RESEARCH REPORT 2017 - Pursuing the future of healthcare together
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2017 RESEARCH REPORT Pursuing the future of healthcare together
Monash Health acknowledges the traditional owners of the land on which our service operates, the Wurundjeri and Boonwurrung People of the Kulin Nation, and we pay our respects to elders past and present.
Contents
About Us 04 About Monash Health Translation Monash Partners Advanced Health
Precinct (MHTP) 09 Research and Translation Centre 18
Message from the Chair of the
Board and the Chief Executive 06 Hudson Institute of Medical Centre for Quality and Patient
Research 10 Safety Research 19
Message from the Chief Medical
Officer and Director of MHTP Clinical Trials Centre 15 Our commitment to investing
Clinical Research 07 in emerging researchers 20
School of Clinical Sciences
Strength in Collaboration at Monash Health 16 Research Support Services 23
and Partnerships 08
Department
research reports
Allied Health and Monash Health Monash Centre for Health Research Oncology 79
Community Research 30 and Implementation (MCHRI) 61
Ophthalmology 82
Cardiothoracic Surgery 34 Monash Children’s Hospital 62
Orthopaedics 84
Clinical Haematology 37 Melbourne Children’s Sleep Centre
(MCSC) at Monash Children’s Monash Pathology 85
Clinical Immunology and Allergy 44 Hospital 64
Patient Safety, Strategy and
Critical Care and Monash Newborn 66 Innovation 86
Perioperative Medicine 46
MonashHeart and Monash Pharmacy 88
Emergency Services 48 Cardiovascular Research Centre 67
Rehabilitation 89
Endocrinology 52 Monash Imaging 70
Rheumatology 90
Gastroenterology & Hepatology 54 Monash Lung and Sleep (MLS) 71
Supportive and Palliative Care 92
Infection Control & Monash Women’s 72
Epidemiology Unit 55 Upper Gastrointestinal and
Nephrology 75 Hepatobiliary and Pancreatic
Infectious Diseases 58 Surgery 93
Neurology 76
Mental Health 59
Neurosurgery 77
Monash Ageing Research Centre
MONARC 60 Nutrition and Dietetics 78
Monash Health
About Us
Monash Health is Victoria’s leading integrated health
service serving the south eastern suburbs of Melbourne,
Victoria, Australia.
We integrate uniquely in one Monash Health Research Vision
organisation, primary, secondary
and tertiary health services, as well
To be a health service that integrates
as university affiliated international
research and teaching facilities.
excellence in clinical services, education and
research. Monash Health provides a supportive
Our core community of more than one
million people depends on us for all
and dynamic environment for healthcare
aspects of its public healthcare, with professionals to conduct world-class clinical
our services available to more than 1.5 and translational research that drives improved
million people. clinical practice.
We offer our community quality patient
healthcare across the entire lifespan
from pre-birth to palliative care, for all
groups and stages of life.
More than 16,000 staff work at more
than 40 sites, admitting more than
260,000 hospital patients, handling Hospitals
more than 220,000 emergency Monash Health Community
Melbourne
presentations and delivering more than CBD
10,000 babies.
Moorabbin Monash Medical
Hospital Centre
Springvale
Kingston Cockatoo
Centre Dandenong Hospital
Dandenong
Doveton
Berwick
Casey Hospital
Pakenham
Cranbourne
Cranbourne Centre
04
Research Report 2017
Our Research at a glance
MORE THAN
420 $20
THERE WERE
new research projects approved
MILLION funding
by Monash Health in 2017
for commercially sponsored clinical trials by leading
pharmaceutical and biotechnology companies for
national and international clinical research.
$ 15.3
MORE THAN
MILLION
in National Health and Medical Research Council (NHMRC)
funding awarded to Monash Health and MHTP partners.
391
THERE WERE
1,171
new clinical drug or device trials under way,
including:
research projects underway involving patients, including:
48 phase I
80 phase II
Clinical drug trials
185 phase III
Device trials
36 phase IV trials
Trials addressing key questions
in clinical medicine, public
health and the social sciences and 42 device trials.
05
Monash Health
Message from the Chair of the Board
and the Chief Executive
We are delighted to present the 2017 Monash Health Translational Precinct (MHTP)
Research Report. The report highlights the outstanding achievements of Monash
Health’s researchers and clinicians, together with our MHTP partners.
This was a remarkable year for MHTP,
with 1171 active research projects
under way. From world-first oncology
trials such as those lead by Dr Ben
Markman and a world-first study in
pre-term infants led by Professor Euan
Wallace – our research offers hope
to many patients and families facing
seriou illness.
The title of this report reflects our
commitment to collaborative research
with our key research partners, the
Hudson Institute of Medical Research
and Monash University.
Clinical trials are a major component of
Monash Health’s research profile and
Research leadership is supported by volunteers and carers who partner
present an opportunity for consumers
Professor Erwin Loh, as the Executive with us and look forward to our work
to access the latest technology,
Director for Research and Professor Bill contributing to better outcomes for
advancements and access to increased
Sievert, Clinical Research Director and all. We could not be prouder of our
resources in terms of monitoring,
the Monash Health Research Council, clinicians and researchers and their
follow up and positive lifestyle
who represent research across Monash wonderful work of discovery and
interventions. This is facilitated
Health and our partners. innovation.
through the state-of-the-art Monash
Health Clinical Trials Centre, which Monash Health is also a major partner
opened in December 2015. in the Monash Partners Academic
Andrew Stripp
Health Science Centre (MPAHSC), a
The calibre of our work has been Chief Executive, Monash Health
group of eight independent, world-
acknowledged by our funding success,
class providers of health services,
with more than $15.3 million in
research and education in Melbourne’s
National Health and Medical Research Barbara Yeoh, AM
south east. We were pleased to lead
Council of Australia (NHMRC) funding Chair, Board of Directors
an application to the NHMRC for this
awarded to Monash Health and our
centre to be recognised as one of a
MHTP partners in 2017. In addition,
limited number of national Academic
we secured more than $20 million in
Science Centres. Our research is
funding for commercially-sponsored
reliant on the participation of patients,
clinical trials by leading pharmaceutical
volunteers and carers, who dedicate
and biotechnology companies.
their time for the benefit of future
Leadership is a key component of healthcare outcomes. We are very
driving outstanding research, leading grateful for their contribution. We
to excellent patient outcomes. would like to thank all of the patients,
06
Research Report 2017
Message from the
Chief Medical Officer and
Director of Clinical Research
At Monash Health, our ambition is to
be a leading academic health science
centre, a place where our patients can
have the opportunity to participate in,
and be direct beneficiaries of, cutting
edge medical research and clinical
trials. We cannot do this without
our talented biomedical scientists,
clinician-researchers, and academics
from a range of health professional
backgrounds, all of whom have
dedicated their lives to the pursuit of
research excellence, for the benefit of
patient care.
We do not carry out research in
isolation – clinical research is a team
sport, and we are privileged to be able The key strength of Monash Health As Neil Armstrong said: “Research is
to partner with Monash University is the breadth and width of the creating new knowledge” – let’s create
and the Hudson Institute of Medical clinical care we provide. Our wide this new knowledge together.
Research to form the Monash Health range of clinical research activities
Translation Precinct. Here we work in use evidence-based, best practice
practically every clinical specialty and treatments to improve the health of Professor Erwin Loh
age group; from neonatology through the community we serve. This vision Chief Medical Officer,
Monash Newborn, women’s health via to lead in clinical research is fully Monash Health
Monash Women’s, paediatric research supported by the Monash Health Board
in our Monash Children’s Hospital, and and Executive, and forms a major part
aged care and palliative care research; of our new strategic plan for the next
but there is research activity in all the five years.
medical disciplines, from MonashHeart
to Monash Imaging, and beyond. We
have strong and productive nursing At Monash Health, we
and allied health research departments intend to relentlessly
that have links with a range of other
pursue excellence in
universities, and the research being
carried out extends from benchtop, clinical research for the
laboratory-based discovery research, benefit of our patients
clinical research, clinical audit and and our community, and
quality assurance, clinical trials of we are glad to be able to
all phases; to translational research
partner with our staff and
that encompasses implementation
science, health services research and our consumers to see this
population and public health research. vision come to reality into
the future.
07
Monash Health
Strength in Collaboration
and Partnerships
We actively work with other world-class researchers to
deliver the best possible care to our community.
A partnership between Monash Health, Hudson Research
Institute and Monash University translating scientific
discoveries into world’s best healthcare.
Our Partners
Monash Health has established Monash Health is a member of Monash health is a member of
the Monash – Deakin Nursing the Victorian Cancer Biobank, Biogrid Australia. The Biogrid
Research Centre. Deakin University a not-for-profit consortium of Australia data linkage platform
is nationally and internationally tissue banks supported by Cancer provides a world class product to
recognised as a centre of Council Victoria and the Victorian Monash health researchers and has
excellence in nursing research in government. The aim is to provide enhanced their ability to conduct
the areas of quality, safety and risk researchers with high quality tissue cutting-edge research and attract
management. samples and data to facilitate associated research grants.
cancer research discoveries.
Acknowledgement goes to Katherine Marks, Communications Manager at Monash University, Faculty of Medicine,
Nursing & Health Sciences; and Ann Pukallus, Manager Communications at Hudson Institute of Medical Research for
their contributions to this report.
08
Research Report 2017
About Monash Health Translation
Precinct (MHTP)
MHTP is a partnership
between:
■■ Monash Health – Victoria’s largest Our vision
public health service, working with
translational research partners The vision of the Monash Health Translation
to provide exceptional care and Precinct (MHTP) partnership is to be a world leader
outstanding outcomes. in translational research, generating innovative
Hudson Research Institute –
scientific discoveries and revolutionising clinical
■■
Improving global wellbeing through
excellence in medical research and care in a dynamic and collaborative environment.
clinical application.
■■ Monash University – Australia’s
largest university with an
Our themes Our purpose
international reputation for ■■ Cancer The MHTP:
innovative health research. ■■ Neurosciences
■■ Is dedicated to translating medical
■■ Endocrinology
MHTP is also a critical component of research to improve healthcare.
■■ Inflammation
Monash Partners Academic Health ■■ Uses clinical insights to focus the
■■ Women’s, Children’s and
Science Centre. agenda of basic research.
Reproductive Health
■■ Is committed to innovative research
Through these partnerships, leading
development.
researchers have direct access to
■■ Enhances research collaboration
clinicians and patients, enabling
locally, nationally and internationally.
scientific breakthroughs to reach the
bedside more effectively than ever
before.
09
Monash Health
Hudson Institute of Medical Research
Delivering cutting-edge
research to patients
As a leading Australian biomedical
research institute, the Hudson Institute
of Medical Research is recognised
internationally for delivering better
health through research into cancer,
inflammation and reproduction and
development.
The Hudson Institute is home to
more than 470 world-class staff,
scientists and students who push the
boundaries of scientific knowledge
to answer complex questions about
human disease.
Photo courtesy of Hudson Institute of Medical Research
The Hudson Institute’s
scientists study human Hudson Institute Grants and
health and disease from at a glance Publications
a molecular and cellular
290 $ 15.3
level through to clinical
application. Through a
translational pipeline, their
staff million
discoveries lead to new
National Health and Medical
diagnostics, treatments Research Council
and cures that change (NHMRC)Funding Awarded
188
in 2017 (20 project grants)
and save lives.
Working alongside clinicians in
Melbourne hospitals for more than 50 students enrolled
years, Hudson’s scientists’ pioneering NHMRC project
grant success rate of
138
discoveries include the differentiation
31
PhD
of embryonic stem cells into new
human cell types, a foundation of
modern stem cell treatments; changes 3 Masters per cent
(national average 16 per cent)
in practice that have helped to prevent
Sudden Infant Death Syndrome (SIDS) 47 Honours
and the discovery of Inhibin, leading
70
to a diagnostic test for some forms of
309
ovarian cancer.
Postgraduate and Honours research
students completed publications
10Research Report 2017
Professor Elizabeth Hartland, Director and CEO, Hudson Institute of Medical Research.
Photo courtesy of Hudson Institute of Medical Research
Director’s Report, In 2017, Hudson Institute scientists Hudson Institute is also an emerging
published more than 309 medical leader in cancer precision medicine, an
Professor Elizabeth research publications and reviews, individualised treatment approach for
Hartland laying groundwork for clinical trials patients.
Hudson Institute’s research success and major advances in health. Our
In 2017, we established a new
in 2017 was outstanding. Integral to scientists also established several
program, in collaboration with
this success was our partnership with significant partnerships with industry
Monash Children’s Hospital, to better
MHTP members, Monash Health and to accelerate the translation of our
treat children with brain and solid
Monash University. Our precinct brings discoveries into clinical practice.
tumours through paediatric precision
together world-leading scientists, Professor Brendan Jenkins led a medicine. Our scientists are growing
clinicians and educators in a culture collaborative study into pancreatic a living biobank of three dimensional
of collaboration and innovation that cancer, leading to a world-first organoids, or ‘mini organs’, from
delivers research advances to benefit clinical trial led by Monash Health patients’ tumours to ensure all children
human health. This unique, end-to-end collaborator and hepatobiliary surgeon receive targeted treatment sooner.
translational environment is supported Dr Daniel Croagh. This precision
by state-of-the-art laboratories, world Our leadership in stem cell science has
medicine approach is utilising a drug
leading technology platforms and led to multiple clinical trials. Together
that is currently used to treat colon
a clinical trials centre in our MHTP with Monash Health collaborators,
cancer with the aim of curbing the
Translational Research Facility. our scientists are using regenerative
devastatingly low survival rates for
medicine to treat end-stage liver
Our success in the 2017 round of pancreatic cancer patients.
fibrosis and premature lung disease.
national competitive grants funding Clinician-researcher, Dr Jun Yang, We are also working on innovative
is testament to the quality and has strengthened the long-standing ways to develop safer and more
importance of our innovative, world- relationship between Hudson Institute effective treatments for pelvic organ
class research programs. Hudson and Monash Health’s endocrinology prolapse using stem cells. Our close
Institute scientists were awarded $15.3 clinic by establishing a new clinic clinical collaborations are crucial to
million in funding for 20 peer-reviewed and treatment guidelines for primary ensuring our innovative work reaches
grants by the National Health and aldosteronism, leading to more patients sooner.
Medical Research Council (NHMRC), a hypertensive patients being cured and
31 per cent success rate - nearly double successfully treated for this previously
the national funded rate of 16 per cent. undiagnosed condition.
11Monash Health
Dr Jun Yang, Hudson Institute Research Group Head and Monash Health consultant endocrinologist and patient,
David Den. Photo courtesy of Hudson Institute of Medical Research
Sharing scientific and clinical than one in a hundred are actually Research to start Australia’s largest PA
expertise – saving lives diagnosed. Crucially, the treatment study. With the objective of preventing
for PA and essential hypertension heart attack and stroke, the study will
A new Monash Health clinic led by
are completely different. This means aim to confirm exactly how common
Hudson Institute clinician-researchers
misdiagnosed PA patients aren’t PA is in the community by asking GPs
is making phenomenal progress in
getting the appropriate medication, to screen hypertensive patients for PA
the prevention of heart attacks and
leaving them at greater risk of stroke using a simple blood test.
strokes through research that could
and heart attack.
inform new screening guidelines for
high blood pressure, also known as As a result of the introduction of Dr
Yang’s new PA guidelines, in 2017 more
“Patients will be identified
hypertension.
than 60 patients were diagnosed and at an early stage and
Dr Jun Yang, a Hudson Institute
successfully treated for PA at Monash given targeted treatment
researcher and consultant
endocrinologist at Monash Health, set
Health compared with just three to effectively manage the
in 2012. With these new guidelines
up the Endocrine Hypertension clinic condition and prevent
in place, the clinic is capturing and
at Monash Health in 2016 to help
treating a previously undiagnosed
further cardiovascular
patients with primary aldosteronism
portion of hypertensive patients. damage,” says Dr Yang.
(PA), a disorder caused by the over-
production of the hormone aldosterone In recognition of their growing The team is hopeful that the project
leading to high blood pressure. impact, the team has been awarded will lead to new hypertension
philanthropic funding in 2017 from management guidelines in GP clinics
PA is often misdiagnosed as essential
the Heart Foundation, Collier across Australia, so that more patients
hypertension of unknown cause.
Charitable Fund, CASS Foundation and can benefit from early detection and
While it is thought to affect one in ten
Foundation for High Blood Pressure treatment.
hypertensive patients, currently less
12Research Report 2017
L-R: Monash Health Hepatobilary surgeon, Dr Daniel Croagh and Hudson Institute Research Group Head, Professor
Brendan Jenkins. Photo courtesy of Hudson Institute of Medical Research
Precision medicine targets In the study, the team also refined an
pancreatic cancer “Instead of a one-size-fits- endoscopic technique used to extract
biopsies of tumours, so that genetic
Pancreatic cancer has a five-year all approach, the drug is material can be extracted from virtually
survival rate of just five to seven per selected for the patient any patient’s tumour for screening with
cent, making every day spent with
based on the genetic the drug.
loved ones extremely valuable. Sadly,
these statistics have not changed
make-up of their tumour The Victoria-wide Monash Health
significantly in 40 years. and how likely it is an clinical trial, led by Dr Croagh, also a
A study by Professor Brendan Jenkins,
individual will respond senior lecturer in surgery at Monash
University, will see between 150 and
PhD student Mr William Berry and to the treatment – an
200 patients screened for suitability for
Dr Daniel Croagh, a hepatobiliary approach known as treatment with this drug.
surgeon from Monash Health, has laid precision medicine.”
the groundwork for a clinical trial that “If successful, this clinical trial will
is aiming to improve survival rates Published in the International Journal be one of the first applications of
with a drug currently used to treat of Cancer, the study showed that precision medicine, targeting cancer
colon cancer. around 10 per cent of patients with a treatment to the genetic profile of the
specific genetic tumour profile could tumour, in pancreatic cancer anywhere
“We are taking the guesswork out
benefit from a particular type of drug, in the world.”
of treatment for pancreatic cancer,”
called an epidermal growth factor
Prof Jenkins says.
receptor inhibitor.
13Monash Health
Hudson Institute Research Group Head, Dr Rebecca Lim.
Photo courtesy of Hudson Institute of Medical Research
The future of stem cell including high production costs and
therapies the need for specialised equipment
to store, transport and prepare What are exosomes?
What if the regenerative properties
these treatments.
of stem cells – their ability to repair Exosomes, or cell-derived
tissue – could be explained by Based on her team’s research, Dr Lim vesicles, are naturally occurring
nanoparticles containing potent is developing a low-cost, cell-free particles approximately 1/1000th
biological ‘cargo’ released by regenerative treatment using exosomes the size of a fine grain of sand.
these cells? extracted from amnion epithelial They are present in many bodily
stem cells. fluids. Many cells, including
Dr Rebecca Lim, head of the Amnion amnion epithelial cells (stem cells
Cell Biology Group, is at the forefront In December, Dr Lim was awarded
found in the innermost layer of
of the next generation of cell-free a prestigious project grant from
the placenta), release exosomes,
regenerative medicine. the National Health and Medical
which contain important proteins
Research Council (NHMRC) to
Exosome therapeutics are a new and other genetic material that
investigate amniotic exosomes as a
alternative to traditional stem cell can be transferred to other cells
potential off-the-shelf treatment for
therapies and Dr Lim is taking a where they can affect function
bronchopulmonary dysplasia (BPD).
pioneering approach using amnion and physiology.
epithelial stem cells. “BPD is a chronic lung disease that
occurs in babies born too early. It’s
Dr Lim is a lead investigator on
expensive to treat and complications
multiple clinical trials using these cells
from treatment can lead to lifelong
to repair scarred and damaged cells in
health problems,” Dr Lim says.
chronic, premature lung disease and
end-stage liver fibrosis – diseases at “Our vision is to develop a treatment
opposite ends of the human lifespan. that could be administered easily and
While current stem cell therapy cost-effectively to preterm babies with
approaches are promising, there BPD – even by parents after babies are
are challenges that limit their use, discharged from hospital.”
14Research Report 2017
MHTP Clinical Trials Centre
MHTP at a glance
MHTP is located in a
self-contained complex, directly
connected to Monash Medical
Centre Clayton by a link bridge.
8
Beds
21
Treatment chairs
10
Consulting
2
Treatment
Rooms Rooms Translational research, simply stated, ■■ Last 2 Quarters of the 2015/16
is the process of moving research Financial Year – 370 Separations in
findings from the researcher’s bench our Beds and Chairs
in a lab, to the bedside of patients
■■ First 2 Quarters of the 2017/18
enrolled in clinical trials and then
Dedicated enhancing best practices out in the
Financial Year – 2502 Separations in
Staff our Beds and Chairs
community. The MHPT Clinical Trials
Centre is the “bedside” piece of This rare facility aims to provide
6.8 EFT of dedicated
research nurses
the Translational Research process. the best care for our patients who
Opened in December 2015, the volunteer their time and their bodies
2 Adminstrative Staff
Centre, operated by Monash Health,
is revolutionising how clinical trials
to answering some of today’s most
interesting and important medical
2 PSAs
are conducted within the network.
This unique facility supports research
questions. It prioritises patient safety
and comfort, exceptional customer
1 Manager
conducted by the Hudson Institute and
Monash University, whilst remaining
service and teamwork, not only to
our patients but also to our sponsors,
part of the largest public health service ensuring our participants’ experiences
in Victoria. are trouble free and as pleasant
A dedicated The Centre is open from 7:00 AM
as possible.
trials pharmacy until 7:30 PM to accommodate For some, participating in a clinical
long trial visits. When required, it trial gives them a chance to contribute
A dedicated trials flexes to a 24 hour facility, to fulfil to science or to give back to society.
pathology lab individual protocol requirements. Others find comfort in the frequent
Since commencing, the centre has visits and having another, sometimes
aided 17 units in conducting their final, treatment option. The Centre
Meeting rooms trial activity, has opened its doors to offers a rapidly growing suite of clinical
1500 patients and has increased its trials to Melbourne’s south east and
activity significantly. encourages national and international
Diagnostic collaborations. Clinical Trials provide
Imaging better health outcomes for participants
Machinery and for those in the community who
will benefit from significant findings in
the future.
15Monash Health
School of Clinical Sciences
at Monash Health
awarded total funding greater than Monash Partners Comprehensive
2017 at a glance any other school of Monash University, Cancer Centre (MPCCC) grant worth
amounting to 30% of the Faculty’s total $184,000 for his research into precision
grants. chemotherapy in pancreatic cancer.
Our researchers’ MHTP Research Week was a success A number of research areas achieved
work featured in for the second year, featuring keynote significant recognition during 2017,
publications speakers Nobel Laureate Professor through high impact publications,
including: Peter Doherty AC and Vice-President, grants, prizes and awards. Monash
Research & Development, CSL Dr Haematology was approved as
The New England Journal Andrea Douglas. Nearly 200 posters a “Myelodysplasia (MDS) Centre
of Medicine were submitted and displayed of Excellence” by the International
throughout Monash Medical Centre MDS Foundation, and Monash
The Lancet and the Monash Children’s Hospital. haematologists received three of
Nature only seven competitive Haematology
The new Monash Children’s Hospital
Society of Australia and New
Blood opened in 2017, which includes a $6
Zealand (HSANZ) New Investigator
million university-funded education
Cell Reports Scholarships across Australia and
and research space and a state-of-
New Zealand. Monash Haematology
the-art Paediatric Simulation Centre
patients benefitted from world-first
to train students for paediatric
clinical trials being undertaken at the
The School enrolled a record of surgical care.
43
MHTP Clinical Trials Centre.
SCS welcomed the University’s first
Early career researchers in the Centre
Chair of Precision Medicine with the
for Inflammatory Diseases (CID)
appointment of renowned molecular
won all major awards at the annual
BMedSc(Hons) students geneticist Professor Melissa Southey.
scientific meeting of the Australian and
In 2017, Professor Southey was part of
New Zealand Society of Nephrology
the international collaborative study
in recognition of their research into
that discovered new genetic variants
kidney disease. Understanding the
that predict the risk of developing
basis of autoimmune disease was
breast cancer.
MHTP is the a significant breakthrough, with
largest site Professor Eva Segelov joined MHTP
as Director of Oncology at Monash
a publication in Nature, and the
Neuroinflammation Research Group
for this cohort in the Faculty Health and Professor of Oncology in took out the majority of awards at the
the Department of Medicine, Monash Australian Vascular Biology Society
Research grant success was a highlight University. In a study led by Professor annual conference. An Australian-first
in 2017, with researchers from the Arun Azad, Head of Medical Oncology lupus registry and biobank (ALRB) was
School of Clinical Sciences at Monash Clinical Trials, a Monash Health patient launched. Led by Monash researchers,
Health (SCS) and the Department of was the first in Australia to be recruited the ALRB will be a valuable resource
Molecular and Translational Science to a new prostate cancer clinical trial. for clinicians, scientists, industry and
(through the Hudson Institute of Lung cancer patients also benefitted government to provide real world
Medical Research) awarded 23 from the relocation of clinical trials evidence of clinical effectiveness
National Health and Medical Research from the Monash Cancer Centre, of existing or new therapies and
Council (NHMRC) Project grants, Moorabbin, to the MHTP Clinical Trials management strategies in patients
totalling $15.3 million. For the first Centre. Monash Health hepatobiliary with lupus.
time, Monash Health Translation surgeon and interventional endoscopist
Stroke research and researchers made
Precinct (MHTP) researchers were Dr Daniel Croagh was awarded a
a significant contribution to the field in
16Research Report 2017
2017. Professor Amanda Thrift received Professor Fabricio Costa and maternal- Other partnership
the Stroke Society of Australasia’s fetal medicine fellow Dr Daniel Rolnik
success included the
Excellence in Stroke Award—the presented their ground-breaking
first woman to be recognised for a research into pre-eclampsia at the
successful German-
lifetime contribution to stroke research Fetal Medicine Foundation’s World Australian scientific
and overall contribution to the Congress in Slovenia, revealing that exchange, the Monash-
field. Professor Dominique Cadilhac low-dose aspirin reduces the rate Justus-Liebig University
was awarded the prestigious Club of pre-eclampsia. The landmark
(JLU) International
Melbourne Fellowship in recognition study was also published in The
of excellence in research, innovation NEJM. Professor Arvind Sehgal’s
Research Training
and leadership. Professor Cadilhac, research, the first in Australasia, Group (IRTG), which
Associate Professor Henry Ma and provided early clues from the placenta, draws together
Professor Thanh Phan won poster which may indicate infants at risk postgraduate students
awards for their research into new of developing bronchopulmonary
and scientists at both
statistical methods comparing 30- dysplasia (BPD).
day hospital mortality rates and the
universities to discover
Associate Professor Judi Porter from
endovascular clot retrieval service new diagnoses and
Monash University’s Department of
boundary utilising the Google Map
Nutrition, Dietetics and Food received
treatments for common
application at the European Stroke
an Outstanding Contribution Award men’s reproductive
Organisation Conference, Europe’s
from the Dietitians Association of health disorders. This
leading stroke conference.
Australia (DAA), acknowledging her collaboration is funded by
Coronary artery disease research won role in advancing the profession,
Germany’s peak research
the trifecta of prizes in cardiology, with particularly in the areas of research,
MonashHeart interventional cardiology publication and continuing professional
funding body, the German
fellow and Monash University PhD development. Research Foundation,
candidate Dr Abdul Ihdayhid receiving which announced its
The MHTP Cell Therapies Platform
the highest awards at the Society of
opened for business in 2017, with renewal in 2017 of more
Cardiovascular Computed Tomography
the addition of a new 3D Bioprinter than $6.24 m Euros for the
in Washington D.C., the annual
scientific meeting of the Cardiac
complementing the suite of facilities partnership.
available to scientists, clinicians and
Society of Australia & New Zealand
external users in the Translational
(CSANZ), and the Australia & New
Research Facility.
Zealand Endovascular Therapies
Meeting (ANZET). Interventional SCS staff and students benefitted from
cardiologist and SCS Early Career industry partnerships, including the
Research Fellow Dr Sarah Zaman Novartis Pharmaceuticals exchange
was awarded the prestigious Heart program and reverse road show event.
Foundation Fellowship to continue These activities arose from a MoU
her research into the prevention of which aims to increase the volume and
sudden cardiac death. The Cardiac scope of research collaborations with
Rhythm Management (CRM) team the goal of improved access to new
at MonashHeart was one of just four medications for patients.
winners world-wide of the international
Atrial Fibrillation Association -
Healthcare Pioneers 2018 Award,
showcasing best practice in atrial
fibrillation.
17Monash Health
Monash Partners Advanced Health
Research and Translation Centre
Monash Partners Academic Health Science Centre, includes Monash Health
as one of two leading organisations, Hudson Institute of Medical Research and
Monash University.
It is a partnership between leading to measure how each bug impacts
2017 at a glance health services (public and private), on important health conditions
research and teaching organisations. like asthma.
Accredited by the National Health and
Medical Research Council (NHMRC) in
2015 as an Advanced Health Research
and Translation Centre (AHRTC)
the purpose of Monash Partners is
to ‘connect researchers, clinicians
During the year Monash
and community to innovate for
Partners:
better health’.
Consulted extensively and
delivered a strategic plan
Monash Partners
Research Highlights
Developed a model to
streamline research ethics
and governance review Towards evidenced-based surgical
Established and delivered a planning for paediatric tonsillectomy
large-scale clinical research Professor Gillian Nixon
training program to over
1000 staff Tonsillectomy is one of the most
common surgical procedures in
Established a data executive, childhood, with more than 50,000
jointly agreed data integration procedures nationwide per year for
priorities, and led a national symptoms of obstructed breathing
project, a data priority setting during sleep (obstructive sleep apnoea)
exercise or frequent tonsillitis. However,
Led engagement with tonsillectomy happens much more
government that delivered Improving Care in our often in some geographical areas than
$2.2M in funding in 2018 for Community others, raising questions about how
new high impact health clinical decision-making and aspects
innovation projects SNOTWATCH Asthma: Mapping of the health service (such as waiting
childhood viruses in real time lists and referral patterns) affect how
Engaged with philanthropy to
Professor Jim Buttery many children have the surgery. This
deliver >$1.2M in funding for a
project will examine the underlying
range of high impact projects SNOTWATCH combines routinely causes of variation in tonsillectomy
Engaged broadly to enhance and collected results from children and rates, and develop better diagnostic
integrate research, education adults across Victorian hospitals and tools for clinicians to guide referral,
and clinical care. clinics to map respiratory germs by treatment and optimal care planning at
time and place. This project will help a service level.
us understand not only how different
viruses and bacteria spread across
Victoria each year but will enable us
18Research Report 2017
Centre for Quality and Patient
Safety Research
A Partnership between Monash Health & Deakin University
The Centre for Quality and Patient tool), to improve nurses’ understanding the ward-based facilitators supported
Safety Research is a partnership of neurocognitive disorders, and to staff to use the strategy, including
between Monash Health and Deakin support them in the application of their BRAIN-TRK, in the care of 32 patients
University. Research undertaken knowledge in patient care. First, a few at risk for BPS. At least one cognitive
through the Centre is led by Professor nurses from each of the two acute and assessment was completed for each
Alison Hutchinson (Centre Director), sub-acute study wards at two Monash patient, and 99 sets of strategies
Associate Professor Bernice Redley Health sites were trained as nurse were recommended based on 146 risk
and Dr Helen Rawson. The Centre’s facilitators. Facilitators worked with assessments.
research addresses quality and safety our research team and a consumer
Staff focus groups and individual
in health services in the themes of representative to develop an online
interviews conducted before and
workforce development, patient education program and an electronic
after implementation evaluated the
experience and patient safety. During decision-support application called
strategy’s usability and acceptability
2017 the Centre collectively supervised BRAIN-TRK (‘Behavioural Resource App
to nurses, and feasibility for use in
seven PhD, one Masters by Research, for Interventions for Neurocognitive
hospital settings. Nurses identified
four Masters Minor Thesis and five disorders – Translating Research
benefits to patients and staff, strong
Honours students. Knowledge’). BRAIN-TRK has been
leadership support, and integration
designed to support nurses in real-time
One of the studies undertaken during with workflows as enablers of
during complex decision-making to
2017 was titled ‘Reducing harm, in success. Potential barriers included
prevent or manage individual patients’
the acute hospital setting, to people staff capacity and capability, and
BPS, and was made available on a
displaying symptoms associated with entrenched workplace culture and
portable device (in this case, an iPad)
a neurocognitive disorder’. Funded practices. Preliminary results also
at the patient’s bedside. The education
by the Dementia Centre for Research suggested the strategy’s potential to
program focused on the assessment
Collaboration as part of an Australian improve uptake of best practice and
and management of BPS, and how
Government initiative, this study outcomes for patients. Tests showed
to apply or adapt best practice
involved development and evaluation nurses’ knowledge of topics covered
interventions within acute care. A
of a strategy to promote uptake of in the education program, including
series of prompts and interactive
best practice recommendations by dementia, delirium and best practice
exercises helped staff to reflect on
hospital nurses caring for patients recommendations, improved by
their current practices and develop
with behavioural and psychological 16.67%. Nurses also completed a
strategies relevant to their setting.
symptoms (BPS) associated with validated questionnaire assessing their
Using BRAIN-TRK nurses could enter
neurocognitive disorders, such dementia-specific knowledge, which
individual patient information, conduct
as dementia and delirium. People demonstrated a 20.55% improvement.
cognitive screening, and choose from
experiencing BPS are at high risk of Over 170 hours of observations of
tailored interventions recommended
experiencing preventable harm during the care provided to patients with
for the patient’s particular set of
their hospital admission. Despite BPS showed that the number of best
behaviours and risk factors. BRAIN-TRK
strong evidence that individually- practice interventions used by nurses
also enabled nurses to evaluate and
tailored, non-pharmacological increased from a median of 1 pre-
track the effectiveness of interventions
interventions can reduce symptoms intervention, to 4 post-intervention.
over time.
and prevent harm, care delivered in The average number of medication
hospitals is frequently inconsistent Between February and May 2017, all errors and falls per month, measured
with best practice. nurses on the participating wards prior to and during the study period,
were invited to complete the online decreased by 26.83% and 5.77%,
Researchers used an integrated
education, receive training in the use respectively; and the use of Constant
knowledge translation approach to
of BRAIN-TRK, and practise using it Patient Observers (‘medical specials’)
co-design and evaluate a three-part
during their shift. Across the two wards, also reduced. Future research is
strategy (comprising facilitation,
60% of nurses completed all or part of warranted to refine the strategy, and
education, and a decision-support
the education program. From March, test impact and sustainability.
19Monash Health
Our commitment to investing
in emerging researchers
We have
an ongoing
commitment
to celebrate
and recognise
our emerging
researchers.
The 2017 Ms Alison Gibbs, Grade 3
Advanced Musculoskeletal
Whilst there have been numerous
studies exploring barriers to
Emerging Physiotherapist implementation of guidelines, there is
little known as to whether increasing
Research Osteoarthritis hip and knee service
GP knowledge and confidence in
(OAHKS) clinics led by Advanced
Fellows are: Musculoskeletal Physiotherapists
management of OA increases their
implementation of the guidelines.
have been utilised in the hospital
If this research demonstrates it is
setting in Victoria for over a decade.
feasible to engage with GPs via face
They aim to provide a comprehensive
to face education and implementing
assessment of patients with hip and
an OAHKS clinic on site, further
knee osteoarthritis (OA), ensure
research on a larger scale could be
conservative management is optimised
undertaken to evaluate if this alters GP
and provide timely referral on to
management decisions and enables
orthopaedics for surgical management
more effective implementation of
as required. Despite this, there is
guidelines for the management of hip
evidence that implementation of
and knee OA.
guidelines regarding hip and knee OA
is suboptimal both within Australia
and internationally.
This project therefore intends to
determine whether it is feasible to:
1. Establish an OAHKS clinic within a
GP practice
2. Engage with GP’s by having an
OAHKS clinic on site and provide
education regarding hip and
knee OA
3. Improve GP’s knowledge and
confidence in managing hip and
knee OA through engagement
20Research Report 2017
Ms Shanelle Karunanayake, 2. Providing service users with access Ms Janice McKeever,
Grade 1 Occupational to an evidence-based employment Occupational Therapist,
Therapist, Doveton program, enabled through a Manager Community
Community Care Unit. partnership with Eastern Region Rehabilitation Greater
Mental Health Association (Ermha) Dandenong Community
As an Occupational Therapist
3. Investigating the process of
Health Services.
working at Doveton Community
Care Unit; a community based implementing the IPS Partnership This research aims to identify the
psychosocial rehabilitation facility, Program with Ermha and its impact client, employee and organisational
Shanelle developed a keen interest in on the employment outcomes for outcomes of high quality leadership in
exploring one of the most significant, service users. Allied Health.
disabling barriers faced by adults
Amalgamation of traditionally separate It is generally accepted that leaders
with serious mental illness; that being
employment and mental health generate a number of positive
unemployment. Within the demanding
services has been achieved through co- outcomes for an organisation however
environment of mental health service
location of an employment specialist evidence is lacking to substantiate
delivery, it became apparent that
at the Community Care Unit. This has these opinions. Furthermore there
access to evidence-based employment
allowed service users to gain access is little information about the skills,
programs for adults presenting with
to a high level of streamlined and knowledge and behaviours of high
serious mental illness within the public
individualised support for vocational quality Allied Health leaders meaning
healthcare setting was scarce and
rehabilitation services. there is a significant knowledge
challenging to access.
gap for this large workforce. By
It is expected that findings from this
Shanelle’s interest in addressing this identifying the leadership skills of
study will provide insights whereby
gap in service delivery in the mental high performing leaders in Monash
similar programs and related IPS
health sector, lead to her submitting Health and specifying how these
knowledge translation can be rolled out
an application for and receipt of an influence patient and organisational
in other sectors of the Victorian public
Emerging Researchers Fellowship. outcomes, it will be possible to better
mental health context. The program will
inform leadership development that
As a piece of translational research, the also have direct translational benefits
will best meet the needs of clients,
Individual Placement and Support (IPS) for the service users engaging in the
staff and health organisations thereby
Partnership Project is aimed at: program, who will have more timely
ensuring we meet our organisational
access to evidence based IPS vocational
1. Embedding a new model of objectives. This will build skill and
rehabilitation services. Ultimately, it is
vocational rehabilitation in capacity in Allied Health to act as
hoped that the results of this research
clinical practice for use in mental system improvement leaders that can
will generate evidence and support for
health treatment settings, with champion innovation in patient care.
the continued provision of employment
service users
rehabilitation support within the
community mental health sector.
21Monash Health
Dr Thomas Suhardja, Dr Jonathon Wong,
Colorectal Research Fellow, Haematology Research Fellow
“This research aims to
Department of Colorectal
Surgery, Dandenong Hospital,
This research aims to initiate a analyse the efficacy of
pilot study for the development
Monash Health. the novel compound
and implementation of a rapid
This research aims to analyse the comprehensive high-sensitivity assay Gabapentin, Amitriptyline,
efficacy of the novel compound for targeted deep sequencing of cfDNA and Lignocaine topical
Gabapentin, Amitriptyline, and to simultaneously survey for i) genome- ointment in providing any
Lignocaine topical ointment in wide copy number alterations, ii) point significant improvement
providing any significant improvement mutations and indels in 35 oncogenes
for the management of
for the management of post- and tumour suppressor genes linked
haemorrhoidectomy pain, when to lymphoma development, iii) post-haemorrhoidectomy
compared with conventional treatment. selected translocations and iv) VDJ pain, when compared with
Haemorrhoidectomy is a frequently rearrangement. Our capacity to conventional treatment.”
performed surgical procedure, detect these changes in cfDNA will be
and pain following the procedure benchmarked against variants detected
is associated with considerable by whole exome sequencing (WES) on
morbidity. We aim to perform a prior biopsies obtained through the
prospective randomised controlled MGHA Aggressive Lymphoma Flagship,
trial comparing conventional analgesia in which a cohort of 20-30 lymphoma
to this new regime of compound patients being treated at Monash
topical ointment. Our study will be Health will have baseline annotation of
prospective and double-blinded, lymphoma specific mutations.
with patients randomised to either
It is hypothesised that the monitoring
receiving the compound ointment or
of tumour response (i.e. MRD tracking)
placebo ointment, on top of receiving
to targeted drugs is critical to
the standard conventional post-
anticancer drug development and that
haemorrhoidectomy care.
NGS cfDNA analyses can i) generate
We hypothesised that the added critically important quantitative
compound topical ointment and qualitative information that can
will provide better post- supplement imaging data acquired
haemorrhoidectomy pain control, than by CT and/or X-ray scan, ii) elucidate
conventional treatment. The significant the impact of tumour heterogeneity
benefit is aimed at improving post- on drug response and iii) identify
haemorrhoidectomy pain in the potential post-treatment changes
acute and intermediate setting. This in allele frequency that may have a
consequently will likely reduce patients’ prognostic value.
post-operative morbidity, length of
hospitalisation, and reduce the risk of
chronic pain.
22Research Report 2017
Research Support Services
Research Support Services is responsible for implementing Monash Health’s research
governance framework and provides comprehensive, practical assistance to
researchers. This includes advice on research ethics, budgets, contracts, indemnities,
grant applications, mentoring, advocacy and advice for our researchers and study
co-ordinators.
The team provides secretariat support Mr Michael Kios,
to the Monash Health Human Research Research Governance Manager
Ethics Committee, Low Risk Review
Ms Julie Gephart,
Panel and Research Council. The team
HREC Co-ordinator (Low Risk & Quality
also supports monitoring of approved
Improvement Projects)
research through the annual report
process and an auditing program. Ms Brinda Kinakkal,
Site Specific Authorisation Coordinator
Research Support
Mr Robert Reid,
Services team
HREC & Site Specific Authorisation
Professor Bill Sievert, Coordinator
Director, Clinical Research
Ms Heather Jackson,
Ms Deborah Dell, Administration Officer
Manager, Human Research Ethics
Ms Joan Angello,
Committee & Research Support
Administration Assistant
Services
23Monash Health
Research Council Matters discussed:
The Research Council maintained a ■■ NHMRC good practice pilot study ■■ Quality improvement activities
key oversight role in the activities of
the Research Support Services. The ■■ Streamlining of review of research ■■ Risk register for research
broad role of the Forum was to develop projects by service departments
■■ Clinical trial safety reporting
and guide research strategy and assist ■■ Start-up agreements with
Monash Health to achieve its goal to ■■ Research structure at Monash
sponsors
be a health service of international Health
standing in the improvement of ■■ Memorandums of understanding
■■ Research activity across Monash
healthcare. Membership of the with affiliated institutions
Health including project and
Research Council reflected the close ■■ Affiliation agreement with participant numbers
relationships between Monash Health, Monash University
Monash and Deakin Universities,
■■ Research ethics and governance
Hudson Research Institute and the
■■ Legislative compliance in
■■ Streamlining and harmonisation
Monash Institute of Medical Research. research
of governance across institutions
The Monash Health Research Council
■■ Strategic research plan and
■■ Annual research reporting
held five meetings during 2016 and five business plan
meetings during 2017.
■■ Auditing of clinical trials and
■■ Good Clinical Practice (GCP)
research projects
training for researchers
Research Council ■■ Medical research future fund
■■ Appointments of academic
Members 2017
clinical leaders ■■ Authority delegations and
■■ Prof Erwin Loh (Chair) research agreements
■■ Emerging research fellowships
■■ Prof Helena Teede ■■ Eligibility of Medicare ineligible
■■ Intellectual property and
participants into research
■■ Prof Alison Hutchinson authorship
■■ Recruitment of Jessie McPherson
■■ Dr Simon Bower ■■ Research week 2016 and 2017
Hospital patients into research
■■ Prof William Sievert ■■ Monash Partners Academic
■■ Honorary appointments of
Health Science Centre initiatives
■■ Prof Peter Fuller researchers
■■ Bio Medicine Victoria initiatives
■■ Prof Stephen Holdsworth ■■ Therapeutic Goods Administration
(until June 2017) ■■ Translational Research Facility (TGA) Clinical Trial Notification
Clinical Trials Centre (CTN) scheme
■■ Dr Terry Haines
(until November 2017) ■■ Paediatric Trials Network ■■ Federal government infrastructure
Australia initiatives funding
■■ Prof Eric Morand
■■ Australian Paediatric Research
Legal Team Ethics and Governance Network
Monash Health Chief Legal Officer,
Ms Katherine Lorenz, Senior Corporate
Counsel, Ms Tammy O’Connor,
Corporate Counsel, Ms Elle Bethune
and the Legal Team provide legal
support as required by the Research
Support Services team, including
assisting with setting up research
agreement templates and providing
advice on legislative issues that may
impact on research.
24Research Report 2017
Human Research Ethics involve minor privacy concerns. The Mrs Angela McAvoy AM,
Committees panels are convened on a fortnightly Lay Woman
based and Chaired by Dr Jim Doery.
The Human Research Ethics Dr Liam McCormick,
Committee (HREC) at Monash Health The Medication Safety and Alternate Medical Researcher
operates in accordance with the Therapeutics Committee, led by Sue
Dr Atul Malhorta,
National Statement on Ethical Conduct Kirsa, provides support to the Ethics
Alternate Health Care Professional
in Human Research (National Health review process by reviewing all drug
and Medical Research Council, 2007 trials and provides advice to the Mr Allan Manser,
under rolling review). The HREC meet Committee. Health Care Professional
monthly, except in January, to review Dr Robert Meek,
research applications for proposals Human Research Ethics
Alternate Medical Researcher
involving patients and staff at Monash Committee Members 2017
Health. The Committee is led by Dr Ms Joanne Mockler,
Dr Simon Bower,
Simon Bower (Chair) and Dr Jim Doery Health Care Professional
Chairperson
(Deputy Chair). Dr Bill Mulley,
Dr Peter Briggs,
In September 2010, Monash Health Medical Researcher
Medical Researcher
received Certification by the National Mr Bernard O’Shea,
Health and Medical Research Ms Susan Brunton,
Lawyer
Council in accordance with the Lay Woman
National Certification Scheme for its Dr Arvind Sehgal,
Ms Sema Cakan,
institutional processes relating to the Health Care Professional
Researcher
ethical review of multi-centre research Ms Pamela Sloss,
in the following categories of research: Dr James Doery,
Alternate Lay Woman
Deputy Chair & Health Care
■■ Clinical Trials Phase I Professional Mr John Stevens,
■■ Clinical Trials Phase II Alternate Lawyer
■■ Clinical Trials Phase III Prof Christine East,
■■ Clinical Trials Phase IV Researcher Dr Peter Temple-Smith,
Paediatric Research Researcher
■■
Prof Peter Ebeling,
■■ Clinical Interventional Research Health Care Professional A/Prof Krishna Vaddadi,
other than Clinical Trials Medical Researcher
■■ Population Health/ and or Public A/Prof David Ernest,
Health Medical Researcher Ms Claire Vosk,
Mental Health Alternate Health Care Professional
■■
Mr Warren Fricke,
The Certification has been renewed Lay Man Dr Flora Wong,
and granted until 31 December 2018. Alternate Medical Researcher
Mr Doug Gimesy,
Monash Health is also accredited for Lay Man Fr Albert Yogarajah,
multi-centre review under the National Minister of Religion
Dr Robert Gooley,
Mutual Acceptance Scheme in Victoria, Alternate Medical Administrator
New South Wales, Queensland, South
Australia, Western Australia and the Prof Andis Graudins,
Australian Capital Territory. Monash Alternate Medical Researcher
Health consistently achieves 100% for Dr Peter Kempster,
review within 30 days in benchmarking Health Care Professional
reports provided by the Department of
Ms Helen Kopp,
Health and Human Services.
Alternate Health Care Professional
There are two virtual Low Risk Review
Mr Ian Larmour,
Panels at Monash Health that review
Health Care Professional
proposals ranging from surveys, and
data collection studies, through to
quality assurance projects which
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