Early-Mid Career Fellowships

In Australia, 6% of adults have diabetes mellitus (DM), which is associated with a doubled risk of heart attack, precipitated by atherosclerotic cardiovascular disease. In the past 25 years, the prevalence of DM in Australia has more than tripled and projected to rise.

An estimated one-third of young adults will develop DM during their lifetime, translating to increased risk of cardiovascular (CV) events.

Despite the high CVD burden associated with DM, the pathways responsible for elevated risk are incompletely understood. CV risk factors often seen in conjunction with DM include
hyperglycaemia, atherogenic dyslipidemia, insulin resistance and low-grade systemic inflammation - all of which may contribute to platelet and myeloid hyperactivity. Platelet hyperactivity is independently associated with long-term mortality and CV events. Notably platelets from DM subjects are more hyperreactive and less responsive to current antiplatelet, antithrombotic-based therapies.

Dr Barrett has recently found that platelets primarily associate with macrophages in atherogenesis, the inflammatory hallmark of lesions, and directly mediate myeloid inflammatory responses accelerating atherogenesis [12, 13]. Moreover, Dr Barrett has found myeloid cells and platelets to be hyper-inflammatory in DM indicating these interactions are exacerbated in DM.

Dr Barrett’s research proposes that an unbiased approach to assess DM platelet hyperactivity will provide insight into the mechanisms by which they contribute to unresolved inflammation, an increasingly appreciated risk factor for CVD. Additionally, this approach is likely to facilitate the development of a new class of therapeutics to suppress platelet inflammatory potential (i.e. distinct from therapies that curtail their thrombotic actions, aspirin & P2Y12 inhibitors) translating to reduced platelet-mediated inflammation in CVD, especially in those with DM.

Heart Disease in Women has been universally described as “under recognised, under treated and under researched.” Australian and international evidence demonstrates poorer outcomes for women with heart disease as well as an extreme paucity of data on female-predominant heart conditions.

Dr Zaman will build a nationally leading and internationally recognised program of research that improves outcomes for women with heart disease. This program of work will be most successful by gaining the mentorship from experienced clinical researchers within the Westmead Applied Research Centre (WARC) of The University of Sydney and, by locating it within a population of need in the Western Sydney Local Health District; a socioeconomically disadvantaged area with a culturally and linguistically diverse population.

Dr Zaman’s two research flagships are (i) atherosclerotic heart disease in women and (ii) improving care of Female-Predominant Cardiac Conditions. The potential impact will be discovering new interventions for women’s heart disease including the development of innovative models of care. Ultimately, these findings will be translated to clinical guidelines and address the large burden of cardiac disease in women.

Professor Jason Kovacic is among the world’s leading authorities on PHACTR1, with his studies demonstrating the key role of this gene in multiple vascular diseases including fibromuscular dysplasia (FMD), spontaneous coronary artery dissection (SCAD) and coronary artery disease (CAD). Due to its profound complexity, prior research efforts spanning almost a decade have struggled to understand this critical gene. In response, Prof. Kovacic has set about to systematically understand PHACTR1 and wishes to establish a cutting-edge program of research in NSW to finally understand its causative mechanisms.

To do so, he has created unique mouse models where the entire PHACTR1 gene is deleted. Partnering with an Australian mouse engineering company (Ozgene), this important resource is now validated ready for immediate transfer to NSW and the VCCRI to facilitate these studies. The vital importance of these studies is underscored by the multiple vascular diseases where a role for PHACTR1 has been shown, including FMD, SCAD, CAD, migraine, cervical artery dissection and hypertension. Thus, the patient populations that stand to benefit from his proposed studies are substantial. PHACTR1 is a causative gene in multiple vascular diseases that afflict a broad spectrum of our population. Due to higher rates of obesity and smoking, CAD, a focus area of this proposal, disproportionately affects socioeconomically disadvantaged groups. Furthermore, PHACTR1 is also involved in the pathobiology of FMD and SCAD – both being diseases that affect women at about a 10:1 ratio over males. Thus, the proposed studies are of major relevance for priority population groups in NSW.

The sympathetic nervous system (SNS) is a key regulator of cardiovascular (CV) and metabolic function. Targeting the SNS to inhibit its activation therefore has great potential to improve both CV and metabolic health. A pioneer in exploring potential therapeutic targets to inhibit SNS activation, Professor Schlaich currently leads a first-in-human study to assess the BP lowering effect of transluminal ablation of the carotid body (CB) and is involved in a first-in-human study of catheter-based hepatic denervation to improve glucose metabolism in patients with T2DM. Mechanistically, he has demonstrated a link between SNS activation and other drivers of CV and metabolic disease such as the immune system14,15. This work provides the foundation for the proposed highly innovative research program. Prof Schlaich will utilize the University of Sydney’s resources to perform further studies and translate these novel therapeutic approaches and technologies into clinical practice. The program’s 5 projects are highly likely to result in significant knowledge gain and changes in clinical practice within 5 years.

Gene therapy, or the use of genes as medicine, has immense therapeutic potential in the treatment of many genetic diseases and cancers that are currently difficult or impossible to treat. While progress in the development of the underpinning gene transfer technology (vectors) has been hard won, we are finally witnessing astounding successes in human clinical trials in both children and adults.

This in turn has led to a global upsurge in clinical trial activity for a vast number of troubling diseases, and unprecedented demand for gene transfer vectors prepared to the exacting GMP manufacturing standards required for human clinical use. This demand has dramatically out-stripped supply and has created a clinical trial log-jam that threatens to slow the realisation of therapeutic benefit to the many potential beneficiaries of gene therapy.

This project will develop CAR T cells to target a broad range of paediatric tumours, and CAR T cells to protect kidney transplants from chronic allograft nephropathy, as well as gene viral vectors to target blinding eye disease and to treat childhood kidney disease. This will allow us to quickly initiate desperately needed paediatric trials for cancer, eye and kidney disease.

Bone marrow transplants (also known as blood stem cell or stem cell transplants) are the only way to cure the worst types of leukaemia and lymphoma in adults and children.

Patients undergoing bone marrow transplant often die of infection rather than the disease for which the transplant was performed because for a year or more after the transplant, the patient’s new immune system is immature and does not function properly.

Cell therapy involves growing infection and malignancy fighting cells called T-cells in the laboratory, training them to recognize infection and disease, and then giving them to patients soon after the transplant. The idea is to make the patient’s immune system functional and strong soon after transplant and to avoid the period when the patient is most vulnerable to dying.

The proposed clinical trial will test the theory that adding cell therapy to standard antibiotic treatment for infection in patients after bone marrow transplant will improve the immune system leading to better control of serious infections, less serious illness and fewer deaths.

In Australia chronic pain is estimated to cost over $30 billion per year to the overall economy, and current therapies do not adequately address pain for most patients.

The primary aim of this proposal is to generate GMP-grade clinic ready transplant material and then test the safety and efficacy of this material in rodents and large mammals. By moving these new technologies to the pain clinic, we can start to provide some relief to the millions of people currently living with untreatable and devastating chronic pain.

We have developed a long-lasting stem cell therapy that can reverse neuropathic pain, and here we will develop this technology for human use.

The adeno-associated virus (AAV) is gaining widespread use in gene therapy due to its ability to safely and efficiently deliver a genetic payload into a broad range of tissues.

In the clinic, AAV has successfully been used to treat patients with the bleeding disorder haemophilia by delivering a good copy of the Factor IX gene to replace a faulty copy in patient livers. Limitations of previous studies have included a failure to achieve a sustained therapeutic dose and recognition of the AAV particle by the host immune system.

While these problems have been addressed by designing custom AAVs, a tremendous opportunity still remains to further boost therapeutic efficacy by identifying the specific cell entry mechanism or receptor used by AAV’s. We will identify the specific receptors that allow entry of two liver-specific AAVs, one which is already in clinical use, using biochemical and genetic approaches.

We will identify genetic variants that may affect receptor expression and enable us to screen patients for those who will be better responders. We will then screen a ‘library’ of clinically-approved drugs to boost receptor expression and AAV uptake in liver cells in mice. This study will identify new avenues to enhance therapeutic efficacy in patients undergoing gene therapy.

Heart failure rates are increasing exponentially in Australia and worldwide. One in two people diagnosed with severe heart failure will die within one year of diagnosis. This burden of heart failure is underpinned by the heart’s limited capacity for self-repair after injury. This limitation could be overcome by stimulating newly discovered stem cell populations residing within the adult heart itself. We recently discovered a cardiac colony-forming stem cell population and have found that the molecule Platelet Derived Growth Factor (PDGF) can improve the heart function of mice and pigs after induced heart attack. PDGF does this by activating and rejuvenating resident heart stem and stromal cells. Before this promising therapy can be considered for clinical trials in humans, further testing to validate its safety is required.

This project will build on over a decade of preliminary work in mice and pigs, validating our results in a preclinical large animal model. In the second phase of this work, new materials such as nanoparticles will be used to more selectively deliver PDGF therapy to the heart. Outcomes of this project include expedited progression of this promising therapy, from the laboratory into the clinic, where thousands of heart failure patients could one day benefit.

Note: This project received project funding only. This project did not received full Fellowship funding.

The proposed projects will study new mechanisms that may be involved in a disease that results in increase in blood pressure in the lungs, which is called pulmonary hypertension. This disease is very deadly and despite the progress made, the survival rates within five years of diagnosis remain unacceptably low (up to 50 per cent of patients may die or require heart-lung transplantation). Therefore, research in this area is of high priority.

We will study two different drugs both in the basic science lab, and if these studies support our theories; and as suggested by the safety of the target drugs that are already in use in patients for other diseases; we believe that the second part of the project where we will test these drugs in patients is practically feasible, promising to add two new drugs for treatment of pulmonary hypertension.

I have studied new intricate methods in my post-doctoral studies In the United States which I am excited to establish back in my lab in Australia. This has also provided the team with the opportunity for collaboration with centers of excellence internationally, which will be key in conducting a multi-center clinical study. The proposed team consist of clinician-scientist who can lead both the basic science project and the human trial.

Heart defects are the most common form of birth defects, occurring in ~1 per cent of live born babies. In 80 per cent of families it is not known why they occur. We use the latest technologies to study the genetic code of families with children that are born with heart defects. We aim to identify mutations, i.e. changes in the genetic code that are the cause of these defects.

The genetic code of each individual is stored in large datasets. Our goal is limited by the current methodologies to analyse such large datasets to identify causal mutations. Currently, a large percentage (~70 per cent) of families we study cannot receive a personalised genetic diagnosis. We propose to develop new quantitative and analytical approaches to improve our ability to identify mutations that are the cause of heart defects in every family.

Our research has specific and immediate clinical benefit for the families affected with heart defects that have been recruited. Increasing the genetic diagnosis of heart defects will help more families receive an accurate genetic diagnosis, personalised advice concerning the disease in their family and a better estimate of the risk of having a subsequent child with a heart defect.

Identifying the genetic causes of heart defects not only has benefits for the patient and the family but also for the community. Currently, efforts to identify causes of disease require large costs, and it can include multiple medical screens and procedures. We expect that systematic adoption of genetic testing in clinical practice will improve the financial sustainability of the health system.

Note: This project received project funding only. This project did not received full Fellowship funding.

Cardiovascular diseases, including heart attack and stroke, are a leading cause of disease and death. In patients who have experienced a cardiovascular event such as a heart attack, smoking increases the risk of future events and death. Programs supporting cardiac patients to quit smoking improve survival and quality of life, and reduce the burden on the hospital system. However, smoking remains undertreated in cardiac patients. Prescribed medicines, including Zyban, Champix and Nicotine Replacement Therapy, are the most effective strategies available to help smokers quit, but there have been highly publicised concerns regarding their safety among cardiac patients, contributing to reluctance to prescribe and use these treatments.

This project will examine whether these safety concerns are supported by Australian data. It will also determine which of the three medicines is most likely to have the greatest long term benefit for cardiac patients, and the extent to which each of these medicines are currently used by cardiac patients after discharge from NSW hospitals. It will achieve this by linking records of filled prescriptions with other data from health services in NSW. This will be the largest study of the safety and effectiveness of prescribed medicines for smoking cessation conducted to date, and the first conducted in Australia. It will use sophisticated statistical techniques that allow data to be analysed in a way that closely replicates the characteristics of a clinical trial.

This project will provide clinically useful information about the risks and benefits of prescribed quit aids when used by cardiac patients. This will allow cardiac patients and health care providers to make informed decisions about whether a smoking cessation medicine and which one(s), should be used. This evidence, together with statistics on how many patients receive these quit aids after they leave hospital, will indicate whether efforts to promote or discourage use of any of these treatments among cardiac patients are needed. The research team will communicate the findings to staff of NSW Health services, cardiology units in particular, so that protocols and guidelines for the discharge of cardiac patients can be updated. Likewise, the findings will be shared with general practitioners to guide the in-community prescribing of smoking cessation aids to patients with cardiovascular disease. By informing changes to the care of cardiac patients who smoke, this project has the potential to improve the survival of patients with cardiovascular disease and reduce healthcare costs.

Hypertrophic cardiomyopathy (HCM) is a clinically variable disease, ranging from asymptomatic diagnoses, to heart failure and sudden cardiac death. It occurs in 1 in 200-500 of the general population, and given it is an inherited disease close family members are recommended to undergo lifetime clinical surveillance. Due to the wide variability in disease presentation and features, there is little ability to predict who will develop the worst outcomes, despite decades of research.

Recent advances in genetic technologies have allowed an opportunity to better understand the underlying genetic causes of HCM, but have also challenged the prevailing view that HCM is primarily an inherited disease. My recent paper in Circulation: Cardiovascular Genetics proposed for the first time that a non-familial sub-group of HCM exists and that it occurs in approximately 40 per cent of cases. Non-familial HCM patients have a less severe disease and while current clinical guidelines recommend lifetime clinical screening of their first-degree relatives, our finding suggests this is not necessary.

No study to date has focused exclusively on the familial HCM sub-group. Reassessment of risk algorithms in a more homogeneous patient population will allow development of accurate risk prediction scores. Until now, risk scores have been developed in populations including both nonfamilial and sarcomere positive HCM and not surprisingly show poor predictive ability. To date, no scores have incorporated genetic variables, and based on my recent work there is a strong likelihood that genotype can impact outcomes.

For the first time, genetic testing could offer a clearer way to understand the disease, allowing us to make more precise recommendations for family screening and better predict those more likely to have poor outcomes. This will reduce uncertainty, but also minimise unnecessary health care resources from clinical screening family members who are not at increased risk of disease.

Note: This project received project funding only. This project did not received full Fellowship funding.

Chest pain is one of the most common presentations to adult emergency departments. Its management requires specialist assessment and tests, which places a significant burden on hospital resources and patients. To address this, Royal North Shore Hospital has implemented a rapid access Chest Pain Clinic (CPC) – a new model of care, for which I am director. As part of this, there is the need for cardiac investigations that are feasible, diagnostic, and cost-effective. Two advanced cardiac diagnostic techniques have untapped potential in this setting in Australia – cardiovascular magnetic resonance (CMR) and advanced electrocardiography (A-ECG). This fellowship seeks to develop new insights into health service of acute chest pain by the application and development of these state-of-the-art investigations to create a paradigm shift in chest pain management and improve healthcare costs.

CMR is the future of non-invasive cardiology, and is utilised widely in clinical practice and research worldwide but less so in Australia because of slow adoption and restrictions with Medicare rebate. In European and UK healthcare models, CMR with stress testing (‘stress CMR’) has been shown to be cost-effective in the management of suspected coronary disease with high diagnostic and prognostic performance. There is a lack of evidence of stress CMR in the Australian healthcare setting. Part 1 of this study will assess the cost-effectiveness of stress CMR in the CPC, in order to optimise its use in Australia.

The traditional ECG is a fundamental cardiac test. Standard analysis depends on visual assessment. Novel methods for computerised ECG measurement permit the application of advanced digital analysis techniques collectively known as A-ECG, which have dramatically higher diagnostic accuracy for detecting disease. Currently, A-ECG is only available in a handful of international centres outside Australia. Part 2 of this study will assess A-ECG in the CPC to show its diagnostic performance, ability to influence downstream tests, and power to predict cardiovascular outcomes. A-ECG could be the much needed paradigm shift in chest pain management – to allow patients to be managed safely as outpatients, thus avoiding hospital admission and unnecessary tests, and improving healthcare costs.

The overarching goals are aligned with Sydney Health Partners’ Cardiovascular Stream and the Northern Sydney Local Health District. Collaboration with international centres of excellence will support the science and the technology. Translation of findings and implementation into clinical practice will be led by the research team, which includes engagement with key stakeholders and hospital administration.

Sudden death or cardiac arrest occurs when the heart goes into a fatal heart rhythm called ventricular tachycardia (VT). These fatal rhythms almost invariable occur due to underlying scar tissue in the heart from a variety of heart diseases. Cardiac arrest survivors receive a specialised form of pacemaker, called an implanted cardiac defibrillator (ICD) placed under the skin that automatically delivers an internal shock if VT recurs, thereby aborting otherwise inevitable sudden death. However, ICDs do not prevent VT from occurring in the first place, they only treat VT when it occurs. Cardiac arrest survivors will experience recurrent VT at an annual rate of 30-50 per cent/year. Recurrent shocks are painful, cause tremendous psychological trauma and lead to increased risk of death. They also lead to frequent hospital visits, and exponential health care utilisation.

Recurrent VT can be treated with strong doses of anti-arrhythmic (AAD) medications but these tend to be minimally effective, and with potent side effects. An alternative is to perform a cardiac ablation (CA) procedure that entails electrical wires navigated up through the veins to the heart, to identify, cauterise and thus destroy the electrical short circuits causing VT. Some studies have shown that CA is highly effective in curing VT, reducing VT burden and improving quality of life in patients with scar tissue due to coronary heart disease (blocked arteries). It is unknown if CA is just as effective for a large population of patients who have scar related to genetic (familial) disease, or infection or inflammation of the heart (termed non-ischemic cardiomyopathy). This group is important as the incidence of non-ischemic cardiomyopathy is rising; such patients tend to be young (30-60 years), and are very likely to experience toxic side effects from AAD and thus stand to gain the most benefit from CA. This research proposal is for a randomised trial that will examine if CA is superior to AAD in the treatment of VT in patients with non-ischemic cardiomyopathy.

Results of this study will be disseminated through clinicians at scientific meetings/publication in journals (and via their social media channels), and by engagement of Sydney Health Partners, NSW Agency for Clinical Innovation and major national/international cardiac societies. Findings will lead to major practice and policy change nationally and globally. Engagement with patients and the general public will be via novel e-health social media channels such as Facebook and Twitter, as well as involvement of charitable foundations.

Blood clots blocking the blood supply to the heart and the brain, known as arterial thrombosis, cause heart attack and stroke – the leading cause of death and disability in the Australia. Platelets are the cells that form these blood clot, thus drugs targeting platelets such as aspirin are the mainstay of heart attack and stroke prevention. Yet current treatment has limited effectiveness with optimal therapy – up to 30 per cent of patients will have a recurrent event within three years, and more effective therapies often lead to bleeding side effects.

Our work has identified a particular sub-set of platelets within people with cardiovascular disease that increase blood clots, but are not turned-off by aspirin. These are called procoagulant platelets. Measurement of procoagulant platelets in patients has initially been very difficult due to the lack of sensitive and specific tests. We have recently developed a way to measure procoagulant platelets in people at risk of heart attack and stroke, and have shown that more procoagulant platelets are indeed formed during stroke and heart attacks. It is therefore this sub-set of platelets in people with cardiovascular disease that we would like to target more specifically when designing new drugs, in order to increase the beneficial effect and at the same time reduce the bleeding side effect when treating patients.

Interestingly, a simple non-invasive process called remote ischaemic preconditioning (RIPC), which is performed by inflating and deflating a blood pressure cuff three times, was able to reduce procoagulant platelets in people with heart disease when aspirin and other anti-platelet drugs could not. Others have previously shown that RIPC can protect the heart muscle and brain from damage during heart attack and stroke, but the mechanism by which it does this is unknown.

My studies indicate that RIPC affects procoagulant platelets by affecting the platelet mitochondria. Mitochondria are organelles inside the platelet that converts glucose to energy. My project investigates the link between procoagulant platelets, platelet mitochondrial function and cardiovascular disease. In addition to providing the rationale for RIPC, these studies aim to identify platelet mitochondrial pathways as a novel target for cardiovascular disease that will work in addition to existing cardiovascular drugs without causing bleeding. Ultimately, our work would be able to provide more tailored therapies for patients, reduce our patients’ waiting time, pain and risk of receiving treatments, improve their disease outcome, and reduce medical cost for the NSW health system.

Atherosclerosis and related complications are a major cause of death and disability in NSW. This project will use see-through zebrafish to literally shed new light on what happens in atherosclerotic plaques using microscopy of the disease inside living zebrafish. We will be able to ask fundamental questions about how plaques form, mature, and harm us by observing the course of disease in zebrafish embryos.

To find new cures of atherosclerosis and it’s complications, the project will take two arms. The first arm will investigate a treatment that may prevent the blood vessel damage necessary for atherosclerosis to get a foothold in our blood vessels while a second arm of the project will set up a zebrafish system to discover new drugs to prevent or reverse the build up of bad fats in atherosclerotic plaques.

Death and disability from stroke is a massive burden on the healthcare system and society. In Australia, it is estimated that one million people will be living with the effects of stroke by 2050 - more than double the number of strokes in 2017. Ischaemic stroke is caused by a blocked artery, leading to a lack of blood flow and oxygen supply to a specific region of the brain supplied by that artery, resulting in brain cell death (infarction). Up to 38 per cent of ischaemic stroke patients present to hospital with mild or rapidly improving symptoms, yet final outcomes are poor, >50 per cent require assistance with self-care at three months post stroke. This delayed progression of stroke due to early neurological deterioration (END) within the first 24hrs post-stroke remains a clinically significant, yet unresolved problem - the number of patients totalling more than the annual number of new cases of multiple sclerosis, Huntington’s disease and motor neuron disease combined. However, its cause and the underlying mechanisms are poorly understood. Currently there are no guidelines or diagnostic tests that can predict the outcome of these patients. Understanding the true pathophysiology and recognising those at risk are key first steps.

Dr Patabendige and her team will use advanced medical imaging analysis and a novel non-invasive method to measure the pressure within the skull, intracranial pressure (ICP) to provide definitive evidence to confirm that ICP elevation causes infarct expansion, and that it is associated with neurological deterioration. In addition, their previous studies confirm that oedema (swelling of the brain) was not the primary cause for this ICP rise. Therefore, Dr Patabendige will investigate whether cerebrospinal fluid (CSF, the fluid that bathes the brain and spinal cord) volume increase is responsible, and if confirmed, show that short-duration hypothermia reverses this.

These findings will provide evidence to confirm the cause for END, and provide for the first time a clear pathological explanation for why these patients, who seem to be improving when initially presenting to the hospital progress to neurological deterioration.

Expected key outcomes:
1. Provide significant fundamental knowledge about a highly clinically relevant, yet unresolved problem of END
2. Help future diagnosis, prevention and management of stroke patients that are at risk of developing END, thereby making a significant reduction in stroke morbidity in the longer term
3. Prove the effectiveness of a potential treatment that is safe, easy to apply and generalizable .

The purpose of this research project is to develop and validate a blood test that can be widely used, e.g. hospital outpatients, and general practitioner offices, to detect a new molecule in blood that we discovered. It will indicate whether a patient has liver fat and whether they are at risk of developing diabetes, which frequently leads to heart disease and stroke.

We are facing a global epidemic of obesity and related diseases. Almost three-quarters of Australians are now overweight or obese, and childhood obesity is at an all-time high. Overweight and obese people have a high risk of developing fatty liver disease and/or type 2 diabetes. Fatty liver disease is often the first stage leading to type 2 diabetes, and puts patients at increased risk of fat deposits in their blood vessels that may cause heart attacks and strokes, which are the most common causes of death in these patients.

We are failing to prevent the catastrophic obesity epidemic. It is a global challenge. The numbers are far greater in developing countries. In China, for example, 114 million people have type 2 diabetes and half a BILLION have prediabetes. These staggering numbers underscore the enormity of this healthcare challenge globally.Although obese people with diabetes most commonly die from heart attacks and strokes, the rate at which this occurs is highly variable, and until now, we cannot predict who is most at risk and who will have an event.

Our results indicate that the new blood molecule discovered by us can predict, more than a decade in advance, who will develop diabetes. This is tremendously important, as it will allow us to target those most at risk with interventions to prevent them from developing diabetes, thereby reducing complications such as heart attacks and strokes. It has been repeatedly shown that the best way to prevent diabetes and its complications is early intervention – by the time of diagnosis a lot of damage has been done, most of it irrevocably.

The way we currently measure this molecule is not widely accessible, limiting its availability to populations that need it most. In this project, we aim to develop a test that can be used everywhere -- even at the bedside, outpatients, general practitioner offices -- and will be fast, precise, and reliable. We will ensure that the public, patients, and clinicians are fully aware of all aspects of this assay.

Note: This project received project funding only. This project did not received full Fellowship funding.

Atrial fibrillation (AF), the most common abnormal heart rhythm (arrhythmia), is a major risk factor for both stroke and heart failure. With an ageing population tackling the problem of arrhythmias, in particular AF, will be a major challenge for healthcare in the coming decades. At present, we lack good drugs to treat AF. As a result there is a pressing need for new strategies to study and better understand the molecular basis of these arrhythmias. This is the best way to identify and develop novel therapeutic avenues.

While clinically we accept that altered mechanical load in the chambers of the heart leads to structural and electrical changes, the molecular mechanisms of how these mechanical forces underpin arrhythmias are not understood. This project aims to identify novel mechanical pathways that underlie arrhythmias in conditions like AF.

This project will identify these new cellular pathways underlying arrhythmia generation by evaluating how mechanical stress affects the cells that line the chambers of the heart. We have access to a unique cell type mimicking the single cell layer that lines the inner wall of the heart chambers. Using state-of-the-art technology to simulate blood flow this project will assess how these cells may provide mechanically-regulated signals to the underlying heart muscle cells and assess how this may contribute to arrhythmias. This crucially acknowledges the inseparable function of the specialized cells that line the heart chambers and the muscle cells in the overall performance of the heart. Understanding these molecular pathways and their effect on the underlying heart muscle will likely identify novel therapeutic targets for prevention but also for management of arrhythmias.

Aside from unearthing targets for therapy, these pathways are also likely to contain candidate genes for genetic studies in patients with inherited heart arrhythmias and atrial fibrillation. Thus data generated in this study will be used to look for disease causing gene variants in studies already ongoing such as a NSW Health funded project aimed at sequencing the genomes of a large cohort of patients with cardiomyopathies, many of whom will develop AF and associated arrhythmias. As a result this project is likely to provide tangible outcomes for patient and family management and counselling.

Cancer and heart disease are the two most common disease conditions and the leading causes of death. Chemotherapy is more effective than ever at treating cancer, but has a price. There are over 400,000 cancer survivors in Australia and this figure is expected to increase due to a continuous decline in cancer death rates: there is a 70 per cent chance of survival from cancer in Australia. However, up to 25 per cent of these cancer survivors die from chemotherapy-induced cardiotoxicity (CIC) within 7 years, making it the leading cause of death in cancer survivors.

Cardio-oncology, an under-recognised area in Australia, is the intersection of heart conditions in cancer patients, an emerging field with immense potential to improve quality of life and cardiovascular burden in a growing number of cancer survivors.

The main reason for long-term cardiovascular and healthcare burden is delay in early detection of CIC due to imperfect diagnostic techniques. This is a major limitation, as early detection and treatment of CIC can lead to prevention of heart failure, and recovery of heart function. In addition, lack of an integrated, patient centred approach in Australia results in the fact that most cancer patients are still largely unaware of this adverse drug reaction and tend to neglect care for risk factors that may precipitate cardiotoxicity.

Thus, our program aims to address poor outcomes for the many cancer survivors who go on to develop CIC by discovering simple blood test(s) that could detect early onset of CIC as well as providing better education and facilitating self-care and empowerment for cancer patients/survivors.

Specifically, I will utilise state-of-the-art high through-put techniques that can gather a large amount of data to identify:
1) proteins in blood that change with early onset of CIC
2) genetic markers
3) chemotherapy-induced changes in genetic dispositions (epigenetics).

This data will be combined with latest imaging modalities to develop an individualised risk prediction tool for our patients. As risk assessment and early detection are cornerstones of early treatment and improved outcomes, this could in future lead to change in clinical practice/guidelines and translate in earlier discontinuation/change in chemotherapeutic regimen and initiation of cardioprotective therapy. I will also establish and facilitate a dedicated cardio-oncology nurse-led program of patient education and empowerment. This would achieve both improved interdisciplinary communication related to the diagnosis, monitoring and therapy of cancer treatment related cardiovascular complications and improved patients’ journey and outcomes through improved and dedicated cardiovascular care.

Incontinence-associated dermatitis (IAD) is a common under-recognised painful skin condition, caused by erosion of the skin from prolonged exposure to urine or stool. Patients with IAD experience pain, burning and itching in the affected areas. IAD can be difficult to diagnose and differentiate from other skin conditions leading to incorrect or delayed management. Furthermore, IAD is a strong risk factor for bed sore development. --- IAD is a neglected clinical area and there are major gaps in health clinicians’ understanding of the prevention and management of the condition. These gaps impact on patients and their quality of life. --- To address these issues, this project will implement and evaluate the IAD International Best Practice Guideline (BPG) and the Ghent Global IAD categorisation tool (GLOBIAD) on the management of patients with IAD and incontinence. --- This project will deliver skin care using a patient-centred approach to prevent the detrimental effects of IAD, reduce the risk of bed sores, and avoid negative patient outcomes. Methods will include surveys, interviews and a before and after study. A healthcare diagnosis code for measurement and reporting purposes will be developed. --- This project will be guided by the principles of translational research. The implementation of district-wide evidence-based practices using a translational research approach that engages key stakeholders will allow standardisation that accommodates a range of settings. This provides evidence, and a model, for future translation into other health districts state-wide and nationally.

Tobacco smoking causes cardiovascular disease, cancer, chronic respiratory disease and a multitude of other negative outcomes. Tobacco smoking rates are highest among people on opiate agonist treatment (OAT), and they find it difficult to quit smoking, even when they are interested and motivated to quit. --- This study is testing whether NRT and vaporised nicotine products, such as e-cigarettes, help OAT clients to quit their tobacco smoking. If found to be effective, e-cigarettes can be used with health care provider and telephone Quitline support, to help people in opiate treatment services to quit smoking tobacco cigarettes. --- This type of support can be rolled out across all drug and alcohol services in NSW, profoundly improving OAT clients, physical health, mental health, financial position and quality of life.A200:E201

Every year, between 200,000 and 500,000 Australians are unable to access alcohol or drug treatment. Specialist services are predominantly located in metropolitan areas, and people in rural and remote areas find it difficult to access these services. Yet, harmful drug and alcohol use is at its highest among people living in rural, regional and remote areas, and this extends to prescription medications. Currently, people in rural and remote areas of NSW can access specialist medical services through telehealth, where a specialist consults with the person via teleconference or phone call, or expensive fly-in-fly-out services. --- Uptake of these services in NSW, however, is lagging. A key component of effective drug and alcohol treatment is the therapeutic relationship between individual clients and practitioners, and this relationship is difficult to foster through intermittent, long distance services. The Hub Project seeks to facilitate engagement between people in rural and remote NSW and their medical practitioners through a mix of telehealth and fly-in-fly-out care. However, unlike current practice, the Hub Project will have a clear focus on practitioner-to-practitioner engagement, local capacity building, clinical supervision and case management. This project will allow local health professionals to develop skills in more complex case management and maintain the relationships built within their communities, leading to improved health outcomes in regional and rural NSW. --- If this model of care proves effective, it can be scaled up to cover the whole of NSW through new use of existing technology. It has the potential to provide support and supervision to alcohol and drug professionals in regional, rural, remote and Aboriginal communities and improve health outcomes for some of Australia’s most vulnerable citizens.

Infection in preterm babies (babies born early) remains a common problem in neonatal units – 1 in 4 babies born at less than 29 weeks of pregnancy develops a serious infection at some time during their stay. Preterm babies are vulnerable to infection, and the impact of infection can be far-reaching: not only can infection kill babies, but can also contribute to poorer health and development when babies grow up into childhood. It is crucial that neonatal units try to reduce infection rates. --- One of the main causes of infection comes from bugs that are usually carried on babies’ or healthcare workers’ skin. These bugs are carried harmlessly on the skin, but if they get into the bloodstream they can make babies unwell. The ‘Gloves On’ study is looking at a simple intervention to try to prevent infection: using gloves when staff touch babies in addition to the handwashing that we would normally do before we touch any baby. Gloves are not used routinely at present. We think using gloves would reduce infection by lowering the rate of transmission of bugs from healthcare workers’ hands to babies and back again. We would like to assess the impact of using gloves on infection rates in preterm babies, as well as making sure it is safe for babies, and safe and acceptable to the families and everyone who uses them. --- This simple and cheap intervention would be easy to introduce into every neonatal unit if it is shown to be successful and cost-effective. This would mean reduced numbers of infections in fragile preterm babies, with improved survival rates. Lower infection rates means shorter times in hospital for the babies and reduced costs for hospitals. Lower infection rates would also improve health and development of these babies when they grow into young children, making life better for families around NSW.

Heart disease remains one of the greatest causes of death and suffering in our community today. Recurrent events among patients transitioning home after a hospital admission represent a significant, and possibly preventable, portion of the total health and economic burden. Programs to support patients in this transition have been shown to improve outcomes, but patient engagement in traditional forms of these programs remains low. --- Our study team have developed a program called “Total Cardiac Care Plus”. The TCC+ app provides patients with information about the management of heart disease and medication reminders. It records activity and comes with a graduated exercise program. Patients are also provided with a blood pressure monitor and weight scales that are paired to the phone. All these measurements are uploaded wirelessly. Patients can track their own progress over time. --- The measurements are also monitored by doctors on the research team who will contact the patient and their treating health care provider if there are any concerning trends, to help organise an early review. The aims of the TCC+ Program are to encourage healthy behaviours by educating and empowering patients, and to monitor patients at home to detect early signs of deterioration before they require readmission to hospital. --- Through this translational project, we hope to demonstrate that the TCC+ program can help patients by: educating patients and helping them to keep track of their own heart disease; enabling greater levels of physical activity, and remotely monitoring their progress at home to detect early signs of deterioration and facilitate clinical review, which in turn will result in improved transitional care and reduced clinical complications.

Unsafe medication practices and medication errors are a leading cause of injury and avoidable harm in healthcare systems across the world. Globally, the cost associated with medication errors has been estimated at $US42 billion annually. Errors can occur at different stages of the medication use process including prescribing, dispensing and administration, which can then result in severe harm, disability and even death. --- Employing clinical pharmacists in hospitals has been found to reduce the rates of unsafe medication practices and medication errors leading to a reduction in preventable harms for patients obtaining care in these facilities. Unfortunately, for our rural and remote Australians, there is limited access to clinical pharmacists in health facilities located in smaller towns. --- This project will provide a clinical pharmacy service using the advanced telehealth facilities to offer a solution to improve the delivery of safe and high-quality healthcare regardless of where a patient is admitted. --- Our research will evaluate the effectiveness and impacts of a virtual clinical pharmacy service utilising telehealth technology to link in with rural and remote facilities to oversee the medication management process. The virtual pharmacist will review medication orders, offer advice and expertise on medication use, interview patients for their medication history on admission, plan their medications on discharge home and refer to additional services if needed. --- This research has been developed via a collaborative partnership made up of clinicians, key state stakeholders and academic experts to ensure linkages in with local, state and national strategic plans to reduce medication-related harm, improve chronic disease management and enhance access to vital health care via the use of state-of-the-art technology.

Unplanned readmission to hospitals within 30 days are a major health issue in NSW. They detract from patient satisfaction, may influence long term outcomes of surgery and are costly and inconvenient to the hospitals and patients. We believe that with an innovative approach to reducing surgical readmissions we can improve outcomes, improve patient satisfaction and decrease cost. --- If the strategy is successful we believe that we will be able to scale the strategy across NSW hospitals. To our knowledge, there has been no strategy such as we have described studied in NSW and we believe it is an innovative project even by international standards.

Transfer of residential aged-care facility (RACF) residents to Emergency Departments (ED) is common, risky and expensive. RACF residents who present to ED are more likely to be readmitted to a hospital, have longer stays and face major risks related to hospital acquired complications. --- ACE is a nurse led, protocol-guided telephone ED outreach model that has been shown to be effective in reducing hospitalisation and length of hospital stay for RACF residents. It has had limited effect in reducing presentations to ED. --- This project enhances ACE by incorporating web-based interactive video assessment and consultation. Telehealth has been shown to be acceptable to staff and families, and reduce the disruption and distress associated with unnecessary transfer to hospital for residents and carers.

Older people undergoing surgery are at a high risk of experiencing delirium (up to 60%). Delirium is an acute, reversible, short-term confusion which presents as agitation and/ or reduced alertness. Untreated and undetected delirium leads to many health problems including falls, longer stays in hospital and sometimes death. Delirium can become a chronic health problem causing individuals to relocate into a nursing home and also develop dementia. --- Much work is undertaken in hospitals to prevent, detect and treat delirium. However in the recovery area, where an individual is transferred immediately after surgery before they go to a ward, there is less evidence on delirium. During this project the research team will work with clinical staff in recovery units at Wollongong, St. George and Bega hospitals to improve delirium care. --- This project will use interactive education to improve the prevention, detection and treatment of delirium experienced by older people after surgery. We will use role play scenarios of a delirium with clinical staff undertaking an assessment of the ‘actors’ to detect delirium and implement management strategies to treat delirium. This type of education is not yet commonplace in healthcare workplaces and will provide evidence for the effectiveness of this approach to improve delirium care. --- The outcomes will be improved detection rates of delirium in recovery units, and thus better treatment of delirium and prevention of associated health problems. This will be achieved by improving staff skills in delirium care. The education goes beyond simply improving knowledge. Findings from this project can be applied by educators working in other clinical areas and expanded to any healthcare problem. Patients in NSW will receive better delirium care and experience less of the health problems associated with untreated and undetected delirium.

Chronic kidney disease (CKD) affects 10% of Australians (1.7 million adults). People with lower health literacy and from culturally and linguistically-diverse (CALD) backgrounds are more likely to have CKD and to die from the condition. However, there are no interventions to help these patients to develop skills needed to make good health decisions, and patients often receive information in formats and at times which make it difficult for them to understand. --- To address this, we have developed the SUCCESS App. The App provides simplified patient information (e.g. about diet, fluids, physical activity) and skills training for CKD patients to support them to make health decisions and communicate with their healthcare providers. Our research team has shown that we can implement the SUCCESS App in dialysis units across New South Wales. We are now conducting a study to evaluate its impact on health outcomes. --- Participants with CKD will be invited to use the SUCCESS App for 6 months and we will collect information at 0, 3, 6 and 12-months to see whether the App can improve their skills, quality of life, behaviour, use of health services and health (e.g. blood pressure; weight gain). --- To compliment the SUCCESS App, we will also develop training for health professionals to facilitate communication with their patients (including those with lower health literacy and from CALD backgrounds), and evaluate the acceptability of this training among CKD staff. --- The potential benefits of the SUCCESS App are far reaching and include improved health skills and decision-making, quality of life and behaviours which are known to translate to improved clinical outcomes and better use of health services. The App will be available to all patients undertaking dialysis after its effectiveness has been established.

The ‘SupportMe’ text messaging service for patients with chronic disease utilises simple technologies to improve ongoing support to patients in managing their condition – wherever they live, as long as they have a mobile phone. Western Sydney Local Health District research teams recently published results of a clinical trial of ‘TEXTME’ – a six month program of approximately 100 unique text messages sent to patients with heart disease that aimed to motivate, support and educate this target group about condition management and positive lifestyle changing behaviours.

The TEXTME trial demonstrated that trial intervention patients receiving the lifestyle-focused text-message support program had lower LDL-cholesterol, blood pressure, body mass index and smoking rates at six months compared to control groups. The SupportMe project aims to extend and translate this work into a service model for a broader patient population with chronic disease – including patients with diabetes and cardiovascular diseases and evaluate this as a clinical trial. This will be conducted within the framework of the Western Sydney Integrated Care Program.

Collaborators: The George Institute, University of Sydney, Office of Preventive Health, NSW Ministry of Health (Office of the Chief Health Officer), Illawarra Shoalhaven Local Health District, Diabetes NSW, Heart Foundation

Constraint Induced Movement Therapy is an effective intervention for upper limb recovery following stroke and traumatic brain injury that produces significant improvements in upper limb function compared to usual therapy, after only two weeks.

The project team aims to establish if a two-week publicly funded Constraint Induced Movement Therapy program can be translated into practice and sustained over two years across multiple health services in South Western Sydney Local health District. Key questions are:
1) Do rehabilitation teams deliver more Constraint Induced Movement Therapy programs after receiving a implementation package?
2) Do stroke and brain injury survivors that complete a Constraint Induced Movement Therapy program achieve upper limb outcomes consistent with published outcomes?

Collaborators: Liverpool Hospital, Bankstown Hospitals, Campbelltown/Camden Health Service, Ingham Institute, Health Education and Training Institute, South Western Sydney Local Health District (Centre for Education and Workforce Development), University of Sydney

The number of older people undergoing surgery continues to rise. Many of these people have complex health care needs including dementia that need to be considered before, at and after the time of any surgical procedure.

Evidence already exists to support geriatricians and orthopaedic surgeons working in partnership to care for older people, delivering benefits which include fewer deaths, fewer complications and better functional recovery.

This research will review if general surgeons and geriatricians working in partnership can lead to better outcomes for older people undergoing surgery in two hospitals from two local health districts test.

The Translational Research Grants Scheme funding will support the shared care model project and conduct the health economic evaluation of the study that is critical to allow a realistic approach to service planning / re-organisation.

Collaborators: Agency for Clinical Innovation (Aged Health Network)

The aim of this project is to determine the effectiveness of a text message intervention (DTEXT) on lifestyle risk factor modification and diabetes self-management for people with type 2 diabetes, and its integration into the NSW Get Healthy Information and Coaching Service.

A pragmatic randomised controlled trial will be conducted in the Illawarra Shoalhaven Local Health District. The intervention group will receive mobile phone text messages for 6 months; the messages will provide information and support on physical activity, nutrition, weight, smoking cessation and diabetes self-management. The control group will receive a diabetes fact sheet and usual care. The primary outcome measure will be glycated haemoglobin levels; secondary measures tested will include physical activity, nutrition, weight, and diabetes management.

Collaborators: NSW Office of Preventive Health (Get Healthy Service), NSW Ministry of Health (Office of the Chief Health Officer), Illawarra Shoalhaven Diabetes Service, University of Sydney, The George Institute, South Eastern NSW Primary Health Network

A new model of care aimed at reducing Indwelling Urinary Catheter use has been developed and piloted in a small study in Hunter New England Local Health District. The care model is based upon ‘bundled catheter care intervention’ – an integrated set of evidence-based practices and steps aimed at reducing Indwelling Urinary Catheter use and catheter insertion duration times within the hospital setting.

The aim of the Translational Research Grants Scheme funding is to trial and evaluate this promising pilot study on a much larger scale – to generate the evidence that the pilot findings are consistent and benefits scalable in wider application. Project data will inform statewide implementation strategies and improve practice and outcomes related to urinary catheter care. Evidence in relation to populations and individuals most at risk can be captured so that resources and education can be targeted to areas of greatest need.

Collaborators: Central Coast Local Health District, Clinical Excellence Commission, Agency for Clinical Innovation, University of New England, University of Newcastle, Hunter Medical Research Institute.

Fractured neck of femur is a common, painful condition in the elderly for which regional nerve block techniques provide effective and safe analgesia. Presently, regional nerve blocks are administered by doctors, usually later in the patient journey. Regional nerve block via Fascia lliaca Nerve Block has been demonstrated to be safe and effective when administered by trained nurses.

This project is designed on the hypothesis that early nurse-initiated Fascia lliaca Nerve Block can be successfully introduced and sustained within a tertiary level emergency department - and can be then generalised and scaled up to other emergency departments. It aims to demonstrate that early nurse-initiated Fascia lliaca Nerve Block can be delivered to a higher proportion of eligible patients than current practice, is at least equi-analgesic and equivalently safe with standard medical regional nerve block, and can be delivered significantly earlier than medically-initiated regional nerve block.

After twelve months, early nurse-initiated Fascia lliaca Nerve Block will be re-evaluated at both sites with respect to embeddedness, safety and effective practice.

Collaborators: Central Coast Local Health District, Agency for Clinical Innovation, College of Emergency Nursing Australasia, Australasian College for Emergency Medicine, Kolling Institute, Royal North Shore Hospital, Gosford Hospital

Reducing smoking during pregnancy is a priority research area, and included in several NSW and National Health Plans and Policies. Pregnant tobacco smokers who also use other substances (for example drugs like cannabis, ice, or heroin) are a particularly vulnerable and priority target population.

This pilot study will trial the acceptability and feasibility of an evidence-based smoking cessation intervention for pregnant women who smoke tobacco with other substance use problems. The intervention will use a combination of counselling and Nicotine Replacement Therapy delivered by a trained Tobacco Treatment Specialist. The study will also offer the women incentives (such as the reward of a shopping voucher) if they are able to quit or reduce their smoking.

This research aims to generate new evidence about effective and translatable strategies for decreasing tobacco smoking in pregnant women with other substance use problems, and develop sustainable solutions in real-life settings. The study will provide important information of the feasibility, acceptability and uptake of effective tobacco cessation strategies, in a population that has extremely low tobacco cessation rates.

Collaborators: Sydney Local Health District, NSW Ministry of Health, Agency for Clinical Innovation

Comorbidity of mental and substance use disorders remains a major cause of disability and poses a significant challenge for the Australian health system.

A new approach to comorbidity treatment has recently been developed involving a Multi-modal Translation Intervention Package (MTP) to train counsellors and aid implementation of integrated care.

The Translational Research Grants Scheme funding will progress the development of the MTP initiative and enable evaluation of the MTP to promote the identification, assessment and clinical management of comorbidity within the drug and alcohol services of NSW local health districts.

Collaborators: Local health districst (South Western Sydney, Central Coast, Hunter New England, Mid North Coast, Sydney, South Western Sydney), National Drug and Alcohol Research Centre, Agency for Clinical Innovation, University of New South Wales, Macquarie University Centre for the Health Economy

This study aims to determine the extent and potential impact of inappropriate polypharmacy (use of harmful or unnecessary medicines) in older inpatients with and without dementia; - and to develop tools to sustainably address inappropriate polypharmacy in routine care.

The study project will aim to establish a procedure to monitor and intervene on clinical variation in management of inappropriate polypharmacy between people with and without dementia, and those accessing different health services. The study collaborators will build on local existing pilot projects to design and pilot a sustainable multifactorial intervention for integrated pharmaceutical care.

This project tackles many of the knowledge and systems barriers, creating a sustainable intervention within existing resources supported by existing quality frameworks and policy.

Collaborators: Northern Sydney Local Health District, Sydney Local Health District, Royal North Shore Hospital, Ryde Hospital, Hornsby Hospital, Concord Hospital, Canterbury Hospital, Balmain Hospital, NSW TAG, Agency for Clinical Innovation, Clinical Excellence Commission, Health Education Training Institute, Alzheimer’s Australia NSW, Alzheimer’s Australia, Sydney North Health Network, eHealth NSW, Sydney Health Partners

Southern NSW Local Health District clinicians identified the need to improve discharge planning and processes for improved patient care and to reduce unplanned readmission.

A local working group of acute and community clinicians concluded that the key to reducing unplanned readmissions lay in gaining a greater grasp of the patient’s issues and concerns. Their initial improvement initiatives had focussed on the clinician’s perspective. These initiatives did not impact on nor provide insight on how to improve patient outcomes.

The Translational Research Grant will resource the collection of information from patients who have experienced unplanned readmission within 28 days. The patient experiences will inform a quality improvement project to develop and implement an evidence-based model of patient centred discharge care. The new process will be monitored and evaluated.

Collaborators: South Eastern NSW Primary Health Network, Agency for Clinical Innovation

This project examines the added value of pathogen whole genome sequencing for public health and clinical management of high burden communicable diseases such as tuberculosis, and two foodborne diseases salmonellosis and listeriosis.

Epidemiologists will work together with microbiologists and public health professionals to examine the precision and timeliness of bacterial identification, genotyping and antibiotic resistance detection as well as the number, size and duration of outbreaks, and the proportion of sporadic or secondary cases. Enablers and barriers to the most optimal use of pathogen genomics by clinicians and public health professionals will be identified.

The use of the Translational Research Grants Scheme funding aims to demonstrate enhanced timeliness and accuracy of outbreak tracing.

Collaborators: Centre for Infectious Diseases and Microbiology-Public Health at Westmead Hospital, Pathology West, NSW Health Protection, University of Sydney (Marie Bashir Institute of Emerging Infectious Diseases)

Self-harm injury is a national health priority, accounting for $4 billion in health care expenditure each year. Repeated self-harm is also a major issue for public hospitals, with approximately 15 per cent% of those presenting with self-harm making a further presentation within the next 12 months.

A previous study by the research team showed that a series of supportive mailout ‘postcards’ did significantly reduce deliberate Self-harm re-presentations to hospital and associated hospital costs. SMS text messaging is well placed to now replace postcards.

The Translational Research Grants Scheme funding will examine the number and timing of deliberate Self-harm-presentations among individuals receiving standard hospital follow-up care compared to those receiving standard follow-up plus supportive SMS messages every 1-2 months for 12 months following their initial hospital presentation.

Collaborators: Blacktown Hospital, Office for Health and Medical Research, NSW Ministry of Health, Translational Health Research Institute, Western Sydney University, Westmead Hospital, Auburn Hospital, Mt Druitt Hospital

Naloxone is an opioid antagonist used to reverse opioid overdose. International and Australian research demonstrates the effectiveness of take-home naloxone (THN) for preventing overdose deaths in opioid users.

A pilot study in South Eastern Sydney Local Health District documented 18 overdose reversals using THN and identified barriers to THN uptake. The District subsequently developed a 10-15 minute THN brief intervention (THN-BI) that incorporates client education and the supply of ‘overdose kits’ with naloxone.

The project will also examine the feasibility, sustainability and scalability of the intervention across NSW Health, by:
(a) examining barriers and facilitators to THN through staff and consumer feedback
(b) an economic analysis of the costs and potential savings to the health system arising from the THN-BI
(c) refinement of THN policies/procedures, and training programs informing future rollout of THN-BI across NSW.

Collaborators: Local health districts (Murrumbidgee, Hunter New England, Sydney, Western Sydney, South Eastern Sydney), St Vincent’s Health Network, NSW Ministry of Health (Mental Health and Drug and Alcohol Office), Kirketon Road Centre, NUAA, Burnett Institute, National Drug Research Institute, University of Sydney

Advance Care Planning is a process of reflection, discussion and communication that enables a person to plan for their future medical treatment, for a time when they are not competent to make, or communicate, decisions for themselves.

Research demonstrates that hospital wards are not ideal setting for Advance Care Planning because decisions made when acutely unwell in an unfamiliar setting could markedly differ from decisions made when people are in a stable condition in their usual environment. Outpatient clinics are therefore better places to have these discussions. However, there is a lack of training and support for outpatient clinic staff to identify patients who may benefit from Advance Care Planning discussions, and facilitate the Advance Care Planning process.

This study aims to conduct a randomised controlled trial to assess if facilitated Advance Care Planning intervention can provide positive outcomes in improved patient care.

Collaborators: Sydney Local Health District, University of Sydney (Centre for Education and Research on Ageing, Academic Sydney Medical School), Concord Hospital (Aged, Chronic Care & Rehabilitation), NSW Ministry of Health (Office of the Chief Health Officer, Integrated Care Branch), Central and Eastern Sydney Primary Health Network, NSW Ambulance Service, University of NSW, Alzheimer’s Australia (NSW)

High dose opioid (morphine like) medications prescribed to patients with non-cancer pain is increasing. Concern about the risks and weak evidence for prescribing long term opioid medications is rising.

Many patients want to reduce their dependence on opioids but feel constrained by fear of more pain and experiencing withdrawal symptoms when the dose is reduced. Currently there are few guidelines on reducing or ceasing high dose opioids. The purpose of this project is to study two pathways to reduce or cease high dose opioid use in patients with non-cancer pain:
1. Infusions of low doses of ketamine (an anaesthetic drug) under the skin over five days in hospital while the patients’ opioid medications are stopped. The ketamine prevents withdrawal symptoms and helps with pain.
2. Slowly tapering high dose opioids in outpatient clinics, and using other medications to help manage pain and withdrawal symptoms.

Collaborators: South Eastern Sydney Local Health District, Prince of Wales Hospital (Pain Management Service), Agency for Clinical Innovation (Pain Management Network), Australian Health Services Research Institute

This project aims to improve the health of adults in NSW who have had a stroke. Uptake and application of The National Stroke Foundation’s Clinical Guidelines for Stroke Management is a critical success factor in improving the health outcomes of stroke patients.

This project objective is to increase uptake and implementation of the stroke guidelines using a collaborative approach that includes allied health clinicians and research staff from Charles Sturt University. Resources will be developed to support clinicians to implement and evaluate their stroke-related care in two key areas: upper-limb rehabilitation and cognitive rehabilitation. The Translational Research Grant funding will support development and evaluation of these resources and will also enable translational activities.

The Translation Research Grants Scheme funding will also enable consumer involvement through a series of focus groups in the regional areas of Albury and Wagga Wagga.

Collaborators: Albury Wodonga Health, Charles Sturt University (Media Services), Stroke Foundation (Albury Wodonga Stroke Recovery Club), Occupational Therapy Australia, Agency for Clinical Innovation, National Stroke Foundation

Anorexia nervosa results in severe starvation with widespread organ dysfunction. Patients admitted to hospital with anorexia nervosa require restoring of essential nutrition to reverse malnutrition and its complications. However, conservative guidelines advocate reintroducing nutrition at a very slow rate to avoid complications. This slow feeding results in poor weight gain, which can increase the hospital length of stay.

There is a growing body of evidence that now supports feeding hospitalised adolescent patients with anorexia nervosa safely with higher caloric intakes, resulting in faster rates of weight restoration and a reduced length of hospital stay, without adverse side effects. However evidence in higher caloric feeding is not as robust in the adult anorexia nervosa population. Of particular concern is the reintroduction of carbohydrate in a starved anorexia nervosa patient, which can lead to potential electrolyte derangement and increase the risk of developing complications.

The aim of this study is to test if a higher caloric introduction of nutrition using a higher fat content versus carbohydrate content will provide better health outcomes to adult patients with anorexia nervosa.

Collaborators: Sydney Local Health District, Agency for Clinical Innovation, Centre for Eating and Dieting Disorders, Royal Prince Alfred Hospital, Westmead Hospital

Traumatic brain injuries arising from external insult to the brain most often affect young adults and can lead to life-long, devastating disability. In Australia, there are more than 2500 cases of moderate-severe traumatic brain injury each year.

Despite the fact that guidelines for world’s best practice in cognitive rehabilitation to treat such impairments have been developed for traumatic brain injury, research shows that frontline staff rarely adopts best practice guidelines into everyday practice.

The Translational Research Grants Scheme funding will support the development of a knowledge translation project to test the efficacy of a recognised four-step Knowledge Implementation Model for traumatic brain injury cognitive rehabilitation. The project will analyse barriers to implementation, develop training resources, and then analyse changes in staff behaviour and patient outcomes arising from the project

Collaborators: Liverpool Hospital (Brain Injury Rehabilitation Unit), Kolling Institute (John Walsh Centre for Rehabilitation Research), University of Sydney, Agency for Clinical Innovation (Brain Injury Rehabilitation Directorate), Monash University (BehaviourWorks)

People with schizophrenia suffer persistent cognitive deficits, which impair their ability to function in everyday activities. These deficits cause substantial disability and many people require high levels of personal support with aspects of daily living in the community.

One approach, with good preliminary evidence in the UK and Canada, is the Computerised Remediation of Cognition – Training for Schizophrenia (CIRCUITS) cognitive remediation therapy program. The CIRCUITS program is an animated, internet-based program, specifically designed to improve patients’ insight into their functional difficulties and provides extensive practice for the use of strategies to help overcome these difficulties in key areas of cognitive functioning.

This project will evaluate the implementation of the first CIRCUITS programs to be offered in NSW Health services. The project aims to evaluate patient outcomes and develop facilitator training and resources.

Collaborators: Justice Health & Forensic Mental Health Network, Pathways to Community Living, NSW Ministry of Health, University of NSW, Macquarie Medium Secure Forensic Mental Health Unit, Bloomfield Hospital (Orange), University of Queensland (Metro South (Brisbane) Addiction and Mental Health Services)

In Australia, Sharp Wound Debridement is performed routinely by podiatrists as an essential aspect in the management of Diabetic Foot Ulcers, most often within multidisciplinary High Risk Foot Services in the non-admitted setting.

There has been no systematic investigation regarding the method or frequency of this treatment. Suggestions that debridement frequency may be important have emerged, but to date there is no established interventional data about the optimal frequency of debridement from appropriately designed clinical trials.

The awarding of this Translation Research Grants Scheme funding enables the conduct of a randomised controlled study of weekly versus second weekly debridement of Diabetic Foot Ulcers - with direct potential for translation into clinical practice.

Collaborators: Bankstown Hospital, John Hunter Hospital, Royal Prince Alfred Diabetes Centre and Concord Hospital High Risk Foot Services, Agency for Clinical Innovation, Newcastle University (School of Medicine and Health)

The Far West NSW Palliative and End of Life Model of Care used by the local specialist palliative care services, has recently been implemented for the generalist context in a residential aged care facility within the Far West Local Health District.

Using the Model, the Far West Palliative Approach Framework was developed to further support and guide the provision of a quality palliative approach to care in rural and remote settings, by generalist and primary health care clinicians. Benefits are already being witnessed through implementation of this model.

This research project will bring the Model and Framework to five new rural and remote generalist healthcare sites across the local health district. The associated Translational Research Grant will support the evaluation activity of this research project model rollout.

Collaborators: Far West Local Health District (Lower Western Sector, including Wentworth Hospital, Balranald MPS, Wilcannia MPS), Southern Cross Care (Broken Hill) Ltd, Broken Hill, Murray House Aged Care (Wentworth), University of Sydney (Broken Hill University Department of Rural Health, Agency for Clinical Innovation

Preventing obesity among children and young people is a NSW Premier’s Priority. A key obesity prevention strategy is the implementation of effective programs to promote behaviours that protect against childhood obesity including physical activity and healthy eating. Despite this recommendation, few programs to date have been effective in impacting on adolescent weight status.

With respect to physical activity, a recent Australian program conducted in the Hunter New England Local Health District known as ‘Physical Activity 4 Everyone’ (PA4E1) has provided promising results. Despite developing a promising physical activity program, there is currently little evidence to guide the successful scale-up and population wide implementation of programs like PA4E1in secondary schools.

The research project seeks to support the development and translation of program evidence to prevent overweight and obesity among adolescents in two ways:
1) Assessment of the effectiveness of a scaled-up delivery of the PA4E1 program in 76 secondary schools across four local health districts in NSW
2) Assessment of potential effectiveness of secondary schools implementing healthy nutrition practices among students and the piloting of a program to promote healthy nutrition in a number of schools.

Collaborators: Local health districts (Hunter New England, Mid North Coast, Central Coast and South Western Sydney), University of Newcastle

The Sweet Smiles project aims to reduce the amount of sugar sweetened beverages consumed by children and adolescents, by targeting parents and children using public dental services in Northern NSW.

The project will investigate whether brief interventions delivered to children and parents by oral health staff will decrease children’s sweet drink intake, and whether these interventions will result in referrals to Go4Fun and the Get Healthy Information & Coaching Service.

The brief intervention training and format, accompanying hard/online resources, data collection instruments, referral pathways and their incorporation into children’s records, will all be available to use in the scaling up phase following the project’s completion in Northern NSW. The Translational Research Grants Scheme funding will enable the development, supporting resources and thorough evaluation of the project.

Collaborators: Northern NSW Local health District (Oral Health and Health Promotion teams), NSW Centre for Oral Health Strategy, NSW Office for Preventive Health, North Coast University Centre for Rural Health

Tackling childhood obesity is one of the 12 Premier’s Priorities in NSW. The importance of early obesity intervention in tackling this challenge has become clear. However, current evidence of effective early interventions is scarce. Consequently successful prevention strategies with a broad population reach and low cost have yet to be fully developed.

The study aims to take one existing program trial that has shown promise in delivering child body mass index reductions – The National Health and Medical research Council-funded ‘Healthy Beginnings’ Trial - and translate evidence from this trial into a scaled-up practice applicable across the state with a low-cost, broad-reach and sustainable delivery model.

The proposed interventions will be delivered in the antenatal period and over the first 12 months.

Collaborators: Local health districts (South Eastern Sydney, South Western Sydney and Southern NSW), NSW Office of Kids and Families , NSW Office of Preventive Health, Centre of Research Excellence in the Early Prevention of Obesity in Childhood, University of Sydney

This project will extend current ST-Elevation Myocardial Infarction (STEMI) management to address healthcare inequalities and higher mortality rates in rural patients resultant from presentation to non-percutaneous coronary intervention (PCI) capable hospitals, requiring lengthy and sometimes multiple transfers. The project will strengthen the District's systems of care and increase utilisation of services by reducing patient transfer out of the District, and reducing costs for patient transport. This model of care will be readily translatable across rural NSW, helping to reduce the inequities between rural versus metropolitan STEMI outcomes in terms of both definitive revascularisation rates and mortality.

The research questions are whether a centralised STEMI management system and immediate NSW Ambulance transfer of all STEMI patients to a PCI centre will improve times to reperfusion and reduce total patient length of stay.

The project is a non-randomised, prospective, controlled trial of a centralised, District-wide STEMI management system implemented by NSW ambulance and all hospitals within the Western NSW Local Health District. Key aspects of the management intervention include mandated transmission of all STEMI ECGs to the District ECG reading service at first contact; immediate cardiologist contact to assist patient management and transfer; and immediate “hot transfer” of all STEMI patients to PCI capable hospitals. All STEMI patients of the Western NSW Local Health District centralised management system over a 24-month period will be included in the study, and outcomes compared with historical controls and to contemporary control groups from Hunter New England and Sydney local health districts.

Anticipated benefits of the project include reduced time to reperfusion for STEMI patients in Western NSW Local Health District; decreased length of stay and unwarranted clinical variation; streamlined patient journeys with quicker access to definitive care and decreased number of hospital and ambulance transfers experienced by rural STEMI patients; improved angiography and revascularisation rates.

Collaborators: University of Sydney (School of Rural Health -Orange NSW), Agency for Clinical Innovation (cardiology), Hunter New England Local Health District, NSW Ambulance

Consistent referral of pre-diabetics to the Get Healthy Service plus a simple zinc supplement has the potential to improve glycaemic control, and prevent progression to diabetes. If effective, the partnership and model of care plan can be readily scaled and translated through the Get Healthy Service, general practitioners, and local health district diabetes services. This study aims to ‘help people manage their own health’, which is identified as a State health priority.

Two million Australians have prediabetes and are at high risk of developing type 2 diabetes and cardiovascular disease. Prevention of diabetes and its cardiovascular consequences is a Translational Research Grants Scheme priority. Tertiary diabetes services do not currently reach those with prediabetes, representing a lost opportunity for early intervention and future cost savings for the health system.

This project seeks to implement a new, evidence-based model of care for diabetes prevention. Lifestyle intervention is well established for prevention, but applied inconsistently. An additional strategy that may be effective in reducing insulin resistance is zinc supplementation, supported by evidence from two different meta-analyses of 25 small-scale randomised controlled trials and other studies. Working through an innovative model of partnership between two local health districts and general practitioners (via the Hunter New England Central Coast Primary Health Network), we will recruit 410 people aged 40-70 years with prediabetes (defined as HbA1c 5.7-6.4%), to test whether we can reduce their risk of diabetes and cardiovascular disease. A randomised controlled trial will be conducted; the control group (n=205) will receive the existing and effective NSW Health Get Healthy Information and Coaching Service for diabetes prevention, and a placebo capsule, while the intervention group (n=205) will receive the same lifestyle intervention, plus a 30mg daily elemental zinc capsule. Outcomes over 12 months will include measures of adherence, insulin resistance and glycaemic markers, lipids, other cardiovascular disease risk factors, and cost-effectiveness.

Collaborators: Clinical Excellence Commission, The Australian Prevention Partnership Centre, Hunter New England Central Coast Primary Health Network, Blackmores Institute, University of Otago (New Zealand)

If successful and cost-effective, this project will define a new paradigm for assessment and management of acute coronary syndromes (ACS) in rural settings utilising a central clinical decision support service. It can rapidly be scaled up to be applied across NSW.

One third of patients presenting to Australian hospitals with ST-segment-Elevation Myocardial Infarction (STEMI) do not receive primary reperfusion treatment, which is the standard of care. In rural and regional Australia, primary reperfusion treatment involves thrombolysis which, if delivered in a timely fashion, provides outcomes similar to primary percutaneous coronary intervention (PCI). Failure to provide reperfusion doubles mortality, increases length of stay and increases readmission rates. A high level of clinical variation, due to misdiagnosis or treatment of ACS, has been found in NSW. Our research in Hunter New England Local Health District shows that missed acute myocardial infarction (MI) from failure to correctly interpret electrocardiogram (ECG) and serum markers is common, leading to increased mortality and morbidity, and is overrepresented in rural hospitals that are maintained by general practitioners. This proposal will randomize small rural hospitals to either usual care or a mandated transmission of ECG and troponin from spoke (rural) hospitals to a central hub service. Protocol directed advice will be given to the randomized rural hospital clinicians and will channel patients into the existing ACS management structures: The State Cardiac Reperfusion Strategy for STEMI patients, and the NSW Chest Pain Pathway for non-STEMI patients. The primary outcome will be the difference in identification of STEMI in patients who present to rural hospitals across two local health districts, Hunter New England and South Western Sydney.

A cost-effectiveness evaluation will report the resources required to increase STEMI identification. Secondary outcomes include major adverse cardiac events and outcomes in non-STEMI. Hunter New England Local Health District has a proven track record in innovation in rural cardiology. The NSW Health Minister's award for translational research was won by Hunter New England in 2016 for pioneering the state reperfusion strategy.

Collaborators: Agency for Clinical Innovation, NSW Ambulance, John Hunter Hospital, Monash University

After hypertensive pregnancy, women have a doubled risk of cardiovascular disease and death within 20 years. Some success of lifestyle intervention after diabetic pregnancy in reducing maternal risks is reported; no Australian data exists after hypertensive pregnancy. This study will provide much needed evidence of whether one-off assessment and education, or education plus lifestyle intervention, is superior to current usual care after hypertensive pregnancy. If evidence of benefit is found, the postpartum clinic and Get Healthy intervention is readily translatable into practice change throughout NSW health services.

Research Question (s):
1. Does an individualised six month healthy lifestyle program instituted six months after hypertensive pregnancy result in lifestyle behaviour and/or blood pressure (BP) change compared to (a) routine care, or (b) one-off individualised risk assessment and education?
2. Secondarily, do such interventions demonstrate likely cost-effectiveness and patient acceptability?

The project is a three-arm randomised controlled trial of women after hypertensive pregnancy, with women recruited after giving birth at one of the study hospitals. Women (n=480) will be randomised into one of then following groups:
1. Usual postpartum care as per hospital guidelines and at discretion of the treating team;
2. Attendance at follow-up clinic six months postpartum, assessment of personal cardiovascular risk profile then one-off cardiovascular diet and exercise education; or
3. In addition to 2., ongoing diet and exercise coaching for six months through the NSW Health Get Healthy Service Women will then be assessed 12 months post-partum [after the active intervention in 3. concludes].

Primary outcomes:
1. Maternal lifestyle behaviour change as assessed by change in weight and/or waist circumference
2. Mean systolic blood pressure.

Secondary outcomes including additional lifestyle behaviour change markers physical activity; fruit and vegetable intake levels; other clinical measures including vascular function, mean arterial pressure, cholesterol, glucose and cardiovascular risk score; economic analysis; patient satisfaction.

Collaborators: NSW Office of Preventive Health, NSW Ministry of Health (Maternity, Child, Youth and Paediatrics Unit, Health and Social Policy Bbranch), Australian Action on Preeclampsia (AAPEC) – peak, Australian consumer organisation for women affected by hypertensive pregnancy, Sydney Local Health District, National Heart Foundation Australia (NSW Division)

Aboriginal people have a disproportionately high burden of cardiovascular disease yet substantially lower rates of participation in cardiac rehabilitation compared to non-Aboriginal people. A family centred outreach model approach to cardiac rehabilitation may have multiple benefits including increasing participation in evidence based cardiac rehabilitation, culturally inclusive care and identifying and managing family members at risk of a cardiovascular event.

Primary research question:
1. Does a family centred, eight week outreach model improve uptake and completion of a secondary prevention program for Aboriginal patients discharged from hospital with selected cardiac conditions?

Secondary research questions:
2. Is a family centred outreach model, delivered in a community setting, acceptable to staff, index case and their household family members?
3. Does a family centred outreach model result in effective management of cardiovascular risk factors among family members and the index case?
4. What are the healthcare costs associated with the implementation of the model?

Quantitative methods will be employed for Question one, three and four. Data will be collected at baseline, and at six and 12 month follow up periods. Data collected will include participation rates, anthropometric measures, biomarkers, psychosocial status, lifestyle measures, medication compliance, and associated costs.
A qualitative approach, using focus groups, will be performed to explore the acceptability of the family centred outreach model, as outlined in Question two. The study has multiple benefits including:
* Increasing access to evidence based and culturally safe secondary prevention services, including for family members
* Statewide relevance and potential for adoption by other local health districts, cardiology services and adaptation to disciplines other than cardiology
* Aboriginal Health Workforce integration and professionalisation.

Collaborators: Illawarra Aboriginal Medical Service, South Coast Aboriginal Medical Service, Heart Foundation, Agency for Clinical Innovation, NSW Ministry of Health, local health districts (Southern NSW, South Eastern Sydney)

Long outpatient waiting times are common, frustrating for patients and clinicians, and may have adverse health consequences. This proposal evaluates eADVICE (electronic Advice and Diagnosis Via the Internet following Computerised Evaluation), an interactive eHealth program that provides treatment advice to patients, supervised by their general practitioner, while they are awaiting a specialist appointment. eADVICE facilitates the exchange of information between the child, parents and specialists using a virtual character (“avatar”), enabling assessment, diagnosis and provision of individualised treatment advice. Researchers will first test eADVICE in incontinence and sleep disorders, because clinics for these conditions have waiting times of over 12 months.

Research questions:
1. Can the number of patients needing to see the specialist be reduced by using eADVICE-continence?
2. Can eADVICE-continence improve patient outcomes and reduce costs? In a wait-controlled randomised trial, we will compare the effects of access to eADVICE-continence at the time of specialist referral (intervention) to six months later for patients referred to the Sydney Children's Hospital Network and John Hunter Children’s Hospital continence services. The primary outcome is reduction in need for specialist referral, with secondary outcomes including clinical, economic and process evaluations.
3. Can eADVICE be adapted for sleep clinics? We will create eADVICE-sleep and test the feasibility of using it for sleep clinics, and assess the impact, practical implications and acceptability to doctors, patients and families.
4. Can we create a scalable framework for adapting eADVICE for other health conditions? Drawing on our experience with eADVICE programs, we will create an eADVICE framework and share the lessons learned about ICT and other issues encountered during the project, to facilitate the development and implementation of eADVICE for other conditions and for future statewide scale up of the program. eADVICE provides a sustainable model of outpatient care that has applicability for many chronic subacute conditions.

Collaborators: Hunter New England Local Health District, eHealth NSW, The Continence Foundation of Australia, Agency for Clinical Innovation, WentWest (PHN), consumers

Individuals in contact with the criminal justice system experience a particular burden of mental illness and have often had poor access to community mental health care. Imprisonment can represent an opportunity to identify those with greatest mental health need but, any benefit from treatment can be lost on release during the prison-to-community transition period if continuity of care is not supported. There has been very little research undertaken to date to guide service development and clinical interventions for prisoners with mental health problems but the concept of ‘critical-time’ intervention has been gaining some support. Such interventions are intended to target transition periods for people with severe mental illnesses that can present a risk of deterioration in mental health and other associated outcomes.

The proposed research project aims to test a novel ‘critical-time’ intervention to support/facilitate continuity of mental health care during the prison-to-community transition period. The intervention (characterised by three elements - early contact with community service, individualised care planning and post-release follow-up) will be embedded in a structured and validated mental health screening process previously developed by the research team and currently being translated into routine practice across prisons in NSW. Embedding the intervention in screening at reception will ensure that the prison-to-community transition planning begins early and is individualised on the basis of the results of screening and subsequent assessment. The research team will examine the feasibility of such an intervention in NSW and will test the efficacy of the approach using a randomised controlled trial design with multi-source follow-up.

The research team has developed partnerships with mental health providers spanning the custodial and community divide in order to facilitate the project and to subsequently disseminate the research findings. If the intervention is found to be feasible and efficacious, a plan to scale-up the intervention will be developed with study partners.

Collaborators: Western Sydney Local Health District, NSW Ministry of Health (Mental Health Branch)

This project aims to investigate the feasibility, acceptability and potential effectiveness of a novel intervention (exergaming) to promote physical activity among patients of locked-ward mental health units. This project addresses a clearly identified priority to reduce the excess health burden associated with cardiovascular disease among this population. Outcomes will directly improve the care of patients of the Justice Health & Forensic Mental Health Network and other NSW Health local health districts/specialty networks, particularly those in restricted psychiatric inpatient settings.

Demonstrated feasibility, acceptability and positive patient outcomes, with minimal impact on resources and patient safety, will maximise the potential for:
1. embedding the intervention into routine practice
2. sustainability
3. scalability statewide across the NSW Health system.

Research questions are:
1. Is a physical activity program based on exergaming able to be conducted within the setting of a locked-ward mental health unit?
2. Is exergaming an acceptable intervention for promoting physical activity among patients and staff of such units?
3. Is the proposed intervention associated with improved physical and mental health outcomes for patients?

The project is a quasi-experimental two-arm pilot study using a non-equivalent control group, pre-test/post-test design conducted across two sub-acute units of the Long Bay Hospital Mental Health Unit (30 patients from each unit). Eligible patients from the intervention site will receive an exercise program comprising 3x30 minute exergaming sessions per week for 12 weeks using activity-based games designed to simulate moderate intensity exercise. Patients from the comparison site will receive “treatment as usual” (i.e. standard model of care provided by the Justice Health & Forensic Mental Health Network).

Collaborators: Sydney Children's Hospital Network, NSW Ministry of Health (Mental Health Branch)

This project will determine what the key facilitators and barriers impacting optimal implementation of an evidenced based online intervention for isolated women living in regional, rural and remote areas of NSW.

The MumMoodBooster program, an internet cognitive-behavioural therapy (CBT) program which has been established as clinically effective, will be used to bring treatment to isolated new mothers experiencing mild to moderate depression and anxiety. The impact of depression can be compounded by isolation, stigma and women not recognising they are depressed or not wanting to seek professional help. The use of an online treatment has the potential to reduce barriers to treatment uptake resulting in enhanced patient care, service delivery and outcomes for depressed women and infant development. However, despite the widespread agreement of the benefits and importance of e-health strategies, difficulties with implementation has slowed their implementation. Various factors can influence implementation - system complexity, internet reliability, costs, planning, policy concerns, clinician and women’s attitudes towards the technology. This study will aim to identify the key barriers and facilitators to accessing the online MumMoodBooster for isolated and hard to reach women in areas of regional, rural and remote NSW.

The study type is informed by an implementation research methodology and framework. An implementation framework facilitates the enactment of scientifically proven health interventions (MumMoodBooster ) into the real world in a wide variety of contexts (isolated rural women). An essential component of this approach is the establishment of strong relationships with diverse partners. The project will use surveys, focus groups, interviews and collect quantitative data to initiate, implement and evaluate the uptake and effectiveness of the program for the target group. Built in to the study will be strategies for scalability and sustainability of the approach.

Collaborators: Western NSW Local Health District, Charles Sturt University, Parent-Infant Research Institute, Northern Sydney Local Health District, Tresillian

Cognitive behavioural therapy (CBT) is the treatment with the strongest evidence base for bullimia nervosa however, access to health services and costs are major barriers to receiving treatment. Eating disorders place a high burden on the health system, with total annual costs estimated at $99.9 million [1]. Consequently, developing new delivery mechanisms to ensure early receipt of evidence based treatment is essential.

With seeding funds from NSW Health, the Centre for Eating and Dieting Disorders have developed as part of the actions arising from The NSW Service Plan for Eating Disorders, a ten session online CBT program. We recently completed a pilot of the CBT program demonstrating it successfully reduces illness severity in bullimia nervosa patients. With our service and government partners we are seeking funding to conduct a randomised controlled trial of guided online CBT, compared to a waitlist control in three local health district settings – an eating disorder outpatient clinic, an adult community mental health team, and a headspace clinic. 128 participants who meet current diagnostic criteria for bullimia nervosa will be recruited across three sites and randomly assigned to guided online CBT or waitlist.

Pre and post assessments of eating disorder psychopathology, binging and purging and general mental health will be conducted via comprehensive online e-screen assessment. Assessment of eating disorder behaviours is built in to each weekly session. Participants will be followed up at one month post-treatment. In a secondary analysis participants will be grouped according to treatment setting, and program effectiveness compared to determine if health outcomes and costs are effected by the setting in which treatment is delivered. A health economic analysis of the online program compared to face-to-face delivery (modelled cost effectiveness analysis (CEA)) and wait-list control (within trial CEA) will be conducted, to inform future decision making and policy development. Should the program prove effective existing statewide structures exist to ensure its broad implementation which could result in early access to evidence based care for many.

Collaborators: local health districts (Northern Sydney, South Western Sydney), NSW Ministry of Health, Butterfly Foundation

[1] The Butterfly Foundation. Paying the Price – The economic and social impact of eating disorders in Australia, 2012.

Advance Care Planning (ACP) is a process of reflection, discussion and communication that enables a person to plan for their future medical treatment and other care, for a time when they are not competent to make, or communicate, decisions for themselves. This proposal aims to extend our current study, funded by the Translational Research Grants Scheme in round one, which is a randomised controlled trial (RCT) (n=197) that aims to address the research question: can Advance Care Planning intervention provided to patients with advanced diseases attending hospital outpatient clinics identified as being at risk of dying in the next 12 months reduce unplanned hospital admissions at six months, improve patient care and encourage health professionals to incorporate ACP into routine care?

This proposal will extend the data collection to 18 months which is important because the benefits and impact of ACP are unlikely to be fully realised after just six months. We will also conduct a health economics evaluation utilising data linkage with NSW Health datasets (admitted patients collection, Ambulance data, emergency department collection), and the Medicare and PBS datasets. We will conduct an audit of patient deaths to determine if ACP results in the patient dying in the setting and receiving end-of-life care consistent with their wishes. Our proposed study will build on our current ongoing study to generate further evidence for the effectiveness of ACP for patients with advanced illnesses, including benefits from the health economics perspective and over a longer time period (of 18 months).

Positive results obtained from this study will provide the necessary evidence to policymakers and health service managers to enable them to make additional investments and therefore implement ACP at a larger scale. Our current steering group has wide representation from the local health districts, the NSW Ministry of Health, health provider organisations, primay health networks, universities, and consumer organisation. This will maximise the possibility of our findings influencing policy and clinical practice in the future.

The research questions are:
Can facilitated Advance Care Planning intervention provided to patients with advanced illnesses identified as being at risk of dying in the next 12 months attending hospital outpatient clinics:
(a) reduce unplanned hospital admissions and acute health resources utilisation after 18 months?
(b) lead to similar or lower health care costs after 18 months?
(c) result in the patient dying (if this was to occur) in the setting and in a manner consistent with their expressed wishes?

Collaborators: Sydney Local Health District, NSW Ministy of Health (Office of the Chief Health Officer), eHealth NSW, Central and Eastern Sydney Primary Health Network (Social Policy branch), NSW Ambulance Service, Alzheimer’s Australia, University of Wollongong, University of Technology Sydney

The outcomes of this research will see fewer children admitted to intensive care at birth, have fewer episodes of life threatening morbidities, and potentially these children will have improved longer term educational outcomes. The research question is: does the provision of educational materials to care givers, mothers and their families safely lengthen the duration of pregnancy, reduce early planned birth rates and reduce health care utilisation costs?

The program of research will provide decision support and raise awareness to practitioners and pregnant women about the importance of timing elective birth as close to 39 weeks as is safely possible. Such approaches have successfully been implemented overseas and also in Western Australia. The researchers are partnering with those who have successfully implemented practice change in WA. A series of interventions will be evaluated to see whether more judicious decision making with respect to the timing of elective birth, leads to less newborn morbidity and newborn intensive care utilisation.

Collaborators: Central Coast Local Health District, South Eastern Sydney Local Health District

The vision for this program is to intervene at a primary care (general practice) level to improve patient outcomes and reduce healthcare costs by reducing preventable admissions. If found feasible and effective, this suite of interventions has the potential to save up to $30 million annually if implemented across NSW.

Heart failure is a progressive, chronic disease that is often marked by frequent hospitalisations and is associated with a high mortality rate. In NSW alone, associated healthcare costs are estimated at $1 billion/year, mainly related to hospitalisation costs. Within 30-days of a first heart failure admission one third of surviving patients will be readmitted. Additionally, 5 year mortality after the first heart failure admission is 50 per cent, similar or even worse than many cancers. In Hunter New England Local health District, the annual rate of death or re-admission following heart failure hospitalisation is 69 per cent.

NSW's Agency for Clinical Innovation, via its Cardiovascular Clinical Expert Reference Group, has identified heart failure service delivery as a key area for improvement. It has published NSW clinical service framework for chronic heart failure this year, directing us to improve heart failure management. Many individuals are not diagnosed with heart failure in a timely manner, and once a diagnosis is made, treatment is frequently sub-optimal resulting in adverse outcomes and unnecessary costs.

We are proposing to implement a combination of interventions in the primary health care setting to improve access to heart failure services and management, especially for patients in rural and remote areas. We will test the feasibility, acceptability and potential effectiveness of this strategy in a primary care based intervention study across a full range of rural settings in Hunter New England and Central Coast local health districts. The intervention involves a one-day general practitioner education “masterclass”, NT-proBNP monitoring, patient-centred daily heart failure diary and home-based heart failure exercise program.

Collaborators: Agency for Clinical Innovation, Hunter New England and Central Coast Primary Health Network, Bonnells Bay Surgery

Preventing childhood obesity is a NSW Premiers’ Priority. Children consume a third of their daily energy intake at school. Much of the food packed in student lunchboxes, however, is energy-dense and nutrient poor. As such, improving the nutritional quality of school lunchboxes is a World Health Organisation, national and NSW priority to avert unhealthy weight gain. Although there has been significant investment in obesity prevention in schools, there has been little change in the nutritional quality of foods packed in children’s lunchboxes, impeding the achievement of NSW obesity prevention targets.

The primary impediment to current approaches to improving foods packed for children is an inability to effectively reach parents. Online communication platforms used by schools to communicate with parents exist in 62 per cent of NSW schools and are regularly used by 72 per cent of parents. Such technological infrastructure provides an opportunity to deliver obesity prevention interventions direct to parents at-scale, with high fidelity and at low cost. We have partnered with the leading provider of an online school communication platform in NSW (accessing 1550 schools and approximately 465,000 children) to develop and pilot a healthy lunchbox intervention delivered via this modality. Pilot findings demonstrated the intervention is feasible and acceptable to principals, teachers and parents and suggests it may be effective in reducing the energy content of lunchboxes. The primary aim of this study is to assess, via a randomised controlled trial, the effectiveness and cost-effectiveness of an intervention that makes use of an existing online communication provider to improve the kilojoule content from discretionary foods and drinks packed in a child’s lunchbox. If effective, partnering local health districts have committed to facilitating dissemination across their district. The application has the clear potential for statewide translation by the Office of Preventive Health, a study partner.

Collaborators: Office for Preventive Health, SkoolBag, Mid North Coast Local Health District, Central Coast Local Health District, NSW Department of Education

This research aims to identify one or more programs for parents of children aged 2-6 years that are effective in improving their child’s health behaviours (nutrition, physical activity, sedentary time and sleep). The programs will be implemented in NSW and contribute to the Premier’s Priority to reduce childhood overweight and obesity by 5 per cent by 2025.

The study will employ a three-arm parallel-group randomised preference trial design of a telephone-based intervention (modified Healthy Habits), an online intervention (modified Time2bHealthy) and educational material intervention (which will serve as a minimal intervention comparison).

The study will address the following research questions:
1. What is the relative effectiveness and cost effectiveness of an online behaviour change program (Time2bHealthy) and a telephone-based support program (Healthy Habits) targeting parents of 2-6 year olds in improving child diet in accordance with Australian recommendation?
2. What is the relative effectiveness and cost effectiveness of the Time2bHealthy and Healthy Habits programs on child physical activity, sedentary behaviour (including screen time), sleep and weight status?
3. What are the most optimal approaches to maximise recruitment to and retention of parents in both interventions?

Collaborator: local health districts (Illawarra Shoalhaven, Southern NSW, Hunter New England, South Eastern Sydney, Mid North Coast), NSW Office of Preventive Health, Department of Education, Early Childhood Australia

Several local health districts are about to implement a new service to deliver integrated weight management services for children and adolescents. This project will help to generate an evidence base for weight management models of care in participating local health districts, as they are established.

The study proposes to answer a range of questions about the different models of care including: what influences their acceptability, reach, participation rates and retention rates; how effective they are on weight management; what impact they have on eating, physical activity and sedentary behaviours; their costs and more.

The project will improve the design and delivery of local services for children and their families, in particular by enhancing the accessibility, acceptability, reach and impact of services for children and families from diverse regions of NSW.

Collaborators: NSW Ministry of Health, Hunter New England Local Health District

The Clinical Excellence Commission has indicated that access to services, including availability of specialist services such as speech pathology, is one of their major areas of complaint from patients.

Until the availability of speech pathology services meet demand, it is important to provide appropriate care while children are waiting for these services. Over many years speech pathologists have been providing advice regarding speech and language stimulation for parents and children while waiting for direct intervention. In this information-rich age, parents also turn to the internet, using devices to support their child.

This study will be the first of its kind in the world to determine the effectiveness of “advice versus device” while children are waiting for speech pathology services.

The outcome of this study will inform best practice regarding appropriate care while waiting for speech pathology services. If the outcomes are positive, the website and speech pathology advice packages will be freely available to families across NSW.

Collaborators: Sydney Children’s Hospital Network, Ministry of Health

This pilot study will determine the clinical utility and uptake of a child abuse and neglect E-Checklist in rural and metropolitan emergency departments. It will also determine if this E-Checklist and training improves clinician documentation and referral of suspected abuse cases, and clinician self-efficacy and outcome expectations when responding to non-accidental injury.

This project will audit the emergency department records of children aged twelve and under, who have presented to the emergency department with an injury. Following this an E-Checklist will be incorporated into the Electronic Medical Record directing clinicians to consider ‘red flag’ indicators of non-accidental injury. A training program will be provided to clinicians alongside the E-Checklist.

Collaborators: NSW Health, Sydney Children’s Hospital Network, eHealth

Eating Disorders are mental illnesses often with severe complications and high rates of morbidity and mortality. Timely and appropriate care may reduce mortality and improve outcomes from eating disorders. Family Based Therapy for eating disorders is an effective treatment when provided by specialists.

There are currently no Family Based Therapy eating disorder programs within Hunter New England Local Health District.

This study aims to answer the following questions:
1. Does implementation of Family Based Therapy treatment in community-based Child and Adolescent Mental Health teams across the district lead to effective and cost-effective improvements in patient outcomes?
2. Do specific clinician or organisational factors influence translation of Family Based Therapy from a specialist treatment to a more mainstream treatment model within these teams?

Collaborators: Sydney Children’s Hospital Network

This study aims to translate a promising community-based systems approach to childhood overweight and obesity prevention previously trialled in rural communities in Victoria and ACT, to evaluate its effectiveness in improving the child obesity environments and behaviours in a socioeconomically and ethnically diverse urban community in south west Sydney.

This project will assess the effectiveness of the approach in changing food and physical activity environments, dietary and physical activity behaviours, and body mass index in children aged 5 to 12 years in this community.

This study will address these research questions:
1. How effective is a community-based approach to childhood overweight and obesity prevention in changing children’s dietary and physical activity habits?
2. To what extent does the approach result in changes in local food and physical activity environments?
3. In the longer term, how effective is the approach in decreasing body mass and the prevalence of childhood overweight and obesity in these children?

Collaborators: NSW Office of Preventive Health, Hunter New England Local Health District

The benefits of Advance Care Planning are well known. For example, patients’ wishes and preferences for care will be respected, and families and health professionals are eased off from the burden of decision-making on patients’ behalf.

This study aims to address how Advance Care Planning can be normalised into practice, and if normalising Advance Care Planning has an effect on increased ‘Planning ahead’ practices in acute and community settings.

The research team will examine the various mechanisms that are necessary for the intervention to become a routine in practice, and to mediate the work that individuals and groups do both independently and collectively to embed and sustain a new intervention.

Collaborators: Hunter New England Local Health District

The Aboriginal Transfer of Care model extends traditional discharge planning to provide a new structured multidisciplinary planning process for Aboriginal patients being discharged from hospital. A pilot of the Aboriginal Transfer of Care model in Campbelltown Hospital demonstrated a decrease in unplanned readmissions for Aboriginal patients

The project will refine, document and evaluate the Aboriginal Transfer of Care model for Aboriginal patients aged 15 years and over with chronic conditions admitted to selected South Western Sydney Local Health District hospitals. The study will use a before and after design using linked administrative health data and qualitative research.

The study aims to determine to what extent implementing Aboriginal Transfer of Care decreases rates of unplanned hospital readmissions, emergency department presentations, and rates of discharge against medical advice, among Aboriginal patients.

Collaborators: Office of the Chief Health Officer, Centre for Epidemiology and Evidence, Tharawal Aboriginal Medical Service, Western Sydney Local Health District, Nepean Blue Mountains Local health District

Childhood overweight and obesity is a significant public health issue. A key contributing factor to overweight and obesity in children is the consumption of sugar sweetened beverages.

This study aims to determine whether a behavioural intervention promoting increased water consumption and the provision of chilled water stations, alone or combined, increase water consumption and effects changes in in year seven secondary school students’ knowledge and attitudes and/or reduces the consumption of sugar sweetened beverages.

This study is designed to determine the effect of the “Thirsty? Choose Water!” behavioural intervention and the installation of chilled water stations. Sixty secondary schools will receive either:
1. Behavioural intervention,
2. Chilled water stations,
3. Behavioural intervention and chilled water stations, or
4. Neither intervention.

Collaborators: Illawarra Shoalhaven Local Health District, South Western Sydney Local Health District, Health Protection NSW, Centre for Population Health

Borderline Personality Disorder is a condition with major impacts on the health of the client, a significant burden on the client families’ quality of life and high costs to health services.

Psychological therapy is the mainstay of treatment of borderline personality disorder; however, the demand for psychological treatment has resulted in excessive waitlists for a high risk cohort.

This study aims to investigate the effectiveness of a stepped care approach, incorporating a briefer, less costly Dialectical Behaviour Therapy program in comparison to individual therapy. The trial will compare stepped individual therapy to stepped group skills training, informed by Dialectical Behaviour Therapy.

The results of the project will provide evidence to inform an effective clinical pathway for Borderline Personality Disorder. Further, the model will be consistent with NHMRC clinical guidelines, which supports psychological therapy as the first line of treatment for Borderline Personality Disorder.

Getting on Track in Time (Got It!) is an early intervention model for children (K-Year 2) with disruptive behaviour problems. The TAG research project will examine the feasibility of providing components of Got It! via telehealth.

New knowledge from this project will assist in better understanding if the telehealth approach to Got It! is efficient, effective, acceptable and can deliver equivalent outcomes to the in-person model. This project will also provide new knowledge on if this model can be scaled to other settings and programs in the future.

The project has potential benefits on practices including children with behaviour problems and their families benefiting from early intervention mental health services where they otherwise may not have received it. It will also help to strengthen partnerships and capacity for translational research and experience in telehealth in local health districts.

Collaborators: Murrumbidgee Local Health District, NSW Ministry of Health, Agency for Clinical Innovation

Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE) and Clostridium difficile (Cdiff) are three major pathogens responsible for severe healthcare-associated infections.

The study aims to address the question: does incorporation of routine strain-typing into healthcare-associated infection surveillance lead to more reliable and rapid identification of outbreaks, and lead to reduction in cases of healthcare-associated infection?

The team will develop rapid, inexpensive, high throughput and accurate strain typing methods for VRE and Cdiff to complement the method we have already implemented for MRSA. The findings are expected to demonstrate earlier detection and termination of outbreaks through the rapid and improved recognition of covert clusters.

Collaborators: Clinical Excellence Commission, Health Protection NSW

This project will examine the feasibility and transferability of an innovative model of nurse-led mental health care in three emergency departments include a large metropolitan emergency department, a regional emergency department at a Base Hospital, and a smaller rural emergency department.

In addition to testing the feasibility of this model of care, the study will evaluate the outcomes for patients with mental health, drug health and acute behavioural problems.

An implementation and evaluation study involving the collection of descriptive data, waiting times, surveys and interviews with staff and patients will be undertaken. The team will translate findings from the successful model of nurse-led care trialled in the emergency departments at the Royal Prince Alfred Hospital.

Collaborators: Western Sydney Local Health District, Hunter New England Local Health District, Western NSW Local Health District

This research project will determine whether an integrated care approach using non-pharmacological interventions in patients with chronic obstructive pulmonary disease can reduce breathlessness, with consequent improvement in quality of life and reduction in health care utilisation and hospital admissions.

It is hypothesised that this approach will help patients to experience better mastery of breathlessness and a reduction in breathlessness, leading to increased quality of life and reduced inappropriate health care utilisation.

This study has the potential to generate world-wide interest in this novel approach to managing breathlessness in chronic obstructive pulmonary disease. It is likely that the non-pharmacological interventions will become the standard of care for patients with severe chronic obstructive pulmonary disease, and would become incorporated into routine clinical practice.

Collaborators: Agency for Clinical Innovation

Thirteen per cent of all Australians visit emergency departments each year, with 2.69 million attendances in NSW. About half of all emergency department visits involve pathology testing, accounting for 52 per cent of non-staffing costs.

Appropriate testing is essential for clinical care, however unnecessary tests not only represent waste in the health system, but can lead to over-diagnosis, over-monitoring with treatment errors, and prolonged emergency department length of stay.

The UNTIE study aims to measure and reduce the number of unnecessary pathology tests ordered, for 35 common emergency department presentations. It will do so by translating the 2013 Australian Guideline into practice.