Emerging Researcher Fellowships

Cassandra Bendall

Paediatric Dietitian

Study Title: Adolescent Eating Disorder Services in Australia and New Zealand

Eating disorders are a psychological illness characterised by pre-occupation with food, weight and body image, and can lead to serious medical, nutritional and psychological implications. Dietitians are ideally placed to provide nutritional expertise and to lead the implementation of high-quality, evidenced-based nutrition therapy in partnership with eating disorder services. Dietetic interventions include the prescription of nutrition therapy via oral or enteral routes, identification of refeeding syndrome, and education on normalised eating behaviours. It is currently unknown how Australian and New Zealand eating disorder services align with current clinical practice nutrition guidelines. The last published study was completed in 2008 which highlighted that there was no ‘standard’ nutritional management for anorexia and bulimia nervosa. The aim of this study is to comprehensively assess the current practice of paediatric and adolescent eating disorder dietitians across Australia and New Zealand and to describe the current dietetic and nutrition-related practices in the context of published recommendations. The anticipated outcome is to align dietitian-led interventions and nutritional support with best-practice guidelines within the paediatric and adolescent inpatient eating disorder settings in Australia and New Zealand.

Dr Madeleine Healy

Geriatrician, Aged and Rehabilitation Division

Study Title: Evaluating the feasibility of a statewide specialised cognition service for people with Down’s Syndrome

Australia lacks recommendations for monitoring cognitive health in individuals with Down syndrome with emerging Alzheimer’s disease. The diagnosis of dementia in people with Down syndrome is challenging due to lack of formal services, diagnostic criteria, and the complexity of differentiating intellectual disability from emerging dementia. Australian expertise and service provision is urgently needed as well as equitable access to treatment and research.
The aims of this project are:
1) What is the best consumer informed, evidence based model for the diagnosis of AD for people with Down syndrome?
2) To implement this new service model.
3) Evaluation of the service model and provide evidence of feasibility to inform health service change.

Dr James Leung

Medical Administration Registrar, Patient Access & Flow

Study Title: The Interdisciplinary Nightly Cadence

The hospital at night on the wards within Monash Medical Centre (MMC) is currently staffed by a skeleton workforce of Junior Medical Staff (JMS). The majority of night shift JMS work in their own respective silos with poor lines of communication for onsite support and escalation, and provided with minimal formal clinical leadership. The current hospital at night setup means that night shift JMS are not provided with the optimal environment to deliver effective patient care.

The Interdisciplinary Nightly Cadence is a co-design quality improvement project that is intended to improve leadership, teamwork and communication amongst the night shift JMS at MMC. Over the next 12 months, this project will involve the sequential implementation of process and system changes to create a formal structure for the night shift JMS. The aim of this structure is to better support and improve the safety amongst the night shift JMS, thereby ultimately improving patient care delivery.

Courtney Nagle

Podiatrist

Study Title: Consensus on the provision of patient education for adults with diabetes-related foot ulceration: a Delphi study of Australian stakeholders

Diabetes-related foot ulceration (DFU) is increasingly recognised as one of the most disabling and costly health complications of diabetes and is a leading cause of hospitalisation and lower limb amputation. This research study aims to identify the most important elements of patient education for adults newly diagnosed with DFU and for adults with long-standing or reoccurring DFUs. In addition, we aim to explore the best ways for clinicians to deliver this information to their patients.

The Delphi study design consists of four online survey rounds presented to a panel of experts and consumers, with the goal of reaching consensus between participants on the elements of education that are most important, and how best to deliver this information. The panel will consist of consumers; adults with lived experience of DFU and experts; healthcare professionals, researchers and academics with specialised experience in managing DFU.

It is envisaged that the findings of this study will help to inform the design of education resources for both clinicians and consumers, ultimately improving staff and patient experiences and resulting in an improvement in health outcomes for adults living with DFU.

Lauren Tomkins

Physiotherapist

Study Title: The Threshold study: examining the physiological effects of threshold positive expiratory pressure in adults with cystic fibrosis

Threshold positive expiratory pressure (PEP) is a device that is proposed to assist with holding the airway open when breathing out. Threshold PEP has been used in clinical practice at Monash Health in adults and children with cystic fibrosis (CF) and shown to be of benefit for cough control and mucus clearance. However, there is limited research examining the effectiveness, physiological effects, safety and feasibility of Threshold PEP in adults with CF. Findings from this research will provide an understanding of how Threshold PEP works to create these observed benefits in adults with CF. In this study, participants will perform a lung function test at various levels of PEP using a new combined Threshold PEP and lung function instrument. The safety, perceived efficacy, and feasibility of using Threshold PEP as an addition to traditional physiotherapy airway clearance techniques in adults with CF will also be explored. Clinically, this will be the first step in identifying specific patient groups who may benefit from this device and will inform recommendations for implementing this device in clinical practice.

Annika Ward

Neurosciences Physiotherapist

Study Title: Does the Trunk Impairment Scale help predict independent discharge mobility in stroke survivors undergoing inpatient rehabilitation? A retrospective cohort study

Physiotherapists are often asked by stroke survivors and their families if they will walk again during assessment. Predicting return to independent walking is complex, but good sitting balance is considered an important positive prognostic indicator. The Trunk Impairment Scale (Verheyden’s version) (TISv) assesses static sitting balance, dynamic sitting balance, and trunk coordination, and is a valid, reliable, and responsive measure of trunk motor impairment after stroke. The Monash Health physiotherapy team have recently implemented the TISv as a recommended routine outcome measure in the assessment of stroke survivors. This study aims to investigate the relationship and predictive power between total TISv score on admission to inpatient rehabilitation post stroke, and discharge Functional Independence Measure (FIM) scores for transfers and walking. We hope this study may enhance the knowledge available to our therapy teams to use specific outcome measures to inform expected functional outcomes, and could improve the accuracy and therefore experience of joint goal setting and discharge planning for stroke survivors admitted to Monash Health.

Sarah Wiggs

Clinical Nurse Specialist

Study Title: The standard of peripheral intravenous catheter care in Monash Health Emergency Departments

Intravenous cannulas are one of the most commonly used invasive devices for the delivery of patient treatment in hospitals. However, they are not harmless. In 2021, the Australian Commission on Safety and Quality in Health Care’s ‘Management of Peripheral Intravenous Catheters Clinical Care Standard’ was developed using best available evidence. A study of clinicians in Australian emergency departments (EDs) in 2023 revealed that many staff routinely performed cannula insertion and management not aligned with the Standard (Xu et al., 2023). Variations from the Standard included the regular placement of ‘just in case’ cannulas, choosing the anterior cubital fossa (inner elbow) as the first site of choice despite it being a site of flexion, providing inadequate documentation, and attempting to insert cannulas ‘without confidence’, to name but a few.

We have partnered with a Queensland research team to perform a point prevalence study on the management of intravenous cannulas, with a unique focus on the ED environment. The research will use an assessment tool based on adherence to the Standard, and design a way to audit the dynamic ED. The study’s aim is to provide valuable insights into the standard of care patients with intravenous cannulas receive at Monash Health EDs. The information collected will not only help identify current practices but will enable the formulation of recommendations for potential improvements. Moreover, this study will serve as a baseline for future research, allowing for the assessment of the impact of any implemented interventions designed to optimise patient care.