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Department of Surgery

Department of Surgery

Key terms: Clinical practice, teaching, innovation, collaboration, 3D imaging and printing, volumetric analysis, patient reported outcome measures

Research Goals: To use research evidence to improve quality in patient care and treatment outcomes.

To teach, mentor and inspire trainees and junior doctors to conduct innovative, excellent research.

To form fruitful collaborations with other research groups and/or health care centres to contribute to greater understanding of disease and process.

Research Overview:

The Department of Surgery at Peninsula Health is committed to conducting the best possible clinical research to improve patient treatment and outcomes. Composed of 11 units (see staff list), our department offers their medical students, interns and junior training doctors the opportunity to learn how to conduct thorough research to inform and progress surgical patient care. Through mentorship, collaborative research and journal and research group meetings, we also endeavour to train how to interpret results and judge the worth and outcome of research projects. Many of our members have adjunct positions within Monash University, and each year we offer a number of Bachelor of Medical Science (BMedSci) student projects. In addition, we currently have 2 Masters of Surgery and a PhD student being supervised in our department. We also collaborate with a number of other Healthcare groups and contribute to a number of clinical registries, increasing opportunities for research. The department has invested in a number of sophisticated software programs to aid research, currently supports a 3D printing lab and employs a full time research coordinator to facilitate ethics application, aid in the design of research projects, the  analysis and interpretation of results and writing scientific papers.

Staff

Directors of Research:

A/Prof David Hunter-Smith (Director)

Mr. Nigel Broughton (Orthopaedic Surgery)

A/Prof Warren Rozen (Plastic and Reconstructive surgery)

Clinical Director:  A/Prof Bob Spychal

PhD Student: Dr Michael Chae

Masters of Surgery:

Dr Bethany Reynolds

Dr Dasun Ganhewa

Contact Details:

Ebony Dejager, PA to A/Prof Spychal 9784 7368

 Vicky Tobin, Research Coordinator 9784 8416

Unit Heads

GI/Thoracic surgery: Mr Bob Spychal

Colorectal surgery: Mr Stewart Skinner

Breast and endocrine surgery: Mr Jonathon Serpell

Vascular surgery: Mr Wai Leng Chue

Orthopaedic surgery: Mr Peter McCombe

Plastic surgery: Ms Patricia Terrill

ENT surgery: Mr Diamanti Diamantaras

Urology: Mr Paul Gilmore

Current Research

Compliance and outcome in a “virtual clinic” for long term follow-up of patients after hip and knee replacement:

Long-term follow-up of patients with total knee and total hip arthroplasties is required to detect late complications.  Bringing each patient to the outpatient department unnecessarily increases surgeon, nursing and administrative workload and costs if face-to-face follow-up is not necessary. We aim to evaluate the efficacy of a “virtual clinic” using remote follow-up of patients who have undergone total hip or total knee arthroplasty at Peninsula Health.

Australian and New Zealand Hip Fracture Registry (ANZHFR)

Hip fracture is the most serious and costly fall-related injury suffered by older people and many people do not return to the same level of independence as before their hip fracture. This project will allow us to measure the quality of care provided to people, against Australian and New Zealand guidelines for the management of hip fractures, and will enable improvements in this care where needed. The ultimate goal is to improve performance, drive change and maximise outcomes for older people. This is a large multi-site international collaboration of 121 public hospitals in Australia and New Zealand.

Prospective randomised control study of PICO for lower leg wounds requiring a split thickness skin graft

A skin graft is required to mend a lower leg wound when there is not sufficient skin in the area to suture the wound closed. The aim of our project is to demonstrate: 1. that a new type of wound dressing, called PICO dressing, is equivalent to a standard dressing in term of graft take rate. 2. that the PICO dressing is superior to a standard dressing in terms of quality of life of the participants during the healing process (up to 4 weeks).

The use of 3D Printing of Imaging in Surgery

When patients present with a problem that requires surgical intervention, we currently use CT or MRI scans, where appropriate, for preoperative planning, patient education, surgical education and training, clinical assistance, and intraoperative guidance. Current practice is to use two-dimensional (2D) printers that generate hard films from these scans to assist surgery. We have developed novel 3D printing methods in a variety of situations. We are showing that this technique may have a substantial benefit to the surgeon in appreciating the operative anatomy and interpreting the preoperative scan data. The 3D prints can, thus, act potentially as a reliable surgical guide during an operation. We have a series of research projects underway to validate our 3D model printing technology using both quantitative and qualitative methods. For quantitative validation, we will be measuring the three dimensions of an anatomical structure (e.g. femoral head) from (1) its imaging (e.g. CT/MRI), (2) the specimen obtained during surgery, and (3) its 3D model. For qualitative validation, we will be recording (1) the clinical outcome from the surgery (e.g. any complications) where the 3D models are used, (2) the surgeon’s objective opinion of the usefulness of the 3D model, and (3) how they were used (e.g. for preoperative planning).

The morphological requirements of an ideal trapezial implant for treatment of base of thumb osteoarthritis 

Thumb base osteoarthritis (OA) constitutes a significant burden of disease in our society, affecting up to one third of post-menopausal women. After conservative measures have failed, the current management is trapeziectomy or removal of the trapezium, the bone at the base of the thumb.  Many prosthetic trapezium implants have been tested, brought to market to ultimately fail. None were based on the shape or volume of the patient’s own hand or trapezium. Ultimately, using 3-D printing, we aim to produce a model trapezium prosthesis which is volume appropriate to the patient and includes structural elements to enhance tendon interposition and ligament reconstruction. This project aims to identify what may predict the trapezium implant size and shape for each patient. This is a collaborative project with the Monash Institute of Medical Engineering which has provided seed-funding.

Key Publications

  1. Ng TT, Diamantaras D, Priestley J, Redman J, De Silva N, Mahanta V. Is celecoxib a useful adjunct in the treatment of post-tonsillectomy pain in the adult population? A randomised, double-blind, placebo-controlled study. The Journal of Laryngology and Otology. 2017;131(S1):S18-s28
  2. Stuchbery R, McCoy PJ, Hovens CM, Corcoran NM. Androgen synthesis in prostate cancer: do all roads lead to Rome? Nature reviews Urology. 2017;14(1):49-58
  3. Chae MP, Rozen WM, Patel NG, Hunter-Smith DJ, Ramakrishnan VV. Enhancing Breast Projection In Autologous Reconstruction Using The St Andrew’s Coning Technique And 3D Volumetric Analysis. Gland Surgery. 2017. In press
  4. Ackerman IN, Bucknill A, Page RS, Broughton NS, Roberts C, Cavka B, et al. Preferences for Disease-Related Education and Support Among Younger People With Hip or Knee Osteoarthritis. Arthritis Care & Research. 2017;69(4):499-508
  5. Lee G, Rozen WM, Hunter-Smith DJ. Autologous Fat Grafting in Hypertrophic and Keloid Scars: A Systematic Review. Scars Burns Heal. 2017 Apr; 3 (1): 1-6. Apr 1 2017.

 

 

Intensive Care Unit

ICU

Key terms: Extracorporeal Therapies and Mechanical Ventilation; Nutrition; Echocardiography and Ultrasound; Sepsis; Acute Kidney Injury and Renal Replacement Therapy: Sedative Practice and Delirium

Research Goal: To undertake sustainable and translational research that delivers evidence-based care of the critically ill.

Research Overview:

Research interests include sedation, renal replacement therapy, nutrition, echocardiography and ultrasound, extracorporeal techniques, mechanical ventilation and sepsis. The department is a member of the ANZICS Clinical Trials Group (CTG) and has collaborated on numerous multi-centre trials. Collaboration with industry has evaluated methods of oxygen delivery that has been published and presented.  The Department has published in excess of 100 peer reviewed publications and presented extensively both locally and internationally over the last decade.

Staff

Head of Department

Professor John Botha – has been site investigator of numerous CTG trials and was on the Management Committee of the NHMRC funded Nephroprotect Trial.

Director ICU Research

Professor Ravindranath Tiruvoipati – is investigating the role of C02 in mechanically ventilated patients. He has extensive experience in ECMO and was a lead investigator in the CESAR study published in the Lancet.

Intensivists

Dr Kavi Haji – is conducting a PhD on the role of bedside echocardiography and ultrasound on management of the critically ill.

Dr. Ashwin Subramanian – 

Associate Professor Ian Carney

Dr. Sachin Gupta

Unit Managers:

Joanne Stewart, Kirsty Sullivan.

PhD Students:

Professor Ravindranath Tiruvoipati

Dr Kavi Haji

Research Assistants

Mr Cameron Green
ICU Research Co-ordinator Mr Cameron Green has an MSc from the University of Edinburgh for his work on Delirium

Contact Details

Research Coordinator: cgreen@phcn.vic.gov.au

Director of Intensive Care Research: Rtiruvoipati@phcn.vic.gov.au

Current Research

PROTECTIN trial

A randomised controlled trial investigating the use of Aspirin for the treatment of systemic inflammatory response syndrome (SIRS)

PLUS study

A randomised controlled trial comparing Plasma-Lyte 148™ to saline for fluid resuscitation in critically ill patients.

Pressure Injury Prediction in the ICU (PIPICU)

A multicentre study to develop and validate a tool for the identification of patients at risk of developing pressure injuries in ICU.

TARGET Trial

A multi-centre randomised controlled double-blind trial investigating the impact of energy-dense enteral nutrition on the outcomes of critically ill patients, when compared to standard enteral nutrition.

Nebulised Heparin Trial

A multi-centre randomised controlled trial of nebulised heparin for the prevention of lung injury in mechanically ventilated patients.

PRE-DELIRIC

Validation study to investigate the ability of the PRE-DELIRIC instrument to predict patients’ risk of developing delirium in ICU

ANZ-CODE

A multi-centre prospective observational study investigating the characteristics and outcomes of patients experiencing in-hospital cardiac arrests in Australia and New Zealand.

AMINO-III

An international survey of the use of aminoglycosides in critically ill patients

AnchorFast audit

A retrospective audit investigating the incidence of oral pressure injuries before and after the introduction of an endotracheal tube attachment device (the AnchorFast™).

ULTRAWEAN

Evaluation of the ability of respiratory and cardiac ultrasound to predict outcomes of weaning from mechanical ventilation.

Key Publications

  1. Tiruvoipati, R., Pilcher, D., Buscher, H., Botha, J., Bailey, M. (2017). Effects of hypercapnia and hypercapnic acidosis on hospital mortality in mechanically ventilated patients. Jul;45(7):e649-e656. doi: 10.1097/CCM.0000000000002332.
  2. Tiruvoipati, R., Botha, J., Fletcher, J., Gangopadhyay, H., Majumdar, M., Vij, S., Paul, E., Pilcher, and the Australia and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group. (2017). Intensive care discharge delay is associated with increased hospital length of stay: a multicentre prospective observational study. PLoS ONE (In press)
  3. Doig, GS., Simpson, F., Bellomo, R., Heighes, PT., Sweetman, EA., Chesher D., Pollock, C., Davies, A., Botha, J., Harrigan, P., & Reade, MC. (2015). Intravenous amino acid therapy for kidney function in critically ill patients: a randomised controlled trial. Intensive Care Medicine, 41 (7), 1197 – 1208
  4. Tiruvoipati, R., Buscher, H., Winearls, J., Breeding, J., Ghosh, D., Chaterjee, S., Braun, G., Paul, E., Fraser, JF., Botha, J. (2016). Early experience of a novel extracorporeal carbon dioxide removal device in management of acute hypercapnic respiratory failure. Critical Care and Resuscitation, 18 (4)
  5. Reade, MC., Eastwood, GM., Bellomo, R., Bailey, M., Bersten, A., Cheung, B., Davies, A., et al. (2016). Effect of Dexmedetomidine added to standard care on ventilator-free time in patients with agitated delirium: a randomised clinical trial. JAMA 315 (14)

Pubmed Links

Professor John Botha

Associate Professor Ian Carney

Dr Kavi Haji

Professor Ravindranath Tiruvoipati  

Dr Sachin Gupta

Dr Ashwin Subramaniam  

Associate Professor Andrew Davies

 

 

Allied and Community Health

 Allied-Health

Key terms: models of care, gait, chronic disease

Allied health, health services research, community health,

Research Overview

Research undertaken in Allied Health and Community Health is a mix of investigator initiated projects and contribution to large multi-centred trials. Research projects span across the community we work with, our professions and the services we provide.

Our unit has and number of active and emerging researchers. Our clinician researchers are leaders in paediatric foot and lower leg research, and also conduct studies in musculoskeletal conditions and chronic diseases (such as diabetes) that reduce quality of life and participation. We are in partnership with other Victorian public health services and universities to contribute to research into models of care and service delivery by allied health.

The research unit currently supports over 30 staff research projects that are either discipline specific or have inter-professional research teams. There are a range of projects including some in intensive care, Parkinson’s disease, and diabetes related foot disease. An emerging focus is in the sphere of ageing and rehabilitation. We supervise eight postgraduate (PhD students and MPhil) students. The unit also supports Monash University allied health student honours projects.

Staff

Allied Health Research Lead

Cylie Williams

Cylie is the Allied Health Research Lead at Peninsula Health. She is the recipient of a NHMRC Early Career Health Professional Research Fellowship. She is a Senior Research Fellow at Monash University and has ~ $1.5m in grant funding and over 40 publications.

Cylie’s research interests are diverse. She leads paediatric foot and gait related research, and coordinates projects relating to older adult foot complications relating to diabetes, health services research into the impact of system change, low back pain research and research into workforce change. She currently supervises nine PhD and MPhil students and six honours students.

Management

Allied Health Director

Kirsten Caspers 

Kirsten is the Allied Health Director of Peninsula Health. She is chair of the Allied Health and Community Health Research Steering committee and committed to supporting allied health professionals at Peninsula Health to contribute to, lead and use research in every day practice.

Email: kcaspers@phcn.vic.gov.au

Community Health General Manager (Acting)

Iain Edwards

Iain is the General Manager of Peninsula Health Community Health services. He has been the primary investigator of a large telehealth partnership project with CSIRO. Iain is an active member of the Allied Health and Community Health Research Steering committee and champion for research support in Community Health.

Email: iedwards@phcn.vic.gov.au

PhD Students

Lucia Michailidis: lucia.michailidis@monashhealth.org.au

Antoni Caserta: antoni.caserta@monash.edu

Freya Coker: fcoker@phcn.vic.gov.au

Research Assistants

Anna Couch: acouch@phcn.vic.gov.au

Contact Details

cyliewilliams@phcn.vic.gov.au

Current Research

Allied Health IMPACT study:

Investigating Models of Practice for Allied health Care and functional Trajectory for subacute patients

This research is funded by the Department of Health and Human Services of Victoria. It aims to evaluate the difference models of allied health services in rehabilitation services across Peninsula Health, Monash Health and Eastern Health.

Understanding and measuring idiopathic toe walking gait

This research seeks to explore any differences between lower limb muscle length, muscle activity and muscle strength in children with idiopathic toe walking gait. It also seeks to understand how clinicians can better measure treatment outcomes and what treatment outcomes are important to parents and children.

Prevention and treatment of foot wounds in older adults.

People with diabetes related foot wounds commonly receive podiatry-based education to prevent further complications. Part of this research seeks to understand this education delivery and if it changes behaviours. Additionally, there are many ways that foot wounds are treated. Another component of this body of research seeks to determine the effectiveness and cost effectiveness of common treatment methods.

Key Publications

  1. Kaplonyi J, Bowles KA, Nestel D, Kiegaldie D, Maloney S, Haines T, Williams C, Understanding the impact of simulated patients on health care learners communication skill: A systematic review, Medical Education, (IN PRESS)
  2. Michailidis L, Kotsanas, D, Orr E, Coombes G, Bergin S, Haines T, Williams C, Does the new low-frequency ultrasonic debridement technology pose an infection control risk for clinicians, patients, and the clinic environment? 2017 American journal of infection control 44 (12), 1656-1659
  3. Williams CM, Skinner EH, James AM, Cook JL, McPhail SM, Haines TP, Comparative effectiveness research for the clinician researcher: a framework for making a methodological design choice, 2016, Trials 17 (1), 406
  4. Bright SJ, Williams CM, Development of Australia’s first older adult‐specific early intervention for alcohol‐related harm: Feasibility and proof of concept, 2017, Australasian journal on ageing 36 (1), 52-55

 

Nursing and Midwifery

Key terms: nursing, midwifery, mental health, interprofessional, education, research, quality, innovation

Research Goal:  To generate high quality evidence leading to clinical translation in areas relevant to nursing and midwifery.

Research Overview

Our program is informed by innovative evidence-based inquiry centred on quality and safety.

At the forefront of understanding how to provide the best nursing and midwifery care in hospital and in the community, researchers are working with a range of local and international partners to improve health issues in fields such as healthcare management and education, emergency and critical care, informatics, mental health nursing, women’s and children’s health, cancer services, acute, sub-acute and aged care.  From exploring the consumer view of care and causes of pressure injuries, to understanding the outcomes of care of newborns with respiratory conditions, falls prevention, living with metastatic breast cancer and the effectiveness of nursing interventions for clinical aggression, the range of studies is diverse.  Further studies have explored the existing evidence on perioperative nurses’ attitudes to organ procurement and nurses’ management of clinical alarms and another developed a screening tool for depression for those with stroke and aphasia. Nursing and midwifery research translates knowledge to policy and practice, to answer clinical questions and demonstrate benefit.

Staff

Group Leader/Head

Associate Professor V. Plummer

PhD Students

Dr David Langton

W. Gao

Contact Details

+61 3 99044064

virginia.plummer@monash.edu

Current Research

Implementing Safewards in Acute Health Care

This study aims to assess the effectiveness of a evidence based conceptual model which is underpinned by a training program in building participants’ knowledge and confidence in using the Safewards model to manage clinical aggression on an acute medical ward for the first time. The aim is to reduce the use of restrictive interventions and make the ward calmer and a safer place to recover, visit and work.

Does removing the FRAT risk status impact falls prevention: A stepped wedge cluster randomised control trial.

The risk factors for patient falls are multifactorial and include intrinsic and extrinsic risk factors.  Falls risk screening tools (such as FRAT) have been promoted for use in inpatient settings, to identify patients at risk of falls.  Numerous falls risk assessment tools have been developed, with varying degrees of sensitivity and specificity. In this study a trial is being conducted across 19 wards to determine if using clinical judgement in addition to a screening questions results in a more comprehensive risk assessment and plan.

Identification & management of the deteriorating patient-(Adult) Emergency Dept

This quality improvement project contributes at a state-wide level to evidence-based care to reduce variation in clinical practice and improve patient care. The aim is to identify indicators of deterioration, increase knowledge of management of escalation and decrease mortality.  The work contributes to the Emergency Clinical Care Network in building sustainable improvements in the delivery of emergency care in Victorian Emergency Departments

Impact of endotracheal tube fastening devices on the incidence of oral pressure injuries in a metropolitan Australian Intensive Care

Link to ICU site

Nursing handover involving clients in acute mental health

This study explores the mental health nursing staff handover where patients are active participants in decision-making processes for transfer of care. It aims to identify solutions and recommendations to improve practices in mental health inpatient units with a focus on collaborative relationships, establishing a shared care culture locally and developing established processes that promote structured meaningful communication.

Key Publications

  1. Olasoji, M., Plummer, V. M., Reed, F., Jacob, S., Shaw, L., Shanti, M., & Cross, W. (2017). The views of mental health consumers about being involved in nursing handover on acute in-patient units. International Journal of Mental Health Nursing,
  2. Molloy, J., Pratt, N., Tiruvoipati, R., Green, C., & Plummer, V. (2017). Relationship between diurnal patterns in Rapid Response Call activation and patient outcome. Australian Critical Care. DOI: 10.1016/j.aucc.2017.01.009. Volume 30, Issue 3, May 2017.
  3. Bloomer, M., Clarke, A. & Morphet, J. (In Press). Nurses’ prioritisation of enteral nutrition in intensive care units: A national survey. Nursing in Critical Care. DOI 10.1111/nicc.12284 
  4. Grover, E., Porter, J. & Morphet, J. An exploration of emergency nurses’ perceptions, attitudes and experience of teamwork in the emergency department, Australasian Emergency Nursing Journal. http://dx.doi.org/10.1016/j.aenj.2017.01.003
  1. Jespersen, S., Lawman, B., Reed, F., Hawke, K., Plummer, V., Gaskin, C. (2016). The impact of integrating crisis teams into community mental health services on emergency department and inpatient demand. Psychiatric Quarterly. December 2016, Volume 87, Issue 4, pp 703–712.

https://www.monash.edu/medicine/nursing/research