Ek In Memory of Ron & Joan Davies Brian Davis Brian M Davis Charitable Foundation Graham Geddes Mrs Diana Gibson John Graham Edith Greiman Dr Felicity Hawker AM Mrs Bernice Huggard Jean & Ern Ireland – Sea Bee Pty Ltd John T King & Lalla C King Joan Lavender Charitable Trust Mr & Mrs Simon & June Lubansky Mr Geoffrey Macwhirter Mr Brian Marshall Matear Family Beverly McGlead Modern Drive Engineering P/L In Memory of Judith Moir Mrs Margaret O’Driscoll Prof Robyn O’Hehir AO Armando Poli Lyn Punter Ralph & Ruth Renard Dr John Rogers AM & Mrs Rogers Richard Rogers & Ros Rogers OAM Mrs Sam Sharman Pamela Shotton – in memory of John Shotton Mr Michael Smith Paul & Rose Spano The Springwaters Foundation Geoffrey H Thomas Yvonne Thompson Joan And Roderick Thomson Alice Vaughan B & A Wain Walsh Family

PAG E 1 0 2

Donald W. Weir Marcia Williams Ms Margaret Wonson

Patrons John & Ruth Adamson Aquanita Racing Pat & Sheril Aughterson Mazda Foundation Besen Family Foundation Mr & Mrs Jack & Meg Bowen Ron Bunker & Evelyn Abaya Reginald & Audrey Campbell Caravan Industry Australia Victoria Trades Division Carter Family Foundation Chris Chadwick Estate Of Mrs Margaret Cochrane OAM Naja David & Family Dr Bruce & Mrs Pat Davis Downie Family Mary Drenen The Duggan Foundation Mr & Mrs Wal Edgar & Family The Marian & E H Flack Trust Gailey – Lazarus Foundation Mr Michael & Mrs Helen Gannon Eli & Kerry Goldfinger Grenda Foundation Dorothy Haines Mr Michael Halprin P & M Harbig (Holdings) Pty Ltd Mrs M Leuwin Harrison Peter Heffernan The George Hicks Foundation Trevor Holborow & Marnie Holborow Jacobs Thomas & Associates Dr Sharon Keeling Mr Doug Kefford AO Langton’s Pty Ltd Annie Rose & Andrew Lazar Foundation Lynette & Kevin Lee Mrs Barbara J Lewis Dr Norman Lewis The Lochtenberg Family Joan Loton The Lowthian Family Andy Lyas Men of Malvern Christopher Marriott In Memory Of Leigh Masel

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

Allan McNicol The Mezo Family Barry & Beatrice Moignard Charitable Trust Mr Bill Montague OAM & Mrs Elaine Montague Montague Group R M Morgan AM Mr Bernard Sweeney Max Edmond Walters Mr John & Mrs Pamela Murphy O’Connor Duffy Foundation The Pierce Armstrong Foundation Proclaim Management Solutions Pty Ltd John Reeves Drs Sue & Phil Ronaldson Rotary Club of Chadstone/East Malvern Rotary Club of Brighton Charitable Foundation Mr Daryl Somers OAM & Mrs Julie Somers OAM Jean St Leger Educational Scholarship Mr & Mrs Frank & Heather Stewart In Memory of Margaret Roff Sutton The Hall Family The Russell Foundation Dinah Tobias Mrs Valma Truin Urquhart Charitable Fund In Memory of Suzanne Vass Peter T. Wain & Family The Wallis Family Marie & John Warnock Mr Choo Keng Wee & Mrs Beverley Anne Wee The Werled Foundation In Memory of Julie Young

Benefactors John Allison Monkhouse Amgen Australia Pty Ltd AON Risk Services Australia Mr Nick & Miss Angela Baldi Beaconsfield & de Winter Families Bib Stillwell BMW W & G Bradshaw Trust John Christophersen Collier Charitable Fund Commonwealth Bank Of Australia - Corporate Financial Services Vic & Tas The De Luca Family David & Kristene Deague Mr Andrew C Facey Mr Geoff & Mrs Lesley Freeman

S U P P O RT E R S

Mr John Grossi Herschel Asset Management Limited Mr Russell Hutchinson Des & Cheri Jackson Jack & Sheila Jenner Kay & Burton Pty Ltd Eleanor Keamy & George Tate The Valda Klaric Foundation Mrs Judith Lang & The Gideon Lang Foundation Jeff Loewenstein Helen Macpherson Smith Trust Mr Colin & Mrs Jannene Madden Alison McElroy M McGauran Ron & Valerie McLaughlan MIA Victoria Doris Mohl OAM Mr Hugh Morgan AC & Mrs Elizabeth Morgan Paul Mullaly QC Mr Patrick Nalty The O’Donohue Family Paulusz Family Foundation Pharmacia Australia Prostate Cancer Foundation of Australia Elinor Rabinov Margaret & Tony Reeves Gary Richardson OAM Roche Products Pty Ltd Irvin Rockman CBE In Memory of Mrs Bella Rogers Rotary Club of Brighton Rotary Club of Malvern The Sanford Partnership Sanofi-Sythelabo Australia Pty Ltd Margaret Savill Alexander Slade The Brian Smith Endowment Smith & Nephew Pty Limited Margery E Snowball Sotheby’S Australia Spooner Family G & K Stansen Tattersall’s, The Estate of The Late George Adams Mr Stewart & Mrs Ingrid Webster Yarra Valley Travel Geoffrey Robin Westacott

Fellows Associated Retailers Limited The Bachrach Charitable Trust

PAG E 1 0 3

SUPPORTERS CONTINUED

In Memory of Jan Bucknall Charter Security Group The Alfred & Jean Dickson Foundation The Fryer Family Prue Gillies/Brian H Gillies Palliative Care Nursing Scholarship/Brian H Gillies Palliative Care Research Fund Richard & Susan Mizgala Ken Grenda AM & Margaret Grenda Mr & Mrs Higgins Mrs Kerrie Hunter & Family Mrs Dinah Krongold & Family Anthony & May Barry Dr Laurence LeWinn Foundation The Matthey Family Kylie Minogue OBE Missionary Sisters of the Sacred Heart of Jesus Christ Richard & Susan Mizgala Frank O’Shea OAM The Family of Duncan Powers In Memory of Marlene Regan The Sasse Family Mr & Mrs P Selzer & Family Signorino Family Victor Smorgon Charitable Fund Mr Brian J Sutton FCNA David & Chasya Tamir PF & RA Tomaino Dr Michael Walsh & Family

Partners The Michael & Andrew Buxton Foundation In Memory of Beverley Barlow Cabrini Medical Staff Lady Patricia Connelly Construction Engineering (Aust) Pty Ltd Maureen Coomber Marc & Bev Fookes Geoff and Helen Handbury Foundation Charles Holckner & Family – In Memory of Lily Harold Johnston OAM & Kay Johnston AM Jreissati Foundation Susan Kavals Memorial Mr David & Mrs Barbara MacDonald Mr Louis Managan AO & Cecile Mangan The McMurrick Family Peter Meese Cancer Nursing Fund Mr & Mrs Mark Newman Richard & Dorothea Nossbaum Ostomy Association Of Melbourne Inc The Phyllis Connor Memorial Trust Michael & Donna Tricarico & Family Wee Family

PAG E 1 0 4

Companions Aventis Pharma Pty Ltd Mr John Gandel AO & Mrs Pauline Gandel Mr Ian & Mrs Linda Gandel Ms Michelle Gandel Mr Tony & Mrs Helen Gandel Heartbeat Cabrini Inc. Mr Alan Jackson AO & Mrs Esme Jackson/Alan Jackson Nursing Research Fellow Mr John Laidlaw OAM & Mrs Betty Laidlaw Equity Trustees Limited Mr Angus Mackay Pfizer Australia Pty Ltd Mr David Mandie AM OBE Merrin Foundation Nigel Peck AM & Patricia Peck The Moniek Sambor Family Memorial Research Fund – The Sambor Family Alan, Ada & Eva Selwyn Family Richard Smith The Stewardson Charitable Trusts Mr George & Mrs Mira Szalmuk Szalmuk Family Department Of Medical Oncology Mrs Anne Wollach-Szalmuk Mr Geoff Szalmuk Mrs Simone Szalmuk-Singer The Simonds Family Neville & June F.M. Smith Dr David & Mrs Lisa Thurin Mr & Mrs Joseph & Helena Frőhlich West/Frőhlich West Chair Of Surgery

In Memoriam Dr Katrina Bottomley Walter Lyle Fish Kerrie Hunter Patricia Janes Dr Angela Marks Mrs Christine Potts Joyce Reed Timothy Russell In Memory of Richard John Savill In Memory of John Selwyn, Our Beloved Husband & Father, from his Wife & Daughters Charlotte Tait Kevin Elias In Memory of George & Mira Szalmuk – The Szalmuk Family

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

Bequests In Memory of Claire Abrahams Estate of Gustav G.H. Apituley Estate of Ellen M Balderstone Estate of Nola Barnes Estate of Elaine Louise Benger Estate of Carmel Mary Blanton Estate of Doris Elaine Boyd Mrs Ann Brewer Estate of Rosina Violet Brown Estate of Nance Nevasa Buchanan Estate of Maxwell Chapman Estate of Agnes Ferguson Clark Estate of Annie Marjorie May Clarke Roger John Cleary Estate of Joyce Mena Coxall Estate of John Lawrence De Yong Estate of John Robert Edwards Estate of Dr Betty Elliott Estate of Carl & June Simpson Estate of Dr Maureen Mackay Estate of Barbara Feil In Memory of Hubert Frances & Margaret Mary McCarthy Estate of Harold Francis Estate of U M Frawley Estate of Dorothy Cecelia Garbutt Estate of Pamela Golding Estate of James Arnold Hancock Estate of John Sutherland Hamling Estate of Diana Mary Harcourt Estate of Pamela Mary Harper Estate of Noel Arthur Hatherly Estate of Mary Kathleen Hauser Estate of Doris Mary Hawkless Estate of Kenneth Swanson Hewitt Estate of Doreen Johnson Estate of Heather Jones

S U P P O RT E R S

Estate of Valda Irene Keil Estate of Irene Kozica Estate of Belinda Lim Estate of Alison Loftus-Hill Estate of Gweneth Mabel Estate of Robert Mackey Estate of Dr Maureen Florence MacKay In Memory of Mrs Katherine Jane Mactier Rita Anversa Magris Estate of Brian Charles Mander Estate of Katherine Mander Estate of Alice Mann Estate of Lynette Manzie Estate of June Masson Frances Maria Miltenov In Memory of Kiril Miltenov Estate of Marjorie May Murdoch Michael Lloyd Niall Estate of Rex Oxnam Estate of Leslie Charles Parkinson Estate of Domenico Romeo Pertile Estate AV Powers Estate of Lindsay G Quinn Estate of William Clifford (Peter) Rawlins Paula & Alexander Reinders Estate of Margaret Rickard Estate of Alexander Graeme Robertson Estate of Grace Saunders Mrs E C Seccull Estate of Alan Selwyn Estate of Leslie Alfred Shapland Estate of Maria (Lina) Concetta Sinelli Bella Taft Estate of Hugh L Wallace Estate of Wilma Elsa White Estate of Betty Geddes Wood

PAG E 1 0 5

Cabrini Mission

The Cabrini Institute Mission

Who we are: We are a Catholic healthcare service inspired by the spirit and vision of Saint Frances Xavier Cabrini and the Missionary Sisters of the Sacred Heart of Jesus.

The Cabrini Institute is committed to improving the clinical outcomes of patients of Cabrini. It embraces the mission, values and vision of Cabrini and works within an ethical framework. The Cabrini Institute has a vital role in helping Cabrini to achieve its vision – that is:

What we believe: We are a community of care, reaching out with compassion, integrity, courage and respect to all we serve. What we do: We provide excellence in all of our services and work to identify and meet unmet needs.

Cabrini Values

“We will provide clinical excellence by learning, researching and continuously improving the quality of our care, and having motivated staff committed to our healthcare mission . . . We will enhance health and quality of life by treating sickness, and by working with our patients and their families to anticipate, prevent and ease suffering.”

Our values form the base of our mission, are built around what we believe and drive how we act. They are drawn from Saint Frances Xavier Cabrini’s life and reflect her heart, her spirit, her conviction and her approach. Compassion: Our drive to care is not just a professional duty to provide excellent quality care but is born of a heartfelt compassion for those in need, motivated by God’s love for all people. Integrity: We believe in the power of hope to transform people’s lives and remain faithful to the bold healing mission and legacy of Saint Frances Xavier Cabrini. Courage: We have the strength, determination, vision and conviction to continue the work of Mother Cabrini and the Cabrini Sisters. Respect: We believe that every person is worthy of the utmost respect and the best possible healthcare. We know that our resources are entrusted to us to use for the benefit of others.

PAG E 1 0 6

C A B R I N I I N S T I T U T E A N N U A L R E P O RT 2 0 1 8 -1 9

Key partners of the Cabrini Institute

Australian Catholic University (ACU) ACU College Cancer Trials Australia (CTA) Capital Markets Cooperative Research Centre (CMCRC) Digital Health Cooperative Research Centre (DHCRC) La Trobe University Monash University Swinburne University University of Melbourne University of Notre Dame Monash Partners Academic Health Science Centre (known as Monash Partners)

Cabrini Institute

154 Wattletree Road Malvern Victoria 3144 Australia ph (03) 9508 3434 email: institute@cabrini.com.au www.cabrini.com.au