The Chief Executive has established the Monash Health Emerging Researcher Fellowship. The primary purpose of the Fellowship is to invest in early research career individuals, with significant potential for a research career and for whom a fellowship would contribute to that end. The Fellowship is to encourage Monash Health employees to conduct a research project and to target emerging researchers.
The Fellowship is to encourage Monash Health employees to conduct a translational research project and to target emerging researchers. The Fellowships have a focus on supporting talented individuals in commencing research and to act as a preparatory step for an individual to be accepted towards a PhD.
Study Title: Immunological predictors of intravesical BCG response in non-muscle invasive bladder cancer
Non-muscle invasive bladder cancer is commonly treated with an immunotherapy medication called BCG which is administered directly into the bladder. Although BCG therapy remains the gold standard for reducing the likelihood of bladder cancer recurrence or progression, this therapy is ineffective in up to 45% of patients. Gavin’s project aims to identify immunological markers to identify patients with non-muscle invasive bladder cancer who are less likely to respond to intravesical BCG therapy.
Study Title: Optimisation between radiation dose and image quality in imaging paediatric extremities with a cast
Radiation risk is a constant concern in paediatric imaging, given that children are two- to three-fold more likely to develop cancers after radiation exposure than adults. With sports and play commonly causing paediatric extremity fractures, children with a cast often need frequent X-ray follow-ups for fracture assessments. Considering the accumulative nature of dose, it is essential to minimise any unnecessary radiation for children in this clinical situation of cast imaging. One of the radiation protection principles is dose optimisation, which is to obtain diagnostic image quality with dose as low as reasonably achievable. However, this is little evidence addressing how to best modify radiation exposure settings in paediatric cast imaging, resulting in various and inconsistent techniques in practice. With a gap in current literature, this research aims to explore optimal radiation parameters in this clinical situation and maximise radiation safety to benefit paediatric patients’ health outcomes in our community.
Study Title: Healthcare Utilisation in Haematology Patients at End of Life
Patients with haematological malignancy often continue to receive aggressive interventions towards the end of life, as good outcomes can be achieved, disease course is unpredictable and it is difficult to foresee who will benefit from intervention. In addition, treatments are changing rapidly with additional lines of therapy and newer ‘novel agents’ available through clinical trials and now on the PBS. The aim of this study is to assess the use of supportive care (transfusion, antibiotics, ICU) at end of life in haematology patients at Monash Health and develop evidence-based strategies to improve patient outcomes and appropriate healthcare utilisation.
Study Title: Reviewing the clinical utility of hyperventilation in routine EEGs in the post-COVID era.
Electroencephalogram (EEG) is a test that measures the electrical activity of the brain. In routine tests, patients are asked to hyperventilate. This refers to intentional over breathing which can bring about changes in the EEG to aid clinicians in diagnosis and management of epilepsy. It is important to implement safe practices in EEG testing and due to risk of transmission of COVID-19, this technique has not been performed over the last two years. This has provided us with a unique opportunity to determine if the yield of EEG has changed by asking these patients to not hyperventilate. This project will also help identify patient groups in which this procedure will most benefit. This may change the way EEG testing is conducted not only at Monash Health but across EEG centres around the world.
Study Title: A Randomised controlled trial for intranasal midazolam versus inhaled nitrous oxide for reducing the pain and distress of nasogastric tube insertion in young children
Nasogastric tube (NGT) insertion is one of the most stressful procedures performed in paediatrics, regardless of age. There is limited research on methods to reduce pain during NGT insertion in young children, with only two studies using nebulised and topical medications that showed limited effect. This research project aims to (a) survey doctors and nurses working across Australia, to determine current practice for nasogastric tube insertion, including methods to reduce pain and distress, and (b) conduct a clinical trial to determine whether midazolam or nitrous oxide (also known as “laughing gas”) is more effective in reducing pain and distress during the procedure in young children.
Study Title: Radiological and clinical sequalae of scaphoid malunion
At present, the guidelines for the management of scaphoid non-union has been established but the management of scaphoid of malunion remains unclear.
Symptomatic scaphoid malunion is uncommon clinically and the natural history has not been determined. It is suggested that scaphoid malunion can lead to biomechanical and kinematic alterations to the wrist and likely subsequent pain and degenerative arthritis.
Some literature on the outcome of scaphoid malunion has been published but there is insufficient data available to guide the management of asymptomatic scaphoid malunion. When wrist arthritis is established, the operative options become limited to salvage procedures such as limited wrist fusions. It is important that we understand better the consequence of scaphoid malunion to mitigate the risk of development of wrist arthritis in the neglected scaphoid malunion.
We aim tom determine if scaphoid malunion leads to degenerative arthritis and the duration it takes to manifest the radiological changes from the date of surgery.
Study Title: Assessing resilience potentials across critical care units at Monash Health – a feasibility study
Resilience performance means that an organisation can function as required under both expected and unexpected conditions (Wears 2015). Resilience is influenced by factors beyond the individual, and is a property of the working environment. To have resilient performance, an organisation must have the potential to anticipate, monitor, respond, and learn (Hollnagel 2017). Eric Hollnagel, a Danish psychologist with an extensive research background in system safety and resilience engineering, designed the Resilience Assessment Grid (RAG) as an objective measure of resilience performance.
Advancing patient safety requires not only investigation of when things go wrong (Safety I), but parallel investigation of why things also go right (Safety II). In critical care, the delivery of successful outcomes relies on the ability of the workers and team to work under pressure, adjust to fluid situations, to anticipate and plan, and to actively seek safe outcomes. Being able to objectively measure a critical care team’s resilience would provide important insights into the team’s strengths and weaknesses, inform educational priorities, and identify cultural factors that should be shared across the organisation.
This project is a feasibility study to assess whether Hollnagel’s RAG can be adapted for use in Monash Health to assess the resilience potential of two critical care teams and identify strengths and weaknesses in the team’s safety culture.
Study Title: Optimising and Orchestrating the Management of Patients with Cirrhosis and varices using a pharmacist-led remote patient monitoring and titration program (OOMPa-C) study
Variceal bleeding is a potentially fatal complication of liver cirrhosis that can be prevented using beta blocker medications such as carvedilol. However, beta blockers are seldom titrated to the most effective dose in a timely manner. The OOMPa-C study will utilise remote patient blood pressure and heart rate monitoring to enable pharmacist led carvedilol dose titration from the comfort of the patient’s home. Sheridan will work within the Virtual Hospital research team led by A/Prof Suong Le and Ms Jo Hunter to investigate the feasibility and acceptability of this new model of care. If successful, Sheridan hopes this model may be used to manage other health conditions in the future.
Study Title: Patient and parent/carer pain and distress ratings across commonly performed hospital-based procedures for paediatric patients
This study aims to collect information on the experience of paediatric patients at Monash Health during commonly performed hospital-based procedures, including needle-stick procedures. Paediatric patients and their parent/carers will independently record their assessments of pain and distress levels associated with medical procedures, utilising a QR Code questionnaire. Collection of data across a number of different practice settings within Monash Health will enable comparison of patient and parent/carer assessments, and may lead to targeted educational initiatives to improve the patient experience.
Study Title: Oral penicillin provocation in the Intensive Care Unit (ICU)
Up to a quarter of hospital patients possess a penicillin allergy label, however true penicillin allergy is uncommon. Unverified penicillin allergy labels can prevent the use of penicillins, leading to the use of alternative antimicrobials with greater association of adverse effects, prolonged hospital stay and increased cost of care. Michelle’s project will investigate the use of a simplified assessment tool to screen penicillin allergy labels, identifying “low” risk penicillin allergic patients in intensive care. “Low” risk patients will be delabeled i.e. removing a penicillin allergy label, by challenge with penicillin. This project brings together a multidisciplinary team of investigators at Monash Medical Centre and is part of a collaborative study.