48
CONCORD HOSPITAL RESEARCH REPORT 2002/2003 Concord Repatriation General Hospital Hospital Road, Concord 2139 Australia

RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

  • Upload
    others

  • View
    1

  • Download
    0

Embed Size (px)

Citation preview

Page 1: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

CONCORD HOSPITALRESEARCH REPORT

2002/2003

Concord Repatriation General Hospital

Hospital Road, Concord 2139 Australia

Page 2: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

Org

anis

atio

nal C

hart

: Res

earc

h at

Co

nco

rd R

epat

riat

ion

Gen

eral

Ho

spita

l

Co

nco

rd H

osp

ital

Man

agem

ent

Co

mm

itte

eM

r M

atth

ew D

aly,

Exe

cutiv

e D

irect

orD

r M

arga

ret

San

ger,

Med

ical

Dire

ctor

Res

earc

h O

ffic

eM

anag

er:

Virg

inia

Tur

ner

Hum

an R

esea

rch

Eth

ics

Co

mm

itte

eC

hair:

Dr

Gar

ry P

earc

eLa

y p

erso

nsM

inis

ter

of r

elig

ion

Clin

ical

Tria

ls P

harm

acis

tC

SA

HS

Boa

rd m

emb

erN

ursi

ng r

epre

sent

ativ

eR

epre

sent

ativ

es o

f re

sear

ch &

wid

er c

omm

unity

Exp

edit

ed E

thic

al R

evie

w P

anel

Cha

ir: D

r G

arry

Pea

rce

Ani

mal

Ser

vice

s S

ub C

om

mit

tee

Cha

ir: P

rofe

ssor

Dav

id H

and

elsm

an

Ho

spit

al D

rug

Co

mm

itte

eC

hair:

Dr

Ros

s B

rad

bur

y

Res

earc

h C

om

mit

tee

Cha

ir: P

rofe

ssor

Ben

Fre

edm

an

Clin

ical

Tria

ls P

harm

acis

tD

irect

or A

NZ

AC

Dire

ctor

CE

RA

Invi

ted

Res

earc

hers

Pos

t-gr

adua

te C

oord

inat

orP

rofe

ssor

of

Nur

sing

(Rep

rese

ntat

ive)

Page 3: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

Contents

Overview of Research 3

Message from the Chair of the Research Committee 4

Message from the Chair of the Ethics Committee 5

Markus Seibel 6

Robert Cumming 7

Rosemary Burke 8

Biao Zeng 9

The ANZAC Research Institute 11

The Centre for Education and Research on Ageing (CERA) 12

Cardiology 14

The Burns Unit 17

Breast Cancer 19

Brain Diseases 21

Respiratory Diseases 23

Andrology 26

Urology Research 27

Research into Pain Relief 28

Orthopaedic Research 30

The Ageing Process and the Liver 32

Palliative Care 33

Cognitive Behavioural Treatment of Panic Disorder 34

Table of Research at Concord Hospital 2002/2003 36

Funding 45

Page 4: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many
Page 5: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

3

Concord

Hosp

italResearch R

eport

Overview of researchResearch at Concord Hospital is diverse,spanning the spectrum from basic,laboratory-based research throughapplied clinical research to population-based studies. This reflects theenormous breadth of talent and expertiseat Concord and our close links with TheUniversity of Sydney and the ANZACResearch Institute. Furthermore,specialist services, such as the BurnsUnit, provide the opportunity for groundbreaking studies in areas of need.

The establishment of the ANZAC Research Institute hasbeen a major factor in promoting laboratory-basedresearch on this campus. The Institute has provided state-of-the-art laboratories to facilitate quality research andpromote an environment which fosters scientificexcellence. This, together with the recruitment over recentyears of a number of world class senior staff withexperience in a variety of research techniques, hasstrengthened and expanded the repertoire of conditionsand diseases investigated.

An important feature of the research at Concord Hospital,and one which sets us apart from many centres, is themultidisciplinary nature of many of the studies. By drawingon the expertise of all facets of professional health care therelevance and calibre of the research in ensured.

Furthermore, research is performed while maintaining the highest standards of clinical medicine and patient care.The combination of talented, dedicated staff and theimproved physical environment brought about by theredevelopment of the hospital suggests that the future of research at Concord Hospital will be bright.

Jillian KrilAssociate Professor (Geriatric Medicine)Editor, Research Report

Page 6: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

4

Con

cord

Hos

pita

lRes

earc

h R

epor

t

Message from theChair of the ConcordHospital ResearchCommitteeIt is a great pleasure to see theproduction of this Research Reportcome to fruition. In some ways it marksthe coming of age of research atConcord Repatriation General Hospital,which for many years has been ateaching hospital of the University ofSydney. The new millennium has seenthe commissioning of the ANZACResearch Institute – a purpose-builtmodern research facility – right here onthe Concord campus.

The ANZAC Research Institute or ARI, headed bythe inaugural Director Professor DavidHandelsman, commemorates in a very tangibleway the Hospital’s links with the veterancommunity, and has a primary theme of ageing.The ARI has initiated new directions of researchexcellence in men’s health and in bone disease, aswell as capitalising on previously establishedresearch in ageing through CERA (Centre forEducation and Research on Ageing) and geneticaspects of neurodegenerative disorders. The ARIhas already established itself as a major focus ofresearch activities at Concord.

This publication illustrates the broad depth ofresearch at Concord on many fronts, ranging fromdirect patient care to the molecular and genetic

basis of disease. It is obvious that this research ismultidisciplinary in nature, with contributions fromnurses, physiotherapists, dieticians, speechtherapists and pharmacists in addition to thosefrom physicians and surgeons and basic scienceresearchers. We have chosen not to beexhaustive, but to showcase the highlights. Wehave also featured biographies of our two newestProfessors, Markus Seibel and Robert Cumming,Rosemary Burke the director of Pharmacy, andBiao Zeng, one of our many PhD students - ourresearchers in training.

This research report would not have been possiblewithout the hard work of Associate ProfessorJillian Kril and Virginia Turner who collected,collated and edited the material. We owe themboth a debt of gratitude for a job well done.

Research in a teaching hospital has a fundamentalplace not only in improving our understanding ofdisease but in improving healthcare. It deservesrecognition and support from the community. Thiscan best be achieved by fostering anunderstanding of what is happening here atConcord. We hope this publication will go someway towards facilitating this goal.

Professor Ben FreedmanChair, Concord Hospital Research Committee

Page 7: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

5

Concord

Hosp

italResearch R

eport

A message from theChair of the EthicsCommitteeThe Human Research EthicsCommittee (HREC) is central to thegovernance of good research in thehospital. As a result of therecommendations of the Review ofResearch at Concord Hospital in 2000,much has occurred to improve therunning of Research and Ethics at ourhospital.

Central to this has been the reorganisation of theResearch Office with the appointment of Virginia Turner,who has worked extremely hard to bring realprofessionalism to the office and who is ably supportedby Rodger Lomberg.

The Concord HREC has 20 members, including laypeople, a Minister of Religion, two lawyers and a groupof professionals with a diverse range of expertise inresearch and clinical care.

In 2002, the HREC was fortunate to have the additionof two more lay representatives (making a total of five),Mr Rob Neurath and Mrs Elizabeth Buckpitt. Dr MattRickard (colorectal surgeon) and Mr Leo Turner (ClinicalNurse Consultant) also took up positions on theCommittee in 2002. In 2003, Professor RobertCumming (Professor of Epidemiology and GeriatricMedicine) and Dr George Lau (Department ofCardiology), joined the HREC. In 2003, the Committeewelcomed Rev Paul Weaver, and was pleased to retainthe services of retiring Minister of Religion, Rev PaulWatkins as one its lay representatives. Two other long-standing members have retired. Dr Sue Liew retired in2000 after 15 years as Chairperson and Mrs Ethel(Stalky) Lane retired as Veterans’ Representative after

serving almost the same length of time. The hospitalowes a debt of gratitude to both these dedicatedpeople.

The Concord HREC has struggled with many issuesover the last twelve months. Many of these issues arisefrom the new Information Privacy laws which have beenintroduced at both State and Commonwealth levels. Inthe light of this new legislation, the Ethics Committeehas had to look at the need to provide more stringentethical oversight of medical records research and theissue of identifiable information kept on databaseswithin the hospital.

The Committee has also developed new policies formeeting the increasingly frequent demands for genetictesting as part of large multi-centre, pharmaceuticalcompany-sponsored drug trials.

The issue of healthy volunteers taking part in researchhas also been a contentious one and the Committeehas developed guidelines for providing sufficientinformation to healthy participants about any risksinvolved in the research for which they are volunteering.

In 2001, the HREC agreed to a process involving anew committee called the Expedited Ethical ReviewPanel (EERP) to assist with some of the moremanagerial/administrative aspects of the ethical reviewprocess.

Finally, I would like to thank my colleague Dr RossBradbury, who chairs the Concord Hospital DrugCommittee, and all the clinicians who assist Ross in theprocess of assessing and reviewing Clinical Drug Trialsbefore they are seen by the Ethics Committee. Mythanks also go to the Pharmacy Department and theClinical Drug Trials Pharmacists who have worked sohard to make clinical trials of new drugs possible atConcord Hospital.

Dr Garry PearceChairmanConcord Human Research Ethics Committee

Page 8: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

6

Con

cord

Hos

pita

lRes

earc

h R

epor

t

Markus J SeibelIn late 2001, Professor Markus Seibeljoined Concord Hospital as Professorof Endocrinology and Head of the BoneResearch Program at the ANZACResearch Institute.

Markus, a native of Germany and France, graduatedfrom the Universities of Mainz, Germany, andPennsylvania, USA. He then trained in AnatomicalPathology (University of Freiburg and WHO CentreMainz, Germany), Rheumatology, Gerontology andRehabilitation Medicine (University of Basel,Switzerland), Immunobiochemistry and Endocrinology(Columbia University, USA) and Internal Medicine(University of Heidelberg, Germany). Markus completedhis PhD on the “Biochemical Assessment of BoneTurnover and Remodelling” in 1997 (University ofHeidelberg, Germany) and became an AssociateProfessor at the University’s Department of Medicineand the Director of the Department’s EndocrineDiagnostic Laboratories.

Markus is an advisor to national and internationalresearch foundations and a member of the scientificadvisory board of the International OsteoporosisFoundation. He is also a member of the editorialboards of several international journals.

Several of the current areas of research which are partof the Bone Research Program at the ANZACResearch Institute are described below.

Preventing The Spread Of Malignant Tumours To BoneDr Colin Dunstan, a world-recognised bone researcher,was awarded the prestigious BioFirst Award to supporthis work on the mechanisms that govern the spread ofmalignant tumours, such as breast and prostatecancer, to bone. This work uses a novel animal modelof metastatic bone disease developed by MarkusSeibel’s team in Germany.

Understanding the mechanisms of malignant spread tobone will help to develop more efficient strategies forthe prevention and treatment of these painful and oftenfatal complications of many cancers.

Genetic Influences on bone mass and bone turnoverin healthy and osteoporotic menDr Christian Meier from the University of Basel,Switzerland joined the laboratory to undertake researchon genetic factors in bone metabolism. This project iscarried out in collaboration with Professor John Eismanand the Dubbo Epidemiological Study. The project isexpected to shed light on the presently ill understoodmechanisms causing osteoporosis in men, and isexpected to provide opportunities for new and betterprevention and treatment.

Bone metabolismResearch is also underway into the mechanismsgoverning normal and abnormal bone metabolism.Using transgenic mouse models, the effects ofcortisone on bone will be evaluated. A frequent adverseoutcome of this widely used drug is severe bonedisease. A better understanding of why cortisone is sodamaging to bone will point the way to strategies forthe reversal or prevention of its detrimental effects onthe skeleton.

Bone markersAll bone diseases are characterised by changes inbone formation and in bone resorption, the two majorprocesses that keep bone alive, healthy and strong.Measurement of specific ‘bone markers’ in serum andurine determines the activity of these processes andcan help the clinician assess the severity, and monitorthe treatment of bone diseases such as osteoporosis.In collaboration with Clinical Associate ProfessorMichael Hooper, research is underway into thedevelopment and clinical validation of novel orimproved markers of bone turnover. Present studiesfocus on the evaluation of bone turnover rates in thevery elderly, the significance of androgens on bonehealth, the effect of anti-osteoporotic drugs on boneremodelling fracture rates in patients with osteoporosis,and the novel use of bisphosphonates on the healing ofprostheses used for total hip replacements.

Page 9: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

7

Concord

Hosp

italResearch R

eport

Robert CummingProfessor Robert Cumming hasrecently been appointed Professor ofEpidemiology and Geriatric Medicine atConcord Hospital. This newly createdChair is the first of its kind in Australiaand one of the few in the world toformally recognise the importantcontribution that epidemiology canmake to improving the health of olderpeople.

Robert graduated in medicine from the University ofNew South Wales in 1979. Following several years atPrince of Wales Hospital he worked in general practicein England and Australia before spending a year inGeriatric Medicine at War Memorial Hospital in Sydney.In 1986, Robert enrolled in the Master of Public HealthDegree at the University of Sydney. He subsequentlywon a scholarship to study at Columbia University inNew York, where his research work on health problemsof older people began. Since returning to Sydney in1990, he has worked in the School of Public Health atthe University of Sydney.

Most of Robert’s research has been in two areas: fallsand fractures in older people and age-related eyediseases, particularly cataract. He has more than 150publications and is well known for his work on the roleof calcium in prevention of fractures and theimportance of psychotropic drugs as causes of falls inolder people. He also has an international reputation forhis expertise in the design and conduct of randomizedtrials of non-pharmacological interventions forprevention of falls and fractures. Robert’s research oncataract resulted in the first paper to report anassociation between use of inhaled corticosteroids andrisk of cataract.

One of the research projects he is currently doing is arandomised trial of improving vision to prevent falls.

This project is based at Concord Hospital and willinvolve more than 1,000 people aged 70 years andover, recruited mainly from aged care services. He isalso involved in randomised trials of hip protectors andof the use of Tai Chi to prevent falls. Another project isthe Blue Mountains Eye Study, one of the world’slargest epidemiological studies of eye diseases.

Future plans include a randomized trial of fallsprevention in hospitals and a large observational studyof the health of older men.

Professor Cumming is a member of the Centre forEducation and Research on Ageing, as well as being amember of the University of Sydney’s School of PublicHealth.

Page 10: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

8

Con

cord

Hos

pita

lRes

earc

h R

epor

t

Rosemary BurkeRosemary Burke commenced asDirector of Pharmacy at ConcordHospital in 2001 after seven years asDirector of Pharmacy at theWollongong and Port KemblaHospitals. She has also worked atPrince Henry and St George Hospitals.Rosemary holds a Diploma ofEducation and is a fellow of TheSociety of Hospital Pharmacists ofAustralia (SHPA). She has beeninvolved for many years in this societyand was NSW Chairman for five years.Rosemary has also chaired the nationalcommittee of Specialty Practice inHospital Pharmacy Management and isthe current chairman of SHPA’sCommittee of Specialty Practice inMedication Safety. She is also areviewer for the Pharmacy Board’sgraduate review panel.

Rosemary’s major professional interests includeeducation of health professionals and patients, and thequality use of medicines and medication safety. Shehas also been involved in a number of projects aimedat improving the continuum of care and developingcommunication networks with General Practitioners.She has been an invited speaker at many meetings andhas presented on her areas of interest at a number ofconferences.

In 2001 Rosemary received the SHPA Neil NaismithBaxter grant which is awarded to a hospital pharmacymanager who is considered to have contributed to theprofession. With this support she undertook a study

tour of the United States focusing on the area ofmedication safety. The report of this visit has recentlybeen published in the Journal of Pharmacy Practiceand Research.

The pharmacy department at Concord has beeninvolved in a number of practice research projects oftenin collaboration with other hospitals through groupssuch as the NSW Therapeutic Assessment Group.These include drug utilisation review and collaborativeprograms for quality improvement. The hospital joinedthe 2001 International Round-table Adverse DrugEvents Improvement Collaborative (ADEIC). There werenumerous projects involving the pharmacy departmentincluding work designed to ensure safer use ofanticoagulants in the hospital.

The pharmacy department plays an important role inthe review of clinical trials at Concord Hospital. TheHospital’s Drug Ciommittee acts as the scientific reviewcommittee and the department is involved in themanagement of suspected adverse drug reactionsrelated to clinical trials. Apart from stock managementand the institutional review process, the department isinvolved in literature searches and the importation ofinvestigational drug material. Pharmacists are oftencalled on to provide advice on the design ofinvestigator initiated trials or randomisation methods.The department is able to offer aseptic reconstitutionfacilities for clinical trials based at the hospital. Thisservice can cover a number of aspects includingaseptic reconstitution, blinding of the investigator andthe design and formulation of placebos.

Recently, Rosemary has been successful in obtaining a$100 000 grant from the Australian Council for Qualityand Safety in Health Care to carry out a study whichaims to identify the reasons for adverse events fromhigh risk drugs in elderly hospitalised patients. Thestudy also aims to design strategies for preventingsimilar recurrences.

Rosemary hopes to facilitate more pharmacy practicebased research programs at Concord. The departmentis well placed to both initiate and assist with a widerange of research activities centred around medicationuse.

Page 11: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

9

Concord

Hosp

italResearch R

eport

Biao ZengDr Biao Zeng obtained his MBBS in1984 and Master’s degree inCardiology from Tongji MedicalUniversity, China. From 1984 to 1993he trained in Cardiology and worked inthe Research Institute of CardiovascularDisease, Union Hospital. From 1994 to1997 he was funded by the VictorChang Foundation to work in theDepartment of Cardiology, Royal NorthShore Hospital.

In 1998 Biao enrolled as a PhD candidate, under thesupervision of Dr David Brieger and Professor BenFreedman in the Department of Cardiology, ConcordHospital. He was awarded an NHMRC PostgraduateResearch Scholarship in 2000. In 2002 Biao wasawarded the poster prize by the Cardiac Society ofAustralia & New Zealand (CSANZ) for his presentationat the XIVth World Congress of Cardiology in Sydney.

Biao’s research interests include the investigation ofneutrophil mediators of fibrinolysis in plasminogenknockout mice. This research, which is described indetail on page 16, was published as a paper titled“Influence of plasminogen deficiency on thecontribution of polymorphonuclear leucocytes tofibrinogenolysis” in the Journal of Thrombosis andHaemostasis in 2002.

Biao has also been involved in research on the role ofmatrix metalloproteinases (MMPs) in patients withcoronary artery disease (described on page 15).Results from this study indicated that circulatingplasma levels of the gelatinolytic MMP-2 and MMP-9were elevated in patients with symptomatic coronarydisease. The strong correlation of MMP-9 levels withcirculating levels of high sensitivity C-reactive protein(hs-CRP), suggests MMP-9 is a more sensitive markerof the systemic inflammatory process that underlies thepathophysiology of acute coronary syndrome.

Biao’s research and clinical experience have given himbroad insights into cardiovascular disease. He hopes tocontinue his research in areas that lead to thediscovery and understanding of the mechanismsunderlying cardiac disorders.

Page 12: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

10

Con

cord

Hos

pita

lRes

earc

h R

epor

t

Page 13: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

11

Concord

Hosp

italResearch R

eport

The ANZAC Research Institute

The ANZAC Research Institute wasestablished in 2000 on the ConcordHospital campus in conjunction withthe University of Sydney. Theestablishment of the Institute ensureddedicated research infrastructure so asto promote basic and applied medicalresearch on the Concord Hospitalcampus.

The main research theme of the ANZAC ResearchInstitute is ageing, with the long-term goal of prolongingenjoyable, independent living for the ageing population.As the only major independent biomedical researchinstitute with a primary focus on ageing, the ANZACResearch Institute aims to co-ordinate the highestquality innovative research at all levels - from public andpopulation health, to clinical research, molecularphysiology (animal models) as well as cell andmolecular biology.

Under the overall leadership of its Director, ProfessorDavid Handelsman, the major research groups of theANZAC Research Institute are:

The Andrology group (leader: Professor DavidHandelsman) is conducting research into malereproductive health, medicine and biology.

The Biogerontology group (leader: Professor David LeCouteur) is studying age-related changes in the liver. Itis proposed that these changes accelerate many of themajor diseases (such as cardiovascular disease andosteoporosis) that accompany ageing.

The Bone Biology group (leader: Professor MarkusSeibel) is studying bone disorders, especiallyosteoporosis and bone cancers.

The Neurobiology group (leader: Professor GarthNicholson) has as its major research focus theidentification of genes that cause neurodegenerativediseases.

The Respiratory group (leader: Dr Sam Lim) has beenstudying lung function and the effects of steroidtreatment in major respiratory diseases such as asthmaand chronic obstructive pulmonary disease. FollowingDr Lim’s recruitment by GlaxoSmithKline (UK) to headtheir respiratory clinical Research & Development, the Vascular Biology group (leader: AssociateProfessor Len Kritharides) has commenced research ina new laboratory. This group is studying the role ofinflammatory factors in cardiac and vascular injury andischemia, with the aim of improving early detection anddeveloping better treatments for heart disease.

Page 14: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

12

Con

cord

Hos

pita

lRes

earc

h R

epor

t

The Centre for Education andResearch on Ageing(CERA)CERA is a multidisciplinary centre thataims to improve the health and qualityof life of older people through researchinto ageing, diseases of old age andservice delivery. CERA is a joint facilityof the Aged and Extended CareDepartment of Concord Hospital andThe Department of Medicine of TheUniversity of Sydney and is involved ineducation of aged care workers andstudents in many professional areas.

CERA is staffed by geriatricians, nurses, psychologists,scientists and other professionals who work together inhealth care delivery and research. CERA’s director,Professor David Le Couteur, is a leading figure ingeriatric pharmacology and he serves on a number ofnational committees including the Australian DrugEvaluation Committee.

In addition to the provision of in-patient and ambulatorycare for Geriatric Medicine, CERA maintains a highprofile in geriatric and gerontological research. Thecentre’s research utilises laboratory, clinical andpopulation methodologies and covers a broadspectrum of issues of significance to ageing. Researchat CERA occurs in four main areas:

The ageing liver – Professor Le Couteur’s team, at itslaboratory in the ANZAC Research Institute, is studyingage-related changes in the blood vessels of the liver, asthese are thought to underlie a number of diseaseswhich increase in prevalence with age (see also p32).

In particular, the team is examining how structuralchanges in the ageing liver can predispose toatherosclerosis, heart disease and stroke, all commondiseases of the elderly. The ultimate aim of thisresearch is the development of therapeutic strategieswhich prevent blood vessel changes in the liver andconsequently prevent many of these debilitatingdiseases.

Neurodegenerative disease – The prevalence ofdementia rises steeply with age, yet Alzheimer’sdisease and other causes of cognitive decline remainpoorly understood. Dr Helen Creasey, AssociateProfessor Jillian Kril, Dr William Brooks and colleaguesat CERA are studying the clinical, psychological,genetic and pathological aspects of brain ageing anddementia in communities and clinic based populations.A major outcome of this research is improvedunderstanding of the risk factors for dementia andimproved diagnosis of dementia. Another major recentdiscovery was the particular genetic defect that causesa dementia syndrome in a family that has been studiedfor decades at CERA.

Population studies - The recent appointment ofProfessor Cumming as the Chair of Epidemiology andGeriatric Medicine has brought internationally renownedexpertise in research into falls, osteoporosis andmedication usage inolder people. Thiswork has shown theimportance ofcalcium inpreventingosteoporosis, andthe role ofmedications andvisual impairment infalls in older people.In addition, themajorepidemiologicalstudy of ageing, theSydney Older Person Study (SOPS), has continued incollaboration with Professor Broe and Dr Creasey. Thisstudy has identified risk factors for neurodegenerationand clarified health service delivery needs of olderpeople in the community.

Page 15: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

13

Concord

Hosp

italResearch R

eport

Residential and Community Care - This area has beendeveloped by Chris Shanley, (Assistant Director,Education and Information Services) to address thehealth care needs of older people in the communityand residential care. In particular, the work has focusedon the prevention of falls in residential care, advancedcare directives in older people (similar to “living wills”),and the organisational strategies for establishing bestpractices in residential care facilities.

PhD candidate Sarah Hilmer at work in the laboratory

Page 16: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

14

Con

cord

Hos

pita

lRes

earc

h R

epor

t

CardiologyThe Cardiology Department has astrong and varied research profile. TheDepartment undertakes clinical,laboratory-based and basic researchinto many aspects of cardiovasculardisease.

The GRACE RegistryAcute coronary syndromes, including the full spectrumfrom unstable angina to myocardial infarction (“heartattack”), represent a major cause of morbidity andmortality throughout the world. GRACE – the GlobalRegistry of Acute Coronary Events – is a large,multinational, observational study of patientshospitalised with acute coronary syndromes (ACS). The aim of GRACE is to improve the quality of care forpatients with ACS. The registry gathers information onthe relationships between patient characteristics,treatment practices, and in-hospital and post-dischargeoutcomes at hospitals around the world. A total of 94hospitals in 14 countries in North America, SouthAmerica, Europe, and Australia/New Zealand arecurrently collaborating in GRACE. In Australia and NewZealand, the study is being coordinated by Dr DavidBrieger.

Information on patient demographics, medical history,acute symptoms, clinical characteristics,electrocardiographic (ECG) findings, treatmentapproaches, and in-hospital outcomes is collected.Patients are followed up by telephone at 6 months afterhospital discharge. The information collected from theGRACE project has provided important and extensiveinsights into patient characteristics, current practicepatterns, and outcomes for patients with acutecoronary syndromes. Given the pressures of practicingevidence-based medicine in a cost-effective manner,the results of GRACE provide a multinationalperspective into these important outcomes, and identifyareas requiring improved patient care.

The SPORTIF 3 StudyAtrial fibrillation is a common condition affecting 5% ofthe population over the age of 65. The danger of thiscondition is that people with it are at a greater risk ofstroke, which can only be prevented by thinning theirblood with anticoagulants. The only orally activeanticoagulant available at present is warfarin. This is adifficult drug to use as it increases the risk of bleedingsignificantly. Furthermore the levels of warfarin in theblood are very sensitive to both diet and othermedications so the blood levels must be constantlymonitored, a major inconvenience for patients anddoctors alike. Recently a new anticoagulant, Exanta,has been developed which appears to be safer andcan therefore be used without monitoring. TheSPORTIF 3 study is an international trial in 4,000patients which compares treatment with warfarinversus Exanta. In Australia, this study is beingconducted out of Concord Hospital under the directionof Dr David Brieger. Promising preliminary resultssuggest that this new therapy should be available in thenear future.

EchocardiographyDr Kevin Fung, under the supervision of AssociateProfessor Len Kritharides, has investigated whethernew ultrasound techniques can detect very mild andpreviously undetectable degrees of heart muscledamage. He found that reversible and irreversibleweakness of the heart muscle can be detected usingthe technique of Tissue Doppler, and applied thistechnique to study patients undergoing electrical shockto revert abnormal heart rhythm. In addition, in acollaborative study with Clinical Associate ProfessorAlastair Corbett from the Department of Neurology, heinvestigated patients with myotonic dystrophy, adisease which causes widespread weakness of themuscles. It was found that Tissue Doppler could detecta reduction in heart muscle function well beforeweakness could be detected by conventionaltechniques.

Liver Dysfunction in Heart FailureIn this study, Dr George Lau and Associate ProfessorLen Kritharides are investigating the build up of fluid inthe liver which occurs in patients with heart failure. Theability to diagnose such build up would be improved byknowing the patterns of damage which are typical of

Page 17: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

15

Concord

Hosp

italResearch R

eport

fluid build up, and the cardiac factors which contributeto it. This study to date has shown that the pattern ofbiochemical damage is the same as the pattern seen inpatients with blockage of bile flow. Furthermore thebiochemical changes are directly related to the severityof leakage across one of the heart valves, the tricuspidvalve. This result may allow doctors to use liver imagingtests more sparingly and save patients inconvenienceand time.

Investigation of matrix metalloproteinases in patientswith coronary disease.Matrix metalloproteinases (MMPs) are enzymesinvolved in the breakdown of extracellular matrixcomponents and have been implicated in both thedevelopment of atherosclerosis and in plaque rupture inacute coronary syndromes. However, few studies haveexamined the association between circulating MMPsand symptomatic coronary artery disease. Dr David Brieger and colleagues measured plasmaactivities of MMP-9 and MMP-2 in healthy controls, andin patients with unstable and stable angina. In patientswith stable angina, MMP-9 levels were significantlyelevated relative to controls. In unstable anginapatients, levels of both MMPs were significantlyelevated relative to controls and patients with stableangina. This incremental elevation in patients withunstable angina may be of diagnostic utility andsupports the role of MMPs in the pathogenesis ofunstable coronary syndromes. Further studiesinvestigating the mechanism and clinical significance ofthese findings are planned.

Minimally-Invasive Detection of Coronary Artery DiseaseComputer tomography (CT) is a minimally-invasivetechnique to image coronary arteries. Recentrefinements in image acquisition and analysis arecurrently being evaluated by the research team ofAssociate Professor Len Kritharides, Dr George Lauand Dr Lloyd Ridley from the Department of Radiology.

In this study patients underwent conventional coronaryangiography followed by CT coronary angiography.The conventional angiographs and the CT angiographswere assessed to identify coronary vessels which haveblockages (stenoses). Using the new CT method,stenoses were identified with 88% accuracy, with lowerrisk and inconvenience to the patients than

conventional angiography. This technique will allow theaccurate assessment and classification of coronaryartery disease in the majority of patients.

Three-dimensional image of the heart by computertomography (CT)

A study patient having a cardiac CT scan

Page 18: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

16

Con

cord

Hos

pita

lRes

earc

h R

epor

t

Investigation of neutrophil mediated fibrinolysis inplasminogen knock out mice.When blood clots (thrombi) form they are broken downby a process called fibrinolysis which most commonlyoccurs due to a protein called plasminogen. If noplasminogen is present then clots cannot be lysed. Inorder to study alternative, non-plasminogen dependentmechanisms of fibrinolysis, mice were bred which donot make any plasminogen (Plasminogen knock-outmice). In these mice it has been found that whiteblood cells contain non-plasmin fibrinolytic proteases,however the degree to which these cells contribute toclot degradation in these animals is not known.

Thrombi were generated in carotid arteries and jugularveins of knock-out and normal (wild type) mice by theapplication of a ferric chloride solution. White bloodcells quickly accumulated in the thrombus and agreater number were retained within the thrombi ofknock-out mice compared to the wild type miceproviding the potential for more fibrinolytic enzymes tobe present. In addition the researchers, PhD studentBiao Zeng and Dr David Brieger, showed that whiteblood cells extracted from knock-out mice were able tobreak down fibrinogen to a greater extent than cellsfrom wild type mice and that the fibrinogen breakdownproducts were distinct in the knock outs. These resultssuggest that a relatively greater role for white bloodcell-initiated fibrinolysis exists in the setting ofplasminogen deficiency.

Page 19: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

17

Concord

Hosp

italResearch R

eport

The Burns Unit The Burns Unit at Concord Hospitalwas established as a statewide referralcentre for burns injuries by the NSWDepartment of Health in the late1980’s. The Unit provides specialisedtreatment to complex burns casesunder the directorship of Dr Peter Maitzin collaboration with Dr Peter Haertsch,Head of Plastic and ReconstructiveSurgery. The Unit will soon move into anew location on the seventh floor of theMulti building. Here it will have a 17-bed treatment centre, dedicatedOperating Theatre and a new skinlaboratory. A multi-disciplinary team ofresearchers carries out its work in theBurns Unit

The Skin Culture LaboratoryThe Burns Unit tissue culture laboratory wasestablished in 2001 to provide tissue for skinregeneration in severe burns patients. The laboratoryhas developed procedures for skin cell replacement(keratinocyte grafting), for the treatment of existingscars and the late resurfacing of burn wounds.

Keratinocyte grafts are prepared from healthy cellstaken from an unaffected area of the patient and grownin the laboratory under specialised conditions (cellculturing). These are used to form skin sheets, or putinto a liquid to spray over the surface of the wound,providing rapid healing with little scarring. Work in thislaboratory has shown that the cultured skin sheetsneeded to resurface 20-25% of the body area can beproduced in 16-18 days, and sheets to cover 90% ofthe body area can be made in 23-25 days. When cellsprays are used, it takes less than 2 weeks to culturecells to cover 25% of the body surface.

The laboratory has also prepared suspensions of cells,harvested from the patient, and sprayed themimmediately onto the patient, without culture. Thesesprays are suitable for small area injury such as harvestsites, and have the advantage of also containing othertypes of skin cells including those which produce thepigment in skin (melanocytes), so that the natural skincolour is preserved.

As well as providing this clinical service for patients inConcord Hospital, the laboratory is working atimproving both the clinical outcome of using culturedskin and the skin culture process. For the bestcosmetic outcome, the cells should be applied to thewound as soon as possible after injury and thelaboratory is working towards speeding up cellproduction time by growing islands of healthy cells onmembranes or dressings which can be applied directlyto the patient soon after injury. In this way the wound isclosed whilst new skin is developing.

Other uses for keratinocyte grafts to be explored in thefuture include their use as biological dressings for thetreatment of chronic skin disorders, such as vascularand diabetic ulcers, congenital navei and smallepidermal injuries.

Investigations into skin graft infection and graft survivalAnother focus of research interest in the Burns Unit hasbeen in the area of skin graft infection.

Currently, the key surgical intervention in severelyburned patients is the replacement of burned skin withskin grafts taken from healthy skin elsewhere on thesame patient. Early excision of deep burns andimmediate skin grafting have been shown to reducefatality rates in severely burned patients, and improvefunctional outcomes by reducing scarring. Skin graftsurvival is important for good functional and cosmeticresults and, in severely burned patients, for patientsurvival.

It is well recognised that infection is an important causeof graft failure in burn wounds. A study was undertakento examine whether there is a clinically importantassociation between biopsy evidence of infection intissues underneath burned skin that has just beensurgically removed, and subsequent skin graft survival.

Page 20: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

18

Con

cord

Hos

pita

lRes

earc

h R

epor

t

Biopsies were examined histologically and weresubmitted for microbiological cultures. Subsequently,percent skin graft survival, graft infection, episodes ofbacteraemia, and length of hospital stay were recordedfor each subject.

Only a small proportion of patients’ biopsies grew anyorganisms at all. The remainder of the biopsies showedno organisms, and only mild inflammation, consistentwith a burn injury. The culture results did not correlatewith skin grafting outcome. Of those with a positiveculture only one (which grew S.aureus) required repeatskin grafting. Meanwhile, several patients who didrequire repeat grafting had biopsies which werenegative on culture. The biopsies, therefore, do notappear to predict the risk of graft failure. Clearly thereare other factors that have more influence on graftoutcome. These may include general factors such aspatient age, and local factors such as size and locationof wounds.

Physiotherapy research in the Burns UnitOver the past five years, a number of projects havebeen conducted by the Senior Burns Physiotherapist,Dr Frank Li, to improve patient care.

It was observed that many burns patients with skingrafts to their hands showed a significant decrease inrange of hand motion and strength when reviewed inthe out-patient clinic 6 weeks after discharge. A studywas conducted to test grip strength using a hand helddynamometer. All patients with skin grafts to theirhand(s) were tested at regular intervals for 3 months. Itwas found that their grip strength improved steadilyafter surgery until about 2 weeks after discharge, thena decline occurred. Unless the patient had regular handtherapy treatment, the decline would continue for 4 to6 weeks. The results demonstrated that this group ofpatients requires regular follow-up for at least the firstthree months following their discharge.

Burns patients experience a great deal of painthroughout their recovery phase and are reluctant toexercise because movement aggravates the pain.Physiotherapy treatment targets this problem by aprogram of daily stretching exercises. In order to walkproperly, a range of movement of the knee of about120 degrees is required. A Continuous Passive Motion

machine, which is used by patients with Total KneeReplacement to improve knee range, was trialled onburn patients. Patients with lower limb burns, whorequired skin grafts to both legs, were invited toparticipate in the study. The Continuous Passive Motionmachine was used on one leg while the other legreceived passive stretches only. The results indicatedthat there was no difference in terms of rangeachieved. However, the patients felt less pain with theuse of the Continuous Passive Motion machine. Thispositive result supports the proposal to purchaseContinuous Passive Motion machines in thedevelopment of the burns service in New South Wales.

Occupational Therapy in the Burns UnitScar management is one of the major tasks in thelong-term management of burn patients. Thetherapeutic value of customised pressure garments inthe management of scarring after burn injury is welldocumented. However, most patients find pressuregarments uncomfortable to wear. Researchers, MichelleCarne and Cheree Walker, are undertaking a study toidentify the most appropriate and cost effectivepressure garment manufacturer from 3 major Australiansuppliers. Participants in the study compare twodifferent brands of pressure garment by wearing themon alternate days and completing satisfactionquestionnaires after 2 weeks and 3 months. Theoccupational therapist also makes an evaluation of theeffectiveness of the garment, and results on theoutcome will be available in 2003.

Page 21: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

19

Concord

Hosp

italResearch R

eport

Breast Cancer

Last year in NSW, over 4000 newcases of breast cancer werediagnosed. Concord Hospitalresearchers are involved in researchstudies which look at promising newapproaches to improve breast cancertreatment and quality of life.

Treating Cancer with ChemotherapySydney Cancer Centre at Concord Hospital is an activeparticipant in international breast cancer research trials,accruing patients from both Concord Hospital andStrathfield Private Hospital. These trials are called‘adjuvant’ therapy trials, which means that they aretesting the value of additional treatment after surgeryfor breast cancer. Giving treatment at this time canimprove the chance of cure.

In 2000-2001, 17 women were recruited toInternational Breast Cancer Study Group trial 20, whichcompared a standard adjuvant chemotherapy toadjuvant chemotherapy including the new drugdocetaxel, in women with breast cancer that hadspread to lymph nodes in the axilla (armpit). The trial is

now closed and the first results should be available inMay 2004.

Currently, Concord Hospital is involved in two BreastCancer International Research Group (BCIRG) trials.Trial 6 is examining the addition of Herceptin® tochemotherapy for women with breast cancer which ispositive for the HER2 oncogene (15 – 20% of all breastcancers). It is known that breast cancers positive forHER2 are more aggressive, and have a worseprognosis. Herceptin® is an antibody which binds withand inhibits HER2. It has been shown to be ofsignificant benefit to women with metastatic breastcancer, and the current research is examining its role inaddition to adjuvant chemotherapy in an internationalrandomized trial. Internationally, 700 women are alreadyparticipating and accrual will be complete in about 12months when just over 3000 women will be enrolled.

In 80% of women breast cancer is negative for HER2.These patients are offered participation in BCIRG trial 5,which is testing sequences of giving chemotherapydrugs. Internationally, 1,800 women are alreadyparticipating and accrual will be complete by the middleof 2003 when just over 3000 women will be enrolled.

Research into Surgery for Breast Cancer: The “SNAC” TRIALThe major morbidity from surgery for breast cancer isrelated to removal of the lymph glands in the armpit (or axilla).

The SNAC (Sentinel Node biopsy vs Axillary Clearance)trial has been set up with a view to minimising theextent of surgery in this area. The trial is being carriedout in hospitals around Australia under the auspices ofthe Royal Australasian College of Surgeons and theNational Health and Medical Research Council ClinicalTrials Centre. At Concord, the trial is being carried outby Professor David Gillett and his colleagues from theDepartment of Surgery. Approximately 5 percent of thepatients involved in the study have come from thebreast service at Concord Hospital and StrathfieldPrivate Hospital.

In 60 to 70 percent of breast cancer patients theaxillary nodes are not affected by metastatic cancerand, therefore, do not require removal. It is essential,

Appearing from left to right: Ms Lili Truong (Clinical TrialsData Manager), Mrs Sumitra Nidagal (receiving Herceptintreatment), Dr Anne Sullivan (Oncologist), Ms ChantalGebbie (Clinical Trials Nurse)

Page 22: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

20

Con

cord

Hos

pita

lRes

earc

h R

epor

t

however, to know if these glands contain cancer or notand in the past, it has been practice to remove at leasttwo thirds of them to determine the likelihood of theirinvolvement.

The SNAC trial has been set up using a technique todefine the pathways along which cancer cells will travelfrom the tumour to the lymph glands and to define themost significant lymph gland or sentinel node. It isbelieved that if this gland is free of tumour all the otherglands will be free of tumour and that removing onlythis gland will adequately determine the status of theaxillary nodes in general. It is proposed that removingone gland will produce much less morbidity thanremoving two thirds of the glands. Preliminary studieshave indicated this to be the case and the SNAC trial isa randomised prospective trial to conclusively provethat the patients are not disadvantaged by having onlythis gland removed (if it is free of tumour) and nothaving any treatment to the other glands in the axilla.

To date some 600 patients have been randomised intothis trial. It is expected that accrual of 1000 women willbe complete towards the end of 2003. The initial dataanalysis has been done and shows that the sentinelnode can be identified in 100 percent of cases and thatcancer has been detected in 30 percent of patients asexpected.

The success of this trial is dependant on cooperationbetween the surgeons, the radiologists and the NuclearMedicine personnel who inject radioactive material nextto the tumour to define and mark the sentinel node.

Quality of Life for patients with Breast CancerResearch into treatments for breast cancer involves notonly measures which improve patient’s length of life butalso their quality of life.

Minh Arvin, Clinical Nurse Consultant for BreastSurgery at Concord Hospital has been looking at thequality of life for women receiving Tamoxifen adjuvanttherapy following surgical management of breastcancer.

Patients were surveyed for sociodemographicinformation (age, marital status, level of education,employment status, number and age of children,

menopausal status) and information relating to theirbreast cancer history. At the same time, patients wereasked about their quality of life, physical symptoms,general and psychosocial well-being and dailyfunctioning. Information was collected from patientsregarding their Tamoxifen treatment (eg side effects),how they adjusted to their breast cancer diagnosis andtreatment, and the effect of both on family and friends.A majority of women with breast cancer who wereprescribed Tamoxifen did well following the completionof their surgery and chemotherapy. This informationmay be helpful for newly diagnosed women, and forwomen facing the end of treatment. However healthcarers should be alert for continuing symptoms ofdistress in follow-up care, such as symptoms ofdepression or social dysfunction. Early intervention mayhelp to reduce subsequent problems. Interventions,such as stress management, relaxation, counseling andsupport for the family can improve mood, physicalfunctioning and quality of life in breast cancer patients.

Many women complained of menopausal symptomswith Tamoxifen. These included fatigue, hot flushes,sleep disturbance and depression. Although mostwomen tolerate these symptoms and are able toremain active, others find it can have an impact ontheir quality of life or functional ability. Some womenhave considered discontinuing therapy, or have beenless compliant with their daily Tamoxifen regimen.

Many women experienced positive effects from breastcancer. Coming to some understanding of and findinga new sense of meaning in their illness experience maybe an important aspect of the recovery process. Thesewomen have developed personal resources and skills,and their positive attitudes greatly enhance their copingand adjustment. Many women reported improvedoutlook on life and stronger interpersonal relationships.

It is hoped that the results of this study can be used toinform clinicians, researchers and breast cancersurvivors about the longer-term impact of Tamoxifen onhealth and related quality of life.

Page 23: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

21

Concord

Hosp

italResearch R

eport

Brain Diseases Researchers from the Department ofNeurology, Molecular Medicine and theCentre for Education and Research onAgeing (CERA) are investigatingdiseases of the brain which occur morefrquently as we age.

Parkinson’s DiseaseThe Parkinson’s Disease Clinic in the Department ofNeurology offers a comprehensive multi-disciplinaryservice to patients and their carers, and provides afocus for clinical research into the disease.

The clinic’s director, Dr Michael Hayes, in collaborationwith researchers from both within the hospital andoutside, is looking at ways of measuring neuronal(nerve cell) damage in patients with Parkinson’sDisease. These studies include blood tests, magneticresonance imaging (MRI) and a smell test, since theloss of smell is an early finding in many patients withParkinson’s Disease. Early diagnosis of Parkinson’sDisease will become very important once more effectivetreatment is available.

The Parkinson’s Disease clinic is also involved in twointernational, multi-centre, Phase III, randomised,placebo-controlled trials of new drugs. Both of thesedrugs act to stimulate chemicals in the brain which aredepleted in Parkinson’s Disease (the dopamine system).One of the studies involves patients whose response tostandard therapy has become less predictable andrequires supplementation. The other is aimed at peoplewith early Parkinson’s Disease who have had little drugexposure and are being tested with a medication in theform of a patch that is only changed once daily. Bothstudies are funded by major pharmaceutical companiesand offer valuable opportunities for Parkinson’s Diseaseresearch. Patients have access to drugs that are nototherwise available in this country and they usuallylearn more about their condition; doctors get first-handexperience in assessing new medications and if thedrugs prove to be useful this local experience is likely to

assist in getting PBS approval.

The pathogenesis of Parkinson’s Disease is also beingstudied by the Molecular Medicine Laboratory, underthe direction of Professor Garth Nicholson, who isresearching the genetics of the disease. Only a fewcausative mutations for Parkinson’s Disease have beenidentified, including one in the so-called parkin gene.Researchers are screening the parkin gene fordeletions, which may cause a sporadic (or therecessive) form of Parkinson’s Disease. To date theyhave found some undescribed mutations which may bea cause of isolated cases of Parkinson’s Disease.

StrokeThe Stroke Unit and Stroke Service at ConcordHospital were established in 1996, the second of theirkind in NSW. The Stroke Unit, directed by ClinicalAssociate Professor Alastair Corbett, has facilitated thestudy of patients with stroke and has participated in anumber of national and international trials for themanagement and prevention of stroke. Currently theunit is participating in two international, multi-centredrug trials. One study is assessing the potentialbenefits of the antihypertensive drug Ramipril (a drugwhich lowers blood pressure) by itself, or incombination with another antihypertensive drugTelmisartan. Another study is investigating theusefulness of Telmisartan alone in preventing strokeand other vascular complications in patients who havealready experienced stroke or myocardial infarction(heart attack).

The Stroke Service is also assessing improvedmethods for patient management and looking at someof the outcomes of stroke, including vascular dementia.

Vascular DementiaAssociate Professor Jillian Kril from the Centre forEducation and Research on Ageing (CERA) incollaboration with Associate Professor Corbett andother neurologists and geriatricians across NSW, isstudying brain pathology in patients with vasculardementia. Professor Kril and colleagues run a braindonor program where interested individuals consent tothe use of their brain for research following their death.This program, which has been running for over tenyears, studies patients with a variety of

Page 24: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

22

Con

cord

Hos

pita

lRes

earc

h R

epor

t

neurodegenerative disorders such as Alzheimer’sdisease and Parkinson’s disease as well as those withstroke. The program also looks at the brains of normal,aged subjects.

Recently, Professor Kril and colleagues have shownthat one of the primary memory areas of the brain, thehippocampus, undergoes substantial degeneration invascular dementia. It was previously thought that thisregion, which is markedly damaged in Alzheimer’sdisease, is spared in vascular dementia. However, theresults of this study suggest that memory impairment isa feature of vascular dementia and that significantoverlap in clinical symptoms between Alzheimer’sdisease and vascular dementia might be expected.

A computer tomography (CT) scan of the brain of a patientwho has had a number of strokes.

Page 25: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

23

Concord

Hosp

italResearch R

eport

Respiratory DiseasesChronic Obstructive Pulmonary Disease (COPD) is a lifelonginflammatory disorder of the lungs thatis ranked third behind heart diseaseand stroke as a major cause ofdisability and early death in Australia.The prevalence, morbidity and mortalityof COPD are increasing in manywestern countries. COPD results in thedeaths of over 5000 patients per yearin Australia and serious disability occursin many more. Chronic cigarettesmoking is the main cause of COPD.Currently, there is no cure for COPDnor is there any treatment available toreverse the lung damage or the declinein lung function.COPD is one of the major focuses ofresearch carried out in RespiratoryMedicine at Concord Hospital.

Cell culture experimentation: The Expression of MatrixMetalloproteinases (MMPs), Tissue Inhibitors ofMetalloproteinases (TIMPs) and Cytokines from AlveolarMacrophages in COPD.Inflammatory cells in the lung called alveolarmacrophages are increased in number in the lungs ofthose who smoke. These cells can producesubstances called cytokines and matrixmetalloproteinases (MMPs), which can destroy the lungtissue and thus may be important in the developmentof COPD. Tissue inhibitors of metalloproteinases(TIMPs), also produced by alveolar macrophages,inhibit the action of MMPs and thus may be protectiveagainst lung damage.Dr Linda Seeto is investigating whether there is an

overproduction of pro-inflammatory cytokines andMMPs and/or an imbalance between the pro- and anti-inflammatory substances produced in the lung incigarette smokers who develop this disease (seeFigures 1 and 2).

Alveolar macrophages are harvested from two sources:lung specimens removed during surgery and lungwashings performed via fibreoptic bronchoscopy. Thecells are cultured in the laboratory and stimulated withvarious drugs including steroids, bronchodilators, andbeta-blockers which inhibit the effect ofbronchodilators. Levels and activity of MMPs andTIMPs are measured by two techniques: enzymelinked immunosorbent assay and zymography.Cytokine levels are measured by the former.

MMP-9

MMP-2

Figure 1: MATRIX METALLOPROTEINASES (MMPs) IN COPD SUBJECTZymogram showing areas of enzymatic digestion by MMPs (white bands) fromlung macrophages from a patient with COPD. The band size reflects theamount of enzymatic activity. Pro-MMP in vivo is the inactive form of MMP-2.

MMP-9

MMP-2

Figure 2: MATRIX METALLOPROTEINASES (MMPs) IN CONTROL SUBJECTZymogram showing MMP activity from lung macrophages from a subjectwithout COPD. Smaller band size reflects lower levels of enzymatic activity.

Page 26: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

24

Con

cord

Hos

pita

lRes

earc

h R

epor

t

A clinical study of theophylline as treatment for COPDTheophylline has been shown to be effective in dilatingthe airways in people with asthma. Although aninexpensive and effective drug, theophylline can beassociated with side effects such as gastrointestinalupset and abnormal heart rhythms. In cell culturestudies, theophylline has been shown to be anti-inflammatory at doses below that required for airwaydilatation in people with asthma.

Dr Seeto’s study, the first of its kind, seeks to definechanges in lung function, quality of life, and airwayinflammation due to theophylline treatment versusplacebo in subjects with COPD. If theophylline is shownto be anti-inflammatory in people with COPD, this willbe the first evidence in clinical trials that it can be usefulin the management of patients with COPD for its anti-inflammatory effect.

Laryngopharyngeal Sensitivity in COPDMembers of the Concord Hospital RespiratoryInvestigation Unit have been using a multi-disciplinaryapproach to investigating the relationship betweenswallowing function and COPD. This research is beingcarried out by Nicola Clayton (Speech Pathology) andrespiratory physicians, Clinical Associate ProfessorMatthew Peters and Dr Alvin Ing.

Preliminary studies have shown that swallowingfunction is impaired in patients with COPD, and thismay lead to increased pulmonary infection throughaspiration and inhalation of food and gastric contents.Pulmonary infection is regarded as a major cause ofCOPD exacerbation, and a major factor in the declineof lung function and increased morbidity in thesepatients.

The aims of this study were to use a newly developedtechnique to assess the degree of swallowingimpairment in patients with COPD as well as to assesslaryngeal sensitivity. The ultimate aim is to establish asimple method of assessing swallowing function andaspiration risk at the bedside.

Patients with COPD underwent the new techniqueknown as Fibreoptic Endoscopic Evaluation ofLaryngeal Sensitivity and Swallowing (FEELSS). Thisprocedure involves the delivery of a quantifiable pulseof air to the larynx via a fibreoptic nasoendoscope,which then induces the Laryngeal Adductor Reflex(LAR). The LAR is an airway protective mechanism andis assessed by the visualization of the vocal cordsadducting (drawing together). In normal subjects an airpulse of 2.5 to 4.5 mmHg is sufficient to induce theLAR. In patients with COPD, air pulses of 9.9 mmHgwere required to induce the LAR. This implies COPDpatients have impaired laryngeal sensitivity and are atrisk of aspiration and recurrent pulmonary infection.

The second part of the study involves assessment ofswallowing. Under direct visualisation of the larynx viathe nasoendoscope, COPD patients swallowed fluidand solids of varying consistency. The passage of foodand fluid into the oesophagus was directly observed.Evidence of laryngeal penetration (material entering thelaryngeal vestibule above the level of the vocal cords)and aspiration was observed and recorded. COPDpatients were found to have a higher incidence ofaspiration and swallowing difficulties than controlsubjects.

This study found that COPD patients have impairedlaryngeal sensitivity and impaired swallowing function,which places them at risk of recurrent pulmonaryinfection. The researchers also found that this newtechnique is reliable and easy to use in the wardsituation. By applying this technique to a larger groupof COPD patients, they hope to predict which patientsare at risk of recurrent infection and COPDexacerbations, and prevent this with diet modificationsand swallowing therapy.

A volunteer undergoingthe FEELSS test

Page 27: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

25

Concord

Hosp

italResearch R

eport

Asthma

Asthma is a major focus of respiratory research atConcord Hospital. Associate Professor Matthew Petersfrom the Department of Thoracic Medicine is co-ordinating a series of clinical trials looking at newtreatments which may lead to improvements in themanagement of this complex disease.

One such trial is investigating a new drug which acts byblocking a specific enzyme involved in the inflammatoryprocess of asthma (called phosphodiesterase 4). In asecond trial another new type of anti-inflammatorymedication (aimed at blocking specific inflammatorycells and their proteins) will be tested in people withmild to moderate asthma. Both trials will usemedication in tablet-form, and not the traditional inhaleror "puffer" form.

In a third clinical trial, also commenced in 2003, a newinhaled preventer medication will be assessed todetermine its effectiveness in asthma management. Asecond aim of this study is to examine the frequencyand occurrence of side effects from the medication incomparison to other inhaled steroids currently availableon prescription.

A nurse initiated discharge plan in the EmergencyDepartment to improve the management of patientswith asthmaAsthma is a significant problem in the community, withone in ten adults affected by the disorder. Over 20,000asthma admissions to hospital are recorded nationallyevery year. Of these, 9% will be readmitted within 28days and 34% within one year, resulting in considerableeconomic costs.A team of researchers led by Julie Munro and MargoRichardson have undertaken a study to try and reducehospital re-presentations due to asthma, following theimplementation of a nurse-initiated discharge plan inthe Emergency Department. The discharge planconsists of an education program for staff andpatients, the provision of an individualised AsthmaAction Plan, education on correct use of medicationdevices and peak flow meters, a follow up medicalappointment and a nurse follow up phone call 2-3 dayspost discharge.

A retrospective medical record audit will establish past

management practices and re-presentation rates to theemergency department, and these will be comparedwith data from those patients who have received thespecialised discharge plan. It is hoped that this will a)increase the number of patients with asthma who havean Asthma Action Plan and regular medical follow up,and b) decrease the number of patients with asthmawho re-present to the emergency department. Findingsfrom this study could also be used to influence policyand practice related to discharge planning in theEmergency Department.

Page 28: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

26

Con

cord

Hos

pita

lRes

earc

h R

epor

t

AndrologyThe Department of Andrology atConcord Hospital is the firstDepartment of its type in Australiacatering specifically to men’sreproductive health.

Therapeutic use of androgen in the older manThe Department has performed a number of novelstudies examining the therapeutic use of androgen(male hormone) in older men as a way to potentiallyreduce frailty and disability. These studies aim todetermine whether androgen therapy can improvequality of life for community-living, healthy older men by improving physical functioning (including enhancedmuscle strength) or by improving balance and walkingendurance. Importantly the safety of such treatmentwas also of prime importance in these studies.

In a series of clinical trials of 3 months duration, twonovel hormone preparations were studied: (1) the mostpowerful naturally occurring androgen(dihydrotestosterone) made into a gel to allow dailyadministration on the skin and (2) a new, geneticallyengineered, hormone (hCG), not yet available forroutine treatment, which can be conveniently self-administered twice weekly. These studies used aspecial design, called randomised placebo controlleddesign. This guarantees that they are of the highestquality and most persuasive to the peer scientificcommunity. In both studies, an increase in muscle anda reduction in fat were found. But the improvement inmuscle strength was only modest and there was nodetectable change in physical function. The studiesshowed that in the short term, these treatments causedno adverse effects on either the cardiovascular systemor the prostate.

In another important study (also a randomised placebocontrolled study) the Andrology group examined ingreater detail the potential safety of high dose standardtestosterone injections on sleep and breathing in oldermen. They showed for the first time that high dosetherapy could shorten sleep and worsen breathing in

community-living, healthy older men thereby raisingsafety concerns regarding high dose standardtestosterone injection therapy. This study was honoredby an invitation for presentation as the first of only 4oral presentations, at the prestigious Clinical TrialsSymposium of the US Endocrine Society AnnualScientific Meeting in San Francisco, California.

Male Hormonal ContraceptionThe staff of the Department of Andrology have beeninvolved in groundbreaking studies to develop ahormonal male contraceptive over the last 15 years.Currently the only male contraceptive methods arecondoms, vasectomy, abstinence and the withdrawalmethod. None are ideal: vasectomy is reliable but notreadily reversible; condom use and withdrawal are oftenunreliable and not popular among couples in stablerelationships. For these reasons, there is a pressingneed to develop a male contraceptive method which isreversible, reliable and safe. Such a method wouldallow couples to share more equally in family planningresponsibilities. Landmark studies performed under theauspices of the World Health Organisation (WHO), withthe Department of Andrology as its largest centre,proved during the 1980’s and 1990’s that a safe andreversible male hormonal contraceptive was feasible.Although successful, this early study required weeklyinjections of testosterone, and was therefore impracticalfor community use.

Since then, the researchers have pursued the idea ofusing depot combination hormonal preparations. Thesepreparations are combinations of 2 or more hormonesand are long acting. (Instead of weekly injections, onlya single visit to a clinic every 4 months for treatment isrequired).

A two-centre Australian study, led by the Department ofAndrology, has recently completed a study of thecombination hormonal preparation and establishedclearly that the approach is feasible. This new treatmentproved much more effective than condom use, and atleast as reliable as female hormonal contraception. Thisresearch is a major contribution to the development ofa practical male contraceptive. Future practicaldevelopments of contraceptive products will requirepharmaceutical company involvement, now thatacademic researchers have proved that a safe, depothormonal male contraceptive is feasible and effective.

Page 29: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

27

Concord

Hosp

italResearch R

eport

Urology ResearchOne in five people over 40 may sufferfrom urinary frequency, urgency orincontinence, a condition termed the‘overactive’ or ‘unstable’ bladder.Although medical disorders such asstroke, Parkinson’s Disease or spinalcord injury may cause symptoms of theoveractive bladder, in the majority ofpeople the cause is unknown.

The ultrastructural basis of voiding dysfunctionThe Detrusor Ultrastructure Group, led by Dr LewisChan and comprising members of the UrologyDepartment, the Electron Microscopy Unit, andscientists from the University of Sydney, has beeninvestigating the cause of this common and oftendebilitating disease.

The project “Ultrastructural Basis of VoidingDysfunction” has been focusing on the structure of the

The project “Ultrastructural Basis of VoidingDysfunction” has been focusing on the structure of thebladder muscle in normal and overactive bladders.Using the electron microscope, this group hasdemonstrated the presence of abnormal connectionsbetween bladder muscle cells in patients withoveractive bladder (see Figure 1).

It is postulated that these abnormal ‘gap junctions’ mayact as short circuits and allow electrical activity in amuscle to spread to its neighbours and cause aninvoluntary bladder contraction resulting in urgency orurge incontinence.

The group’s recent study using a molecular biologytechnique has demonstrated that there are higher levelsof gap junctional proteins (called connexins) in theseunstable bladders. The researchers are currently tryingto identify the exact type of connexin protein present atthese abnormal gap junctions. In future, drugstargeting these proteins may offer a novel treatment forpatients with overactive bladder.

A view of the bladder under theelectron microscope. Protrusion and Ultracloseabutment junctions arepostulated to act as lowresistance electrical pathwayswhich may play a role in thepathophysiology of detrusorinstability. (x 29900)

Types of JunctionsProtrusion ( )Ultraclose abutment ( )Normal intercellular ( )

FIGURE 1

Page 30: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

28

Con

cord

Hos

pita

lRes

earc

h R

epor

t

Research into Pain ReliefSeveral teams of investigators atConcord Hospital, from a number ofdisciplines, are undertaking researchinto pain and pain relief.

Prevalence of pain in a teaching hospital (Departmentof Palliative Care)A number of studies in the past have suggested thatmany patients in hospital experience pain. Dr GhauriAggarwal and colleagues from the Department ofPalliative Care are investigating this finding to establishhow common pain is at Concord Hospital. They areinterested in whether patients report pain to nursing ormedical staff, and if so, whether adequate pain relief(analgesia) is used.

In addition, the researchers are using an interview-stylequestionnaire called the brief pain inventory as well as aself-administered questionnaire to look at the impact ofpain on the functional ability of the patient. Medicalstudents are involved in administering part of thequestionnaire, including recording patientcharacteristics.

Early results of the study indicate that about 60% ofpatients in hospital experience pain. This pain is mild tomoderate in intensity and interferes with quality of life toa moderate degree. However, under-treatment withanalgesics or under-reporting of pain to medical staff isnot common. Studies of this type allow researchers toassess the adequacy of pain management in thehospital setting.

Continuous wound infusion with ropivacaine usingthe OnQ/Painbuster system following thoracotomy(Department of Anaesthetics and Pain Management)In 2001 Dr Janet Smith, from the Department ofAnaesthetics led a team of investigators which trialled anew pain management procedure followingthoracotomy.

Thoracotomy (an incision to the chest wall made duringsurgery) is a very painful procedure, and it is oftennecessary to use several different types of analgesia tomake patients as comfortable as possible (multimodalanalgesia). The mainstay of analgesia is morphine, oranother similar opioid, usually delivered by a patient-controlled analgesia machine, but in addition localanaesthetics (intercostal nerve blocks) are also usedwhich anaesthetise the wound for several hourspostoperatively. Once the blocks wear off, opioid drugsused alone in sufficient doses to control the pain oftenproduce unpleasant side effects such as nausea,vomiting, or drowsiness.

This study aimed to see whether the continuousinfusion of ropivacaine (a long-acting local anaesthetic)into the wound for 2-3 days would increase patientcomfort, and decrease the amount of morphineneeded. The invesigtators used a simple, commerciallyavailable infusion device, the OnQ™ device (which isnow marketed as Painbuster™). The device consists ofa distensible elastomeric balloon, which infuses drug ata constant rate through a simple restrictor tubing(Figure 1).

The investigators studied a total of 40 patients who hadcatheters placed in the posterior part of their wounds,near the intercostal nerve, before the wound wasclosed. Half the patients received ropivacaine, and halfreceived normal saline at a rate of 5mls/hour via thecatheter for 2-3 days after their operation. All patientswere able to use as much morphine as needed fromtheir patient-controlled analgesia machine. Theinvestigators collected information on how much painthe patients had (using pain scores at rest and oncoughing), how much morphine was used on each ofthe first two days, and what side effects occurred.

Mr Arthur Darnley ofAuburn received bothpatient-controlledanalgesia (opioid) andlocal anaestheticdelivered by thePainbuster device tooptimise analgesia afterhis operation.

Page 31: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

29

Concord

Hosp

italResearch R

eport

Physiotherapists assessed how well the patientsperformed physiotherapy, and patients were also askedto rate how easily they could do their physiotherapy,which is an important part of recovery from theprocedure.

The study found that a much higher proportion ofpatients receiving ropivacaine were able to use very lowamounts of morphine, and had far fewer side effects(Figure 2). The physiotherapists did not detect anydifference in actual performance of physiotherapy, but a higher proportion of patients receiving ropivacaine

reported finding physiotherapy easy or very easy to perform. There were no complications or side effectsattributed to the infusions.

This study has demonstrated a safe, simple andeffective way to improve patient comfort afterthoracotomy

Pain relief following back surgery (Department of Neurosurgery)The success rate for the surgical treatment of rupturedlumbar discs is directly related to the early mobilisationof the patient after surgery. This in turn is related to theeffectiveness of post-surgical analgesia. Currentmethods of pain control are generally effective, buthave less desirable side effects such as making therecipient drowsy.

It has long been known that morphine applied directlyto the spinal region (epidural space) is an effectiveanalgesic, but it is rapidly absorbed and has a shortduration of action. One of the risks of this type ofdelivery is suppression of respiration. Morphine mayinstead be delivered by a tube into the region, but thismethod introduces the risk of infection.

The present study being conducted by ClinicalAssociate Professor Noel Dan and colleagues from theDepartment of Neurosurgery, is testing a morphinepaste applied directly to the epidural space. Thisstudy, which is being conducted in collaboration withthe paste’s manufacturer, The Bard Corporation, isexamining whether the morphine paste will providesatisfactory pain relief with a lower risk ofcomplications. The success of the technique isassessed by carefully monitoring the quantity of otheranalgesics used during the six weeks immediatelyfollowing surgery.

Preliminary results indicate that the use of otherpainkillers is reduced following surgery. Furthermore,an assessment of the cost effectiveness of deliveringthe analgesia by the epidural route indicates that it iscompetitive with other methods.

Figure 2Proportions of patients with low morphine use

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

1 2Days after surgery

% o

f pa

tien

ts

Ropivacaine group

Normal saline group<20mg

<10mg

Figure 1 The PainbusterTM continuous infusion device (courtesy of Smith+ Nephew)

Page 32: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

30

Con

cord

Hos

pita

lRes

earc

h R

epor

t

Testing new joint replacementsDr Bruce also researches new joint replacements thatare put on the market, to assess their performancebefore they are used in a patient. This involves usingpressure measurement devices to see that there arenot areas of high pressure which may lead topremature wear of a knee or hip replacement.

The investigators also carry out computer modelling tosee how the hip and knee replacements will affect boneover a long period of time. Some joint replacements areso rigid that they do not stress the patient’s boneevenly and can lead to loss of bone over many years.

Orthopaedic ResearchDr Warwick Bruce, an orthopaedicsurgeon, has major research interestsin the areas of Sports Medicine andJoint Replacement.

Sports Medicine Research – anterior cruciate ligament reconstructionA large part of Dr Bruce’s research has looked atimproving anterior cruciate ligament reconstructions ofthe knee, particularly where the tendon is in contactwith the bone. The aim of this research is to usedifferent methods to improve bony ingrowth into thetendon. If bone grows more rapidly into the tendon,then the patient is able to rehabilitate more quickly andget back to sport more quickly.

An initial study was to assess the improvement ofanterior cruciate ligament grafting in sheep by addinggrowth factors. Whole blood was taken from the sheepand concentrated using a special filter which gave aconcentrate of growth factors. An anterior cruciateligament reconstruction was then performed on thesheep and growth factors were injected into the bonytunnels. The growth factors had a positive effect on thehealing tendon bone interface with improved strengthof the graft and improvement in the radiographicappearance of the tunnel.

The next stage of the study was to use low doseultrasound (Cartogen) on sheep after cruciatereconstruction. The sheep had a standard cruciateligament reconstruction and then had an ultrasounddevice strapped to their knee for approximately 20minutes each day. There was rapid improvement inbone ingrowth into the tendon in both the femur andthe tibia. The benefit of this research is that people whohave anterior cruciate ligament reconstruction canshorten their rehabilitation time and their return to sportby attaching an ultrasound to their leg in the recoveryperiod.

0

1

2

3

4

5

GRADE

3 wks 6wks 12 wks

BONE INGROWTH AT INTERFACE

Control

Cartogen

Twenty minutes ultrasound treatment per day rapidly improved boneingrowth into the tendon after surgery to the knee in sheep.

Page 33: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

31

Concord

Hosp

italResearch R

eport

complication rate after joint replacement surgery issignificantly decreased. This has major implications forjoint replacements in the future.

Diffuse mottling is seen in both lung fields (arrows) at sites of fat embolism. The lungs would normally show no uptake and would be a uniform black colour in apatient without fat embolism.

Distinguishing fat emboli from pulmonary emboli afterjoint replacement surgeryAnother major study has examined the incidence of fatemboli and pulmonary emboli after joint replacementsurgery. After a joint replacement, fat can be releasedinto the blood vessels of the leg and travel to the lungsand cause respiratory distress to the patient(embolisation). Another possibility is that blood clotscan be released into the vessels and travel to the lungs.Until now, it has not been possible to tell the differencebetween emboli of blood or fat.

In collaboration with Dr Hans Van Der Wall, Departmentof Nuclear Medicine, the investigators have developeda test that can be performed postoperatively if patientshave respiratory complications. This test will telldoctors whether a patient has a fat embolus or a bloodclot. The advantage of knowing this is that a fatembolus does not need to be treated with bloodthinning agents, whereas the blood clot does. Doctorstherefore do not have to use blood thinning agents onpatients who have fat emboli, which means that the

Page 34: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

32

Con

cord

Hos

pita

lRes

earc

h R

epor

t

The Ageing Processand the LiverThis research is led by CERA DirectorProfessor Le Couteur and Dr Muller inthe ANZAC Research Institute. Theteam are interested in why ageingincreases the susceptibility to disease.Their main interest has focused on anage-related change in the bloodvessels of the liver which they recentlydiscovered and calledpseudocapillarisation.

Pseudocapillarisation involves thickening of the bloodvessels with loss of pores and these changes preventthe passage of toxins and nutrients from the blood tothe liver for processing. These changes in the liver,particularly the loss of pores, impair the ability to breakdown dietary fats and predispose to atherosclerosis,heart disease and stroke. Professor Le Couteur andcolleagues have also shown that ageing is associatedwith impaired capacity of the liver to handleneurotoxins, including pesticides. This may explain whyageing is the main risk factor for Parkinson’s disease.

Pseudocapillarisation of the ageing liver is associatedwith impaired oxygenation of the liver cells, whichprovides an explanation for the age-related impairmentof liver medication metabolism, contributing to theincreased prevalence of adverse drug reactions in olderpeople. These studies are now focusing on therapeuticstrategies to reverse or prevent age-relatedpseudocapillarisation, as a way of preventing andtreating diseases of older age. The researchers areutilising cultured liver endothelial cells to improveunderstanding of the basic biology of the pores in theliver blood cells and to screen for novel therapeuticagents.

Scanning electron micrographs of the liver endothelium. In theblood vessel from a young liver (top), there are numerouspores called fenestrations that allow the passage of fat andpossibly other large molecules. With old age (bottom), thefenestrations are reduced, thereby impeding the ability of theliver to break down fat. This may explain why hyperlipidaemiaand atherosclerosis are more common in old age.

Page 35: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

33

Concord

Hosp

italResearch R

eport

Palliative CarePalliative care is the total care ofpatients whose disease is notresponsive to curative treatment.Palliative care encompasses control ofpain and other symptoms, as well asthe psychological well-being and qualityof life of the patient.

End of life decision-making in the care of the patient.The aim of this study is to assess the care of the dyingpatient and how health care professionals’ decisionsmay play a role in this last phase of life. This will beassessed by collecting information from the medicalrecords of 150 patients who have died at ConcordHospital. Dr Ghauri Aggarwal and colleagues havedeveloped a survey form to document a number offactors believed to be of importance in the decision-making process. These factors include the use ofmedication in the last phase of life; any procedures orinterventions in that phase; the documentation of a‘Not For Resuscitation’ (NFR) order and how well this isexplained in the medical records.

Other background information about the patient’s lastillness, diagnosis and reason for admission will also becollected. Patients’ charts, nursing and physiciannotes will be examined to provide further informationabout decision-making and changes of care in the lastphases of life. It is hoped that the data will becollected over a period of 8 months. The patient’sterminal phase will be looked at in a critical manner,documenting the appropriateness of decisions, medicaland nursing care and changes to interventions andmedications during that time.

This study will provide valuable information on theneeds of dying patients by recording the adequacy ofcare in this important phase of life. It will be used tohelp develop strategies to improve the care of thedying. It is also hoped that the results will be used toprovide educational tools to better equip our medicaland nursing staff to react appropriately to changing

conditions in this last phase, and in particular, toprovide adequate palliative care and comfort measureswhen it is apparent that a patient is dying.

Page 36: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

34

Con

cord

Hos

pita

lRes

earc

h R

epor

t

Cognitive BehaviouralTreatment of PanicDisorder Fiona Kemp & Fiona Wilkinson, clinicalpsychologists at Concord Hospital,have undertaken research intotreatments for Panic Disorder. Theinvestigators analysed the componentsof Cognitive Behavioural Therapy (CBT)which were most successful in thetreatment of Panic Disorder.

Cognitive Behaviour Therapy (CBT) is a psychologicaltherapy that focuses on irrational thoughts (cognitions),and how these thoughts effect subsequent emotions andbehaviours. Therapy includes ‘cognitive restructuring’which involves identifying these thoughts, challengingthem and developing a different set of attributions. Thebehavioural component of CBT includes changingbehaviours so that these thoughts and emotions mayfurther be challenged. For example, a person who isanxious may be required to go into a fearful situation thatthey would normally avoid in order to challenge thethoughts and emotions that have previously beenassociated with the situation. This type of behaviouralexercise is known as exposure therapy and may be donein the situation itself, in the imagination, or interoceptively(behaviours that induce feared bodily sensations). CBTfor people who are anxious may also include ‘breathingretraining’, a technique that rectifies the shallow breathingand ensuing hyperventilation often associated with panic.

A person who experiences Panic Disorder will typicallyexperience the following symptoms: a brief episode ofintense fear with physical sensations such as heartpalpitations, dizziness, and shallow breathing. In additionthe person will be concerned about future panic ‘attacks’.For example they may fear losing control or ‘going crazy’.They may also modify their behaviour to avoid futurepanic attacks.

Substantial evidence supports the efficacy of CBT in thetreatment of panic disorder. Controversy exists as towhich components of CBT are essential for change.Standard cognitive behaviour treatment of panic disorderusually includes the following components: cognitiverestructuring, “in situation” exposure, breathing retraining,relaxation training and psychoeducation. Researchershave suggested an increasing trend towards omitting thebreathing retraining component in panic control, andincluding interoceptive exposure. To investigate this issue,the current study examined the relative efficacy of twostandard components of CBT for panic disorder, namelyinteroceptive exposure and breathing retraining. Subjectsmeeting the criteria for panic disorder were recruited andallocated to one of two treatment groups: - interoceptiveexposure and breathing retraining. Each group receivedsix one hour CBT sessions which differed only by theinclusion / exclusion of breathing retraining andinteroceptive exposure.

Findings to date suggest that, contrary to expectationsand previous research, it would appear that the groupthat received breathing retraining has attained greatertreatment benefits than the group that receivedinteroceptive exposure. This finding suggests thatbreathing retraining is an essential component in theeffective treatment of panic disorder, while the importanceof interoceptive exposure requires further investigation.

Page 37: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

Concord

Hosp

italResearch R

eport

Page 38: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

36

Con

cord

Hos

pita

lRes

earc

h R

epor

t

RE

SE

AR

CH

AT

CO

NC

OR

D H

OS

PIT

AL

2002

/200

3

Res

earc

her

sP

roje

ctO

rig

in o

f F

un

din

g

Ana

esth

esio

logy

J S

mith

, A S

pral

ja a

nd P

Hen

del

A s

tudy

to in

vest

igat

e th

e ef

fect

s of

con

tinuo

us in

filtr

atio

n w

ith r

opiv

acai

ne u

sing

a c

omm

erci

ally

avai

labl

e in

fusi

on d

evic

e on

pos

tope

rativ

e op

ioid

req

uire

men

ts, p

ain

scor

es a

nd p

atie

nt m

obili

tyA

stra

Zen

eca

John

son

&Jo

hnso

nA

nato

mic

al P

atho

logy

/Ele

ctro

n M

icro

scop

e U

nit

B L

in, R

L S

uthe

rland

et a

l.M

olec

ular

pat

holo

gy o

f pan

crea

tic c

ance

r

B L

in,C

Cha

n, E

L B

okey

et a

l.M

olec

ular

gen

etic

s an

d im

mun

ohis

toch

emic

al a

naly

sis

of S

tage

B c

olon

ic c

arci

nom

as

L H

ughe

san

d L

Cha

nA

naly

sis

of p

53 e

xpre

ssio

n in

tran

sitio

nal c

ell c

arci

nom

a

L H

ughe

s, S

Lim

et a

l.A

sses

smen

t of d

isea

se c

ontr

ol in

chr

onic

airw

ays

limita

tion

by s

putu

m e

osin

ophi

l cou

nt

S B

ram

mah

, L W

right

, E D

elik

atny

et a

l.U

ltras

truc

tura

l cha

nges

indu

ced

by T

TP

-bas

ed c

atio

nic

lipop

hilic

pho

spho

nium

sal

ts (

CLP

S)

and

chlo

rpro

maz

ine

(CP

Z)

NH

MR

CLe

o &

Jen

ny L

euka

emia

and

Can

cer

Fou

ndat

ion

C H

awke

, P K

irwa,

R v

an D

riel a

ndA

Bax

ter

Myc

obac

teriu

m a

s an

env

ironm

enta

l enh

ance

r of

SLE

in a

mou

se m

odel

of S

LE

Bur

ns U

nit

T H

eath

, P

Mai

tz a

nd T

Got

tlieb

Inva

sive

bur

n w

ound

infe

ctio

n: it

s re

latio

nshi

p to

ski

n gr

aft o

utco

me

and

seps

is

P M

aitz

and

J S

harp

The

app

licat

ion

of c

ultu

red

epith

elia

l cel

ls to

gra

fts o

n bu

rns

wou

nds

P M

aitz

and

R J

ohns

onA

Pha

se Ii

a cl

inic

al e

valu

atio

n of

a to

pica

lly a

pplie

d, b

iolo

gica

lly a

ctiv

e, m

ilk-d

eriv

ed e

xtra

ct (

B60

11A

) in

the

trea

tmen

t of s

kin

graf

t don

or s

ite w

ound

sG

roP

ep L

imite

d

M C

arne

Pre

ssur

e ga

rmen

t com

paris

on

F L

i and

M C

arne

Doe

s sp

lintin

g ef

fect

the

inci

denc

e of

het

erto

pic

ossi

ficat

ion

at th

e el

bow

in b

urns

?

Car

diol

ogy

A S

indo

neC

HA

RM

(C

ande

sart

an in

pat

ient

s w

ith h

eart

failu

re)

Ast

raZ

enec

a

A S

indo

neE

PH

ES

US

(E

pler

enon

e in

the

surv

ival

from

hea

rt fa

ilure

afte

r he

art a

ttack

)S

earle

A S

indo

neO

VE

RT

UR

E (

Om

apat

rilat

vs

Ena

lapr

il in

pro

long

ing

surv

ival

and

del

ayin

g th

e pr

ogre

ssio

n of

hea

rtfa

ilure

)B

risto

l-Mye

rs S

quib

b

A S

indo

neE

NA

BLE

(B

osen

tan

in h

eart

failu

re p

atie

nts)

Act

elio

n Lt

d.

A S

indo

neC

HA

T (

Qua

lity

of li

fe o

f pat

ient

s w

ith h

eart

failu

re)

A S

indo

neI-

PR

ES

ER

VE

(Ir

besa

rtan

in h

eart

failu

re p

atie

nts

with

pre

serv

ed s

ysto

lic fu

nctio

n)B

risto

l-Mye

rs S

quib

b &

San

ofi~

synt

hela

boA

SIn

done

PE

RIN

DO

PR

IL (

Per

indo

pril

in h

eart

failu

re p

atie

nts

with

pre

serv

ed s

ysto

lic fu

nctio

n)S

ervi

er

Page 39: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

37

G L

au, L

Krit

harid

es, L

Rid

ley

and

D B

riege

rA

ccur

acy

of C

oron

ary

CT

ang

iogr

aphy

G L

au, L

Krit

harid

es, D

Sul

livan

,L

Rid

ley,

P B

anno

n an

d D

Brie

ger

CA

BG

-Ris

k S

tudy

(R

isk

fact

ors

for

coro

nary

vei

n gr

aft d

isea

se)

G L

au, H

Tan

and

L K

ritha

rides

Live

r D

ysfu

nctio

n in

Hea

rt F

ailu

re

S C

hand

ar, R

Wal

ls a

ndS

B F

reed

man

C-R

eact

ive

Pro

tein

(C

RP

) an

d th

rom

bus

in u

nsta

ble

angi

na

G L

au, S

Rim

into

n an

dS

B F

reed

man

C-R

eact

ive

Pro

tein

(C

RP

) an

d va

scul

ar in

jury

D B

riege

r an

d M

Hay

esS

PO

RT

IF (

Stu

dy o

f a n

ew a

ntic

oagu

lant

in p

atie

nts

with

atr

ial f

ibril

latio

n)A

stra

Zen

eca

D B

riege

rG

RA

CE

(A

reg

istr

y to

def

ine

char

acte

ristic

s, m

anag

emen

t and

out

com

es o

f pat

ient

s w

ith A

cute

Cor

onar

y E

vent

s A

CE

)A

vent

is

D B

riege

rS

yner

gy (

Eno

xapr

in in

hig

h-ris

k pa

tient

s w

ith a

cute

cor

onar

y sy

ndro

mes

)A

vent

is

D B

riege

r, D

Bru

ce, B

Zen

g an

dS

B F

reed

man

Alte

rnat

e m

edia

tors

of f

ibrin

olys

is in

pla

smin

ogen

kno

ck-o

ut m

ice

NH

MR

C

CE

RA

(C

entr

e fo

r E

duca

tion

and

Res

earc

h on

Age

ing)

D L

e C

oute

ur, A

McL

ean

and

A A

nsse

linH

epat

ic o

xyge

natio

n an

d ag

eing

NH

MR

C (

proj

ect g

rant

)

D L

e C

oute

urP

atho

gene

sis

and

func

tiona

l sig

nific

ance

of a

ge-r

elat

ed p

seud

ocap

illar

isat

ion

SE

SQ

UI,

Uni

vers

ity o

fS

ydne

yD

Le

Cou

teur

, Z K

halil

, G A

ndre

ws,

J K

ril e

t al

Sco

ping

stu

dy o

n ag

eing

res

earc

hN

HM

RC

D L

e C

oute

ur, C

Sha

nley

, et a

l.F

alls

pre

vent

ion

in r

esid

entia

l car

eD

ept o

f Hea

lth a

nd A

ged

Car

e

D L

e C

oute

urP

urch

ase

of H

PLC

NH

MR

C E

quip

men

t gra

nt,

K D

oubl

e, G

Hal

liday

, D L

e C

oute

uret

al

A p

oten

tial n

ew te

st fo

r di

agno

sing

ear

ly d

opam

ine

cell

loss

Aus

tral

ian

Bra

in F

ound

atio

n

A M

cLea

n an

d D

Le

Cou

teur

Age

ing

and

the

liver

NH

MR

C/D

VA

J K

ril, P

Wal

ey, S

Pat

el a

ndF

Png

Cor

rela

tes

of b

rain

atr

ophy

in A

lzhe

imer

�s d

isea

se (

AD

)M

edic

al F

ound

atio

n of

The

Uni

vers

ity o

f Syd

ney

J K

ril, H

Cre

asey

, G H

allid

ay a

ndM

Bro

eN

on-A

lzhe

imer

dem

entia

s: P

atho

gene

sis

and

clin

icop

atho

logi

cal c

orre

latio

nsN

HM

RC

G H

allid

ay, G

A B

roe,

A H

ardi

ng a

ndW

S B

rook

sG

enet

ic fa

ctor

s an

d re

gion

al b

rain

atr

ophy

in th

e di

agno

sis

of d

emen

tia w

ith L

ewy

bodi

es.

NH

MR

C (

gran

t hel

d by

PO

WM

edic

al R

esea

rch

Inst

itute

)C

Mas

ters

, P R

Sch

ofie

ld, G

A B

roe,

H C

reas

ey a

nd W

S B

rook

sN

HM

RC

Net

wor

k of

Bra

in R

esea

rch

into

Men

tal D

isor

ders

(G

enet

ic L

inka

ge C

onso

rtiu

m, D

iagn

ostic

Ass

essm

ent C

onso

rtiu

m)

NH

MR

C

(gra

nt

held

by

th

eU

nive

rsity

of M

elbo

urne

)J

Kw

ok, P

R S

chof

ield

and

W S

Bro

oks

Clo

ning

and

bio

chem

ical

cha

ract

eris

atio

n of

a n

ew g

ene

that

cau

ses

Alz

heim

er's

dis

ease

.D

VA

(gr

ant h

eld

by th

e G

arva

nIn

stitu

te o

f Med

ical

Res

earc

h)

Con

cord

Hos

pita

lRes

earc

h R

epor

t

Page 40: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

38

Con

cord

Hos

pita

lRes

earc

h R

epor

t

Clin

ical

And

rolo

gyD

Han

dels

man

, S K

elle

her

and

A C

onw

ayA

stu

dy o

f the

pro

stat

ic c

ontr

ibut

ion

of c

ircul

atin

g D

HT

(di

hydr

otes

tost

eron

e)

D H

ande

lsm

an, S

Kel

lehe

r an

dA

Con

way

Long

-ter

m p

harm

acok

inet

ics

and

clin

ical

effi

cacy

of A

ndro

men

For

te 5

% C

ream

for

andr

ogen

repl

acem

ent i

n hy

pogo

nada

l men

Law

ley

Pha

rmac

eutic

als

D H

ande

lsm

an, S

Kel

lehe

r an

dA

Con

way

Pha

rmac

okin

etic

s of

And

rom

en F

orte

5%

cre

am: A

dos

e-fin

ding

stu

dyLa

wle

y P

harm

aceu

tical

s

D H

ande

lsm

an a

nd P

And

erso

nD

evel

opm

ent o

f a s

erum

pan

el to

dev

elop

nor

mal

labo

rato

ry r

ange

s w

hen

test

ing

for

repr

oduc

tive

heal

th in

men

And

rolo

gy A

ustr

alia

D H

ande

lsm

an, L

Tur

ner

and

A C

onw

ayE

ffica

cy, s

afet

y an

d se

rvic

e fe

asib

ility

of a

n an

drog

en/p

roge

stin

dep

ot r

egim

en fo

r ho

rmon

al m

ale

cont

race

ptio

n.C

ON

RA

D

D H

ande

lsm

an a

nd M

Cou

sins

The

effe

cts

of N

andr

olon

e D

ecan

oate

on

reha

bilit

atio

n an

d qu

ality

of l

ife in

men

with

chr

onic

pai

n an

dop

ioid

-indu

ced

andr

ogen

def

icie

ncy:

a r

ando

miz

ed, p

lace

bo-c

ontr

olle

d cr

oss-

over

clin

ical

tria

l.P

Liu

, D H

ande

lsm

an a

ndR

Gru

nste

inA

dou

ble-

blin

d, p

lace

bo c

ontr

olle

d ra

ndom

ised

cro

ssov

er s

tudy

of t

esto

ster

one

on p

hysi

cal a

ctiv

ity,

slee

p an

d co

gniti

on in

men

ove

r 60

yea

rs o

f age

.S

eron

o

D H

ande

lsm

anP

rena

tal F

acto

rs in

Mal

e R

epro

duct

ive

Hea

lthN

HM

RC

Col

orec

tal U

nit

L Ir

wig

, L B

okey

, P C

hapu

i et a

l.P

opul

atio

n sc

reen

ing

for

colo

rect

al c

ance

rC

omm

onw

ealth

pro

ject

gra

nt

L B

okey

, P C

hapu

is e

t al.

Mai

nten

ance

of t

he C

olor

ecta

l Can

cer

(CR

C)

Hos

pita

l Reg

istr

y

Der

mat

olog

yE

Col

lins,

M P

iggi

n, J

Feg

on a

ndC

Ong

An

open

-labe

l stu

dy to

eva

luat

e th

e sa

fety

and

long

-ter

m c

linic

al e

ffica

cy o

f Im

iqui

mod

cre

am a

pplie

don

ce d

aily

, sev

en d

ays

per

wee

k fo

r 6

wee

ks o

n th

e tr

eatm

ent o

f sup

erfic

ial b

asal

cel

l car

cino

ma

3M P

harm

aceu

tical

s

End

ocrin

olog

yM

Hoo

per

CO

RE

(R

aloi

fene

in lo

wer

ing

risk

of b

reas

t can

cer

in p

ostm

enop

ausa

l wom

en w

ith o

steo

poro

sis)

Eli

Lilly

M H

oope

rG

HB

Q-P

TH

(N

ew c

ombi

natio

n tr

eatm

ent f

or o

steo

poro

sis

in w

omen

)E

li Li

lly

M H

oope

rA

lend

rona

te in

Pag

et�s

dis

ease

Mer

k, S

harp

& D

ohm

e

M H

oope

rR

io-L

ipid

s st

udy

(a n

ew d

rug

for

wei

ght l

oss

in o

bese

pat

ient

s w

ith d

yslip

idae

mia

s)S

anof

i

M H

oope

rP

EA

RL

(Las

ofox

ifene

for

post

men

opau

sal w

omen

with

ost

eopo

rosi

s)P

fizer

M H

oope

rLa

sofo

xife

ne in

sex

ual d

ysfu

nctio

nP

fizer

R C

hen

HM

R 1

964

(fas

t-ac

ting

insu

lin)

in T

ype1

dia

bete

sA

vent

is

M H

oope

rE

xten

sion

stu

dy: R

ised

rona

te in

ost

eopo

rosi

sP

roct

or a

nd G

ambl

e

M H

oope

rZ

olod

roni

c ac

id in

ost

eopo

rosi

s ex

tens

ion

2N

ovar

tis

M H

oope

rZ

olod

roni

c A

cid

in P

aget

�s D

isea

seN

ovar

tis

M H

oope

rR

ised

rona

te fo

r os

teop

oros

is in

men

Ave

ntis

/Pro

ctor

Gam

ble

Page 41: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

39

R C

hen,

M H

oope

r, T

Cro

mer

,C

Tin

g, N

Kor

mas

and

C S

hank

ley

HM

R19

64 V

S r

egul

ar h

uman

insu

lin in

type

2 d

iabe

tes

mel

litus

Ave

ntis

Gas

troe

nter

olog

yG

Par

k, M

Ngu

, B J

ones

, P K

atel

aris

and

D L

e C

oute

urT

he C

affe

ine

Bre

ath

test

NH

MR

C

Hyp

erte

nsio

n U

nit

R W

yndh

amF

IELD

stu

dy (

Fen

ofib

rate

in p

reve

ntin

g va

scul

ar d

isea

se in

pat

ient

s w

ith n

on-in

sulin

dep

ende

ntdi

abet

es)

NH

MR

C

Imm

unol

ogy

R W

alls

and

G H

uT

radi

tiona

l Chi

nese

med

icin

e in

trea

tmen

t of a

llerg

ic d

isea

ses

Tai

ji-U

nive

rsity

of S

ydne

yR

esea

rch

Fun

d fo

r T

radi

tiona

lC

hine

se M

edic

ine

Mic

robi

olog

yT

Got

tlieb

and

G F

unne

llA

ustr

alia

n G

roup

for

Ant

imic

robi

al R

esis

tanc

e (A

GA

R)

� S

taph

aur

eus

stud

y

T G

ottli

eb a

nd G

Fun

nell

Aus

tral

ian

Gro

up fo

r A

ntim

icro

bial

Res

ista

nce

(AG

AR

) �

Gra

m N

egat

ive

stud

y

T G

ottli

eb a

nd G

Fun

nell

Aus

tral

ian

Gro

up fo

r A

ntim

icro

bial

Res

ista

nce

(AG

AR

) �

Pne

umoc

occa

l stu

dy

T G

ottli

ebC

omm

unity

acq

uire

d ba

cter

aem

ia

S S

iara

kas,

T G

ottli

eb e

t al.

Mul

ti-C

entr

e E

valu

atio

n of

Rap

id C

omm

erci

al T

ests

for

the

Dia

gnos

is o

f Clo

strid

ium

diff

icile

Mul

tiple

com

pany

spo

nsor

ship

S S

iara

kas,

J S

anto

s an

d H

Agu

sT

he R

ole

of C

lost

ridiu

m p

erfr

inge

ns in

Nos

ocom

ial a

nd C

omm

unity

dia

rrho

ea (

Sup

ervi

sed

Hon

ors

Pro

ject

)C

ompa

ny s

pons

orsh

ipU

nive

rsity

of S

ydne

yS

Sia

raka

s, A

. K

ew

ley,

P L

oren

tzos

and

H A

gus

Clo

strid

ium

diff

icile

: Liv

ing

in th

e V

aria

nt E

ra (

Sup

ervi

sed

Hon

ors

Pro

ject

)U

nive

rsity

of S

ydne

y.

M L

eroi

, S

Sia

raka

s an

d T

Got

tlieb

Rol

e of

Nov

el A

ntib

iotic

s ag

ains

t Clo

strid

ium

diff

icile

Pha

rmac

iaB

ayer

T G

ottli

eb a

nd M

Pet

ers

Line

zolid

vs.

Van

com

ycin

/ Oxa

cilli

n in

Gra

m P

ositi

ve C

annu

la r

elat

ed s

epsi

sP

harm

acia

T G

ottli

ebA

ustr

alia

n C

andi

dem

ia s

tudy

J M

erlin

o, R

Bra

dbur

y, T

Got

tlieb

et a

lP

heno

typi

c an

d G

enot

ypic

stu

dies

of S

taph

yloc

occu

s au

reus

(no

n-m

ultid

rug

and

mul

tidru

g re

sist

ance

MR

SA

) is

olat

es in

CS

AH

SU

nive

rsity

of S

ydne

y

J M

erlin

o, R

Bra

dbur

y, T

Got

tlieb

et a

lS

urve

illan

ce a

nd E

valu

atio

n of

New

Det

ectio

n an

d Is

olat

ion

Met

hods

for

Sta

phyl

ococ

cus

aure

us (

non-

mul

tidru

g an

d m

ultid

rug

resi

stan

ce M

RS

A)

in C

SA

HU

nive

rsity

of S

ydne

yC

ompa

ny s

pons

orsh

ipM

Poy

ten,

J M

erlin

o an

d T

Got

tlieb

Det

ectio

n of

Ext

ende

d S

pect

rum

Bet

a-La

ctam

ases

in G

ram

-neg

ativ

e B

acill

i at C

RG

HC

ompa

ny s

pons

orsh

ip

T G

ottli

eb, M

Ler

oiC

onco

rd A

nim

al H

ospi

tal

Cox

iella

bur

netii

in c

ats

in S

ydne

y �

a se

rolo

gica

l sur

vey

T G

ottli

eb a

nd G

Fun

nell

Mox

iflox

acin

sus

cept

ibili

ty in

res

pira

tory

isol

ates

� M

ultic

entr

e st

udy

Bay

er

Con

cord

Hos

pita

lRes

earc

h R

epor

t

Page 42: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

40

Con

cord

Hos

pita

lRes

earc

h R

epor

t

Mol

ecul

ar M

edic

ine

G N

icho

lson

and

M K

enne

rson

Gen

etic

Bas

is fo

r C

harc

ot-M

arie

-Too

th a

nd H

ered

itary

Sen

sory

Neu

ropa

thy

type

IN

H&

MR

C

G N

icho

lson

and

M K

enne

rson

Fin

ding

the

gene

for

here

dita

ry s

enso

ry n

euro

path

yR

ebec

ca L

. Coo

per

G N

icho

lson

and

M K

enne

rson

Fun

ctio

nal s

tudi

es o

n th

e ge

ne c

ausi

ng h

ered

itary

sen

sory

neu

ropa

thy

Cliv

e an

d V

era

Ram

acio

ttiF

ound

atio

nG

Nic

hols

onM

appi

ng th

e m

utat

ion

for

here

dita

ry s

enso

ry n

euro

path

yU

SA

Mus

cula

r D

ystr

ophy

Ass

ocia

tion

G N

icho

lson

and

M K

enne

rson

Gen

e m

utat

ion

anal

ysis

in P

arki

nson

�s d

isea

se u

sing

rea

l tim

e P

CR

Cliv

e an

d V

era

Ram

acio

ttiF

ound

atio

nG

Nic

hols

onId

entif

ying

new

gen

e m

utat

ions

for

mot

or n

euro

ne d

isea

seT

he A

myo

trop

hic

Late

ral

Scl

eros

is A

ssoc

iatio

n U

SA

G N

icho

lson

and

M K

enne

rson

Mol

ecul

ar g

enet

ics

of s

pina

l cor

d ne

urop

athi

esD

epar

tmen

t of M

edic

ine

Uni

vers

ity o

f Syd

ney

Neu

rolo

gyA

Cor

bett

PR

OG

RE

SS

(P

erin

dopr

il an

d In

dapa

mid

e fo

r se

cond

ary

stro

ke p

reve

ntio

n)S

ervi

er a

nd M

RC

New

Zea

land

A C

orbe

ttT

RA

NS

CE

ND

and

ON

TA

RG

ET

(R

amip

ril a

nd T

elm

isar

tan

for

seco

ndar

y pr

even

tion

of c

ompl

icat

ions

inst

roke

, cor

onar

y ar

tery

dis

ease

, dia

bete

s an

d pe

riphe

ral v

ascu

lar

dise

ase)

Bo

eh

rin

ge

r In

gle

he

im/C

an

ad

ian

Ca

rdio

va

sc

ula

r C

oll

ab

ora

tio

nP

roje

ct O

ffice

M H

ayes

A m

ulti-

cent

re, m

ultin

atio

nal,

Pha

se 3

, ran

dom

ized

, dou

ble

blin

d, d

oubl

e-du

mm

y, 3

-arm

par

alle

l gro

up,

plac

ebo-

and

rop

iniro

le-c

ontr

olle

d tr

ial o

f the

effi

cacy

and

saf

ety

of r

otig

otin

e C

DS

pat

ch in

sub

ject

s w

ithea

rly s

tage

, idi

opat

hic

Par

kins

on d

isea

se

Sch

war

z P

harm

a

M H

ayes

A p

hase

3, d

oubl

e bl

ind,

pla

cebo

con

trol

led,

ran

dom

ized

stu

dy c

ompa

ring

the

effic

acy,

saf

ety

and

tole

rabi

lity

of s

uman

irole

ver

sus

plac

ebo

or r

opin

irole

, as

an a

djuv

ant t

o le

vodo

pa, i

n pa

tient

s w

ithad

vanc

ed P

arki

nson

s D

isea

se

Pha

rmac

ia

M H

ayes

Bot

ulin

um to

xin

and

low

er li

mb

spas

ticity

follo

win

g st

roke

Alle

rgon

A C

orbe

tt, J

Wat

son,

J C

ulle

n an

dS

Alle

nP

riorit

y H

ealth

Car

e P

rogr

am �

Str

oke

Dep

artm

ent o

f Hea

lth

Neu

rosu

rger

yN

Dan

and

N K

azem

iA

pro

spec

tive,

ran

dom

ized

, dou

ble-

blin

d tr

ial t

o ev

alua

te th

e ef

ficac

y of

ana

lges

ic e

pidu

ral p

aste

inlu

mba

r di

sc s

urge

ryN

ursi

ngJ

Ran

dall,

L C

heno

wet

h, C

Luc

k,C

Sm

ith a

nd C

Fen

nell

Dis

char

ge P

lann

ing

from

the

pers

pect

ive

of p

atie

nts

and

thei

r fa

mily

/car

er.

The

Ass

ocia

tion

of D

isch

arge

Pla

nnin

g N

urse

s

V S

uthe

rland

and

D L

ear

Ext

rave

ntric

ular

dra

ins

� st

erile

ver

sus

asep

tic te

chni

que

Res

earc

h C

entr

e fo

r A

dapt

atio

nin

Hea

lth a

nd Il

lnes

s, U

nive

rsity

of S

ydne

yG

Gly

nnT

he im

plem

enta

tion

of th

e F

amily

nee

ds P

roto

col t

o as

sist

nur

ses

in a

ddre

ssin

g th

e ne

eds

of th

e fa

mily

mem

bers

of c

ritic

ally

ill p

atie

nts

Res

earc

h C

entr

e fo

r A

dapt

atio

nin

Hea

lth a

nd Il

lnes

s, U

nive

rsity

of S

ydne

yJ

Mu

nro

, M

Ric

ha

rdso

n,

J O

�Co

nn

ell

and

R H

awle

yE

valu

atio

n of

a n

urse

-initi

ated

dis

char

ge p

lan

to im

prov

e th

e m

anag

emen

t of p

atie

nts

with

ast

hma

in th

eE

mer

genc

y D

epar

tmen

tR

esea

rch

Cen

tre

for

Ada

ptat

ion

in H

ealth

and

Illn

ess,

Uni

vers

ityof

Syd

ney

Page 43: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

41

Nut

ritio

n an

d D

iete

tics

P M

acLe

nnan

, K J

ukko

la,

A T

horn

ton,

N C

zinn

er a

nd J

Rav

ens

Inve

stig

atio

n o

f th

e e

ffe

cts

of

cha

rtin

g H

igh

Pro

tein

, H

igh

En

erg

y N

utr

itio

na

l S

up

ple

me

nts

on

th

eO

utco

mes

of E

lder

ly H

ospi

talis

ed p

atie

nts

at r

isk

of M

alnu

triti

on.

Res

earc

h C

entr

e fo

r A

dapt

atio

nin

Hea

lth &

Illn

ess,

Uni

vers

ity o

fS

ydne

yN

Cro

cket

t, P

Bea

le, J

Jac

quet

and

P M

acLe

nnan

Inve

stig

atio

n in

to th

e ef

fect

of N

utrit

ion

Inte

rven

tion

in L

ong-

term

Che

mot

hera

py P

atie

nts.

Res

earc

h C

entr

e fo

r A

dapt

atio

nin

Hea

lth &

Illn

ess,

Uni

vers

ity o

fS

ydne

yL

Bay

tieh,

R J

ohns

on a

nd P

Mai

tzD

iarr

hoea

inci

den

ce in

bur

ns p

atie

nts

in th

e B

urn

s U

nit a

t Con

cord

Hos

pita

l � p

ossi

ble

aet

iolo

gic

al

me

chan

ism

s a

nd in

terv

entio

n.R

esea

rch

Cen

tre

for

Ada

ptat

ion

in H

ealth

and

Illn

ess,

Uni

vers

ityof

Syd

ney

Onc

olog

yP

Bea

le, S

Cla

rke

and

A S

ulliv

anN

SA

BP

C-0

7 tr

ial (

Clin

ical

Tria

l of c

hem

othe

rapy

follo

win

g su

rger

y fo

r bo

wel

can

cer)

Nat

iona

l Su

rgic

al A

djuv

ant B

reas

tan

d B

owel

Pro

ject

(N

SA

BP

)P

Bea

le a

nd S

Cla

rke

Cel

ecox

ib/C

PT

11 (

Clin

ical

tria

l of c

eleb

rex

with

che

mot

hera

py fo

r pa

tient

s w

ith a

dvan

ced

colo

n or

rec

tal

canc

er).

Pha

rmac

ia

M S

tock

ler,

A S

ulliv

an a

nd P

Bea

leA

NZ

0001

tria

l(Clin

ical

tria

l of c

hem

othe

rapy

for

wom

en w

ith a

dvan

ced

or m

etas

tatic

bre

ast c

ance

r)A

ustr

alia

New

Zea

land

Bre

ast

Can

cer

Tria

l Gro

up (

AN

ZB

CT

G)

A S

ulliv

an a

nd P

Bea

leB

CIR

G tr

ials

005

& 0

06 (

Clin

ical

tria

ls o

f che

mot

hera

py a

nd a

ntib

ody

trea

tmen

ts fo

r w

omen

follo

win

gsu

rger

y fo

r br

east

can

cer)

.B

reas

t Can

cer

Inte

rnat

iona

lR

esea

rch

Gro

up (

BC

IRG

)M

Sto

ckle

r, M

Boy

er, S

Cla

rke

and

P B

eale

YM

598

pro

stat

e tr

ial (

Clin

ical

tria

l of a

new

dru

g w

ith c

hem

othe

rapy

for

adv

ance

d pr

osta

te c

ance

r)Y

aman

ouch

i

P B

eale

and

S C

lark

eC

hrys

in/C

PT

11 s

tudy

(C

linic

al tr

ial o

f a d

rug

to p

reve

nt d

iarr

hoea

with

che

mot

hera

py fo

r bo

wel

can

cer)

M S

tock

ler

ZE

ST

stu

dy (

Clin

ical

tria

l of a

ntid

epre

ssan

t dru

g in

adv

ance

d ca

ncer

pat

ient

s)N

HM

RC

-CT

C

S C

lark

e, M

Mill

war

d an

d P

Bea

leJM

AT

NS

CLC

(C

linic

al tr

ial o

f che

mot

hera

py fo

r pa

tient

s w

ith a

dvan

ved

lung

can

cer)

Eli

Lilly

S C

lark

e, M

Mill

war

d, P

Bea

le a

ndM

Boy

erA

G33

40 N

SC

LC (

Clin

ical

tria

l of a

new

dru

g to

pre

vent

tum

our

spre

ad in

lung

can

cer

patie

nts)

Ago

uron

A S

ulliv

an a

nd M

Sto

ckle

rIB

CS

G S

tudy

20

(Clin

ical

tria

ls o

f che

mot

hera

py fo

r w

omen

follo

win

g su

rger

y fo

r br

east

can

cer)

.A

ustr

alia

New

Zea

land

Bre

ast

Can

cer

Tria

l Gro

up (

AN

ZB

CT

G)

S C

lark

e, M

Mill

war

d an

d P

Bea

leIR

ES

SA

NS

CLC

(C

linic

al tr

ial o

f a n

ew d

rug

with

che

mot

hera

py to

pre

vent

tum

our

grow

th in

lung

canc

er p

atie

nts)

Ast

ra Z

enec

a

M S

tock

ler,

M B

oyer

and

P B

eale

TA

X 3

27 (

Clin

ical

Tria

l of c

hem

othe

rapy

for

men

with

adv

ance

d pr

osta

te c

ance

r)A

vent

is

S C

lark

e an

d P

Bea

leC

apec

itabi

ne T

S s

tudy

(P

redi

ctin

g to

xici

ty fr

om tr

eatm

ent f

or a

dvan

ced

bow

el c

ance

r)

M S

tock

ler

and

P B

eale

Cis

plat

in in

patie

nt/o

utpa

tient

stu

dy

Ort

hopa

edic

sW

Bru

ce a

nd H

Van

der

Wal

lE

arly

Pro

spec

tive

Det

ectio

n of

Bon

e M

arro

w/F

at E

mbo

lism

afte

r Jo

int A

rthr

opla

sy

Con

cord

Hos

pita

lRes

earc

h R

epor

t

Page 44: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

42

Con

cord

Hos

pita

lRes

earc

h R

epor

t

Oph

thal

mol

ogy

F B

ooth

, J G

eorg

e an

d A

Lee

Eva

luat

ion

of d

ry e

ye te

sts

in n

orm

al a

sym

ptom

atic

pop

ulat

ion

Pal

liativ

e C

are

G A

ggar

wal

and

M A

gar

Doc

umen

tatio

n of

the

Inci

denc

e of

Mal

igna

nt A

scite

s an

d th

e U

se o

f Par

acen

tesi

s an

d D

iure

tics

inC

urre

nt M

anag

emen

t of M

alig

nant

Asc

ites

(Pilo

t Stu

dy)

G A

ggar

wal

, N S

atha

siva

m a

ndC

Won

gE

nd o

f life

dec

isio

n-m

akin

g in

the

care

of t

he p

atie

nt

G A

ggar

wal

Dou

ble-

blin

d, D

oubl

e-du

mm

y, R

ando

mis

ed, p

aral

lel-a

rm e

quiv

alen

ce s

tudy

com

parin

g H

ydro

mor

phon

eH

ydro

chlo

ride

exte

nded

-rel

ease

cap

sule

s (H

HE

R)

with

MS

Con

tin T

able

ts, a

t a d

ose

ratio

of 1

:7.5

, in

Can

cer

or N

on-C

ance

r pa

tient

with

a h

isto

ry o

f mod

erat

e to

sev

ere

pain

Mun

diph

arm

a

P G

lare

and

G A

ggar

wal

Dat

abas

e of

pat

ient

s us

ing

stro

ng o

pioi

ds fo

r no

n-ca

ncer

pai

n

G A

ggar

wal

and

A K

outa

ntos

Pre

vale

nce

of p

ain

in a

teac

hing

hos

pita

l

J C

layt

on, P

But

ow, M

Tat

ters

all

R C

hye

and

G A

ggar

wal

Com

mun

icat

ion

of p

rogn

ostic

info

rmat

ion

in p

allia

tive

med

icin

e �

an a

naly

sis

of a

udio

tape

ddo

ctor

/pat

ient

con

sulta

tions

NH

MR

C M

edic

al/D

enta

lR

esea

rch

Sch

olar

ship

P G

lare

, J Y

ip a

nd G

Agg

arw

alP

ain

in h

ospi

talis

ed p

atie

nts

with

can

cer:

pre

vale

nce,

clin

ical

cha

ract

eris

tics,

impa

ct o

n qu

ality

of l

ifean

d ba

rrie

rs to

trea

tmen

t.J

Cla

yton

, M T

atte

rsal

l, P

But

ow a

ndG

Agg

arw

alP

ilotin

g a

ques

tion

prom

pt s

heet

for

palli

ativ

e ca

re p

atie

nts

and

subs

eque

ntly

con

duct

ing

a ra

ndom

ised

cont

rolle

d tr

ial o

f the

que

stio

n pr

ompt

she

et.

NH

MR

C m

edic

al p

ostg

radu

ate

scho

lars

hip

Phy

siot

hera

pyY

Silv

a an

d F

Li

Qua

lity

Impr

ovem

ent P

roje

ct to

rev

iew

out

com

e m

easu

res

post

upp

er a

nd lo

wer

abd

omin

al s

urge

ry

P v

an d

en D

olde

r an

d M

Kw

anA

Tria

l int

o th

e E

ffect

iven

ess

of s

oft t

issu

e m

assa

ge in

the

trea

tmen

t of S

houl

der

Pai

n

K R

efsh

auge

, C M

aher

, L B

arns

ley

and

L P

enge

lE

xerc

ise

or A

dvic

e fo

r su

bacu

te L

ow B

ack

Pai

n?N

HM

RC

Aus

tral

asia

n P

hysi

othe

rapy

low

back

tria

l con

sort

ium

F L

i and

Y S

ilva

For

ces

and

Fre

quen

cies

use

d in

per

cuss

ion

and

vibr

atio

n te

chni

ques

Y S

ilva,

F L

i and

M P

eter

sT

he e

ffect

iven

ess

of p

ulm

onar

y re

habi

litat

ion

on p

atie

nts

post

lung

res

ectio

n.

F L

i, V

Gra

ham

, N B

uckl

e,D

Del

aney

and

A. K

arko

vic

Mul

ti-ce

ntre

tria

l of a

rev

ised

ver

sion

of t

he E

lder

ly M

obili

ty S

cale

; a r

etro

spec

tive

stud

y.

Psy

chol

ogic

al M

edic

ine

I McG

rego

r an

d G

Hun

tT

he b

ehav

iour

al a

nd n

euro

toxi

c ef

fect

s of

MD

MA

(�E

csta

sy�)

NH

&M

RC

Psy

chol

ogy

F K

emp

and

F W

ilkin

son

Cog

nitiv

e be

havi

oura

l tre

atm

ent o

f pan

ic d

isor

der

Res

earc

h C

entr

e fo

r A

dapt

atio

nin

Hea

lth a

nd Il

lnes

s, U

nive

rsity

of S

ydne

yP

Man

gion

iC

ompa

rison

of p

atie

nts�

psy

chol

ogic

al s

tate

atte

ndin

g ca

rdia

c re

habi

litat

ion

with

thos

e pa

tient

s re

ceiv

ing

�nor

mal

� di

scha

rge

care

Re

sea

rch

Ce

ntr

e f

or

Ad

ap

tatio

nin

He

alth

an

d I

llne

ss,

Un

ive

rsity

of S

ydne

y

Page 45: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

43

Rhe

umat

olog

yR

Cho

w a

nd L

Bar

nsle

yLo

w L

evel

Las

er fo

r N

eck

Pai

n

L B

arns

ley

Out

com

es o

f rad

iofr

eque

ncy

dene

rvat

ion

for

chro

nic

neck

pai

n

L B

arns

ley

Rem

icad

e fo

r R

heum

atoi

d ar

thrit

is

Spe

ech

Pat

holo

gyN

Cla

yton

, A In

g, M

Pet

ers

and

G M

ann

The

effe

ct o

f chr

onic

obs

truc

tive

pulm

onar

y di

seas

e (C

OP

D)

on la

ryng

o-ph

aryn

geal

sen

sitiv

ity (

LPS

)an

d dy

spha

gia

Tho

raci

c M

edic

ine

L S

eeto

The

rol

e of

AK

T in

the

mol

ecul

ar p

atho

gene

sis

of C

hron

ic O

bstr

uctiv

e P

ulm

onar

y D

isea

se (

CO

PD

).

L S

eeto

Alv

eola

r m

acro

phag

e ex

pres

sion

of p

21 in

Chr

onic

Obs

truc

tive

Pul

mon

ary

Dis

ease

(C

OP

D).

L S

eeto

The

exp

ress

ion

of m

atrix

met

allo

prot

eina

ses

(MM

Ps)

and

cyt

okin

es fr

om a

lveo

lar

mac

roph

ages

inC

hron

ic O

bstr

uctiv

e P

ulm

onar

y D

isea

se (

CO

PD

): T

he e

ffect

of o

ral t

heop

hylli

ne in

CO

PD

, ara

ndom

ised

dou

ble

blin

d pl

aceb

o co

ntro

lled

stud

y in

pat

ient

s w

ith C

OP

D.

Mits

ubis

hi

L S

ecco

mbe

Ris

k fa

ctor

s fo

r de

velo

ping

hyp

oxia

dur

ing

air

trav

el in

pas

seng

ers

with

lung

dis

ease

.

M C

omsa

Stu

dy o

n th

e et

iolo

gy o

f com

mun

ity-a

cqui

red

pneu

mon

ia in

pat

ient

s ad

mitt

ed to

Con

cord

Hos

pita

l.

G C

ossa

A s

tudy

to e

xam

ine

the

effe

cts

of e

nviro

nmen

t (ae

roal

lerg

ens)

on

noct

urna

l ast

hma

usin

g an

aut

omat

edw

heez

e qu

antif

icat

ion

devi

ce (

Pul

moT

rack

)K

Wad

e an

d L

Plo

wm

anM

eter

ed d

ose

inha

ler

(MD

I) a

sses

smen

t in

subj

ects

with

chr

onic

obs

truc

tive

pulm

onar

y di

seas

e(C

OP

D)

or a

sthm

a.A

Ing

and

B R

ost

The

Rol

e of

Neu

rotr

ophi

ns in

Chr

onic

Idio

path

ic C

ough

Uro

logy

V T

se, L

Cha

n, J

Yin

, C M

cLac

hlan

E W

ills

and

S B

ram

mah

Ultr

astr

uctu

ral B

asis

of V

oidi

ng D

ysfu

nctio

n (C

orre

latio

n of

Gap

Jun

ctio

nal P

rote

in E

xpre

ssio

n an

dU

ltras

truc

tura

l Fea

ture

s in

the

Uns

tabl

e H

uman

Det

ruso

rA

bbot

Aus

tral

asia

Inst

itute

of U

rolo

gy, C

SA

HS

A L

alak

, L C

han,

A M

itter

dorf

er,

D V

asila

reas

and

N H

anly

GU

OG

� A

Pha

se II

Stu

dy to

Ass

ess

the

Effe

ct o

f Int

erm

itten

t And

roge

n B

lock

ade

in th

e T

reat

men

t of

Adv

ance

d P

rost

ate

Can

cer

Sch

erin

g P

loug

h

L C

han,

D E

isin

ger,

A M

itter

dorf

erJ

Rog

ers,

D V

asila

reas

and

N H

anly

A R

ando

mis

ed, D

oubl

e-bl

ind,

Par

alle

l Gro

up, P

lace

bo a

nd A

ctiv

e C

ontr

olle

d, M

ulti-

Cen

tre

Stu

dy o

fY

M90

5 5

mg

and

10 m

g in

Pat

ient

s w

ith O

vera

ctiv

e B

ladd

erY

aman

ouch

i

L C

han,

D E

isin

ger,

A M

itter

dorf

erJ

Rog

ers.

D V

asila

reas

and

N H

anly

An

Ope

n-la

bel,

Long

-ter

m S

afet

y an

d E

ffica

cy F

ollo

w-u

p S

tudy

of Y

M90

5 5m

g an

d 10

mg

in P

atie

nts

with

Ove

ract

ive

Bla

dder

Yam

anou

chi

L C

han,

D V

asila

reas

and

N H

anly

UK

-338

,003

(S

tudy

of a

new

dru

g fo

r tr

eatin

g sy

mpt

oms

of b

enig

n pr

osta

tic o

bstr

uctio

n).

Pfiz

er

A L

alak

, A M

itter

dorf

er, P

Mah

er a

ndN

Han

lyT

RIU

MP

H S

tudy

(S

tudy

of t

he m

anag

emen

t of p

atie

nts

with

ben

ign

pros

tatic

hyp

erpl

asia

)Y

aman

ouch

i

J M

edd,

A L

alak

, L C

han,

P M

aher

and

M S

tock

ler

Pat

ient

s E

xper

ienc

e of

Uro

dyna

mic

s an

d P

rost

ate

Bio

psy

Con

cord

Hos

pita

lRes

earc

h R

epor

t

Page 46: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

44

Con

cord

Hos

pita

lRes

earc

h R

epor

t

Page 47: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many

Funding:

The research described in this publication was supported by funding from the following sources:

● Altana Pharma● Amgen Inc.● Astra-Zeneca● Australian Brain Foundation● Aventis Pharma● Bard Corporation● BioFirst Award (NSW Government)● CONRAD● Department of Veterans’ Affairs● Eli Lilly ● Federal Department of Health and Ageing ● International Osteoporosis Foundation● Johnson and Johnson● Mitsubishi (Japan)● National Health and Medical Research Council● National Health and Medical Research Council Postgraduate Scholarship● NSW Health Department Infrastructure Grant● Pfizer Cardiovascular Lipid Research Grant● Pharmacia Australia● RACP McCaughey Research Scholarship● Research Centre for Adaptation in Health and Illness, University of Sydney● Roche Pharmaceuticals● RM Gibson Foundation of Australian Association of Gerontology● Royal Australian College of Surgeons● SchwarzBiosciences● Serono● Singapore College of Physicians● Swiss National Research Fund● The University of Heidelberg Research Foundation● The Medical Foundation of The University of Sydney● The University of Sydney● Vingmed GE Australia

45

Page 48: RESEARCH REPORT 2002/2003 - Sydney Local Health District · 2015-11-13 · research activities at Concord. This publication illustrates the broad depth of research at Concord on many