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  • Innovative research on show

    Innovative research on show

    An impressive group of emerging leaders addressed the Kolling’s Neuroscience and Pain Showcase, sharing details of their diverse and exciting research projects.

    With a broad range of expertise in this field, the showcase involved representatives from the pain management and rehabilitations teams, as well as the ageing, mental health, neurogenetics and neuromuscular imaging groups.

    The early and mid-career researchers discussed their latest progress across the scientific spectrum from their ground-breaking discovery projects through to their potentially life-changing translation and implementation work.

    Co-chair of the Neuroscience and Pain Priority Research Area and pain specialist Professor Paul Glare said there is a tremendous need for new approaches and models of care with an escalating number of people living with conditions impacting the mind, brain and nervous system.

    “We have a large number of researchers making important inroads in this field, and it was encouraging to learn more about their innovative work from an award-winning program to help injured workers get back to work faster to new treatments for Parkinson’s disease,” he said.

    “With the return-to-work initiative, we learnt extra support for injured workers saw them return to the workplace in half the time of those who didn’t receive the extra care. This is a good example of high quality research significantly improving health outcomes for our community.

    “Our researchers are leading a host of valuable projects, including a pilot intervention to reduce the inappropriate use of multiple medications in older in-patients. This program is optimising medication use, while minimising risks to a patients’ physical and cognitive function.”

    Researchers at the showcase also shared details of their work broadening our understanding of the debilitating Ehlers-Danlos Syndrome, as well as conditions characterised by irritability like depression and anxiety.

    We also learnt more about the role of autonomic function in injury recovery, and how it can delay a return to health. 

  • Remarkable service recognised in Queen’s birthday honours

    Remarkable service recognised in Queen’s birthday honours

    We would like to congratulate our Kolling Institute researcher Professor Sarah Hilmer who’s been awarded an AM for her service to clinical and geriatric pharmacology as part of the Queen’s birthday honours.

    Professor Hilmer has worked as the Head of Clinical Pharmacology and as a geriatrician at Royal North Shore Hospital since 2005. Her research and clinical expertise is respected both nationally and internationally.

    Sarah leads a research program in ageing and pharmacology at the Kolling Institute and has contributed widely to the management of medication across the community. She chairs the Royal North Shore/Ryde Hospital Drug and Therapeutics Committee, the NSW Therapeutic Advisory Group, and initiated the NSW Health COVID-19 Drug and Therapeutic Advisory Community of Practice.

    Her research focuses on understanding and optimising medication use and improving outcomes in older people, particularly those living with multiple conditions. She developed the Drug Burden Index, a tool to measure the overall risk of a person’s medicines to their physical and cognitive function. This tool is being used widely across the Northern Sydney and Central Coast local health districts, supporting thousands of people.

    Professor Hilmer has welcomed her award.

    “I am lucky to have worked in clinical practice, research and policy, with a wonderful network of mentors, colleagues and mentees,” she said.

    “I am particularly glad that I have helped train clinicians and researchers with backgrounds in medicine, pharmacy, nursing and basic science in geriatric pharmacology, who can help build this emerging field.

    “I hope that our work improves medicines use and outcomes for older people, whether they’re at home, in a residential aged care facility or in hospital.”

  • Ground breaking approach to emergency care in NSW to be tested

    Ground breaking approach to emergency care in NSW to be tested

    New funding will see a large-scale project launched across NSW to significantly improve patient outcomes and experiences in Emergency Departments.

    Chief investigator and Kolling Institute researcher Professor Margaret Fry said more than $2.8 million will be invested in the EPIC-START program, giving patients better access to early evidence-based treatment pathways.

    30 Emergency Departments will initially be involved in the project which is aimed at achieving better outcomes through earlier decisions, delivery of care and detection of clinical deterioration.

    Professor Fry said a new approach is needed with our Emergency Departments across NSW facing unprecedented demand.

    “We know that millions of Australians seeking care in our EDs are confronted by overcrowded waiting rooms, ambulance ramping, time-poor clinicians and long wait times,” she said.

    “Overcrowding causes delays in treatment and diagnosis, leading to adverse events and poor patient outcomes.

    “Our current models of care are not equipped to deal with this or designed to help patients move through ED efficiently in these situations.”

    “The EPIC-START model of care however, will implement data analytic tools and evidence-based clinical pathways to improve patient flow.”

    The model focuses on faster decision-making and delivery of care. Validated decision support tools will be used at triage to stream patients to various parts of the hospital, with treatments commenced earlier using standardised nurse-initiated pathways across all common illnesses presenting to ED.

    “The project will upskill emergency nurses to ensure all patients attending Emergency Departments have access to earlier evidence-based interventions, like pain relief, blood tests and x-rays, rather than waiting hours for a doctor to order them.

    “Those who deteriorate despite early interventions will be flagged to senior doctors using electronic alerts based on data in the electronic medical record. This will improve efficiency and safety.

    “Our approach is founded on reviews of the literature, our local research outcomes and our real-world experience in Emergency Departments over the past decade. It’s now time to upscale this model for all NSW emergency patients.

    “We would like to see a stronger system where all Australians have timely access to high-quality, patient centred emergency care, by using sustainable and data-driven approaches.”

  • Back pain treatments shouldn’t neglect the mind

    Back pain treatments shouldn’t neglect the mind

    ysiotherapy treatments with those focusing on the mind.

    The study, involving Emma Ho, Professor Manuela Ferreira and Lingxiao Chen, analysed evidence from almost 100 trials worldwide involving over 13,000 patients.

    It found a combination of physiotherapy alongside psychological interventions, like behavioural therapy and pain education, produced the best outcomes for physical function and pain intensity.

    The researchers say these results could help improve the clarity of guidelines to better support patients and clinicians in making treatment decisions.

    Lead author Emma Ho said we know that adults with chronic low back pain not only experience physical disability, but often also suffer psychological distress including anxiety, depression or fear of pain from movement.

    “Clinical guidelines recommend a combination of exercise and psychosocial therapies for managing chronic low back pain, however very little is actually known about the different types of psychological therapies available and their effectiveness,” she said.

    “This often leaves doctors and patients unclear about the best choice of treatment.

    “This uncertainty motivated us to conduct the study and we are pleased to say we now have a clearer picture of the most effective psychological interventions for people with chronic low back pain.

    “Our in-depth analysis looked at a broad range of interventions such as counselling and cognitive programs, and we found behavioural therapy and pain education alongside traditional physiotherapy offered the best results and reduction in pain,” she said.

    Researchers from Australia and Canada were involved in the collaborative research project, with the results to inform healthcare guidelines not just in Australia but internationally as well. 

  • Link between obesity severity and adverse outcomes for pregnant women and their babies

    Link between obesity severity and adverse outcomes for pregnant women and their babies

    There are calls for a greater focus on weight management following new research defining the relationship between obesity and pregnancy-related complications for mother and baby.

    The study follows an increase in obesity levels globally as well as a rise in prevalence during pregnancy. Today, more than 20 per cent of Australian women have obesity at the time of conception.

    Kolling Institute and University of Sydney researcher and Royal North Shore Hospital Endocrinologist Associate Professor Sarah Glastras said we know that obesity in pregnancy increases the risk of the mother developing gestational diabetes, gestational hypertension or high blood pressure, and pre-eclampsia. There’s also a higher risk of stillbirth as well as a caesarean section delivery.

    “Women with obesity are more likely to deliver a baby with congenital abnormalities, respiratory distress syndrome and have a large baby,” she said.

    “Our research has now given us a much clearer picture of the direct link between the severity of obesity and the risk of adverse impacts for both the mother and her baby.”

    Three classes of obesity were identified based on body mass index with class one assessing women with the lowest severity of obesity.

    • The research found 21 per cent of women with class I obesity developed gestational diabetes, compared with 28 per cent with class III.
    • Women with class I obesity had half the risk of developing pre-eclampsia compared class III. (2.8% versus 6.2%).
    • There was an increased risk of caesarean delivery, with a 40 per cent risk in class I, a 45 per cent risk in class II and 54 per cent in class III. This compared with the national average of 33 per cent.
    • 26 per cent of women with class I obesity had a large baby compared with 33 per cent in class III.
    • Stillbirth and birth defects were more common in women with more severe obesity.

    “Our study highlights the importance of weight management in women of child-bearing age, not just during pregnancy, but also at time of conception,” said Associate Professor Glastras.

    “Encouragingly, we also demonstrated that with good obstetric care, we can mitigate some of the risks associated with obesity in pregnancy.

    “Our research not only provides individuals with an incentive to manage their own weight, but also offers health providers and policy-makers more evidence to support pre-conception weight management initiatives.”

  • Masters players committed to the team, ignore heart health

    Masters players committed to the team, ignore heart health

    Research from the University of Sydney and Royal North Shore Hospital provides insights into cardiac risk among footballers of masters age (35 years and older), an increasingly popular pastime.

    In what is believed to be the first study to assess cardiac knowledge and beliefs in this higher-risk amateur football group, researchers have found that one in five players experienced one or more potential cardiac symptoms while playing in the past year, but only one in four of them sought medical attention.

    The findings from the survey were published today in the Royal Australasian College of Physicians’ peer-reviewed journal The Internal Medicine Journal.

    Associate Professor Tom Buckley from the University of Sydney’s Faculty of Medicine and Health explained although regular exercise improves health, he and others have shown previously that strenuous exercise can cause a temporary increase in risk of heart attack and sudden death.

    “Although events during sport may be rare, each death is a tragedy and insight into motivations and health behaviours of masters’ players helps plan preventative approaches,” he said.

    “It is important for people to recognise and act quickly on symptoms when participating in sports events,” Associate Professor Buckley said.

    “Our research is also relevant for other sports besides football, which is the most common masters team sport.”

    Professor Geoffrey Tofler, senior author of the paper, and Professor of Preventative Cardiology at Sydney Medical School and cardiologist at Royal North Shore Hospital, says:

    “Although regular exercise improves health, the temporary increase in cardiac risk during strenuous exercise reinforces that it is important to recognise the warning signs of an impending cardiac event.

    “If a cardiac arrest occurs, acting promptly with CPR and defibrillator availability is critical.”

    “Our research provides insights for masters football players and other masters players so that they can continue to enjoy the benefits of weekend amateur sport but know when to seek help if required.”

    Some key findings include:

    • 21.6 percent experienced at least one potential cardiac symptom during physical activity in the preceding 12 months, but only 24.2 percent of them sought medical advice.
    • Almost half (49.6 percent) had little or no confidence that they would recognise a heart attack in themselves, with even less expressing confidence in recognising one in others.
    • In response to a hypothetical episode of chest pain while playing, less than half (46.6 percent) would leave the field immediately, while 49 percent would stay on the field for 5-10 minutes to see if the pain eased, and several A grade (16.6 percent) and B grade (2.2 percent) players would continue playing until their performance became unsatisfactory or until the end of the game.
    • Three quarters (76.5 percent) said they would use the internet for information about their symptoms before seeing a doctor.
    • Although knowledge of typical heart attack symptoms was high (>80 percent) it was lower (<40 percent) for less typical symptoms.
    • One high-risk attitude was that nearly half (45 percent) said if they thought they were having a heart attack, they would prefer someone to drive them to the hospital rather than have an ambulance come to their home.
    • While most (81.7 percent) would see a doctor within one week of experiencing a health problem such as chest pain, 18.3 percent would wait longer or not go.
    • A positive response was that prevention strategies were strongly supported by participants, in particular, defibrillator availability at games and training in their use, and educational information about cardiac health and warning symptoms.

    About the study

    Lead author Dr Matthew Francis said the Masters Football and Cardiovascular Risk survey collected self-reported, anonymous data via a web-based questionnaire, which sampled 153 amateur masters footballers from Sydney.

    Participants were of average age 49.3 ± 7.5 years, mainly male (92 percent), and from A -grade competition, B- or lower-grade competition and social games. Competitive drive and intensity of emotions while playing was greatest in the competition players.

    Dr Francis said that almost three quarters (73.3 percent) had played football for at least five years since 35 years of age, and participants exercised or played sport an average of 3.6 days per week.

    The most popular reasons for playing football were social interaction and enjoyment (93.5 percent), health and exercise (89.5 percent) and love of football (79.7 per cent).

    Co-author Mr Alexander Tofler, a student at the Susan Wakil School of Nursing and Midwifery, said players were invited to participate through researcher attendance at team sessions, or telephone and email communication with team and area coordinators who distributed study information.

    Because the level of education was high in survey participants (75 percent had university degrees), the findings may be a best-case scenario, assuming those with a lower educational level may have less awareness about cardiac issues.

    To find out more about heart-attack causes, warning signs and what to do, people are encouraged to visit the Heart Foundation resource page.  

  • Researchers identify the best way to ease chronic pain

    Researchers identify the best way to ease chronic pain

    With large numbers of people across the community looking for effective and lasting ways to treat pain, our researchers at the Kolling Institute are driving nationally significant projects to reduce a reliance on opioid medication and promote proven alternative options.

    The research by our team from the Pain Management Research Centre follows the latest figures which indicate around 20 per cent of the population experience chronic pain and a large share of those are still relying on opioid treatment to reduce the impact of their pain.

    Centre Director and RNSH specialist Professor Paul Glare said despite the wide use of opioids, we now know they are not an effective, long-term option for most people, and cause a wealth of adverse side effects including addiction issues.

    “Opioid use is directly linked to an increase in mortality, and now accounts for more deaths than car accidents,” he said.

    “Our research is focusing on the best ways to reduce opioid use considering the complex challenges with medication withdrawal and patient fears that their pain will become unmanageable.

    “Our research indicates that cognitive behavioural therapy is the most effective option to reduce pain, and patients are three times more likely to be able to stop their opioid use if they adopt the self-management strategies promoted through the cognitive based therapies.

    “With the number of people experiencing chronic pain continuing to escalate, it’s crucial that we’re able to provide the very latest evidenced-based data around the treatments that work and help people manage their pain. It can make a life-changing impact.”

    One part of the research program is assessing the effectiveness of digital technologies to support those with chronic pain while reducing their reliance on opioids.

    Associate Professor Claire Ashton-James says with demand for support at an all-time high, they are investigating the value of a technological approach which can be delivered to a large number of people at any time of the day.

    “Our research has initially focused on how patients would like to engage with the programs, and one key trend has shown us that the community would prefer to receive consistent SMS messages, rather than tap into an App,” she said.

    “It’s important that we seek consumer input early to ensure our strategies will be effective and broadly adopted.

    “Our research has led to the development of carefully-scripted messages, videos and patient testimonies.

    “We anticipate these resources will complement the care provided by clinicians and we are undertaking a clinical trial to test their effectiveness in providing additional support. This trial is being funded by the Ernest Heine Family Foundation and we hope the strategies will directly assist those living with constant pain.”

  • Researchers to join leading cancer care centres in exciting new trial

    Researchers to join leading cancer care centres in exciting new trial

    Researchers from the Kolling Institute and Royal North Shore Hospital will help drive a new project investigating a revolutionary approach to care for those with neuroendocrine tumours.

    Cancer specialists Professor Nick Pavlakis and Dr David Chan will join the AUS-NET trial after a funding announcement by Health Minister Greg Hunt.

    The study will assess whether a new patient-specific care model improves health outcomes and quality of life for patients with the rare neuroendocrine cancers.

    Around 500 patients from five centres across Australia are set to be involved in the clinical trial and Dr Chan said the local team is thrilled to have been chosen to participate.

    “This is a really important study which we hope will improve the experience of patients going forward and lead to a better model of care with additional resources,” he said.

    “The clinical trial will examine a multi-disciplinary, shared-care approach involving greater specialised support and follow-up.

    “Importantly, this tailored treatment could be adopted in both metropolitan and regional centres where access to specialised care is a significant challenge for patients with this uncommon and complex cancer.

    “We hope this new model could be broadly adopted with the support of clinicians, GPs and nurses.

    “Currently, some of our patients spend a large amount of time travelling hundreds of kilometres to receive the care, knowledge and advice they need. Patients requiring lutate treatment for instance, can only receive this care at Royal North Shore Hospital and one other site in New South Wales.

    “We expect this new approach will make a marked difference to their lives if they’re able to access comprehensive, tailored care close to home, and have confidence that they’re receiving the same care that they would in a larger, metropolitan centre.

    “Our research and clinical teams have helped to develop this care model and are looking forward to trialling this promising initiative.” 

  • Research shows your age and sex influence the impact of medications

    Research shows your age and sex influence the impact of medications

    A new study by researchers at the Kolling Institute will directly guide the use of medications by older Australians after it identified the profound adverse effects of taking multiple medications.

    The study follows the latest figures which show around 50 per cent of Australians over 75 years take five or more medications every day to treat multiple chronic illnesses.

    The trend is leading to an increased risk of geriatric syndromes, including functional and cognitive impairments.

    Concerned by the growing number of adverse issues, Professor Sarah Hilmer and her team from the Laboratory of Ageing and Pharmacology used a preclinical model to assess the impact of multiple medications on physical activities.

    Trang Tran, the PhD student who led the paper said the research identified significant adverse impacts, including a reduction in physical movement such as walking speed and behavioural changes similar to a drug-induced delirium prior to sleep.

    “Interestingly, some of the impacts were greater with females than males, confirming that gender can influence outcomes, particularly the effect of medications on physical and cognitive performance,” she said.

    “Part of the strength of this research is due to the consistent monitoring involved, with behaviour patterns recorded continuously for 23 hours in both night and day settings.

    “Our research represents an important body of work which we hope will highlight the need to consider age and sex when prescribing or managing multiple medication use in patients.

    “It will provide evidenced-based information to help clinicians understand the global effects of multiple medication use and individual susceptibility.”

    Members of the nursing community have welcomed the research, with clinical nurse consultant Allyson Waird, from the Aged Care, Delirium and Dementia units at RNS and Ryde hospitals, saying the new findings provide valuable information.

    “The clinical importance of unsettled, agitated or aggressive behaviours by patients, especially later in the day, should never be underestimated,” she said.

    “Such behaviours may be due to a number of factors, not the least of which is medications, and should always be investigated.

    “Whilst nurses are aware of addressing unmet needs as a person-centred strategy when caring for these patients, it is also imperative that medications be reviewed.”

    The study, which has been published in Scientific Reports, builds on Professor Hilmer’s internationally significant research fostering the safe use of medications across the hospital, aged care and community settings. 

    The research represents an important achievement for lead author Trang Tran, who is a Vietnamese doctor who first came to Royal North Shore Hospital in 2017 as a Hoc Mai Fellow. Trang returned to Sydney to undertake her PhD at the Kolling, which was submitted this week.  

  • Exciting study to investigate new treatment for acute myeloid leukaemia

    The Cancer Council NSW today announced funding for a new stem cell team at the Kolling Institute to examine a revolutionary approach to treatment for those with acute myeloid leukaemia.

    This aggressive form of blood cancer has a tragically poor survival rate, and while we have seen tremendous progress for many other types of cancer in recent years, there have been very limited improvements in treatment for this deadly form of blood cancer.

    Internationally respected researcher Dr Jenny Wang will lead the promising new study following the Cancer Council NSW grant of $450,000.

    “We are thrilled to have received this generous funding for our project which we hope will lead to an effective, new therapy for this complex cancer,” said the University of Sydney researcher.

    “Chemotherapy is currently the first-line treatment for acute myeloid leukaemia.

    “There are however, high rates of relapse as this form of cancer is protected by a rare group of cells known as leukaemic stem cells, which have the ability to lay dormant and evade chemotherapy. They then reactivate and renew themselves to drive fresh cancer growth.

    “My team and I recently uncovered a mechanism which is crucial to the survival of leukaemic stem cells. This mechanism is only found in leukaemic stem cells, not in normal human stem cells, making it a promising target for a new treatments.”

    In this project, Dr Wang and her team will investigate how leukaemic stem cells are able to survive and renew. The team will then develop a treatment strategy to inhibit this unique mechanism in clinically relevant experimental models.

    “We are very excited by this approach targeting leukaemic stem cells, as this potential new treatment could eradicate acute myeloid leukaemia at its root,” she said.

    “If our pre-clinical tests are successful, we hope to start clinical trials of this innovative approach in collaboration with clinicians and our longstanding industry partner.

    “Today’s funding announcement represents an important step towards a greater understanding of this complex cancer and promising new treatment options to improve outcomes for those with this form of blood cancer.”

    Dr Wang returned to Sydney in 2011 from Harvard Medical School where she undertook postdoctoral research in cancer and stem cell biology. She subsequently established an independent stem cell laboratory at Children’s Cancer Institute/UNSW in 2013, before her recent transition to the Kolling Institute.

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