Canberra Hospital Auditorium - Find-a-health service

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Celebrating Health Research in the
Canberra Region
Canberra Hospital Auditorium
August 12th – 15th, 2014
WELCOME FROM KATY GALLAGHER,
MLA. CHIEF MINISTER AND MINISTER FOR HEALTH
I am delighted to welcome all participants to the Canberra Health Annual Research
Meeting, or CHARM.
Many institutions from the Canberra region are represented and I am pleased that
more submissions have been presented for this meeting than ever before. There
are also more sponsors than in previous years, another very healthy sign that the
Territory is a major hub for learning and the development of knowledge for the
benefit of all.
CHARM really does give us something to celebrate.
I acknowledge the ACT Health Research Office for the planning and delivery of
this meeting, and thank Professor Matthew Cook in particular, not only for his
contribution to CHARM, but also for his ongoing commitment to the research
endeavour. Thank you too, on behalf of the ACT Government, to all our sponsors
for their generous support.
Katy Gallagher MLA
Chief Minister
Minister for Health
4 | Canberra Health Annual Research Meeting
CONTENTS
Organising Committee
6
Scientific Review Committee
7
Our Sponsors
8
Charm 2014 timetable
9
15. Recognising trauma and adversity in young
people and their families who access the ACT
Child and Adolescent Mental Health Service
27
16. Poor minimal trauma fracture treatment as a
cause of subsequent hip fractures in the elderly
27
17. What strategies are acceptable to primary
caregiver when informing them of their child’s
Body Mass Index (BMI) result as gathered
through The Kindergarten Health Check (KHC)?
What type of information do primary caregivers
find helpful in regard to potential management
options to follow up a BMI result of their child?
28
18. A 3D numerical simulation of vocal-fold vibrations
28
19. Health Behaviours in the Capital
29
20. Essential nursing care: how well are we doing
it in 2014?
29
30
Keynote Speakers
10
Workshops
13
Daily Timetable
15
Oral Presentations
19
1. Heritability of childhood constipation
20
2. “Getting the First Birth Right” A retrospective
study of birth outcomes for primiparous
women receiving standard care in the birth
suite versus continuity of midwifery care in the
birth centre at Canberra Hospital
20
3. Development of a neonatal early warning score
(NEWS) to detect deteriorating neonates
21
4. A new function for testis-specific histone
variants in cancer
21
21. What are young people telling us about their
health-related behaviours? Results from the
ACT Secondary Students’ Alcohol and Drug
Surveys (ASSAD)
22
22. Comparing the support needs of men with
prostate cancer and their significant others
30
5. Evaluation of scattered synchrotron
radiation with physical and biological dosimetry
31
6. Targeting glucose metabolism—a strategy for
overcoming drug resistance in breast cancer
22
23. Use of the Ward Atmosphere Scale to gauge the
link between milieu and environment
31
7. An intervention for cancer-related fatigue
in men treated for prostate cancer: Energy
Conservation and Management
23
24. M-Clinic: Expanding access to HIV testing for
Men who have Sex with Men in the ACT
25. What women want: A national audit of access
to a midwife in the immediate postnatal period
32
8. Benefit of adjuvant trastuzumab with
chemotherapy (ATWC) in T1N0 HER2 positive
breast cancer—interim results
23
26. AINs as additional staff in an acute medical
ward for the elderly: Staff perceptions of this
initiative
32
9. Predictive value of Immunohistochemical
4 plus Clinical Treatment Score in determining
risk of Loco Regional Recurrence in Early
Breast Cancer
24
27. The economic and social value of Telephone
Triage and Advice Services (TTAS): A rapid
review of the literature.
33
10. Abnormal knee kinematics during step and turn
following multiple-ligament knee reconstruction
24
28. Innovations in Workforce Retention for the
Clinical Measurement Sciences Team
33
11. How reliable is Computer Assisted THA
Polyethylene Wear Measurement with Current
Radiography Practices?
25
29. Ventilator Hyperinflation – Safety and feasibility
of translating evidence into practice in ICU
34
34
12. Dislocation following total hip replacement,
a descriptive study of common factors and
treatment in Canberra
25
30. Weaned but weak and weary: Inspiratory muscle
weakness and raised perceived exertion in adults
following 7 days of mechanical ventilation
35
13. Biodegradable Magnesium Yttrium (Mg-Y) Alloy
Promotes Osteogenic Differentiation of Human
Mesenchymal Stem Cells (hMSCs)
26
31. Patient feedback: improving health care safety
and quality?
32. Primary health care teams: A social
network analysis
35
14. The relationship between the measures of
postural sway, mechanical pain threshold
testing and self – ratings of pain and disability
in chronic neck pain sufferers
26
33. Beyond childbirth-related trauma: a
collaborative study to detect trauma and
posttraumatic stress symptoms in mothers
36
August 12th – 15th, 2014 | 1
55. Genetic analysis of Escherichia coli, focusing on
adherent, invasive E. coli isolated from Crohn’s
disease patients
47
56. Exercise slows growth of dysplastic hepatocytes
by improving insulin sensitivity and enhancing
DNA damage surveillance pathways in mice
genetically predisposed to obesity and diabetes
47
57. Prevalence of Connective tissue disorders in
Diabetes Mellitus and their links to diabetic
microvascular complications
48
58. Horse related injury presentations to a tertiary
trauma centre
48
59. Testing the safety of multifocal pupillographic
objective perimetry (mfPOP) in patients with
photosensitive epilepsy
49
60. Driving Cessation in Later Life: Depressive
Symptoms and Coping
49
61. Automated perimetry in neurological visual
field loss
50
40
62. Putting the ‘GO’ into mobilisation in
ICU: Preliminary Results from the GoSAM Study
50
42. Calcium Balance During Hemodialysis
40
63.Interactive visualization of deep knee flexion, in
four dimensions and in vivo
51
43. Molecular insights into the loss of heparan
sulfate (HS) during islet isolation and HS
recovery after islet transplantation
41
64. Mapping symptoms of neurodegenerative disease
to the brain: a vision for a subcortical connectome
51
44. Comprehensive B cell phenotyping according
to normal ontogeny improves detection of
peripheral blood and bone marrow involvement
and demonstrates immunophenotypic and
genotypic diversity
41
Poster Presentations
52
1. Extending the Physiotherapy Repertoire:
Ventilator Hyperinflation allows more treatment
of ICU patients than Manual Hyperinflation—an
observational study
53
45. Mutations in Roquin prolong microRNA
longevity in Lupus mice
42
2. Caesarean Section Confers Survival Benefit for
Breech Premature Infants < 29weeks
53
46. Cellular responses to vaccination in the
assessment of immune competency
42
54
47. Newly acquired lymphoma-related somatic
mutations appear in relapsed DLBCL patients
43
3. Preventing falls and harm from falls— not just
a national priority! Results of the Falls Risk
Assessment Pilot Project
54
48. A novel deep sequencing method for tracking of
driver mutations in non-Hodgkin lymphoma
43
4. Have we kept the pressure down? Results from
the 2014 pressure injury audit
55
49. Human T follicular regulatory cells signal
directly to germinal centre B cells using IL-10
44
5. Attitudes and knowledge towards management
of novel oral anticoagulants (NOACs): a survey
of hospital clinicians
50. Identifying the rate of Monoclonal B cell
Lymphocytosis in Patients diagnosed with
Primary Autoimmune Cytopenia
44
6. The Role of DOCK8 in antibody formation and B
cell memory response
55
56
51. DOCK8 is critical for the survival and function of
NKT cells
45
7. Herpes Simplex Virus Type I viral gene
expression and latency
56
52. Whole exome sequencing in early-onset cerebral
SLE identifies a pathogenic variant in TREX1
45
8. Glutathione transferase Omega 1 is a
novel redox regulator of TLR4-dependent
inflammatory signalling in macrophages
53. RBP atlas: an exploration of interactions
between mRNA and proteins and their impact
on cardiomyocyte biology
46
9. Comparison and synthesis of current Australian
guidelines on the management of obese adult
patients in General Practice
57
54. Non-immune islet β-cell susceptibility to failure
in NODk mice
46
10. A point prevalence survey of healthcare
associated urinary tract infections: be cautious
of cautis but not haughty about HAUTIS
57
34. Our children’s health: Results of the ACT
General Health Survey
36
35. Identification of a novel right ventricular
cardiomyopathy in two Collaborative Cross
(CC) strains
37
36. Sustainability of bed management changes
targeting ed overcrowding
37
37. Adverse patient outcomes within 24 hours of
ward admission from the ED: A retrospective
analysis of the Modified Early Warning Score
(MEWS)
38
38. Treating overweight and obese adults in
General Practice – a systematic review
38
39. Learning about endometriosis and selfmanagement of illness: an exploratory study of
advanced practice nurse education for females
with endometriosis and pelvic pain.
39
40. Role of adipose tissue in the pathogenesis of
non-alcoholic steatohepatitis (NASH) in high fat
fed foz/foz mice
39
41. Novel immunotherapy using Complete
Freund’s Adjuvant
11. NODk compared to C57BL/10 Mice are more
Prone to Islet Beta-Cell Failure Due to Greater
Susceptibility to Endoplasmic Reticulum Stress.
58
32. Spirituality in Successful Aging: Data from the
Singapore Successful Aging Study (SSOSA)
68
12. Endothelial Connexin40 regulates ActivityDependent Blood Pressure
58
33. High dietary iron synergises with high fat
feeding in causing acute pancreatitis in
Sprague-Dawley rats
69
13. End of Life Care and ICU
59
34. Compliance with international guidelines and
readability of informed consent forms for
cancer clinical trials
69
14. Developing trauma-informed and traumaspecific services for child and adolescents who
access Mental Health Services
59
35. The importance of the 6 minute walk test in
cardiac rehabilitation.
70
15. Characterizing epigenetic signatures that mark
transcriptional memory responsive genes in
human T lymphocytes
60
36. The 6 minute walk test in cardiac rehabilitation;
differences between surgical and non-surgical
populations
70
16. User friendly method of rat kidney transplant
60
17. Incorporating Advanced Three-Dimensional
Left Ventricular Imaging into Routine Clinical
Practice (Baseline Study)
61
37. “Timed Up and Go” results in the Exercise
Physiology Department
71
71
18. The evidence for cervical muscle morphometric
changes after whiplash: A systematic review
and meta-analysis
61
38. Clinical characteristics and outcome in a series
of patients with psychogenic (conversion)
movement disorders in a neuropsychiatry clinic
72
19. Immunophenotyping of monocytic myeloidderived suppressor cells in DLBCL and
investigating its potential association with
lymphocytopenia – a pilot study
62
39. miRNA biomarkers for early prediction of adverse
pregnancy outcomes in obese pregnant women
40. Increasing physiotherapy treatment time
for stroke patients in acute care at Canberra
Hospital and Health Services.
72
20. Neonatal mobile imaging: Establishing
consistency and reducing dose
62
73
21. Cardiac Pacemaker Procedure and
Complications in Canberra Hospital in 2012
63
41. The impact of moderate chronic kidney disease
on 1 year outcomes after percutaneous
coronary intervention
42. Patients’ quality of sleep at Canberra Hospital
73
22. Routine culture-based screening versus
risk-based management for the prevention of
early-onset group B streptococcus disease in
the neonate: a systematic review.
63
43. The effect of noise on patient sleep within
Medical Wards
74
74
23. Research protocol on suicide and contributing
factors in the ACT
64
44. How can we look after ICU survivors better?
A benchmarking study.
45. MaskED Simulation in the Health Classroom
75
24. Redesigning ACT Health Psychology workforce
to meet National Psychology Board Australia
requirements
64
46. Trichofolliculoma-like lesion of the vulva
associated with vulvar intraepithelial neoplasia
– a case report.
75
25. Education of nurse practitioners: findings
of a project exploring advanced specialty
competence, clinical learning and governance
65
47. Myoepithelial carcinoma ex pleomorphic
adenoma – case report
76
76
26. FISH (Fluorescent In situ Hybridisation) on
trephine imprints to achieve cytogenetic results
on ‘dry tap’ bone marrow collections
65
48. Provision of a Physiotherapy Service at the
Alexander Maconochie Centre: A Scoping
Project
77
27. The treatment of community acquired
pneumonia in HITH
66
49. Compartment Syndrome – Presentations and
Principles
66
50. Shifting targets: microRNA and mRNA 3’-end
variants in cardiac hypertrophy
77
28. Novel Biomarkers & Therapeutic Targets for
Systemic and Specialised Vascular Diseases
78
29. Reporting on a proof of concept plan for
national online surveillance of healthcare
associated urinary tract infections
67
51. ACT Health Extended Scope Physiotherapy:
“Perspectives Matter”
52. Plastics Outpatient Clinic X-Ray On Admission
Ordering Procedures: A Clinical Audit
78
30. Phenibut – a legal toxidrome
67
53. Predictors of slow colonic transit in children
79
31. Flexible Fibre-optic Bronchoscopy, Obesity
and Sleep Disordered Breathing: Patients
Characteristics and Complications in 221 Cases
68
54. Developing a model for studying late effects of
ednrb malfunction on brain development.
79
August 12th – 15th, 2014 | 3
55. Increased use and decreased cost
effectiveness of ultrasound in abdominal pain:
changes over a decade
80
76.The Emergency Department Post-admission
Round Pilot Project
90
56. Closed gastroschisis as a cause of midgut
atresia: report of two cases
80
77. Project Venturi: Discharge Summary and
Medication Prescriptions Survey
91
57. Familial Chronic Intestinal Pseudo-Obstruction
presenting as Sigmoid volvulus segregates
with an enteric actin mutation.
81
78. Sarcomatoid Hepatocellular Carcinoma – An
Aggressive Tumour Diagnosed in a Young Female
91
92
58. Antimicrobial resistance among urinary tract
infection isolates of Escherichia coli in an
Australian population-based sample
81
79. Growth and development follow up: Making a
difference in a baby’s future!
80. Importance of regular post-assessment in a
new Heart Failure Rehabilitation Course
92
59. Family Centred Developmental Care: A New
Beginning for Neonatal Intensive Care and
Special Care Nursery
82
81. Autosomal dominant B cell deficiency with
alopecia due to a mutation in NFKB2 that
results in non-processible p100
93
60. Planning a sustainable health workforce for
ACT Health
82
93
61. Helicobactor-induced gastric cancer:
Identification of ER stress effectors associated
with the development of precancerous disease
83
82. Establishment of a Tissue Viability Unit at
Canberra Hospital—Nurse Led Advancement in
Health Services
83. Pyloric Stenosis in Preterm Twins -Three
Case Histories
94
62. Comparison of short term outcomes of extremely
premature neonates with Patent Ductus
Arteriosus in surgical and non-surgical centres
83
94
63. Improving the Management of Pelvic
Inflammatory Disease Through Clinical Audit
84
84. What are the clinical and workforce impacts of
Unplanned Personal Leave (UPL ) in the nursing
population at Canberra Hospital Intensive Care
Unit (ICU)?
95
64. ERp29\MGMT axis confers resistance to
ionizing radiation in breast cancer cells
84
85. CeasIng Cpap At standarD criteriA (CICADA):
Implementing CICADA reduces CPAP duration
95
65. Nurse Led Clinic For Patients Post
Radiation Therapy
85
86. Are there benefits to having onsite blood
borne virus screening at an opioid treatment
service? A review of data collected during the
implementation of interagency collaboration.
66. Effects of elevated fatty acids and/or glucose
on glucose metabolism pathways in human
trophoblasts
85
87. Is there functional quality of life after ICU?
A systematic review
96
67. Improving Sexual Health Care for Aboriginal
and Torres Strait Islander Youth in the ACT
86
88. Feasibility and accuracy of a novel right
ventricular real time three-dimensional
Echocardiograph tool within a clinical setting
96
68. Comparison of staff walking distances: Open
plan vs two cot design
86
89. Communicating endometriosis with young
women to decrease diagnosis time
97
69. Participating in clinical bedside rounds: Staff
and parent focus groups
87
90. Incorporating Velocity Vector Strain Imaging
into Routine Clinical Practice (Baseline Study)
97
70. Canberra Hospital Cardiology Outpatients
“Patient Experience Survey” (Pilot Study)
87
91. Improved energy and protein provision for
critically ill patients in Canberra Hospital
98
71. Carbon nanotube/ultrahigh molecular weight
polyethylene composite as a novel electro-active
sensing material for orthopaedics applications
88
92. CPAP usage patterns in a consecutive series
of patients during and after physician -led
acclimatisation programme
98
72. Improved flow associated with streaming in an
enlarged ED without changes in staffing.
88
93. The Burden of Geriatric Readmissions in
Canberra Hospital
99
73. The perspectives of obese women receiving
antenatal care: A qualitative study of women’s
experiences
89
94.Identifying and tracking autoimmune-inducing
T cell clones in Aire-/- Cblb-/- mice
99
74. Intravesical gemcitabine (GEM) versus bacillus
Calmette-Guérin (BCG) for the treatment of
non-muscle invasive bladder cancer
89
95. Changing epileptic activity in the primary
olfactory cortex: what a shock!
100
100
75. Determinants of Road Crash Severity in the ACT
90
96. An evaluation of the antimicrobial activity
of kunzea oil, in comparison with other
commercial myrtaceous essential oils
97. The therapeutic potential of glutathione
transferase M2-derived peptides to treat heart
failure through cardiac ryanodine receptor Ca2+
channel inhibition
101
117. Introduction of a General Medicine Unit to a
Tertiary Hospital and Effects on Length of Stay
in the Medical Assessment and Planning Unit
111
98.Further evidence of a lack of interaction
between APOE and late-life blood pressure in
predicting cognitive decline: The PATH Through
Life Study
101
118. A Case of Cytogenetic evidence supporting the
diagnosis of Double-Hit (DH) Lymphoma
111
112
99. Characterisation of Escherichia coli B2 strains
from waters of Sydney and Gold Coast regions
102
119. Reduced Adipose Inflammation through
Exercise Improves Insulin Sensitivity and
Confers Hepatoprotective Effects in Hyperphagic
Obese Mice
100. Escherichia Coli in poultry meat: Prevalence,
resistance and virulence
102
120. Sunitinib therapy for metastatic renal cell
carcinoma (mRCC) in elderly patients (age 70 and
older): a multi-institutional Australian experience
112
101. Enzymology and molecular function of
5-methylcytosine (m5C) as a modification
of human RNA
103
121. Acute abdomen in a diabetic patient: Ischaemic
bowel or Metformin Associated Lactic
Acidosis?
113
102. Characterization of the interactions between
RNA and ‘moonlighting’ metabolic enzymes
in rodent cardiomyocytes and their change in
response to stress
103
122. Trafficking and function of the malaria protein
PIESA2 in parasite-infected human red blood cells
113
114
103. Identifying the drug binding sites of the mulitdrug efflux pump, P-glycoprotein
104
123. A new function for testis-specific histone
variants in cancer.
114
104. An exploratory study on the safety and efficacy
of kunzea oil containing formulations for the
management of psoriasis
104
124. Diffuse effects of an endothelin b receptor
(ednrb) mutation: more on the non-enteric
phenotype of Hirschsprung disease.
115
105. Mahara an electronic portfolio system
for recording of continuous professional
development (CPD) and competency for nurses
105
125. Physician-Led Multidisciplinary Positive Airway
Pressure Therapy Acclimation Experience from
Canberra Hospital Registry
115
106. Results from the introduction of a Nurse Led
Clinic for Patients after Radiation Therapy
105
126. Modeling and parameter identification of gene
regulatory networks in human osteoblasts
CHARM sponsors
116
107. Evaluation of the one-day Questionnaire Design
Introductory Course (QDIC)
106
Sponsored Research Awards
122
108. Translating evidence into practice: An action plan
for promoting patients’ sleep at Canberra Hospital
106
109. The effect of noise on patient sleep in the
Medical Wards at Canberra Hospital
107
110. Behavioural modification of healthcare
professionals in an adult critical care unit to
reduce nocturnal noise: An evidence based
implementation project
107
111. What hath night to do with sleep: Noise levels
in the ICU
108
112. Supporting parents during neonatal transfer:
development of the ACT NETS brochure
108
113. The emotional wellbeing of women after
cardiac surgery
109
114. Implementing the National Perinatal
Depression Initiative in the ACT
109
115. Nurses and Midwives perceptions of their
rosters at an acute public hospital
110
116. Evaluation of the University of Canberra’s
Academic Mentor Model (UCAMM) for clinical
supervision of student nurses
110
August 12th – 15th, 2014 | 5
ORGANISING COMMITTEE
Chair
Dr Hannah Clarke
ACT Health Research Office
Treasurer
Mr Matthew Wafer
Members
Dr Marian Currie
Research Centre for Nursing and Midwifery Practice, ACT Health
Dr Diana Perriman
Trauma and Orthopaedic Research Unit, ACT Health
Dr Jennie Scarvell
Physiotherapy Faculty of Health, University of Canberra
Dr Danica Robinson
Research and International Office UNSW Canberra
Mr Matthew Wafer
Mrs Minu Mathew
Ms Ayumi Hoska
Mr Bee Souvannaphong
Administrative Support
SCIENTIFIC REVIEW COMMITTEE
Professor Christian Lueck
ACT Health and ANU Medical School
Professor Matthew Cook
ACT Health and The John Curtin School of Medical Research ANU
Professor Paul Pavli
Professor Julia Potter
Professor John Biggs
Visiting Fellow, ANU
Associate Professor Desmond Yip
Associate Professor Kieran Fallon
ANU Medical School
Adjunct Associate Professor Marian Currie
ACT Health and ANU Medical School and The University of Canberra
Associate Professor Mark Pickering
UNSW Canberra
Dr Deborah Heydet
The University of Canberra
Dr Ashwin Swaminathan
Dr Dipti Talulikar
Dr Ian Parish
The John Curtin School of Medical Research ANU
Dr Pranav Dorwal
College of Medicine, Biology and Enviroment, ANU
Dr Katrina Randall
Dr James D’Rozario
Dr Louise Morauta
Chair ACT Health Human Research Ethics Committee
Dr Alesia Ivashkevich
ACT Health
Dr Elizabeth DeSilva
Dr Hannah Clarke
Dr Aude Fahrer
Dr Sharon Pok
ANU Medical School
Dr Andrew Ziokowlski
ACT Health
Dr Sean Geogehan
ACT Health
Dr Bruce Shadbolt
ACT Health
Dr Dohai Zhang
ACT Health
Dr Lucy Coupland
Dr Claire O’Brien
ANU Medical School
Ms August Marchesi
ACT Health
Dr Helen Gustaffson
ACT Health
Dr Gordon Waddington
Dr Diana Perriman
ACT Health
Dr Emma Southcott
ACT Health
Ms Rosalyn Stanton
ACT Health
Mr Matthew Wafer
ACT Health
Mr Joe Lynch
ACT Health
Dr Oyebola Fasugba
Australian Catholic University
Mr Peter Lisacek
August 12th – 15th, 2014 | 7
OUR SPONSORS
The Canberra Health Annual Research Meeting Committee
would like to thank our partners and sponsors in this event
PLATINUM SPONSORS
Canberra Hospital Foundation
Australian National University College of Medicine, Biology & Environment
GOLD SPONSOR
University of Canberra and the Australian Institute of Sport
SILVER SPONSORS
University of New South Wales Canberra
Australian Catholic University Canberra
Thermofisher Scientific
SteriHealth
BRONZE SPONSORS
Hospital IP ACT and ACT Health Intellectual Property office
Canberra Hospital Radiation Oncology Private Practice Trust Fund
Sports Medicine Australia Canberra Branch
National Science Week Canberra
AWARD SPONSORS
Canberra Hospital Radiation Oncology Private Practice Trust Fund
ACT Health Human Research Ethics Committee
University of New South Wales Canberra
Canberra Hospital Private Practice Fund
Professor Guan Chong
DiscoverQuick
CHARM 2014 TIMETABLE
Tuesday
12th August
Wednesday
13st August
Thursday
14th August
Friday
15th August
9.00
REGISTRATION
REGISTRATION
REGISTRATION
REGISTRATION
9.15
Robert De Castella
9.30
9.45
Paediatrics and
NICU Research
Trama and
Orthopaedic Research
Emergency
Medicine Research
Gastroenterology and
Hepatology Research
10.00
AbstrACT
AbstrACT
AbstrACT
AbstrACT
10.15
Associate Professor
Professor
Imogen Mitchell,
ACT Health,
ANU Medical School
Adjunct Associate
Professor
Marian Currie,
ACT Health,
ANU Medical School
Professor
Rachel Davey,
University of Canberra
Professor
Nicholas Glasgow,
ANU Medical School
10.30
MORNING TEA
MORNING TEA
MORNING TEA
MORNING TEA
Cancer Research
General Health
Research
General Health
Research
General Health
Research
Prof Lindsay Grayson,
Director, Infectious
Diseases & Microbiology
Department,
Austin Health
Dr Norman Swan,
multi-award winning
broadcaster
and journalist
Prof Peter Chong,
Sir Hugh Devine Chair
of Surgery, and Head of
Department of Surgery
University of Melbourne
Dr Charlie Teo,
Director of Sydney’s
Centre for Minimally
Invasive Neurosurgery
LUNCH
LUNCH
LUNCH
LUNCH
RCNMP & Allied Health
Research
Immunology,
Heamatology and
Diabetes Research
10.45
11.00
11.15
11.30
11.45
12.00
12.15
12.30
12.45
13.00
13.15
13.30
14.00
Human Research
Ethics Session
15.00
Research:
How to do it well
16.00
17.00
18.00
Poster Presentation
Wine and Canapés
Conference Awards
Dinner, The Great Hall
University House ANU
August 12th – 15th, 2014 | 9
KEYNOTE SPEAKERS
“SUPERBUGS IN THE SUPERMARKET?
Why the future of antibiotics is linked to food and what Australia can do about it”
Prof. M. Lindsay Grayson, Infectious Diseases Dept., Austin Health, Department of
Medicine, University of Melbourne, Melbourne, Australia
In the space of about two human generations, antibiotics have been so misused that
the emergence and spread of pathogens resistant to all available agents is now almost
inevitable. Combine this with a massive reduction in new drug development and a future
without effective antibiotics requires genuine consideration. So – how will we manage?
While efforts to slow the emergence of new multi-drug resistance (MDR), such as
antibiotic stewardship in hospitals are laudable and necessary, the time has largely
passed for these to be particularly effective. Instead we need to focus on efforts to
reduce cross-transmission of existing MDR clones through improved application
of basic infection control concepts that in many cases were developed in the
pre-antibiotic era. In particular, 5 key areas need attention: Improved hand hygiene;
National Standards for hospital cleaning; National Standards for the insertion
and maintenance of invasive devices; Improved hospital design (“One bum per toilet”) and Tightening of antibiotic
prescribing and use.
However, all these initiatives are likely to have limited impact if we do not control the emergence of MDR gut bacteria and their
spread via contaminated food and water. The massive increase in antibiotic and antifungal use in intensive food production
in Europe and Asia is resulting in widespread environmental contamination with MDR pathogens and drug residues such
that acquisition of MDR resistance genes is now common in many regions. Since gut bacteria are the usual source of intraabdominal infections, urinary tract infections and septicaemia associated with immunosuppression (e.g. cancer chemotherapy
and transplantation), MDR acquisition can have major clinical impact. Within the agricultural sector, the time has come to ban
all non-therapeutic antibiotic use worldwide and adhere to avoiding animal use of agents on the World Health Organization list
of “Critically Important Antimicrobials for Human Medicine”.
Currently Australia has regulations to test local and imported food for drug residues but no requirement for these foods
to be free of MDR pathogens. Furthermore, current policing and testing schedules are very limited. Recent surveys of
Australian-produced meat suggest widespread surface contamination with extended-spectrum beta-lactamase (ESBL)
producing Gram-negative bacteria, but these are currently rarely resistant to multiple drug classes. Thus, with concerted
legislative action and the implementation of a national “One Health” program to controlling antimicrobial misuse in both
humans and agriculture, there is a narrow opportunity to avoid an otherwise inevitable “tsunami” that will takes us back
to a pre-antibiotic era.
WHY IS PRACTICAL DISCOVERY SO SLOW? GETTING BENEATH THE BULL
IN TRANSLATION
Dr Norman Swan, Multi-award winning broadcaster, journalist and health commentator.
Dr Norman Swan hosts The Health Report on the Australian Broadcasting
Corporation’s Radio National, and Tonic on ABC News24 (Television). The Health
Report is probably the world’s longest running health programme and Norman
has won many awards for his work including Australia’s top prize for journalism,
the Gold Walkley. He trained in medicine in Scotland and paediatrics in London and
Sydney before joining the ABC and has hosted many other programmes on radio
and television. He ran Radio National in the early 90s and created shows such as RN
Breakfast, Life Matters and Late Night Live with Phillip Adams. Norman has also
been the medical host on Channel Ten’s Biggest Loser for the past five seasons.
Norman created, wrote and narrated Invisible Enemies, a four part series on disease
and civilisation for Channel 4 UK and broadcast in 27 countries. He has consulted
to the World Health Organisation and, for example, co chaired a global meeting
of health ministers in Bamako West Africa focused on evidence based policy and
priorities in health research. THE CHALLENGE OF ACADEMIC SURGERY IN THE NEW MILLENIUM
Professor Peter F.M. Choong, Sir Hugh Devine, Chair of Surgery, Head of University
of Melbourne Department of Surgery, St. Vincent’s Hospital
Academic surgery, which is the basis for all surgical care, has contributed
significantly in the areas of patient and disease oriented research, and from which
many advances in care and improvements in outcomes have followed. Academic
surgeons today are not only clinicians, but also teachers, researchers and
administrators. They bring together the acquisition of knowledge through discovery
and transfer this knowledge through teaching and training while inciting creativity
and innovation to develop the safest, most effective and efficient ways for delivering
surgical care.
At a time of great community demand, surgery as a specialty may be facing a
decline in popularity amongst future doctors. The reasons for this are multifactorial
but are likely to be an amalgam of changing lifestyles and professional experiences
encountered from early medical student days, to residency and beyond.
Understanding the perspectives that students, residents, trainees and surgeons
hold for choosing a career in surgery, and how the current system supports academia may give some insight into why
surgery as a vocation is declining.
Strategies to support and grow academic surgery into the future should be at the forefront when planning the medical
workforce of the future whether at the university, institutional or governmental levels.
August 12th – 15th, 2014 | 11
“THE CHANGING FACE OF NEUROSURGERY”
Dr Charlie Teo Neurosurgeon, Director of Sydney’s Centre for Minimally Invasive
Neurosurgery, Founder of the Cure for Life Foundation.
Dr Teo is an internationally acclaimed neurosurgeon and a pioneer in keyhole
minimally invasive techniques. He has been invited to many distinguished
universities in over 50 countries as Visiting Professor, including the Karolinska
Institute, Vanderbilt, Stanford and Johns Hopkins universities. Dr Teo has published
over 100 articles in peer-reviewed journals and authored 2 books on keyhole
techniques in neurosurgery. He is the past President of ThinkFirst Australasia,
the Director of the Centre for Minimally Invasive Neurosurgery, the Australian
representative for the Tumor Section of the AANS and CNS and the Founder of the
Cure for Life Foundation that has raised over $8 million for brain cancer research.
Dr Teo has been recognised with awards from Rotary International, including the
Paul Harris Fellowship (for contribution to World Health), the Brainlab Community
Neurosurgery Award by the Congress of Neurological Surgeons and as a finalist in
the NSW Australian of the Year awards in 2003 and 2009. In the 2011 Australia Day
awards he was named as a Member of the Order of Australia and in 2012 was given
the honour of delivering the Australia Day Address to the Nation. Charlie is a father to 4 beautiful girls and when not
performing brain surgery is proud to support his 2 favourite charities, the Cambodian Children’s Trust, which runs an
orphanage in Battambang, and Voiceless, which funds legislative reform for the prevention of cruelty to industrial and
farm animals.
PREVENTION, AS SIMPLE AS LEFT FOOT / RIGHT FOOT, BUT AS DIFFICULT AS
A MARATHON – SOME LESSONS LEARNT
Robert de Castella AO MBE, Founder & Director of The Indigenous Marathon Project
Foundation Ltd, Rob de Castella’s SmartStart for Kids Ltd
In 1999, after a life in elite sport, I developed and launched a program to address
child obesity, SmartStart for Kids (SSFK) and the HEELP, (Health Eating, Exercise
and Prevention Program). Since then SSFK has conducted over 52,000 physical
screenings with children, and put 1,000s of children through our intervention.
In 2010, following on from successfully taking four NT/WA Aboriginal men from
no running to finishing the New York City Marathon in 9 months, I developed the
Indigenous Marathon Project (IMP). IMP helps address the gap between Indigenous
and non-Indigenous Australians in life expectancy, chronic disease, education,
employment, incarceration and suicide.
Now, reflecting back over the last fifteen years, I look forward to sharing some
observations, achievements and even some frustrations.
WORKSHOPS
ACT HEALTH HREC: CAN WE DO BETTER?
2:00PM – 3.30PM
TUESDAY 12 AUGUST
This session will look at whether it is possible for the
HREC, ACT Health and the research community working
together to improve HREC outcomes. If success means
being approved in full at the first meeting where a
proposal is considered, in 2013 only 27 per cent of
proposals were successful at HREC and 55 per cent of
proposals at the Low Risk Committee out of a total of
294 proposals across both committees. Resubmissions
were required for 24 per cent of HREC proposals. A
number of speakers will discuss options for improving
outcomes from HREC decisions and there will be time
for comments and discussion from the floor.
Chair of session: Professor Charles Guest, Director of
Research, ACT Health
Dr Louise Morauta, Chair ACT Health HREC: What
happens to proposals when they go for ethics review
and what do these results mean?
Associate Professor Frank van Haren, Deputy Chair,
HREC: Implications of results and looking forward
EXTERNAL COMMENTATORS:
Professor Larry Saha, Chair, Australian National
University HREC (invited)
Professor Craig McDonald, Deputy Chair, University of
Canberra HREC
Dr Jason Mazonov, Chair Social Research SubCommittee of ACT Health HREC : What researchers
using social research methods need to do better
ACT HEALTH INTELLECTUAL
PROPERTY OWNERSHIP,
PROTECTION, DEVELOPMENT AND
COMMERCIALISATION
3:30PM – 4.00PM
TUESDAY 12 AUGUST
Dr Deborah Kuchler, Professor Paul Smith, Marcus St
John Dawe and Bill Mobbs
ACT Health Intellectual Property Office, and Hospital
Intellectual Property ACT Limited Canberra, ACT.
[email protected]
Intellectual property plays an essential role in driving
innovation by providing a basis for return on investment
in research and development. Like other Health entities
within Australia, the ACT Health has an intellectual
property policy that stipulates intellectual property must
be protected and developed.
Aspects of ACT Health’s intellectual property policy
will be outlined. The risks in not adequately managing
intellectual property in a hospital environment will
be discussed. Drawing on ACT Health intellectual
property case studies, the presentation will highlight
some of the key issues relating to the identification and
commercialisation of intellectual property in a research
setting, including ownership, protection, development
and commercialisation.
Various forms of intellectual property protection options
will be outlined together with strategies on how to
protect and publish.
Professor Walter Abharayatna, Chair, Clinical Trials SubCommittee of ACT Health HREC: Do QA/QI projects need
ethics approval? – recent developments
August Marchesi, Secretary, ACT Health HREC: How can
we get a better success rate on Patient Information and
Consent Forms?
DISCUSSION
Professor Charles Guest, Director of Research, ACT
Health: A comment from ACT Health perspective
Dr Louise Morauta, Chair ACT Health HREC: Summing up
August 12th – 15th, 2014 | 13
WORKSHOPS
RESEARCH WORKSHOP: CLINICAL
RESEARCH FOR DUMMIES
HAEMATOLOGY RESEARCH
TISSUE BANK
4:00PM – 4.30PM
TUESDAY 12 AUGUST
11:50AM – 11.55AM
THURSDAY 14 AUGUST
Chair: Hannah Clarke, Director of Research Operations,
ACT Health Research Office. Presenters: Marian
Currie A/g Director – Research Centre for Nursing and
Midwifery Practice (RCNMP), ACT Health, Adjunct A/
Professor University of Canberra and the Australian
National University , Director, Australian Capital
Regional Centre for Evidence-Based Nursing and
Midwifery: Affiliate Centre of Joanna Briggs Institute.
Diana Perriman, Clinical Research Coordinator, Trauma
and Orthopaedic Research Unit, Canberra Hospital.
E-mail: [email protected]
The Haematology Research Tissue Bank is an important
resource for researchers working on haematological
and related disorders such as acute myeloid and
lymphoid leukaemia, chronic lymphoid leukaemia,
other lymphoproliferative disorders, myeloproliferative
neoplasms and non-malignant haematological
conditions. The bank holds peripheral blood, bone
marrow and tissue samples which are processed
and stored as mononuclear cells, cell pellets, trizol
preparations and plasma. It has supported several
projects and collaborations at Canberra Hospital and
Australian National University, and more recently,
projects from interstate.
Clinical Research is essential to improving clinical
outcomes but the process is often not as obvious as we
would like and getting started can be daunting. In order to
perform ethical and meaningful research practitioners need
to be specifically educated in research theory and practice.
The aim of this session is to provide a basic guide
through the clinical research process including
highlighting our top tips for starting a successful clinical
research project. These tips will include: finding a
mentor, gathering your resources, nailing the question,
designing the study, and planning your analysis and
reporting.
This session is targeted at health professionals, who are
interested in research but are unsure about the process
and where to start. The workshop will be very interactive
so please bring your research ideas and experiences
along to share.
Please direct enquiries to Dipti Talaulikar, Department of
Haematology at [email protected].
August 12th – 15th, 2014
Canberra Hospital Auditorium
DAILY TIMETABLE
Tuesday 12 August
9.00
REGISTRATION
9.15
Opening - Robert De Castella, AO MBE, Founder & Director The Indigenous Marathon Project
Foundation Ltd, Rob de Castella’s SmartStart for Kids Ltd
Paediatrics and NICU Research Session
9.30
Kane Wu – Heritability of childhood constipation
9.40
Nola Wong “Getting the first birth right” A retrospective study of birth outcomes for primiparous
women receiving standard care in the birth suite versus continuity of midwifery care in the
Birth Centre at Canberra Hospital
9.50
Seren Ovington Development of a neonatal early warning score to detect deteriorating neonates
10.00
AbstrACT – Professor Imogen Mitchell,
ACT Health, ANU Medical School
10.30
Morning Tea
Cancer Research Session
10.50
Shayla Wu A new function for testis-specific histone variants in cancer. 11.00
Alesia Ivashkevich Evaluation of scattered synchrotron radiation with physical and biological dosimetry
11.10
Santhi Achtuam Targeting glucose metabolism — a strategy for overcoming drug resistance in breast cancer 11.20
David Larkin An intervention for cancer-related fatigue in men treated for prostate cancer: Energy
Conservation and Management.
11.30
Yada Kanjanapan Benefit of adjuvant trastuzumab with chemotherapy (ATWC) in T1N0 HER2 positive
breast cancer- interim results
11.40
Roopa Lakhanpal Predictive value of Immunohistochemical 4 plus Clinical Treatment Score in
determining risk of Loco Regional Recurrence in Early Breast Cancer. 12.00
Prof M. Lindsay Grayson
Director, Infectious Diseases & Microbiology , Austin Health
13.00
Lunch
14.00
Human Research Ethics Commitee Workshop
15.30
Intellectual Property Information Session
16.00
Research: How to do it well
August 12th – 15th, 2014 | 15
Wednesday 13 August
9.00
REGISTRATION
Trama and Orthopaedic Research Session
9.15
Joe Lynch Abnormal knee kinematics during step and turn following multiple-ligament knee reconstruction
9.25
Dianna Perriman How reliable is Computer Assisted THA Polyethylene Wear Measurement with Current
Radiography Practices?
9.35
Michael Adhern Dislocation following total hip replacement, a descriptive study of common factors and
treatment in Canberra
9.45
Rachel Li Biodegradable Magnesium Yttrium (Mg-Y) Alloy Promotes Osteogenic Differentiation of
Human Mesenchymal Stem Cells (hMSCs) 10.00
AbstrACT - Adj A/Prof Marian Currie Nursing and Midwifery Research Current Opinions
10.30
Morning Tea
General Health Research Session
10.50
Adrian Rumore The relationship between the measures of postural sway, mechanical pain threshold
testing and self-ratings of pain and disability in chronic neck pain sufferers
11.00
Valissa Aplin Recognising trauma and adversity in young people and their families who access the
ACT Child and Adolescent Mental Health Service 11.10
Hasibul Haque Poor minimal trauma fracture treatment as a cause of subsequent hip fractures in the elderly 11.20
Rebecca Kathage What sort of strategies are acceptable to primary caregiver when informing them of a child’s Body
Mass Index (BMI) result as gathered through The Kindergarten Health Check (KHC)? What type of information do
primary caregivers find helpful in regard to potential management options to follow up a BMI result of their child? 11.30
Fang-Bao Tian A 3D numerical simulation of vocal-fold vibrations
11.40
Lara Morris Health Behaviours in the Capital
12.00
Dr Norman Swan – Multi-award winning broadcaster, journalist and health commentator
13.00
Lunch
RCNMP & Allied Health Research Session
14.00
Irene Lake Essential nursing care: how well are we doing it in 2014? 14.10
Elizabeth Chalker What are young people telling us about their health-related behaviours? Results from
the ACT Secondary Students’ Alcohol and Drug Surveys (ASSAD) 14.20
David Larkin Comparing the support needs of men with prostate cancer and their significant others.
14.30
Kevin Kidd Use of the Ward Atmosphere Scale to gauge the link between milieu and environment
14.40
Shannon Woodward M-Clinic: Expanding access to HIV testing for Men who have Sex with Men in the ACT 14.50
Ann Burgess What women want: A national audit of access to a midwife in the immediate postnatal period 15.00
Barbara Conroy AINs as additional staff in an acute medical ward for the elderly:
Staff perceptions of this initiative 15.10
Marian Currie The economic and social value of Telephone Triage and Advice Services (TTAS):
A rapid review of the literature. 15.20
Lauren Brooks Innovations in Workforce Retention for the Clinical Measurement Sciences Team
15.30
Vince Marzano Ventilator Hyperinflation - Safety and feasibility of translating evidence into practice in ICU 15.40
Bernie Bissettt Weaned but weak and weary: Inspiratory muscle weakness and raised perceived exertion
in adults following 7 days of mechanical ventilation.
15.50
Deborah Schaler Patient feedback: improving health care safety and quality?
16.00
Lynn Cheong Primary health care teams: A social network analysis 16.10
Kate Carnall Beyond childbirth-related trauma: a collaborative study to detect trauma and
posttraumatic stress symptoms in mothers. 16.20
Lindy Frtische Our children’s health: Results of the ACT General Health Survey
Thursday 14 August
9.00
REGISTRATION
Emergency Medicine Research
9.15
Leonard Arnolda Identification of a novel right ventricular cardiomyopathy in two Collaborative Cross
(CC) strains 9.25
Drew Richardson Sustainability of Bed Management Changes Targeting ED Overcrowding
9.35
Tim Fleming Adverse patient outcomes within 24 hours of ward admission from the ED: A retrospective
analysis of the Modified Early Warning Score (MEWS) 9.45
Elizabeth Sturgiss Treating overweight and obese adults in General Practice - a systematic review 10.00
AbstrACT- Prof Rachel Davey Public Health Research
10.30
Morning Tea
10.50
Genna Ward Learning about endometriosis and self-management of illness: an exploratory study of
advanced practice nurse education for females with endometriosis and pelvic pain
11.00
Tenzin Dagpo Role of adipose tissue in the pathogenesis of non-alcoholic steatohepatitis (NASH) in high
fat fed foz/foz mice 11.10
Christina Salmon Novel immunotherapy using Complete Freund’s Adjuvant 11.20
Richard Singer Calcium Balance During Haemodialysis
11.30
Fui Jiun Choong Molecular insights into the loss of heparan sulfate (HS) during islet isolation and HS
recovery after islet transplantation 11.40
Dipti Talaulikar Comprehensive B cell phenotyping according to normal ontogeny improves detection of
peripheral blood and bone marrow involvement and demonstrates immunophenotypic and genotypic diversity
12.00
Prof Peter Choong, Sir Hugh Devine Chair of Surgery, and Head of Department of Surgery St. Vincent’s
Hospital VIC
13.00
Lunch
Immunology, Heamatology and Diabetes Research
14.00
Monika Srivastava Mutations in Roquin prolong microRNA longevity in Lupus mice 14.10
Elizabeth da Silva Cellular responses to vaccination in the assessment of immune competency
14.20
Andrew Ziolkowski Newly acquired lymphoma-related somatic mutations appear in relapsed DLBCL patients 14.30
Yogesh Jeelall A novel deep sequencing method for tracking of driver mutations in non-Hodgkin lymphoma 14.40
Rebecca Sweet - Human T follicular regulatory cells signal directly to germinal centre B cells using IL-10
14.50
Nana Yaa G. Owusu-Tieku Identifying the rate of Monoclonal B cell Lymphocytosis in Patients diagnosed
with Primary Autoimmune Cytopenia
15.00
Break
15.30
Katrina Randall DOCK8 is critical for the survival and function of NKT cells
15.40
15.50
Julia Ellyard Whole exome sequencing in severe early-onset cerebral SLE identifies a pathogenic
variant in TREX1
Ya Lin Liao RBP atlas: an exploration of interactions between mRNA and proteins and their impact
on cardiomyocyte biology 16.00
Ainy Hussain Non-immune islet b- cell susceptibility to failure in NODk mice 16.30
Poster Viewing Event - Wine and canapés Evening
August 12th – 15th, 2014 | 17
Friday 15 August
9.00
REGISTRATION
Gastroenterology and Hepatology Research
9.15
Claire O’Brien Genetic analysis of Escherichia coli, focusing on adherent, invasive E. coli isolated from
Crohn’s disease patients 9.25
Evi Arfianti Exercise slows growth of dysplastic hepatocytes by improving insulin sensitivity and
enhancing DNA damage surveillance pathways in mice genetically predisposed to obesity and diabetes 9.35
Chloe Abbott Prevalence of Connective tissue disorders in Diabetes Mellitus and their links to diabetic
microvascular complications
9.45
Nushin Ahmed Horse related injury presentations to a tertiary trauma centre 10.00
AbstrACT - Prof Nicholas Glasgow 10 years of the ANU Medical School
10.30
Morning Tea
10.50
Ted MaddessTesting the safety of multifocal pupillographic objective perimetry (mfPOP) in patients
with photosensitive epilepsy 11.00
Sarah Walker Driving Cessation in Later Life: Depressive Symptoms and Coping
11.10
Brendan Tonson Older Automated perimetry in neurological visual field loss 11.20
Margot Green Putting the `GO’ into mobilisation in ICU: Preliminary Results from the GoSAM Study
11.30
Jennie Scarvell Interactive visualization of deep knee flexion, in four dimensions and in vivo 11.40
Jeff Looi Mapping symptoms of neurodegenerative disease to the brain:
a vision for a subcortical connectome
12.00
Dr Charlie Teo
Neurosurgeon, Director Sydney’s Centre for Minimally Invasive Neurosurgery,
Founder — Cure for Life Foundation
13.00
Lunch
18.30
Close of Conference Dinner, Great hall, University House, ANU, Acton
ORAL PRESENTATIONS
August 12th – 15th, 2014 | 19
ORAL PRESENTATIONS
1. Heritability of childhood constipation
Kane Wu
Mushira Mokhtar, GDH Croaker, Department of
Paediatric Surgery, Canberra Hospital, Canberra, ACT.
Introduction: Constipation is a common symptom,
and accounts for a large percentage of paediatric clinic
appointments. We have previously found that carriage
of mutations in the CFTR gene is associated with
constipation. In this study we ask “To what extent are
constipation symptoms heritable in general?”
Methods: Parents of children attending the constipation
clinic were asked to fill in a questionnaire about bowel
habit and family history. Answers were compared with a
control group.
Results: Parents of constipated children are no more
likely to admit to constipation than control parents, but
do have a significantly reduced stool frequency. 50%
of control parents admit to passing stool at least once
a day compared to 14% of constipation clinic parents
(p = 0.001). Of those study group parents who do give
a history of constipation, two thirds say it dates back
to childhood or infancy. There is slightly more rectal
bleeding, dietary modification, and abdominal pain and
bloating in the constipation group parents, although
these symptoms do not reach statistical significance.
In the family history 25% of siblings are also constipated.
15% of families have at least one individual with autism
spectrum disorder, and 45% have a family history of
allergic problems. 25% have a history of colon cancer in
the extended family.
Conclusion: Our results support the conclusion that
constipation tendency is heritable. There does seem
to be a link with irritable bowel syndrome, atopic
tendency, autism spectrum disorders, and possibly with
colon cancer.
2. “Getting the First Birth Right”
A retrospective study of birth outcomes
for primiparous women receiving
standard care in the birth suite versus
continuity of midwifery care in the birth
centre at Canberra Hospital
Nola Wong
University of Canberra ACT and Centenary Hospital
for Women & Children Canberra, ACT.
Introduction: The aim of this research is to inform our
understanding of the clinical outcomes of primiparous
women accessing varying maternity models of care at
Canberra Hospital in order to determine best practice
and assist future planning: to compare a retrospective
cohort of primiparous women who have accessed the
Canberra Midwifery Program (CMP) with those who
received standard public care at Canberra Hospital.
Methods: The study was conducted using data collected
from records held by Canberra Hospital for the period
1 January 2010 to 31 December 2011. A retrospective
comparative cohort study design was implemented
drawing on data from two databases.
Results: The study found significantly increased rates
of normal vaginal birth and spontaneous vaginal birth
and correspondingly decreased rates of instrumental
birth in the CMP cohort. There were fewer interventions
in the CMP group including: induction of labour, epidural
anaesthesia and use of narcotics in labour. There were
significantly increased rates of breast feeding initiation
within an hour of birth and early transfer home (within
24 hours of birth) within the CMP cohort.
Conclusion: This is the first local study comparing
clinical outcomes of different models of care. It
concentrates on mostly ‘low risk’ primiparous women
in the ACT. Continuity of midwifery care/carer has been
shown in this study to make a statistically significant
difference to some clinical outcomes for primiparous
women at this site.
ORAL PRESENTATIONS
3. Development of a neonatal early
warning score (NEWS) to detect
deteriorating neonates
4. A new function for testis-specific
histone variants in cancer
Seren Ovington , Nicole Slater , Zsuzsoka Kecskes
1
2
1,3
Australian National University Medical School,
Canberra, ACT 20002 Canberra Hospital, Canberra,
ACT3 Department of Neonatology, Canberra Hospital,
Canberra, ACT.
1
Introduction: Early warning scores are used
successfully in adults as essential patient safety
strategies. However, there is no such system for
neonates. The aim of this study was to develop an early
warning score for neonates and to assess its correct
use, and if it identifies sick neonates and leads to earlier
medical review in a postnatal setting.
Methods: A risk assessment and neonatal early
warning score (NEWS) was developed and trialled in
3 different settings during a 6 month period. Data of
babies born before and after the implementation of the
new system was collected. Outcome was defined as
MET calls or admission to higher care, i.e special care
or neonatal intensive care, or death. Data was was
analysied using SPPSS.
Results: Data of 100 babies (mean 38.4 weeks
gestation, mean birth weight 3276g, p=NS between
groups) showed that before implementation of NEWS,
only rarely were physiological observations done, even
when risk factors were present. Most babies required
higher care for reasons other than clinical deterioration.
However, NEWS identified more babies (15/108, 13.5%
vs. 11/115, 9.5%, p<0.05) deteriorating and led to timely
review and transfer.
Conclusion: The implementation of a risk assessment
tool and NEWS is beneficial to neonates.
Yu-Huan Wu1, Jane Dahlstrom2, David J. Tremethick1
and Tanya Soboleva1
Chromatin and Transcriptional Regulation Laboratory,
The John Curtin School of Medical Research, The Australian
National University. 2Australian National University Medical
School, Canberra Hospital, Canberra, ACT.
1
Chromatin is a highly dynamic and hierarchical structure.
Its main function is to package cellular genome in a
way that will allow the regulation of gene expression
and silencing. The basic subunit of chromatin is a
nucleosome, which is comprised of 8 histone proteins
and the DNA that is wrapped around the histone core. In
order to understand how chromatin regulates genome
function, we study histone variants, which can be viewed
as natural histone mutants, and provide an excellent
platform to investigate alterations in the structure and
function of chromatin in the presence of such variants.
Two histone variants, human H2A.Bbd and its mouse
homolog, H2A.Lap1, are unique tissue-specific histone
variants, which are expressed exclusively in the testis
and in the brain. We have shown that H2A. Lap1 is a
novel component of the Transcription Start Site (TSS)
of active genes expressed during specific stages of
spermatogenesis (1).
Here, we report that human H2A.Bbd histone variant has
an unexpectedly high expression levels in a subgroup
of human blood cancers. We have raised highly specific
polyclonal anti-H2A. Bbd antibodies and showed that
H2A. BBd protein is not only highly expressed in the
cancer cells but also successfully incorporates into the
chromatin of those cells. Considering that its mouse
homolog is involved in the activation of transcription
of testis-specific genes, many of those are the known
cancer-testis antigens (CTAs), it is anticipated that the
presence of H2A. Bbd in the chromatin of cancer cells
also drives expression of CTAs and other oncogenes.
Further experiments will also show if H2A.BBd can be
used is a novel tool for cancer detection/progression.
References: 1. Soboleva TA, Nekrasov M, Pahwa A,
Williams R, Huttley GA, Tremethick DJ. A unique H2A
histone variant occupies the transcriptional start site
of active genes. Nature structural & molecular biology.
2012 Jan;19(1):25-30. PubMed PMID: 22139013.
August 12th – 15th, 2014 | 21
ORAL PRESENTATIONS
5. Evaluation of scattered synchrotron
radiation with physical and
biological dosimetry
6. Targeting glucose metabolism—
a strategy for overcoming drug
resistance in breast cancer
Alesia Ivashkevich1,2;3, Pavel Lobachevsky2, Carl
N. Sprung3, Helen Forrester3, Andrew Stevenson4,
Christopher J. Hall4, and Olga Martin2,5
Santhi Achuthan and Anneke C Blackburn
Radiation Oncology, Canberra Hospital, Canberra,
ACT1, Molecular Radiation Biology Laboratory, Peter
MacCallum Cancer Centre, Melbourne, VIC, 30022,
Monash Institute of Medical Research, Monash
University, Melbourne, VIC, 31683, Australian
Synchrotron, Melbourne, VIC, 31684, and Division
of Radiation Oncology and Cancer Imaging, Peter
MacCallum Cancer Centre, Melbourne, VIC, 30025
Introduction: Microbeam radiation therapy (MRT) is a
novel normal tissue sparing mode of cancer treatment.
Scattered radiation alone with ROS and cytokine
signaling results in abscopal/bystander effects described
in conventional radiation therapy.
Biological and physical dosimetry methods have been
implemented to characterize radiation scattering
associated with synchrotron MRT.
Methods: Scattered radiation was assessed with γH2AX
assay and radiochromic film dosimetry for 10 and 40Gy
of broadbeam (BB) and microbeam configurations at
30min postirradiation. Imaging and medical beamline
of Australian Synchrotron was utilized. γH2AX foci and
radiochromic film derived scatter values were calibrated
against dose response.
Results: Study demonstrated the capabilities of
radiochromic EBT3 film for measurement of spatial
distribution of absorbed doses of X-ray with resolution
on a few micrometer scale at peak doses up to 10Gy.
Based on film dosimetry, peak valley dose ratio (PVDR)
of IMBL MRT was estimated in the range 31-35.
Scattered radiation can induce substantial level of γH2AX
foci at biologically relevant distances from irradiated
field. γH2AX assay is sensitive tool for biodosimetry of
doses of IR above 6mGy.
Conclusion: Significant scattering of MRT was
established with biological and physical dosimetry.
Detection and quantification of γH2AX repair foci
emerges as a sensitive and rapid biodosimetrical assay.
Cancer Metabolism and Genetics Group, The John Curtin
School of Medical Research, The Australian National
University, Canberra, ACT.
Introduction: The primary hurdle for effective
chemotherapy is the inherent or acquired drug
resistance of cancer cells. The glycolytic phenotype (or
Warburg effect) is a major metabolic signature of cancer
cells. Dichloroacetic acid (DCA) is a non-toxic drug,
which can reverse the glycolytic phenotype by inhibiting
pyruvate dehydrogenase kinases (PDKs). Recent studies
have linked changes in cancer cell metabolism to multidrug resistance phenotypes. We have examined whether
reversal of the glycolytic phenotype with DCA can
restore drug sensitivity in resistant cancer cells.
Methods: We examined DCA’s effects in doxorubicin
(DOX)-resistant MDA-MB-231 and MCF7 cells (made by
continuous exposure to increasing DOX concentrations
for one month) and their DOX-sensitive counterparts
by neutral red cell viability assay. Intracellular drug
concentrations were measured by flow cytometry and
western blotting was used to determine protein levels of
drug transporters and PDKs.
Results: DCA treatment (1mM for 48hrs) significantly
(p<0.05) enhanced DOX toxicity in DOX-resistant cells
restoring sensitivity to a level similar to parental cells.
This is despite DCA having no effect on DOX toxicity
in parental cells. DCA pre- treatment increased the
intracellular retention of DOX. DCA effectively reduced
the expression of ATP-binding cassette (ABC) drug
transporters such as P-glycoprotein and ABCG2. Drug
resistant cells displayed elevated PDK2, which was
repressed with DCA treatment.
Conclusion: DCA may be an effective chemo-sensitizing
agent in drug resistant cancers, acting by reducing drug
transporter expression and inhibiting PDK2.
ORAL PRESENTATIONS
7. An intervention for cancer-related
fatigue in men treated for prostate
cancer: Energy Conservation and
Management
David Larkin
1,2,4
8. Benefit of adjuvant trastuzumab with
chemotherapy (ATWC) in T1N0 HER2
positive breast cancer—interim results
Violeta Lopez Edoardo Aromataris
1,3
4
Research Centre for Nursing and Midwifery Practice,
ACT Health, 2Cancer, Ambulatory and Community Health
Support, ACT Health, 3Alice Lee Centre for Nursing
Studies, Yong Loo Lin School of Medicine, National
University of Singapore 4School of Translational Health
Science, University of Adelaide.
1
Introduction: Cancer-related fatigue (CRF) is
reportedly one of the most common and debilitating
side-effects of cancer and its treatment. Energy
Conservation and Management (ECAM) has not
been tested on men with prostate cancer. Two pilot
randomised controlled trials were conducted to examine
the effectiveness of ECAM in men with prostate cancer
who were commencing, or had completed, treatment in
the previous twelve months.
Methods: Participants were randomised into either
intervention or control groups and received three,
weekly telephone information sessions. The
intervention group received tailored information on
CRF, principles of activity management and energy
conservation and advice for integrating these principles
into their daily lives. Men in the control group received
general information on CRF and dietary advice.
Outcomes of interest included perception of fatigue and
functional performance.
Results: Sixty-one men were enrolled into the
two studies. Results show that when compared to
control groups, men in the intervention groups had
lower perceived fatigue, lower fatigue intensity and
experienced less difficulties with physical activities.
Conclusions: Managing CRF is challenging, often
requiring both physical activity and psychosocial
interventions. The findings from these two pilot studies
demonstrate that ECAM is promising for mitigating CRF
in men treated for prostate cancer.
Yada Kanjanapan1, Desmond Yip1,3, Jane Dahlstrom2,3,
Paul Craft1,3
Medical Oncology, Canberra Hospital, Canberra
ACT 2615 2 Department of Anatomical Pathology,
Canberra Hospital, Canberra ACT 2615 3 Australian
National University Medical School, Australian National
1
Introduction: Human epidermal growth factor receptor
2 over-expression (HER2+) occurs in 10-15% of breast
cancers. Adjuvant trastuzumab with chemotherapy (ATWC)
reduces risk of recurrence and death by 40% and 34%1.
We determine the 5-year disease free survival (DFS) and
overall survival (OS) benefit in T1N0 (≤2cm node-negative)
patients who were mostly excluded in trials.
Methods: Subjects consented for enrolment in a
prospective database of the ACT/South-East NSW
Breast Cancer Treatment Group. Survival functions
are estimated by the Kaplan-Meier method and
absolute survival benefits derived from hazard ratios
for recurrence/death with ATWC in meta-analysis1. A
stepwise Cox regression analysis will examine the effect
of age; tumour size, oestrogen receptor (ER) staining,
grade, lymphovascular invasion (LVI) and anthracycline
chemotherapy on survival.
Results: 100 women with T1N0 HER2+ breast cancer
diagnosed between July 2005 – June 2013, mean age
58yo (range 32-84yo), were identified. They comprised
59% ER+, 95% grade 2-3 and 10% LVI+ cases. All ER+
patients received endocrine therapy. ATWC was given in
52%. The ATWC-treated had similar mean age (56yo vs
60yo) and ER+ rate (54% vs 65%, p=0.28) as untreated
patients. One patient had disease recurrence (ATWCtreated) and six died (5 ATWC-untreated).
Conclusion: Our cohort of T1N0 HER2+ breast cancer
had 52% receiving ATWC. Interim results suggest a good
outcome in these patients and final survival analysis is
planned with interstate collaborators.
References: 1. Moja et al. “Trastuzumab containing
regimens for early breast cancer.” Cochrane Database
Syst Rev (2012).
August 12th – 15th, 2014 | 23
ORAL PRESENTATIONS
9. Predictive value of Immunohistochemical
4 plus Clinical Treatment Score in
determining risk of Loco Regional
Recurrence in Early Breast Cancer
Roopa Lakhanpala, Bruce Shadbolt , Genevieve
Bennett3, Michael Brown3, Tessa Phillips3, Amanda
Bullman3, Angela Rezo1
2
Department of Radiation Oncology, Canberra
Hospital, Garran, ACT 2605 2 Centre for Advances in
Epidemiology and IT, Canberra Hospital, Garran, ACT
2605 3 Department of ACT Pathology, Canberra Hospital,
Canberra, ACT.
1
Introduction: Combined score obtained using
Immunohistochemical (IHC) 4 (based on oestrogen and
progesterone receptor status, Her2 status and Ki-67
score) plus Clinical Treatment Score (based on nodal
status, tumour size, grade and age) is a very promising
clinicopathological tool predicting risk of distant
recurrence. This study explores the role of the combined
score in predicting risk of loco-regional recurrence
(LRR) in women who had breast conservation surgery
without radiotherapy.
Methods: Patients were selected from the ACT and
SENSW BCTG database over a 13 year period. Tumour
blocks were retrieved to perform IHC testing on those
that were incomplete. Clinical scores were obtained
from the database and combined scores were calculated
using the appropriate formulae.
Results: Cox regression indicated a significant
association between the combined score and the risk of
LRR (p=0.03).When the cut-off points as in the original
study by Cuzick et al, were applied to the LRR outcome,
the incidence of LRR was zero, 20 % and 33.3 % in the
low, intermediate and high risk groups respectively
(p=0.007). Conclusions: This is the first study of its kind.
The combined score may be used to identify women at
negligible risk of LRR in whom adjuvant radiotherapy
can be omitted.
10. Abnormal knee kinematics during step
and turn following multiple-ligament
knee reconstruction
Joe Lynch1,2, Corey Scholes1, Brett Fristch1, Milad
Ebrahimi1, Myles RJ Coolican1, Richard Smith3, Paul N
Smith2, David A Parker1
Sydney Orthopaedic Research Institute, Chatswood
NSW 2067 2Trauma and Orthopaedic Research Unit,
Canberra, ACT.3 University Sydney, Lidcombe, NSW.
1
Introduction: There is a lack of knowledge regarding
the biomechanical outcomes of surgical reconstruction
following multiple-ligament knee injury (MLKI).
We compared the kinematic differences in MLKI
reconstructed knees with normal knees during a stepand-turn task.
Methods: Three-dimensional gait analysis was
performed on 16 patients with multiple-ligament knee
reconstructions and their healthy matched controls.
Patients were asked to descend two steps onto their
injured leg and pivot 90° before initiating level walking.
Three-dimensional knee angles were calculated from
skin-mounted motion tracking. Knee angles at initial
foot strike and end of weight acceptance, as well as
ranges of motion during weight acceptance and over the
total pivot were extracted and compared.
Results: At initial foot contact during step descent,
the reconstructed group displayed significant (p<0.05)
externally rotated tibiae than healthy controls.
Furthermore, significantly increased internal rotation
was observed during weight acceptance onto the
reconstructed limb. There was considerable variability
between reconstructed knees and controls with up to 63%
of the cohort displaying significant differences in flexion
and varus-valgus motion during the step-turn task.
Conclusions: This study reveals that the effect of injury
and reconstruction may not be the same in all patients.
The majority of reconstructed patients appeared to preempt pivoting by rotating their foot prior to contact with
the ground thereby potentially reducing the load on the
joint. The reasons for this compensation strategy could
have important implications for rehabilitation.
ORAL PRESENTATIONS
11. How reliable is Computer Assisted THA
Polyethylene Wear Measurement with
Current Radiography Practices?
Diana M.Perriman, Shyam Rajagopalan, Paul N Smith
Australian National University Medical School, Trauma
and Orthopaedic Research Unit, Canberra Hospital,
Canberra, ACT.
Introduction: Clinical studies of polyethylene wear use
plain x-rays taken at different times. The necessity for
these images to be obtained using identical parameters
has not been tested. We compared `Polyware Pro’ wearmeasurement values using identical and non-identical
images in order to evaluate the effect of non-identical
parameters when measuring wear.
Methods: Wear measurements were made from
postoperative and final follow-up (mean 9-years)
x-rays of 34 patients (38 hips). These patients were
selected because they had multiple images at follow-up.
Measurements made were made from an `identical’ set
of x-rays and a `non-identical’ x-ray set with randomly
selected follow-up x-rays. Measurements were repeated
after one week. Intra-class correlation coefficients
(ICC2,1) and Bland-Altman limits-of-agreement (LOA)
for each method were calculated.
Results: The ICC2,1 for identical and non-identical 2D
wear were 0.98vs; 0.71 for 2D linear wear/year were
0.99 vs 0.84; for 3D wear 0.98 vs 0.46; volumetric
wear 0.99 vs 0.48; and volumetric wear/year 0.99 vs
0.3. The LOA’s for identical and non-identical wear
measurements were ± 0.14mm vs ± 1.12mm for 2D
linear wear, ± 0.21mm vs ±1.3mm for 3D wear, and ±
34.5mm3 vs ± 777.35mm3 for volumetric wear.
Conclusion: Intra-observer reliability was excellent but
markedly reduced for non-identical x-rays. The LOA
were wider for all non-identical measurements but
particularly for volumetric wear. The results suggest that
extraordinary rigour needs to be applied to standardizing
radiographic parameters for wear measurement to be
sufficiently accurate for use in research.
12. Dislocation following total hip
replacement, a descriptive study of
common factors and treatment in
Canberra
Michael K Ardern, Diana M Perriman, Paul N Smith
Australian National University Medical School, Trauma
and Orthopaedic Research Unit, Canberra Hospital,
Canberra, ACT.
Introduction: Dislocation following total hip
replacement (THR) is a complication that causes
significant morbidity and loss of function. Post-operative
dislocation is seen in 1-4% of patients who undergo a
THR and results in the deployment of increased health
service resources and sometimes costly revision surgery.
Methods: This retrospective study aimed to identify
and describe patient and surgical factors, as well as
mechanism and treatment of dislocation in a cohort of
272 patients presenting to Canberra Hospital Emergency
Department between August 1997 and November 2012.
Results: The cross-sectional dislocation rate over
the entire study period was found to be 4.3%. Female
patients were primarily affected and the proportion of
female patients presenting for dislocation has steadily
increased. Multiple dislocations were not uncommon
but 50.7% of patients presented only once. The most
common activity causing dislocation was hyperflexion
leading to a posterior dislocation. Closed reduction was
most often utilised to treat dislocation and procedural
sedation has become the most common mode of
anaesthetic.
Conclusion: The results indicated that the dislocation
rate for all patients reduced during the study period and
the majority of patients achieve stability. However, more
research is required to determine why a disproportionate
number of female patients presented with dislocation
following THR.
August 12th – 15th, 2014 | 25
ORAL PRESENTATIONS
13. Biodegradable Magnesium Yttrium
(Mg-Y) Alloy Promotes Osteogenic
Differentiation of Human Mesenchymal
Stem Cells (hMSCs)
Rachel W. Li1,2, Paul N. Smith1,2, Nick Birbilis3
Trauma and Orthopaedic Research Unit, Medical School,
Australian National University, Canberra, ACT 0200 2John
Curtin School of Medical Research, Australian National
University, Acton, ACT 26013Department of Materials
Engineering, Monash University, Clayton, Victoria.
1
Introduction: Magnesium (Mg) alloys offer considerable
promise for implants due to their inherent properties
including biodegradability, biocompatibility and
bioactivity. We investigated the effects of degradation
products of selected binary Mg-yttrium (Y) alloy on the
osteogenic differentiation of human mesenchymal stem
cells (hMSCs).
Methods: High purity 99.99% Mg and Mg-X master
alloys were combined in carefully controlled ratios to
the Mg-alloy compositions: Mg5AL, Mg2Ca and Mg1Y.
hMSCs were exposed to the alloy degradation products
and osteogenic differentiation, osteogenic related gene
and protein expression were studied.
Results: The differentiation of hMSCs exposed to
Mg1Y was superior to the other test samples. This
is most likely due to Mg1Y alloy having the slowest
rate of corrosion and hence having less hydrogen
evolved, resulting in a decrease in pH of cell culture
media. The Mg1Y extract showed a superior osteogenic
differentiation and superior proliferation compared
to pure Mg control. The degradation product of the
Mg1Y alloy was found to downregulate gene TNFα, but
upregulate TGFβ1, FGF2, FGF10, SMAD4 and BMP2,
important in osteogenic differentiation. Increased protein
expression of TGFβ1, FGF2, SMAD4 and COL1A1 were
also detected.
Conclusion: The results are instrumental for the future
development of magnesium-based implants.
14. The relationship between the measures
of postural sway, mechanical pain
threshold testing and self – ratings
of pain and disability in chronic neck
pain sufferers
Adrian J Rumore, Faculty of Health, University of
Canberra, Canberra, ACT.
Gordon Waddington, Faculty of Health, University of
Stuart Cathcart, Centre for Applied Psychology, Faculty
of Health, University of Canberra, Canberra, ACT.
Introduction: Emotion and cognitive traits and tasks
modulate multidimensional aspects of chronic neck
pain (CNP), local sensory mechanical hyperalgesia and
posture. These features can be assessed through selfrating of pain and disability, mechanical pain threshold
testing (MPTT) and postural sway assessment. This
study examined whether there is a relationship between
these measures in cnp sufferers.
Method: Postural sway was measured using a
computerised force plate and accelerometer during
five balance tests in 25 participants. Self-rating tools
included – VAS (Pain), VAS (Stress), NDI, SF-36 and
DASS-21. Pressure algometry detecting MPTT was also
undertaken. Statistical analyses were performed using
Pearson’s r correlation coefficient.
Results: Postural sway (AP direction) was significantly
correlated with VAS (Pain), SF-36 and DASS-21 (r = .41
- .57; p < 0.05), as well as MPTT measures (r = .46 - .57;
p < 0.05) for more challenging balance tests. Self-rating
questionnaires and MPTT measures were correlated for
self-perceived pain and physical health disability only (r
= .4 - .53; p < 0.05).
Conclusion: This study extends the understanding
of the relationship between the measures of various
features of CNP and may allow development of more
sensitive outcome measures for this condition.
ORAL PRESENTATIONS
15. Recognising trauma and adversity in
young people and their families who
access the ACT Child and Adolescent
Mental Health Service
Raphael B , Aplin V , Reay R.E. , McAndrew V , Cubis
J.C1, Preston W3, Riordan D.M.3, Palfrey N3, Harris A.2
1
1,3
1
1,3
Academic Unit of Psychiatry & Addiction Medicine,
Australian National University Medical School, Canberra
Hospital, Garran ACT 2605 2Australian Child and
Adolescent Trauma Loss and Grief Network, Australian
National University Medical School, Canberra Hospital,
Canberra, ACT.
3
Child & Adolescent Mental Health Services, ACT Mental
Health, Justice Health and Alcohol and Drug Services
(MHJHDAS), Canberra, ACT.
1
Introduction: Childhood trauma and family adversity
increases vulnerability to mental health problems.
However, uncertainty exists about the nature and
prevalence within the Child and Adolescent Mental
Health Service (CAMHS) population. This study
ultimately aims to improve the recognition, treatment
and management of this vulnerable population of
children and adolescents.
16. Poor minimal trauma fracture treatment
as a cause of subsequent hip fractures
in the elderly
Hasibul Haque 1, Anil Paramadhathil 1, Wichat
Srikusanukul 2, Alexander A Fisher 1,2
Department of Geriatric Medicine, Canberra Hospital,
Garran, ACT 2606. 2 Australian National University
Medical School, Canberra, ACT.
1
Introduction: Minimal trauma fracture (MTF) is a
recognised risk factor for subsequent fractures including
hip fractures (HFs). The present study aimed to evaluate
the incidence of MTF prior to the first HF and the use of
antiosteoporotic treatment.
Methods: We analysed 327 consecutive patients (mean
age 82.7 +9.5 years, 73% females) with osteoporotic
HF admitted to the Canberra Hospital in 2012. Medical
records were explored for any previous hospital
presentations in the last 5 years with special attention to
MTF and antiosteoporotic treatment.
Methods: All children and adolescents attending their
initial assessment at a CAMHS service and their parent/
guardian were invited to participate in the Stressful
Life and Family Difficulties study. Three methods
were used to gather data on the prevalence of trauma
and adversity: young person’s questionnaire; parent
questionnaire and clinician interview.
Results: Of 327 HF patients, 112 (34.2%) had 137
episodes of previous MTF including 76 (55.4%)
vertebral, 28 (20.4%) hip, 21 (15.3%) upper limb, 7
(5.6%) pelvic, and 5(3.5%) lower limb fractures. Of 76
vertebral fractures, only 19 (25%) were documented;
on reviewing lateral view chest x-rays, we identified 57
vertebral fractures of which only 8 (13.7%) were formally
reported. Of 112 patients with MTF, 52 (45.5%) did not
receive adequate antiosteoporotic treatment after the
first fracture.
Results: 162 families participated in the study.
Young people were more likely to experience multiple
adversities (3 or more; 55%) in the last 12 months than
single events. The most common adversities reported
included being bullied and conflicts with peers. Around
half of the young people and half of their parents/
guardians reported a potentially traumatic event.
Conclusions: In about one third of patients, HF
was preceded by a MTF and half of them were not
treated adequately. Taking a falls and fracture history,
evaluating vertebral fractures on spinal x-rays and
adequate antiosteoporotic therapy after the first fracture
may significantly reduce the incidence of subsequent HF
and use of resources.
Conclusion: We found that trauma and adversity were
common in this population and that multiple adversities
were more common than single events. Implications and
recommendations for the assessment and treatment of
CAMHS clients will be discussed.
August 12th – 15th, 2014 | 27
ORAL PRESENTATIONS
17. What strategies are acceptable to
primary caregiver when informing
them of their child’s Body Mass Index
(BMI) result as gathered through The
Kindergarten Health Check (KHC)?
What type of information do primary
caregivers find helpful in regard to
potential management options to follow
up a BMI result of their child?
Rebecca Kathage, Kirsty Douglas.
Academic Unit of General Practice, Canberra, ACT
Introduction: The Kindergarten Health Check (KHC)
is a universal, voluntary health assessment program
that is offered to all ACT Kindergarten children. One
component is an assessment of height, weight and body
mass index (BMI).
Despite the KHC high uptake, controversies around
the BMI led to this component of the screen being
withdrawn in the years 2011-2013 inclusive.
The impending reinstatement of the BMI result by the
KHC prompted us to explore what ACT parents feel
are acceptable strategies of informing them of their
child’s result as well as what parents feel are important
management options.
Methods: Data was collected from Primary Carers of
children, as recruited through a mail out survey as well
as waiting rooms (Emergency Department, General
Practice and Paediatric Outpatients).
Results: Recruitment of parents proved very difficult
(n= 40, mostly higher education). Generally parents
wanted uncomplicated and straight forward means of
getting the result with the use of non-judgemental but
straightforward language. Most responded best to selfdirected management (i.e. educational information) or
free services (e.g. dietician). Management through GPs
and Paediatricians were not as strongly supported.
Conclusion: These results will help to guide future KHC
and potentially impact on the management of childhood
obesity in primary/tertiary care.
18. A 3D numerical simulation of
vocal-fold vibrations
Fang-Bao Tian, John Young and Joseph C. S. Lai
School of Engineering and Information Technology
University of New South Wales, Canberra, ACT.
Introduction: Speech is a basic means of daily
communication. Voice disorders are debilitating and can
lead to many problems. An advanced computational
model of the fluid-structure interaction (FSI) during
phonation will find useful applications in diagnosis and
surgery planning for voice disorders. For example,
the stresses and strains in the tissue calculated from
the model can be used to correlate with the changes
observed in different conditions, and may lead to new
explanations for the cause of voice disorders. In
addition, computational modeling of the surgically
altered vocal folds may be used to predict and improve
the outcome of surgery. To date, such an advanced
model is still under development.
Methods: In this work, we adopt a new method that
couples an immersed-boundary method and a finiteelement method to compute the 3D vibration of vocal folds.
Results: With the advanced numerical method, the
simulation incorporates large deformations of the
tissue. In addition, the wave motions along the inferiorsuperior, lateral, and anterior-posterior directions are
discussed by considering two vocal folds of uniform
cross section.
Conclusion: Our work shows that the proposed
numerical method is versatile and is well suited for
modeling a range of biological FSI systems.
ORAL PRESENTATIONS
19. Health Behaviours in the Capital
Lara J Morris1, Cate D’Este2 & Kaarin J Anstey1
1
Centre for Research on Ageing, Health and Wellbeing
Research School of Population Health.
Australian National University College of Medicine,
Biology and Environment The Australian National
University Building 62 Mills Road Canberra ACT 0200
2
National Centre for Epidemiology and Population
Health Research School of Population Health Australian
National University College of Medicine, Biology and
Environment The Australian National University
Building 62 Mills Road Canberra, ACT.
Introduction: Emerging research suggests some
unhealthy behaviours may be interrelated such that
individuals with one risk factor are more likely to
have additional risk factors. This study explores the
prevalence of three major lifestyle risk factors (smoking,
alcohol and physical inactivity) and defines subgroups
with elevated risks of multiple lifestyle risk factors.
Method: Data on 5,633 adults aged 28-32, 48-52 and
68-72 from wave 3 (2007-2010) of the PATH Through
Life Cohort Study, were used to estimate prevalence
of individual and combinations of risk factors, and
multinomial regression analysis undertaken to examine
factors associated with number of risks.
Results: Clustering of risks varied by age and gender,
with more people than expected having none or all of
the risk factors. Smoking clustered with drinking as well
as physical inactivity. No relationship between physical
inactivity and drinking was observed. Several sociodemographic characteristics were associated with the
number of lifestyle risk factors including partner status,
gender, education, health related quality of life and
household income.
Conclusions: The tendency for lifestyle risk factors
to aggregate has meaningful implications for health
promotion strategies. Better insight in the more
vulnerable subgroups could help to identify those who
are at increased risk of developing chronic diseases.
20. Essential nursing care: how well are we
doing it in 2014?
Irene J. Lake1, Marian J Currie1, Veronica Croome2
Research Centre for Nursing and Midwifery Practice
(RCNMP) ACT Health, Australian National University
[email protected] 2Nursing and Midwifery Office,
ACT Health.
1
Introduction: A UK National Health Service report and
an American study showed inadequate standards of
nursing care. The aim of this audit was to determine the
frequency of essential nursing care at Canberra Hospital.
Methods: An audit tool comprising a documentation
review, observation of patient care and patient interview
was devised. All wards except Mental Health, Paediatrics
and Intensive Care were audited by 1 experienced
Registered Nurse over a 2-week period. Only patient
interview results are reported here.
Results: 85 audits were completed.
Of patients interviewed:
• 79% had their call bell answered promptly
• 73% had been involved in planning their care
• 70% received education on preventing pressure
injuries and falls
• 47% were assessed for pressure injury risk
• 45% were assessed for falls risk.
Of dependent patients interviewed:
• 95% received assistance with meals
• 69% were offered the opportunity to wash their
hands after using the toilet
• 51% were offered the opportunity to wash their
hands before meals
• 41% had their mouth care attended
• 27% were assisted to ambulate.
Conclusion: Many elements of essential nursing care
are not adequately attended to. Staff must be mindful of
the essential nature of these activities.
August 12th – 15th, 2014 | 29
ORAL PRESENTATIONS
21. What are young people telling us
about their health-related behaviours?
Results from the ACT Secondary
Students’ Alcohol and Drug Surveys
(ASSAD)
Elizabeth Chalker, Melanie Thompson
Epidemiology Section, Health Improvement Branch, ACT
Health Directorate, Canberra, ACT.
Introduction: ACT Secondary Students’ Alcohol and Drug
(ASSAD) surveys examine changes in substance use, sun
protection, physical activity and nutrition in ACT secondary
students. The results help to inform and evaluate health
promotion interventions and policies in ACT.
Methods: The survey is conducted every 3 years and
approximately 1,500 ACT students aged 12 to 17 years
complete a paper questionnaire on their substance use;
sun protection, nutrition, physical activity behaviours
and weight status. Prevalence is presented as weighted
proportions; comparisons with previous ACT and
national data associated with a p value of <0.05 are
reported as statistically significant.
Results: Since 2005, alcohol, tobacco and cannabis
use has decreased while tranquiliser use has increased.
Younger students consistently report higher inhalant use
than older students. The proportion of non-substance
users has increased. There has been a decline in several
important sun protection behaviours over time and
three-quarters of participants still reported getting
sunburnt last summer. Less than 5% of students met
the fruit and vegetable guidelines or physical activity and
screen time recommendations.
Conclusion: Many important improvements in healthrelated behaviours have been reported by students since
1996, however there is still room for improvement.
22. Comparing the support needs of men
with prostate cancer and their
significant others
David Larkin1,2,4 Violeta Lopez1,3
ACT Health 2Cancer, Ambulatory and Community Health
Support, ACT Health 3Alice Lee Centre for Nursing
Studies, Yong Loo Lin School of Medicine, National
University of Singapore.
1
Introduction: The support needs of men with prostate
cancer and those of their significant other have not been
well studied. This study examined the met and unmet
support needs of both groups, and compared the needs
of those who attend prostate cancer support groups
against those who do not.
Methods: The Cancer Survivors’ Unmet Needs
Measure and the Cancer Survivors’ Partners Unmet
Needs Measure questionnaires were used to gather
information on met and unmet support needs.
Participants were recruited through a tertiary hospital
urology and radiation oncology clinics and support
groups throughout Australia.
Results: 132 prostate cancer survivors and 47 partners
participated in this study. The highest unmet need for
patients was existential survivorship, and relationships
for partners. For both men with prostate cancer and
their partners, mean scores were considerably lower
in those attending support groups. Men who had
undergone prostatectomy and their partners both scored
higher for unmet needs in all domains.
Conclusions: The study findings suggest that neither
men with prostate cancer nor their significant other are
receiving the level of support they require for managing
the symptoms or psychosocial aspects of a prostate
cancer diagnosis. Attendance at support groups should
be encouraged to promote coping.
ORAL PRESENTATIONS
23. Use of the Ward Atmosphere Scale
to gauge the link between milieu
and environment
24. M-Clinic: Expanding access to HIV
testing for Men who have Sex with Men
in the ACT
Daniel Nicholls1, 2, Kevin Kidd 2, Jennifer Threader 3,
Catherine Hungerford 1
William Mitchell3 Shannon Woodward1 Maureen Todkill
1
Rendry Del Rosario1 Fiona Murphy1 Anne M Baynes1
Sarah J Martin1, 2
Faculty of Health, University of Canberra, ACT 2601 1
Mental Health, Justice Health and Alcohol & Drug Services,
Canberra, ACT 2 Research School of Psychology, Australian
National University, Canberra, ACT 3
Introduction: In 2012 a new, specifically tailored Adult
Mental Health Unit was opened in Canberra to cater for
acute adult mental health admissions. The paper will
outline the process and the pre and post survey data
and analysis.
Methods: Utilising the Moos Ward Atmosphere Scale
40 standard questions from the scale were posed
to consumers and 100 questions to staff and carer
participants. Preliminary analyses included planned
contrasts using t-test analysis to assess differences
on scores between the old unit and the new unit, and
multivariate analyses of variance (MANOVA), as well as
univariate analyses of variance (ANOVA) as required.
The data were entered and analysed in an SPSS version
22.0 database.
Results: For staff there were significant differences
in Order and Organization and Program Clarity.
For consumers there were significant differences
in Involvement, Practical Orientation, Order and
Organization, Program Clarity, and Staff Control. The
number of carers who participated was too small to be
included in the analysis.
Conclusion: The data show some differences and a
broad view of the social milieu(x) of mental health
facilities. The study has also provided some insights to
the efficacy of the tool utilised.
Canberra Sexual Health Centre. Canberra Hospital,
Canberra, ACT 2 Academic Unit of Internal Medicine,
Hospital, Canberra, ACT. 3GP Registrar, Victorian
Metropolitan Alliance General Practice.
1
Introduction: In response to increasing HIV diagnoses
in the ACT and feedback from Canberra Sexual Health
Centre’s (CSHC) 2013 Patient Survey, an after-hours
clinic for men who have sex with men (MSM) was
introduced in 2013. M-Clinic was designed to provide
specialist after hours access to sexually transmissible
infection (STI) and blood borne virus (BBV) screening for
asymptomatic MSM.
Methods: M-Clinic occurred on the first Monday evening
of each month at CSHC. Data was collected on number
of attendees, prior screening, and risk behaviours. A
patient survey evaluated this service.
Results: 60 patients attended between August 2013
and June 2014 (84 occasions of service). 23 patients
(38%) were new to CSHC, 12% had never had an STI
screen, and of those who had, 32% had not been
screened within 12 months. 52% of attendees reported
recent high risk sexual behaviour. 51/60 (85%) men
completed the satisfaction survey with 15 (25%) stating
they would not have had screening without M-Clinic. All
respondents stated that after-hours access was a major
factor influencing attendance.
Conclusion: Patient feedback identified areas for early
improvement which supported the success of this
initiative. A dedicated M-Clinic has increased testing
among MSM and is now ongoing at CSHC.
August 12th – 15th, 2014 | 31
ORAL PRESENTATIONS
25. What women want: A national audit of
access to a midwife in the immediate
postnatal period
Ann Burgess, 2Marian J Currie, 3Deborah Davis and
Veronica Croome
26. AINs as additional staff in an acute
medical ward for the elderly: Staff
perceptions of this initiative
Barbara Conroy, 2Rhonda Maher, 2Hazel Hurrell,
Maria Trudinger, 2Linda Kohlhagen, 2Ramila Varendran,
1
Marian J Currie.
1
1
1
2
ACT Nursing and Midwifery Office, ACT Health ann.
[email protected] 2Research Centre for Nursing and
Midwifery Practice (RCNMP) ACT Health, Australian
National University. 3RCNMP and University of Canberra
Disciplines of Nursing and Midwifery, Bruce, ACT.
1
Background: The National Maternity Services Plan
focuses on improving maternity services in Australia.
Aim: To audit access to midwifery care.
Methods: In a cross-sectional survey, women who
had given birth in Australia (past 5 years) were asked
about their access to midwifery services in the first 2
postnatal weeks. Data were collected using an online
questionnaire advertised through social media.
Results: 82% of the 3123 respondents had access to
midwifery care, 74% of those who did not would have
liked access. Women giving birth in the public sector
were more likely to see a midwife (OR 9.3, 95% CI 7.611.5). Place of residence (metropolitan/rural/remote) did
not affect access to a midwife (OR 1.2; 95% CI 0.9 – 1.4).
35% of respondents saw a doctor (61% GP, 22% hospital
doctor, 16% private obstetrician). Respondents who
did not see a midwife were not more likely than those
who did see a midwife to see a doctor (OR 1.2 95% CI
0.9-1.5). The most commonly reported sources of nonhealthcare support were partners/family/friends (77%),
the Internet (64%) and books (55%).
Conclusion: The majority of Australian women have
access to postnatal midwifery care. Many use online
resources, but most are primarily supported by family
and friends.
Research Centre for Nursing & Midwifery Practice,
Canberra Hospital and the Australian National
University, 2Rehabilitation, Aged and Community Care,
Canberra Hospital, Canberra, ACT.
E-mail:[email protected]
1
Introduction: ACT Health introduced 5.5 FTE specially
trained AINs to an acute geriatric medical ward to
provide one-on-one care to patients at high risk due to
impaired cognitive functioning. The aim of this analysis
was to ascertain staff perceptions.
Method: As part of a larger project designed
to determine the impact on patient outcomes,
questionnaires (all open-ended questions) were
distributed to AINs and ward staff in February-June
2014. Data were independently thematically analysed by
2 researchers.
Results: 6/7 (86%) AINs and 32/49 (65%) other staff
responded. Main themes identified by the AINs were:
overall positive experience (6), supportive staff (6), made
a difference to patient safety (6), positive interaction
with carers (6), challenged by caring for 4 patients at
once (3). Main themes for other ward staff were: asset
to the team, carers’ peace of mind (12) continuity of care
(5) patient safety (9), more time for other duties (10),
AINs’ training (5), scope of practice (3), bridge to team –
including carer, (4) and time management (4).
Conclusion: The initiative was rated positively by all
respondents particularly in respect to patient safety,
releasing other staff to concentrate on all patients and
aspects of patient care, and interaction with carers.
ORAL PRESENTATIONS
27. The economic and social value of
Telephone Triage and Advice Services
(TTAS): A rapid review of the literature.
28. Innovations in Workforce Retention
for the Clinical Measurement
Sciences Team
1
Marian J Currie, 1Jill Parke and 2Rhian Parker
Lauren Brooks
(RCNMP) ACT Health, Australian National University
[email protected] 2 Centre for Research and
Action in Public Health (CeRAPH), University of
Clinical Measurement Sciences Clinical Educator,
Chief Allied Health Office, ACT Health, GPO Box 825,
Canberra, ACT.
1
Introduction: TTAS aim to increase the efficiency of
healthcare systems and increase equity of access. TTAS
objectives are to educate callers, reduce uncertainty,
encourage self-management and triage.
Method: Academic and grey literature were searched
in March 2014. Search terms: national health call
centre, telephone triage, health advice line, telephone
enquiry service, telephone consultation, health
hotlines, satisfaction, compliance, safety, surveillance,
economics, cost savings, costs and cost analysis.
Results: 103/9,916 documents were included.
Main findings:
• Lack of good quality research.
• Demand is increasing.
• TTAS are either cost-neutral or have a positive return
on investment.
• TTAS address issues such as ED access block
and after-hours service provision and staffing but
confusion remains about the impact on emergency
services, i.e. cost saving = cost shifting.
Introduction: Workforce recruitment, retention and
staff shortages are significant challenges for Clinical
Measurement Sciences (CMS) in ACT Health, particularly
as no local training institute for CMS exists in the ACT. In
addition, the majority of science and biomedical degrees
do not have compulsory CMS placements included in
the curriculum. An innovative, four branched model was
designed through a collaborative partnership between
the Chief Allied Health Office and the CMS Departments
to address these challenges.
Methods: The four branched model included
implementation and evaluation (through informal
interview) of these innovative strategies:
• Participation in the Allied Health New Graduate
Program, developing interprofessional practice skills
• Discipline-specific skills and knowledge supported by
the CMS Clinical Educator
• Financial support and contracted commitment to
ACT Health through an Allied Health Undergraduate
Scholarship
• Professional and collegial support from the CMS
Managers and team.
• Evidence is lacking for access by some groups e.g.
Indigenous peoples and immigrants.
Results: This model has resulted in successful retention
of competent and confident Allied Health professionals
in the CMS team. Interviews with CMS staff and the Chief
Allied Health Officer have revealed that this model has
achieved the goals of improving workforce recruitment
and retention and is worthy of continuation.
• TTAS enable detailed reporting of caller issues/
demographic characteristics/clinical outcomes. Data
linkage allows for measurement of impact on other
health care services.
Conclusion: This innovative model aligns itself with
ACT Health core values in providing continuing support
for staff in their transition from new graduate to health
professional.
• Callers appear satisfied.
• Callers comply with the triage and advice they receive.
• TTAS appear to be safe.
Conclusions: TTAS appear to provide a valuable
service to the public, but further research into their
value is needed.
August 12th – 15th, 2014 | 33
ORAL PRESENTATIONS
29. Ventilator Hyperinflation – Safety and
feasibility of translating evidence into
practice in ICU
Vince Marzano,1, Bernie Bissett1,2, Anne Leditschke3
Physiotherapy Department, Canberra Hospital, ACT
Health, Canberra ACT 2605 2 Discipline of Physiotherapy,
University of Canberra, Canberra ACT 2617 3 Intensive
Care Unit, Canberra Hospital, ACT Health, Canberra, ACT.
1
Introduction: Ventilator hyperinflation (VHI) has been
shown to be as effective as manual hyperinflation
(MHI) as a physiotherapy treatment to clear sputum
and reverse atelectasis in ventilated patients. Despite
this, the literature reports multiple barriers and limited
implementation across Australia and New Zealand
intensive care units (ICU). Using a quality improvement
approach, we investigated the feasibility and safety of
introducing VHI at Canberra Hospital ICU.
Methods: A prospective observational audit of MHI
practices was conducted over three months. Following
implementation of an evidence-based VHI guideline, a
subsequent audit of VHI practices was conducted over
3 months. Outcome measures included: frequency;
prescription; contraindications; incidence of adverse
outcomes, and requirements for nursing assistance. All
data was recorded by treating physiotherapists at the
time of care and extracted to a purpose-built database.
Results: Following training of physiotherapists, VHI
was feasible occurring on 109 occasions in the 3 month
period, compared to 56 occasions of MHI in the previous
period. VHI required less nursing assistance (26/56
MHI episodes versus 0/109 VHI; p<0.0001 Fisher’s
exact test) and VHI was safe with an adverse event rate
of 3% compared to 11% for MHI. All VHI treatments
maintained peak airway pressures below 40cmH2O in
accordance with safety guidelines.
Conclusion: VHI has been safely implemented in our
tertiary ICU, resulting in lower requirements for nursing
assistance with physiotherapy treatments.
30. Weaned but weak and weary:
Inspiratory muscle weakness and raised
perceived exertion in adults following 7
days of mechanical ventilation
Bernie Bissett1,2,3, Anne Leditschke4, Teresa Neeman5,
Robert Boots3,6, Jennifer Paratz6
Health, Canberra ACT 2605 2 Discipline of Physiotherapy,
University of Canberra, Canberra, ACT.3 School of
Medicine, University of Queensland, Brisbane QLD 4029
4
Intensive Care Unit, Canberra Hospital, ACT Health,
Canberra, ACT. 5 Statistical Consulting Unit, Australian
National University, Canberra ACT 0200 6 Intensive Care
Unit, Royal Brisbane and Women’s Hospital, Brisbane, QLD.
1
Introduction: Prolonged mechanical ventilation (MV)
results in long term respiratory muscle weakness.
However little is known about respiratory muscle
endurance immediately following weaning from MV.
Furthermore we investigated whether there is a
relationship between inspiratory muscle weakness and
patients’ perceived exertion immediately following MV.
Methods: Prospective observational study of 43
heterogeneous adult intensive care patients recently
weaned from prolonged MV (> 7 days duration). 48 hours
following weaning, inspiratory muscle endurance was
measured using the fatigue resistance index (comparing
inspiratory strength scores before and after a 2-minute
loaded breathing test). Patients self-reported perceived
exertion both at rest and at peak exercise using a
Modified Borg Scale.
Results: Inspiratory muscle fatigue resistance was
low (FRI = mean 0.90, SD 0.31), with 37% of patients
demonstrating scores below 0.80. Perceived exertion
was elevated both at rest (RPE = mean 1.95, SD 2.78),
and during peak exercise (RPE = 3.40, SD = 3.50), with
a strong correlation between these (r = 0.78, p<0.01).
Inspiratory muscle strength was positively correlated
with fatigue resistance (r = 0.39, p<0.01) but not with
exertion during exercise (r = - 0.179, p = 0.27).
Conclusion: Inspiratory muscle endurance is reduced in
one third of adult patients recently weaned from MV, and
perceived exertion is elevated both at rest and during
peak exercise. The relationship between respiratory muscle
weakness and perceived exertion remains unclear.
ORAL PRESENTATIONS
31. Patient feedback: improving health care
safety and quality?
32. Primary health care teams: A social
network analysis
Deborah Schaler
Lynn Cheong1,2, Carol Armour2 and Sinthia BosnicAnticevich2
Menzies Centre for Health Policy, University of Sydney.
Address: Research & Evaluation, Population Health
Division, ACT Health, GPO Box 825, Canberra City, ACT.
Introduction:
Research aims:
• assess the relative effectiveness of three patient
feedback methods (complaints, satisfaction/
experience surveys and collection of narrative) in
facilitating improvement to health service safety
or quality.
• develop a method for health services to analyse and
link patient feedback data to service improvement
. This is especially relevant to Australian health
services which are required to meet new Australian
National Safety & Quality in Healthcare (NSQHC)
Standards related to patient feedback.
Methods:
• Case Study (ACT Health): Grounded Theory methods
including situational analysis mapping
• Review peer-reviewed literature
• Review /analysis of relevant policy documents,
patient feedback data and quality & safety
governance
• Semi-structured interviews with health service staff
• Development of a model to analyse aggregated
patient feedback data.
Results: The study identified improved practices for
managing and analysing patient feedback that also
meet the new NSQHC Standards. These include: a risk
management approach to patient complaints; a method
of aggregating patient feedback data from multiple
sources; and governance related to health service
improvement.
Discipline of Pharmacy, Faculty of Health, University of
Canberra, Bruce, ACT, 2617; 2Sydney Medical School,
University of Sydney, Sydney, NSW.
1
Introduction: Multidisciplinary care (MDC) has been
proposed as a potential strategy to address the
rising challenges of modern health issues. However, it
remains unclear as to how patients’ health connections
may impact on multidisciplinary processes and
outcomes. This research aims to describe patients’
health networks and their impact on MDC.
Methods: In-depth, semi-structured interviews were
conducted with asthma patients from Sydney, Australia.
Participants were recruited from a range of standard
asthma healthcare access points (community group)
and a specialized multidisciplinary asthma clinic (clinic
group). Mixed-methods social network analysis was
used to map and analyse participants’ health networks.
Results: A total of 47 interviews were conducted.
Although participants’ health networks consisted of a
range of health care professionals (HCPs), these did not
reflect or encourage MDC. Not only did participants favour
minimal interaction with any HCP, they preferred solecharge care and were found to strongly rely on alternative
sources such as family members and the internet.
Conclusion: Patients presented limited opportunities
for their HCPs to collaborate, particularly pharmacists.
Patients’ choices of health connections strongly
influenced collaborative processes and outcomes.
This research highlighted the need to consider patient
perspectives in the development of MDC models in
primary care.
Conclusion: The policy implications are that health
services:
• re-consider their level of investment/selection of
patient feedback methods
• analyse patient feedback data more effectively
leading to improvement in patient safety.
August 12th – 15th, 2014 | 35
ORAL PRESENTATIONS
33. Beyond childbirth-related trauma: a
collaborative study to detect trauma
and posttraumatic stress symptoms
in mothers
34. Our children’s health: Results of the
ACT General Health Survey
Reay R.E.1, Ringland C2, Carnall K.E.2, Mazzer K1, Cubis
J1,2, Raphael B1, Morrison R2
Epidemiology Section, Health Improvement Branch,
ACT Health Directorate.
AUSTRALIAN NATIONAL UNIVERSITY Medical School
(ANUMS), Canberra Hospital, Canberra, ACT.
Lindy Fritsche, Carol Kee
1
Perinatal Mental Health Consultation Service (PMHCS),
Child & Adolescent Mental Health Services, ACT Mental
Health, Justice Health and Alcohol and Drug Services,
Woden, ACT.
2
Introduction: Exposure to trauma and adversity
can greatly increase women’s risk of mental health
disorders during the perinatal period. This can interfere
with attachment to the infant, relationships and overall
adjustment to motherhood. Furthermore, engaging
mothers with trauma histories can create unique
challenges for health services. This study aimed to
investigate a broad range of trauma experiences
and symptoms in pregnant and postpartum mothers
attending a specialist perinatal mental health service.
Methods: All mothers who attended their initial
interview were invited to complete a questionnaire
measuring potentially traumatic events (PTE), emotional
well-being and posttraumatic stress symptoms (PTS).
Mothers also participated in a clinical interview for
assessment and treatment planning.
Results: One hundred and two mothers consented to
participate. Of these women, 86% experienced a lifetime PTE
and more than half of the participants scored in the clinical
range for PTS symptoms. Co-morbid PTSD and depressive
symptoms were more common than either alone.
Conclusion: Interpersonal trauma, such as emotional,
physical, sexual abuse and domestic violence, was more
common than trauma arising from childbirth. The high
proportion of mothers with elevated posttraumatic
stress symptoms and co-morbid depression
underscores the importance of raising awareness of
trauma and its impacts on mothers.
Introduction: Healthy behaviours adopted in childhood
can lay the foundation for future health benefits.
Information collected from the ACT General Health
Survey (ACTGHS) provides an overview of the health and
wellbeing of children in the ACT since 2007.
Methods: The survey randomly samples about 500
children from ACT households each year; with parents/
carers as proxy respondents for children less than 16
years. The telephone interview asks about child health
behaviours, health status and use of health services.
Weighted means and proportions are assessed for
statistical significance by comparing 95% confidence
intervals or using p-values of <0.05.
Results: In 2007-2010, 89.3% of parents reported that
their child’s health was good to excellent. Seventy percent
of children met the minimum dietary requirements for
fruit consumption, but only 40% met the minimum
requirement for vegetable consumption. Physical activity
levels require improvement with only 23% of children
doing one or more hours of physical activity outside of
school per day and 19% walking to school. Twenty-three
percent were overweight or obese. A small proportion
(6%) were at risk of developing a clinically significant
behavioural problem.
Conclusion: This snapshot highlights the areas that
could be targeted to improve the health and wellbeing of
children in the ACT.
ORAL PRESENTATIONS
35. Identification of a novel right ventricular
cardiomyopathy in two Collaborative
Cross (CC) strains
Yi Zhang , Quang Nguyen , Lavinia Hallam , Mark
Koina4, Fuad Iraqi5, Ramesh Ram3 Grant Morahan3 &
Leonard Arnolda1, 2.
1,2
3
4
Medical School 1Australian National University, Canberra,
Australia; Departments of Cardiology2 and Pathology4,
Canberra Hospital, Canberra, Australia; 3West Australian
Institute of Medical Research, Perth, Australia. 5Human
Microbiology, Tel Aviv University, Israel.
1
Introduction: We have characterized a right ventricular
(RV) cardiomyopathy in inbred strains of mice from the
CC; a panel of strains designed for genetic mapping.
Methods: Hearts from 2 inbred strains were examined
histologically. In subsets of animals we did electron
microscopy, echocardiography and telemetric ECG
recording.
Results: Both strains had similar histological changes.
Marked RV dilatation was observed with wall thinning
and patchy full thickness fibrosis of the RV. The left
ventricle (LV) was often involved with subepicardial
fibrosis extending into the mid-ventricle. These
features are pathognomonic for Arrhythmogenic RV
Cardiomyopathy (ARVC), a common cause of sudden
death in young people. Echocardiography showed a
dilated poorly-contractile RV with normal LV function.
Ventricular arrhythmias were observed by telemetry.
Electron microscopy demonstrated highly convoluted
and disorganised intercalated discs; similar changes to
those observed in human ARVC.
36. Sustainability of bed management
changes targeting ed overcrowding
Drew Richardson, School of Clinical Medicine,
Australian National University, Garran, ACT.
Michael Hall, Director of Emergency Medicine, Canberra
Hospital, Garran, ACT.
Introduction: In 2013, TCH ED introduced a modified
Overcapacity Protocol (OCP) to reduce the number of
patients waiting for inpatient beds. There was a small
decrease in mean numbers waiting and a marked
decrease in periods of overcrowding over 5 weeks, and
this study aims to assess the long term sustainability.
Methods: Prospective descriptive study of ED
crowding with inpatients over four 3-month periods
compared with the previous year. Occupancy with
patients waiting for beds was calculated minutely, the
outcome measures were the mean daily number and
the proportion of time when more than 10 waiting was
exceeded (>10).
Results: Improvement was confined to the first quarter
after the change, when the mean number waiting for
beds was 6.06, compared to 6.78 in the control quarter
(P<0.0001). The means were identical in the second quarter
(6.54) and higher in the third and fourth quarters after
the OCP (6.02 vs 4.49, 6.27 vs 5.98, both P<0.0001). The
proportion of >10 was lower in the first two quarters (8.3%
vs 14.6% then 11.5% vs 14.2%, P<0.0001), but higher in the
third (11.9% vs 6.4%) and fourth (13.0 vs 11.4%).
Conclusion: The beneficial results of the OCP were not
sustained beyond 6 months.
Conclusion: The occurrence of the ARVC phenotype
in two CC strains excludes new mutation(s) as a likely
cause. Instead, ARVC in the CC strains is best explained by
the interaction of genetic variants that individually caused
no disease in the progenitor strains. The power of the CC
to produce novel disease models, even of rare diseases
like ARVC, demonstrates the value of this resource.
August 12th – 15th, 2014 | 37
ORAL PRESENTATIONS
37. Adverse patient outcomes within 24
hours of ward admission from the ED:
A retrospective analysis of the Modified
Early Warning Score (MEWS)
Timothy Fleming1, Sumeet Rai2
1
Student; Australian National University Medical School,
Canberra, ACT.
2
Senior Staff Specialist in Intensive Care; Canberra
Hospital, Garran, ACT.
Introduction: The primary aim of this study was to
determine the validity of the modified early warning
score as a predictor of adverse outcomes within 24hrs in
patients admitted to general wards from the emergency
department (ED).
Methods: A retrospective cohort study was conducted
at Canberra Hospital. The study sample presented to
the emergency department between 01 July 2011 and
31 December 2011. A modified early warning score
(MEWS) was calculated on ED discharge, as well as time
between ward admission and Medical Emergency Team
(MET) call out. General characteristics of patients were
also collected. A binary logistic regression was used to
determine the relationships between ED MEWS and ICU
admission and/ or death. Our main outcome measure
was adverse patient outcome. This was defined as ICU
admission and/ or death after MET call.
38. Treating overweight and obese adults in
General Practice – a systematic review
Elizabeth Sturgiss, Kirsty Douglas, Sonia Res, Rebecca
Kathage, Alex Stevenson.
Academic Unit of General Practice, Australian National
University Medical School, Canberra, ACT.
Introduction: Obesity is arguably the single most
important health issue facing modern primary care.
General Practitioners are on the front line caring for
patients with this health issue along with the multitude
of health impacts that it brings. On average Australians
attend their GP 2-7 times a year and patients report
high rates of feeling respected and listened to by GPs.
Despite this and the acknowledged positive effect of
GP involvement in health prevention current obesity
management strategies require referral outside the GP
environment. This project was developed to identify
and understand the evidence around GP delivered
interventions for obesity.
Methods: A systematic review with the following
inclusion criteria: RCTs, adults, BMI over 25 and a
weight loss program delivered by a Primary Care doctor
in a Primary Care setting. The primary outcome was
BMI measured at 2 years with reporting of adverse
outcomes. We used Pubmed, PsycInfo and Cochrane
Central Register of Controlled Trials.
Results: We found no significant relationship between
ED MEWS and ICU admission and/or death within 24hrs
of ward admission from the ED.
Results: There is almost no research on strategies
delivered by General Practitioners – we identified one
International study, and no Australian data.
Conclusion: Although no statistical relationship was
found between ED MEWS and adverse patient outcome
within 24hrs of ward admission in our population, we
recommend that a large, multicenter study should
be undertaken to evaluate the use of an appropriate
screening tool in this setting.
Conclusion: We will reflect upon why there is so little
research on GP delivered strategies for obesity treatment.
ORAL PRESENTATIONS
39. Learning about endometriosis and
self-management of illness: an
exploratory study of advanced practice
nurse education for females with
endometriosis and pelvic pain
Genna C Ward, University of Canberra, Canberra, 2600,
Melissa A Parker, Canberra Endometriosis Centre, TCH,
Canberra, ACT, 2606, Vikki Knott, Research Fellow,
Menzies School of Health Research, Brisbane.
Introduction: This study aimed to explore the outcomes
and acceptability of an advanced practice nurse education
intervention focussed on increasing knowledge of
endometriosis and encouraging self-management.
Treatment for endometriosis has been dominated by
a focus on medical interventions that deliver limited
results. Therapeutic patient education that encourages
self-management is known to be effective in some
chronic illnesses. The efficacy of such an intervention with
endometriosis has not to date been explored.
Methods: In 2013 fifteen participants with diagnosed or
suspected endometriosis were interviewed by telephone
after receiving a nurse-led education intervention
delivered at the Canberra Endometriosis Centre within
TCH. Interviews employed a brief semi-structured
interview schedule focussing on outcomes of the
intervention, perceptions of the intervention and needs of
the patients. Data were subjected to thematic analysis.
Results: Levels of knowledge about endometriosis and
engagement with self-management increased postintervention. Participants reported that the intervention
was acceptable and helpful. Thematic analysis of
interview data highlighted that patients experienced
the following benefits: getting information, learning
self-management, receiving personalised support and
breaking isolation. Interviews also yielded data on
participant perceptions of what would help with their
condition and the difficulties involved with medical and
community responses to endometriosis.
Conclusions: Nurse-led education on endometriosis
that promotes self-management appears to be a useful
intervention meriting further investigation.
40. Role of adipose tissue in the
pathogenesis of non-alcoholic
steatohepatitis (NASH) in high fat fed
foz/foz mice
Tenzin D. Dagpo1, Ainy Khan1, Fahrettin Haczeyni2,
Geoffrey Farrell2, Christopher Nolan1 and Viviane
Delghingaro-Augusto1.
Endocrinology1 and Liver2 Research groups,
AUSTRALIAN NATIONAL UNIVERSITY Medical School,
Canberra Hospital, ACT.
Introduction: Alms1 mutant (foz/foz) mice develop
obesity due to defective appetite regulation. NOD.B10
foz/foz mice on 24 weeks of high fat (HF) diet develop
diabetes, adipose tissue restriction and non-alcoholic
steatohepatitis; whereas Balb/c foz/foz mice do not.
The aim of this study is to determine the role of adipose
tissue in the abnormal metabolic phenotype of NOD.B10
foz/foz mice.
Methods: Female NOD.B10 and Balb/c WT and foz/foz
mice were fed chow or HF-diet from 4 weeks of age and
body, liver and adipose weights, blood glucose, plasma
insulin, adiponectin and alanine transferase (ALT) were
measured after 2, 4, 6 and 8 weeks on diet. mRNA
expression of markers for adipose differentiation and
inflammation were analysed at 6 and 12 weeks of age.
Results: At 12 weeks of age, HF-fed NOD.B10 foz/
foz mice developed hyperglycaemia, hyperinsulinaemia
and hepatomegaly with increased plasma ALT and
hypoadiponectinaemia. These features were not evident
in Balb/c foz/foz mice. However, no difference was
observed in the adipose tissue weights and mRNA
expression of differentiation and inflammation markers
between both strains.
Conclusion: There was early evidence of diabetes
and insulin resistance in HF-fed NOD.B10 foz/foz
mice without concomitant adipose restriction and
dedifferentiation, suggesting a secondary role for
adipose tissue in the pathogenesis of NASH.
August 12th – 15th, 2014 | 39
ORAL PRESENTATIONS
41. Novel immunotherapy using Complete
Freund’s Adjuvant
Christina Salmon1, Joseph Altin1, Anneke C Blackburn2,
David Tscharke1, Narci Teoh3, Moira Brennan4, Rachel
Allavena4 and Aude Fahrer1.
Research School of Biology, The Australian National
University, Canberra, ACT; 2The John Curtin School of
Medical Research, The Australian National University,
Canberra, ACT, 0200; 3Canberra Hospital, Garran, ACT,
0200 4School of Veterinary Science, University of
Queensland, Brisbane, QLD.
1
Introduction: The field of cancer immunotherapy aims
to modulate immune responses to enhance tumour
destruction. The aim of this project is to investigate
the efficacy of an immunotherapeutic cancer vaccine. The
hypothesis is that injecting a strong immunostimulant
intratumourally could induce an anti-tumour immune
response (Fahrer, 2012).
Methods: Mice were injected subcutaneously with
tumour cells and treated when tumours reached 5 mm
in diameter. Mice received either a single intratumoural
injection of CFA emulsified in PBS, or just PBS for control
mice. Mice were euthanized when tumours reached 15
mm in diameter or animals showed signs of illness.
Intratumoural infiltrates were collected by fine-needle
aspiration, and analyzed by flow cytometry. Canine
cancers were injected with CFA intratumourally, and
monitored by veterinarians and owners.
Results: We observed that intratumoural CFA
treatment of P815 mastocytomas and 4T1 mammary
adenocarcinomas resulted in a statistically significant
survival increases (p-value 0.0002, p-value 0.0229,
respectively). In the P815 model, responding CFA mice
had increased levels of intratumoural neutrophils.
Intratumoural CFA trials have begun in canine veterinary
trials, resulting in complete remissions of terminal
cancers in two dogs.
Conclusion: CFA treatment was found to be a
promising candidate for use as a simple and
inexpensive cancer vaccine.
Reference: Fahrer, AM (2012) A proposal for a
simple and inexpensive therapeutic cancer vaccine.
Immunol Cell Biol, 90:310-313.
42. Calcium Balance During Hemodialysis
Richard F Singer 1,2 Oliver Williams1 Chari Mercado2
Bonny Chen2 Girish Talaulikar1, 2
The Australian National University, Acton, ACT 2601,
Australia 2 Canberra Hospital, Garran, ACT.
1
Introduction: Intradialytic calcium balance has not been
well studied. It is a potentially important factor in the
pathogenesis of mineral bone disease, a condition that
affects most dialysis patients.
Methods: Three different dialysates were studied.
Regional citrate anticoagulated (RCA) haemodialysis
was performed using a zero-calcium dialysate and a
calcium infusion. Calcium balance was calculated by
subtracting dialysate effluent calcium from the amount
infused. Conventionally anticoagulated hemodialysis
was performed using dialysate containing either
1.25mmol/L calcium (acetate stabilized), or 1.5mmol/L
calcium (citrate stabilized). Calcium balance was
calculated as the difference in dialysate inflow and
effluent calcium.
Results: During the study period, 15 RCA and 30
conventionally anticoagulated hemodialysis sessions
were assessed. Median calcium losses were 1.3mmol
per hour dialyzed in the RCA sessions, and 0.8mmol
in both the 1.25 and 1.5mmol/L calcium containing
dialysate sessions (p=0.04).
Conclusion: Conventional dialysis using acetate
stabilized dialysate containing 1.25mmol/L calcium
results in the same small, negative, calcium balance
as dialysis with citrate stabilized dialysate containing
1.5mmol/L calcium. RCA haemodialysis, using the
studied calcium infusion algorithm, results in a slightly
more negative calcium balance. Prospective studies
assessing the effect of calcium balance on mineral bone
disease are necessary to determine the clinical impact of
these calcium fluxes.
ORAL PRESENTATIONS
43. Molecular insights into the loss of
heparan sulfate (HS) during islet
isolation and HS recovery after
islet transplantation
Fui Jiun Choong, Lora Jensen, Sarah Popp, Debra
Brown, Danushka Wijesundara, Craig Freeman,
Christopher Parish, Charmaine Simeonovic.
Department of Immunology, The John Curtin School of
GPO Box 334, Canberra, ACT.
Introduction: Islets are enriched in the
glycosaminoglycan heparan sulfate (iHS), which is
critical for the survival of insulin-producing beta cells.
During islet isolation, iHS is significantly reduced,
potentially impacting on the quality of islet transplants.
This study investigates whether heparanase (an HSdegrading endoglycosidase) contributes to the loss of
iHS during islet isolation and evaluates strategies for
replenishing iHS in vitro.
Methods: Islets were isolated from wild-type or
heparanase knockout C57BL/6 mice and transplanted
into isogeneic mice. iHS was localised by Alcian blue
histochemistry. HS proteoglycan (HSPG) core protein
levels were assessed using flow cytometry and
immunohistochemistry. Islet/beta cell uptake of FITC-HS
mimetics was examined using confocal microscopy and
flow cytometry. qRT-PCR was used to assess transcript
levels of Exostosin-like 3 and N-deacetylase/Nsulfotransferase 2.
Results: iHS correlates with the distribution of intraislet HSPG core proteins for collagen type XVIII,
syndecan-1 and CD44. During isolation, islets selectively
lose iHS, independently of heparanase. iHS fails to
recover after 4 days of culture and is not reconstituted
in vitro using HS mimetics. Significant recovery of iHS
to ~50% of normal levels occurs by 5-10 days after
isotransplantation.
Conclusion: These findings suggest that preservation of
iHS during islet isolation may significantly improve islet
graft integrity.
44. Comprehensive B cell phenotyping
according to normal ontogeny
improves detection of peripheral
blood and bone marrow involvement
and demonstrates immunophenotypic
and genotypic diversity
Dipti Talaulikar1,2,3; Andrew Ziolkowski1; Josh Tobin2;
Sanjiv Jain4; Bruce Shadbolt2,5,Yogesh Jeelall3; Chris
Goodnow3; Matthew Cook2,3,6.
Department of Haematology, Canberra Hospital;
AUSTRALIAN NATIONAL UNIVERSITY Medical
School, College of Medicine, Biology and Environment;
3
JCSMR, College of Medicine, Biology and Environment,
AUSTRALIAN NATIONAL UNIVERSITY; 4Department of
Anatomical Pathology, Canberra Hospital; 5Department
of Statistics and Epidemiology, Canberra Hospital;
6
Department of Immunology, Canberra Hospital.
1
2
Aims: While characterisation based on cell-of-origin
(COO) into germinal centre (GC) and activated B-cell
(ABC) subtypes is prognostic in diffuse large B-cell
lymphoma (DLBCL), considerable heterogeneity remains
unexplained. We developed a comprehensive B-cell
maturation flow cytometry panel for diagnosis and
staging in DLBCL patients aiming to improve detection
of B-cell clones and characterise their phenotypic and
genotypic diversity.
Methods and results: The flow cytometry panel
elucidated several B-cell populations in 104 DLBCL
patients [PB: 79, BM: 83, lymph node: 12]. Mean age:
64.01 years, range: 30.08-94.08 years); COO: GC:
30/79, ABC: 49/79. Overall survival at 5 years: 56.8%
(SE=0.08). Clonal populations were identified in 26/104
(26.5%) PB/BM samples (cf. 44/238, 18.5% historical
controls). Immunophenotyping in 35 cases allowed
classification based on normal B-cell ontogeny. The
IgM memory immunophenotypic variant was found to
be less likely to have >7 lymphoma-associated somatic
mutations compared to other phenotypes (p=0.03) further
suggesting that the variants have differing cellular origins. Conclusions: Comprehensive B cell phenotyping
based on normal ontogeny can improve detection
of small B cell clones in PB/BM, and demonstrate
immunophenotypic diversity in DLBCL. Correlations
with genotyping suggest these variants may arise from
differing cellular origins and potentially improve the
traditional COO classification.
August 12th – 15th, 2014 | 41
ORAL PRESENTATIONS
45. Mutations in Roquin prolong microRNA
longevity in Lupus mice
46. Cellular responses to vaccination in the
assessment of immune competency
Monika Srivastava1, Tony Duan1, Vicki
Athanasopoulos1, Slobodan Jergic2, SashikaRichards1,
Mark Chong3, Nicholas Dixon2, Jeff Babon3 and Carola G
Vinuesa1.
Elizabeth N da Silva1,2, Rochna Chand1, Alan Baker3,
Anastasia Wilson1, Krishna Karpe4, Matthew C Cook1,2
The John Curtin School of Medical Research, The
Australian National University, Canberra, ACT; 2School of
Chemistry, University of Wollongong, Wollongong, NSW;
3
The Walter Eliza Hall Institute, Parkville, VIC.
Department of Immunology & Translational Research,
Canberra Hospital, Garran, ACT, 2605; 2The Australian
National University, Canberra, ACT, 0200; 3Department
of Immunology, Royal Prince Alfred Hospital,
Camperdown, NSW, 2050; 4Department of Renal
Medicine, Canberra Hospital, Garran, ACT.
Introduction: Roquin is a ubiquitous and highly
conserved RNA-binding E3-ubiquitin ligase, and
Roquinsan/san mice carrying the ‘san’ point mutation
in Roquin develop autoimmunity due to failed
posttranscriptional regulation of T cell and macrophage
mRNAs (Vinuesa et al, 2005; Yu et al, 2007; Pratama
et al, 2013). Post- transcriptional regulation of
mRNA targets by miRNAs has been implicated in
autoimmunity. A paradoxical increase of miRNAs and
their target mRNAs in Roquinsan/san mice suggests
a role of Roquin in miRNA homeostasis and miRNAmediated mRNA repression.
Introduction: Routine assessment of specific
immunity following vaccination is by measurement
of serum antigen-specific antibodies. In chronic kidney
disease (CKD), seroconversion following hepatitis B
vaccination is impaired, however an underlying cellular
defect to explain this is lacking. Plasmablasts (PB) and
circulating follicular helper T cells (Tfh) peak in the
peripheral blood 7 days following seasonal influenza
vaccination, and correlate with antigen-specific
responses. We hypothesized that analysis of these
parameters following hepatitis B vaccination could
explain the impaired seroconversion seen in CKD.
Methods: The miRNA profile of the Roquinsan/san mice
was analysed by miRNA microarrays. The effect of Roquin
on miRNA biogenesis and miRNA processing was studied
by Q-RT-PCR/ Northern Blot and in vitro processing
assays. miRNA turnover and decay was analyzed in vivo
and in vitro. Putative interactions of Roquin with miRNAs
were examined by SPR and RIP assays.
Methods: CKD patients and healthy controls were
recruited to undergo peripheral blood collection before
and 7 days following routine hepatitis B or seasonal
influenza vaccination. Peripheral blood mononuclear
cells were separated and analysed by flow cytometry,
using specific markers for PB and circulating Tfh.
1
Results: ~30 miRNAs were upregulated, and no miRNA
were downregulated, in T cells of Roquinsan/san mice
compared with wild type. Accumulation of these miRNAs
occurred after Dicer processing in a T cell autonomous
manner. In vitro processing assays excluded a role for
Roquin in miRNA biogenesis. RNA-protein interaction
studies demonstrate that Roquin binds directly to
miRNAs in vitro and in vivo, with Roquinsan having
increased binding affinity. Our most recent data suggests
that Roquinsan prolongs the half-life of miRNAs through
a novel molecular pathway.
Conclusion: Stabilization of specific T cell miRNAs by
Roquin represents a novel role for this RNA-regulating
protein in posttranscriptional regulation. Roquin emerges
as the first mammalian enzyme to control a unique step
in miRNA longevity and possibly function.
1
Results: Influenza vaccination generated an increase
in circulating PB in both CKD and healthy controls. No
PB response was seen following hepatitis B vaccination
in either group. No consistent change was seen within
conventional (CXCR5+PD-1+) circulating Tfh in any
group, however there was an increase in PD-1 mean
fluorescence intensity on CXCR3+ memory CD4+ Tfh in
healthy controls receiving either vaccination, but not in
CKD patients.
Conclusion: While PB response following hepatitis B
vaccination does not predict serological response, CKD
imparts an effector T cell defect which may account for
impaired seroconversion.
ORAL PRESENTATIONS
47. Newly acquired lymphoma-related
somatic mutations appear in relapsed
DLBCL patients
48. A novel deep sequencing method for
tracking of driver mutations in nonHodgkin lymphoma
Andrew Ziolkowski1 , Yogesh Jeelall2, Dan Andrews2,
Matthew Cook2,3, Josh Tobin4 , Sanjiv Jain5, Chris
Goodnow2, Dipti Talaulikar1,4
Yogesh Jeelall1, Andrew Ziolkowski2, Daniel Andrews1,
Julia Rayner1, Matt Field1, Sanjiv Jain3, Matthew
Cook1,4,5, Chris Goodnow1, Dipti Talaulikar1,2,5
Department of Haematology, ACT Pathology, Canberra
Hospital, Canberra ACT, 2605; 2The John Curtin School
of Medical Research, Australian National University,
Canberra ACT, 2600; 3Department of Immunology,
ACT Pathology, Canberra Hospital, Canberra ACT,
2605; 4Australian National University Medical School,
Australian National University, Canberra ACT, 2600;
5
Department of Anatomical Pathology, ACT Pathology,
Canberra Hospital, Canberra ACT, 2605.
1
1
Introduction: Diffuse large B-cell lymphoma (DLBCL)
is an aggressive lymphoma with relapsed or refractory
DLBCL seen in ~30% of cases following R-CHOP
chemotherapy. Tumour evolution and selection of
a chemoresistance clone are likely explanations for
treatment failure/relapse. A better understanding
of clonal heterogeneity at diagnosis and relapse is
therefore required. We aimed to map clonal evolution
at relapse using immunoglobulin variable heavy chain
(IgVH) sequencing and genotyping for known somatic
mutations (in key lymphoma genes) within matched
diagnostic and relapses DLBCL pairs.
Methods: Six matched diagnostic and relapsed DLBCL
samples were Sanger sequenced to determine the
unique lymphoma IgVH gene usage. Next Generation
genomic Sequencing following HaloPlex™ Target
Enrichment System was used to determine common
lymphoma mutations at diagnosis and relapse.
Results: IgVH sequencing showed 3 cases with
2 distinct lymphoma clones at diagnosis. A single
detectable clonal population at relapse was identified for
all patients. Lymphoma-associated somatic mutations
detected at diagnosis were preserved at relapse and in 4
cases, acquisition of additional mutations was observed.
Conclusions: Our results show that while multiple IgVH
sub-clones are present at diagnosis of DLBCL, a single clone
evolves at relapse with acquisition of additional somatic
mutations that are likely to facilitate tumour relapse.
Department of Immunology, John Curtin School
of Medical Research, Australian National University
2
Department of Hematology, Canberra Hospital 3
Department of Anatomical Pathology, Canberra Hospital
4
Department of Immunology, Canberra Hospital 5
Australian National University Medical School.
Introduction: Non-Hodgkin’s lymphoma (NHL) is the
6th most common cancer in Australia. Currently, a large
proportion of patients fail standard treatments including
chemotherapy and immunotherapy, indicating a gap in
our understanding of the pathogenesis of lymphoma.
While genome sequencing has identified a number
of somatic mutations in genes such as MYD88 and
CARD11, the cell of origin of these mutations and how
they contribute to lymphoma development is currently
not known.
Methods/Results: To identify the cell of origin of the
lymphoma mutations, we developed custom nextgeneration sequencing approaches. In an initial cohort
of 45 DLBCL samples, we have identified 8 cases
with MYD88 mutations. These cases are currently
being studied using a novel ‘ultra-deep sequencing’
assay to identify the cell of origin of the mutations. By
the addition of nucleotide barcodes during the PCR
amplification process, we have eliminated processing
and sequencing errors, and have identified very low
numbers of non-lymphoma cells with gain-of-function
MYD88 mutations (> 0.01%).
Conclusions: Novel custom sequencing approaches
have demonstrated that the MYD88 mutation arises
earlier in ontogeny in normal haemopoietic
precursors in patients with DLBCL, potentially
accounting for treatment failure and acting as a
reservoir for future relapse.
August 12th – 15th, 2014 | 43
ORAL PRESENTATIONS
49. Human T follicular regulatory cells
signal directly to germinal centre B
cells using IL-10
50. Identifying the rate of Monoclonal B cell
Lymphocytosis in Patients diagnosed
with Primary Autoimmune Cytopenia
Rebecca A Sweet, Pablo F Cañete and Carola G Vinuesa
Nana Yaa G. Owusu-Tieku1, Andrew Ziolkowski1,
Dipti Talaulikar1,2
Department of Pathogens and Immunity, The John Curtin
-Abstract not available-
Department of Haematology, ACT Pathology,
Canberra Hospital, ACT; 2Australian National University
Medical School, ANU, ACT.
1
Introduction: Patients with autoimmune diseases
have an increased risk of developing lymphoma. To
test the hypothesis that chronic antigen stimulation in
patients with autoimmune haematological disorders
results in development of small B cell clones and
drives lymphoproliferative disease, we aimed to screen
patients with autoimmune haemolytic anaemia (AIHA)
and Immune Thrombocytopenia (ITP) and perform
molecular characterisation on B-cell clones.
Methods and Results: 23 normal and 27 AIHA and
ITP patient samples were screened using 9 colour flow
cytometry. 4% of normal samples (1/23) and 33% of
AIHA/ITP samples (9/27) (p = 0.0136) contained small
clonal B cell populations.
The identified clonal populations on a pilot cohort of
4 patients were cell sorted and the immunoglobulin
heavy chain variable (IgHV) gene usage and mutational
status was determined using multiplex PCR and Sanger
Sequencing. IgHV gene usage varied in each case and
3/4 of clones carry somatically mutated IgHV genes.
Conclusion: The increased rate of clonal populations in
AIHA/ITP compared to normal provides support to the
hypothesis that autoimmunity may be an intermediate
step in the development of lymphoproliferative disease.
IgHV analysis was inconclusive and the role of antigen
stimulation in the development of lymphoproliferative
disease was unable to be determined.
ORAL PRESENTATIONS
51. DOCK8 is critical for the survival and
function of NKT cells
Greg Crawford1, Anselm Enders2, Uzi Gileadi1, Sanda Stankovic3,
Qian Zhang4, Teresa Lambe1, Tanya L. Crockford1, Helen E.
Lockstone5, Alexandra Freeman6, Peter D. Arkwright7, Joanne
M. Smart8, Cindy S. Ma9, Stuart G.Tangye9, Christopher C
Goodnow2, Vincenzo Cerundolo1, Dale I Godfrey3, Helen C. Su4,
Richard J. Cornall1, and Katrina L Randall2,10
MRC Human Immunology Unit, Weatherall Institute for
Molecular Medicine, Oxford University, John Radcliffe Hospital,
Oxford, UK; 2John Curtin School of Medical Research and
Australian Phenomics Facility, Australian National University,
Canberra, ACT, Australia; 3Department of Microbiology &
Immunology, University of Melbourne, Parkville, Victoria,
Australia; 4Laboratory of Host Defenses, National Institute
of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA;
5
Wellcome Trust Centre for Human Genetics, University
of Oxford, Oxford, UK; 6Laboratory of Clinical Infectious
Diseases, National Institute of Allergy and Infectious Diseases,
NIH, Bethesda, MD, USA; 7University of Manchester, Royal
Manchester Children’s Hospital, Manchester, UK; 8Department
of Allergy and Immunology, Royal Children’s Hospital,
Melbourne, Victoria, Australia; 9Immunology Program,
Garvan Institute of Medical Research and St Vincent’s Clinical
School, Faculty of Medicine, University of NSW, Darlinghurst,
Australia; 10 Department of Immunology, Canberra Hospital
and Australian National University Medical School, Australian
National University, Canberra, ACT, Australia. *joint first
authors, # equal senior authors.
1
Introduction: Patients with the DOCK8
immunodeficiency syndrome suffer from recurrent viral
and bacterial infections, high levels of IgE, eczema and
greater susceptibility to cancer. Many different primary
immunodeficiencies have defects in natural killer T
(NKT) cells so we wanted to investigate whether NKT
cells were affected by DOCK8-deficiency.
Methods: NKT cells were enumerated by flow
cytometry in two different cohorts of patients with
DOCK8 immunodeficiency and in two different mouse
models of the disease. The NKT cells in the mouse
models were further studied for in vitro proliferation
and cytokine production using anti-CD3/CD28 or
α-galactosylceramide.
Results: A defect in NKT cell numbers was found in
the two different human cohorts. Using the mouse
models, we found that DOCK8-deficiency resulted in
impaired NKT cell development, principally affecting
the formation and survival of long-lived, differentiated
NKT cells. In the thymus, DOCK8-deficient mice lack
a terminally differentiated subset of NK1.1+ NKT cells.
Although the initial NKT cell response to antigen is intact
in the absence of DOCK8, their ongoing proliferative and
cytokine responses are impaired.
Conclusion: Our data demonstrate that DOCK8 is
required for the development and survival of mature
NKT cells, consistent with the idea that DOCK8 mediates
survival signals within a specialised niche.
52. Whole exome sequencing in early-onset
cerebral SLE identifies a pathogenic
variant in TREX1
Julia I Ellyard1, Rebekka Jerjen1, Jaime L Martin1,
Adrian Lee1, Matthew A Field2, Simon H Jiang1,3, Jean
Cappello1, Svenja K Naumann1, T Daniel Andrews2,
Hamish S. Scott4, Marco G. Casarotto5, Christopher C
Goodnow2, Jeffrey Chaitow6, Virginia Pascual7, Paul
Hertzog8, Stephen I Alexander9, Matthew C Cook2,10,
Carola G Vinuesa1
Department of Pathogens and Immunity, John Curtin
School of Medical Research, Australian National
University, ACT, 0200. 2Department of Immunology,
John Curtin School of Medical Research, Australian
National University, ACT, 0200. 3Department of Renal
Medicine, Canberra Hospital, Canberra, ACT, 2605.
4
Division of Molecular Pathology, Institute of Medical
and Veterinary Science and The Hanson Institute, and
School of Medicine, University of Adelaide, SA, 5000.
5
Department of Molecular Bioscience, John Curtin
School of Medical Research, Australian National
University, ACT, 0200. 6Dept. of Rheumatology, Sydney
Children’s Hospitals Network, Sydney, NSW, 2001.
7
Baylor Institute for Immunology Research, Dallas TX;
The University of Texas Southwestern Medical Center
at Dallas, Dallas, TX. 8Monash Institute of Medical
Research (MIMR), Clayton, VIC, 3168. 9Centre for Kidney
Research, Children’s Hospital at Westmead, NSW,
2145.10Department of Immunology, Canberra Hospital,
Canberra, ACT.
1
Introduction: Systemic lupus erythematosus (SLE)
is a chronic and heterogeneous autoimmune disease.
Twin studies indicate a strong genetic contribution to
lupus, but in the majority of cases the pathogenic variant
remains unknown. The genetic contribution to disease is
likely to be greatest in cases with early-onset and severe
phenotypes. Whole exome sequencing (WES) now offers
the possibility of identifying rare alleles responsible for
disease in such cases.
Methods: We performed WES in a 4-year-old
female with early-onset cerebral SLE and conducted
biochemical analysis of the putative defect.
Results: WES identified a rare, homozygous mutation
in the Three Prime Repair Exonuclease 1 (TREX1)
that was predicted to be highly deleterious. The
TREX1 R97H mutant protein had a 20-fold reduction
in exonuclease activity and was associated with an
elevated IFN-a signature in the patient. The discovery
and characterization of a pathogenic TREX1 in our
proband has therapeutic implications: the patient is now
a candidate for neutralizing anti-IFN-a therapy.
Conclusion: Our study is the first to demonstrate that
WES can be used to identify rare or novel deleterious
variants as genetic causes of SLE and, through a
personalized approach, improve therapeutic options.
August 12th – 15th, 2014 | 45
ORAL PRESENTATIONS
53. RBP atlas: an exploration of
interactions between mRNA and
proteins and their impact on
cardiomyocyte biology
Yalin Liao 1, Hao Yang1, Alfredo Castello 2, Bernd Fischer
2
, Sophia Foehr 2, Stefan Leicht 2, Rastislav Horos 2, Jeroen
Krijgsveld 2, Matthias Hentze 2 and Thomas Preiss 11
The John Curtin School of Medical Research, The
Australian National University, Canberra, ACT, 0200;
2
European Molecular Biology Laboratory (EMBL),
Heidelberg, Germany, 69117. E-mail: [email protected]
Introduction: RNA-binding proteins (RBPs) control all
aspects of RNA fate, often by organizing multiple functionally
related RNAs into “post-transcriptional operons”. Defects
in RBP function furthermore underlie a broad spectrum of
human pathologies (1). How such RBP networks operate in
cardiomyocytes and respond to (patho-) physiological cues in
the heart is poorly understood.
Methods: We chose to investigate this in murine HL-1
cardiomyocytes, a cell line that can be propagated
in culture while maintaining the ability to contract
and other differentiated cardiac morphological
and functional properties (2). Deploying a recently
developed combination of UV-crosslinking of proteins
to RNA in living cells with identification of proteins copurifying with poly(A)+ RNA by mass spectrometry (3).
Results: We have now identified ~1000 proteins as the
cardiomyocyte “mRNA interactome”. Domain features
and gene ontology enrichment broadly validate
the sensitivity and specificity of the cardiomyocyte
RBP capture. ~370 of the identified proteins have
no RNA-related annotations and ~65 of these were
identified as RBP candidates for the first time. Of direct
relevance to cardiac pathology, ~180 of cardiomyocyte
RBP genes are associated with heart disease (based
on genecards.org), and only ~50 of these have
established links to RNA biology. Notably, ~60 of the
cardiomyocyte RBPs are enzymes of intermediary
metabolism; these are enriched for functions in energy
metabolism, mitochondrial localization and dinucleotide
co-factor requirement.
Conclusion: Our work reveals the first
comprehensive dataset of cardiomyocyte RBPs, and
the data provides a tentative link between cellular
metabolism and gene expression through RNA-binding
by metabolic enzymes (4). Ongoing work is focused on
identifying the RNA targets of selected RBPs, as well as
probing changes to the RBP-RNA interaction network
in cardiomyocytes responding to metabolic challenges.
Castello, A et al. (2013) RNA-binding proteins in
Mendelian disease. Trends Genet. 29:318-27.
Claycomb, WC et al. (1998) HL-1 cells: a cardiac
muscle cell line that contracts and retains phenotypic
characteristics of the adult cardiomyocyte. Proc Natl
Acad Sci USA. 95:2979–84.
Castello, A et al. 2012. Insights into RNA biology from
an atlas of mammalian mRNA-binding proteins. Cell.
149:1393–406.
Hentze, MW and Preiss, T (2010) The REM phase of gene
regulation. Trends Biochem Sci. 35:423-6.
54. Non-immune islet β-cell susceptibility
to failure in NODk mice
Ainy K. Hussain, Tenzin D. Dagpo, Viviane DelghingaroAugusto, Christopher J. Nolan
Endocrinology and Diabetes Research Unit, Medical
School, The Australian National University, Canberra ACT.
Introduction: Islet β-cell susceptibility factors may
contribute to the initiation of β-cell damage and
triggering of autoimmune attack in type 1 diabetes
pathogenesis. NODk mice are congenic for the protective
MHC H2k (Idd 1 locus) and unlike NOD mice do not
develop autoimmune diabetes. The aim of the study was
determine if NODk β-cells are susceptible to failure by
non-immune stressors.
Method: NODk male mice were fed chow or high fat (HF)
diets from 4 weeks of age. Body weight and blood glucose
were measured fortnightly. Intraperitoneal glucose
tolerance tests (ipGTT) were performed at 13 weeks of
age. Plasma insulin assay, triglycerides (TG) and free fatty
acid (FFA) were measured fasted (ipGTT, time 0) and fed
(prior to sacrifice 3 days later). At sacrifice, the pancreas
was harvested for histological assessment.
Results: NODk male mice develop hyperinsulinaemia
and severe glucose intolerance after 10 weeks of
HF feeding. HF-fed male NODk mice also develop
dyslipidaemia compared to chow fed controls with
elevated fed FFA and fasted TG levels. Pancreas
histology assessment is to follow.
Conclusion: HF-diet is diabetogenic in NODk mice,
consistent with islet β–cell susceptibility to failure.
ORAL PRESENTATIONS
55. Genetic analysis of Escherichia coli,
focusing on adherent, invasive E. coli
isolated from Crohn’s disease patients
Claire L O’Brien,1,2 Paul Pavli,1,2 David M Gordon3
Medical School, Australian National University,
Canberra, ACT. 2Gastroenterology and Hepatology Unit,
Canberra Hospital, Canberra, ACT.3Research School of
Biology, Australian National University, Canberra, ACT.
1
Introduction: Adherent-invasive E. coli (AIEC) are a
leading candidate bacterial trigger for Crohn’s disease
(CD). The AIEC phenotype is based on a strain’s ability
(i) to adhere to and invade epithelial cells, and (ii) to
survive and replicate within macrophages. No defining
molecular features have been identified for AIEC;
phenotypic testing is used to identify them. The aim of
this study was to identify a common molecular property
of the AIEC phenotype.
Methods: The whole genomes of 51 E. coli isolates
were sequenced and their AIEC phenotype determined.
Adherence/invasion assays were conducted using I-407
epithelial cells, survival/replication assays using THP-1
macrophages. A PCOA plot comparing the properties of
adherence/invasion and survival/replication, and gene
content was produced.
Results: 23% of strains were positive for the AIEC
phenotype. The ability of a strain to adhere and invade
was highly correlated, but its ability to replicate
within macrophages was independent of its invasion
ability, suggesting the two components of the AIEC
phenotype are under different genetic controls. Strains
with the AIEC phenotype cluster together, even when
unsupervised iterative clustering is used, indicating that
it is a valid phenotype. AIEC strains share gene blocks.
Conclusions: Multiple genetic elements are responsible
for the AIEC phenotype.
56. Exercise slows growth of dysplastic
hepatocytes by improving insulin
sensitivity and enhancing DNA damage
surveillance pathways in mice genetically
predisposed to obesity and diabetes
Evi Arfianti1, Vanessa Barn1, W. Geoffrey Haigh2, George
N. Ioannou2, Narci Teoh1, Geoff Farrell1
Liver Research Group, Australian National University
Medical School at Canberra Hospital, ACT
2
Division of Gastroenterology, Veterans Affairs
Puget Sound Health Care System and University of
Washington, Seattle, WA.
1
Background: The present study was aimed to
investigate whether exercise sufficient to reduce the rate
of weight gain, reduces growth of dysplastic hepatocytes
and HCC development in DEN-injected foz/foz mice.
Methods: DEN-injected male foz/foz and wild-type (WT)
littermates were randomly assigned either to cages
provided with an exercise wheel or housed similarly
without an exercise wheel. Dysplastic hepatocytes
were identified by glutathione S-transferase pi (GSTpi) immunohistochemistry (IHC), protein and gene
expression were analysed by immunoblotting and
semi-quantitative real-time PCR, respectively; glucose
tolerance by i.p. glucose tolerance test, hepatic lipid
content using HPLC, and oxidative status by reduced
(GSH) and oxidized glutathione (GSSG).
Results: foz/foz mice maintained weight gain similar
to WT mice, at least until 12wks of age. GST-pi
immunostaining showed a significant reduction in the
number of dysplastic hepatocytes in exercising foz/foz
mice compared to foz/foz littermates without exercise,
associated with prevention of excessive weight gain
and adiposity. Exercise also improved insulin sensitivity
in foz/foz mice, as indicated by lower fasting blood
glucose, reduced serum insulin and enhanced glucose
tolerance and attenuation of hepatic lipid accumulation.
Nrf1/2 signalling was down-regulated by exercise,
inferring decreased metabolic activity to support
hepatocellular proliferation.
Conclusions: Exercise prevents growth of dysplastic
hepatocytes in the early stage of DEN-induced HCC in
obese and diabetic mice. Whether this is sufficient to
delay DEN hepatocarcinogenesis in foz/foz mice will be
apparent by August 2014.
August 12th – 15th, 2014 | 47
ORAL PRESENTATIONS
57. Prevalence of Connective tissue disorders
in Diabetes Mellitus and their links to
diabetic microvascular complications
Chloe E Abbott, Roger Chen, Steven Boyages
Concord Clinical School, Concord Repatriation and General
Hospital, University of Sydney Camperdown NSW.
Objective/background: Determine evidence regarding
the relationship between connective tissue conditions,
which have been the source of debate and confusion
in literature, and associated diabetic complications.
This review focuses on the Syndrome of limited joint
mobility, Dupuytrens disease and adhesive capsulitis
and assesses, synthesizes, critically appraises and
challenges the currently available research in order
to establish a time course relationship between these
conditions and diabetic complications.
Method: Systematic Searches were conducted through
Medline, EMBASE and Pubmed using MeSH terms.
Literature on both type 1 (T1D) and type 2 (T2D) was
included in the review, and differentiated for analysis
purposes.
Results: Current data lacks prospective long
term follow up from onset of Diabetes Mellitus to
presentation of disease and is difficult to interpret
based on methodology and criteria for diagnosing these
conditions, particularly the syndrome of limited joint
mobility. Different methodology has been used to assess
presence of disease and complicating factors, making
comparison of data impossible.
Conclusion: The inconsistency in measurement, a lack of
individual prospective follow-up from time of diagnosis
and poorly evidence based data on disease classification
provides reasoning for different results in multiple studies
and direction for future research in the area.
58. Horse related injury presentations to a
tertiary trauma centre
Nushin R Ahmed, MBBS 1, Rebekah Ogilvie, NP, PhD (c)
2
, Kate Curtis, RN PhD 3, Ailene Fitzgerald, FRACS 2
Department of Surgery, Canberra Hospital, Canberra,
ACT, 2605. 2 Shock Trauma Service, Canberra Hospital,
Canberra, ACT, 2605 3 Sydney Nursing School, University
of Sydney, Sydney, NSW.
E-mail contact: [email protected]
1
Background: Equestrian activities are popular in
Australia with over 250,000 people participating in
horse related recreation annually1. These activities carry
substantial risk of injury which is estimated to be one
injury per 1000 riding hours2. The aims of this study are
to determine the incidence and characteristics of horse
related major traumatic injury presenting to a tertiary
trauma centre.
Methods: A retrospective analysis of ACT (Australian
Capital Territory) Level 1 Trauma Centre registry data
from July 2007 to June 2013 was conducted. Inclusion
criteria: horse related injury within the ACT or region of
responsibility and one or more of the following – Injury
Severity Score (ISS)> 15, ICU admission, hospital stay>3
days, or death.
Results: 108 patients were identified in this study
period. Female riders were over represented with
the most common injury mechanism being a fall
from a horse. Helmet use was low(29%) where
protective equipment was documented(65%). Injury
was more likely to occur in regional areas(86%). One
quarter(25.9%) of all patients required ICU admission.
The most frequent injuries were to the thorax, head and
lower extremity with single system injury being more
common. One third(35.18%) of patients had an ISS>15.
Mortality was 0.92%.
Conclusion: Females are the most represented injured
equestrian riders in the ACT and surrounds. Injury
prevention strategies that target this cohort are required;
as well as changes to the legislation for the use of
protective equipment. This is of particular importance in
regional areas.
ORAL PRESENTATIONS
59. Testing the safety of multifocal
pupillographic objective perimetry
(mfPOP) in patients with
photosensitive epilepsy
60. Driving Cessation in Later Life:
Depressive Symptoms and Coping
Eman N Ali1, Teddy L Maddess1, Kate Martin2, Angela
Borbelj2, Christian J Lueck1,2,3
Department of Psychology The Australian National
University Canberra.
Eccles Institute of Neuroscience, John Curtin School
Acton 0200, ACT, Australia, 2Department of Neurology,
Canberra Hospital, Canberra 2605, ACT, Australia;
3
Australian National University Medical School, Acton,
ACT, Australia.
Sarah W Walker
1
Introduction: Current guidelines which refer to the
safety of artificial light-emitting sources in patients
with photosensitive epilepsy (PSE) rely on comparison
against stimulus parameters which are known to
evoke PSE. However, such guidelines lack objective
proof of the safety of such sources. To demonstrate the
safety and tolerability of the multifocal pupillographic
objective perimeter (mfPOP) we undertook
electroencephalography (EEG) during perimetric testing
with mfPOP in patients known to have epilepsy.
Methods: A cross-sectional open-labelled, study tested
15 consecutive patients with epilepsy (including 3 with
known photosensitivity) and 15 patients without epilepsy
during their routine EEG testing in the neurophysiology
laboratory in Canberra Hospital. The primary endpoint
was the development of a seizure, a photo-paroxysmal
response (PPR), or increased spike-and-wave activity on
the EEG.
Results: All subjects tolerated mfPOP testing well. No
patient developed an epileptic aura or clinical seizure
during (or even shortly after) testing, but one patient
had evidence of subclinical seizure activity which started
before mfPOP testing. This activity continued during
and after testing but there was no sign of augmentation
by the perimetry. There was no evidence of a PPR or
increased spike-and-wave activity in any subject.
Introduction: Driving cessation is related to increased
depressive symptoms (Fonda, et al., 2001; Legh-Smith,
et al., 1986; Marottoli, et al., 1997; Ragland, et al., 2005;
Windsor, et al., 2007), the mechanisms underpinning the
relationship are poorly understood. This study examined
the relationship between driving status and well-being,
and driving cessation experiences and well-being;
explored whether pressure to cease driving predicts
poorer post-cessation experiences and whether ongoing
post-cessation experiences predict poorer well-being;
and whether coping strategies and access to transport
moderate the relationship.
Methods: Older adults (n = 517) participated in this
study, 20.7% were ex-drivers the remaining were
current drivers. Participants completed a battery of
self-report inventories. IBM SPSS Statistics 20 was
used to conduct hierarchical regression and moderation
statistical analysis.
Results: After controlling for sociodemographic and
health related variables, driving status was not related
to well-being. Pressure to cease driving predicted more
negative post-cessation experiences. More negative
post-cessation experiences predicted poorer well-being.
Ex-drivers who self-reported flexible goal adjustment
tendencies experienced fewer depressive symptoms.
Availability of alternative transport failed to moderate
the relationship between driving status and well-being.
Conclusion: These findings provide an initial framework
for developing targeted and flexible psychological
interventions to promote and improve post-driving
cessation levels of well-being.
Conclusion: To our knowledge, this is the first study
incorporating EEG during mfPOP testing. The results
provide strong evidence attesting to the safety of mfPOP in
patients with known epilepsy, even those with known PSE.
August 12th – 15th, 2014 | 49
ORAL PRESENTATIONS
61. Automated perimetry in neurological
visual field loss
Brendan Tonson-Older1, Ted Maddess1, Jason Bell2,
Christian Lueck1,3
Eccles Institute of Neuroscience, John Curtin School
Canberra, ACT, 0200. 2 School of Psychology, The
University of Western Australia, Perth, WA, 6009.
3
Department of Neurology, Canberra Hospital,
Canberra, ACT.
1
Introduction: Stroke, pituitary tumour and anterior
ischemic optic neuropathy (AION) present with visual
field loss. Automated perimetry is widely used to detect
this as it provides a standardized test which is accurate
and consistent. However, there are problems with
existing perimeters, e.g. they take considerable time
and depend on subjective responses. This study was
designed to evaluate the level of agreement between
different methods of automated visual field testing in
patients with these neurological disorders.
Methods: Patients with stroke, pituitary tumour or
AION were recruited from the Canberra Hospital records.
Acuity, intraocular pressure measurement, and optical
coherence tomographic scans were performed to
exclude retinal disorders before completing Humphrey
and Matrix perimetry over 2-3 weeks.
Results: Perimetric demonstration of superior
altitudinal hemifield loss was well-correlated in AION
patients (p=0.0398), but that of inferior fields was
not. Bitemporal field loss from pituitary tumours was
also significantly correlated (p=0.0223). Homonymous
hemifield loss in stroke patients were significantly
correlated (left: p=0.0051, right p=0.0001).
Conclusion: Humphrey and Matrix results were wellcorrelated in areas of significant visual field loss.
However, the correlation was less marked in unaffected
portions of the visual fields. The implications for clinical
practice will be discussed.
62. Putting the ‘GO’ into mobilisation in
ICU: Preliminary Results from the
GoSAM Study
Margot Green1, Anne Leditschke3, Sean Chan2,
Imogen Mitchell2,3, Bernie Bissett1,4, Vince Marzano1,
Teresa Neeman5
Health, Canberra ACT 2605 2 Intensive Care Unit,
Canberra Hospital, ACT Health, Canberra, ACT 2605 3
Australian National University Medical School, ACT 2600
4
Discipline of Physiotherapy, University of Canberra,
Canberra, ACT 5 Statistical Consulting Unit, Australian
National University, Canberra, ACT.
1
Introduction: Intensive Care Unit (ICU) survivors
frequently experience poor long term functional
outcomes. Early rehabilitation in ICU may reduce muscle
weakness and improve function. We report results
from the initial intervention in the GoSAM study, which
investigates whether ‘Goal-Directed Sedation and
Mobilisation’ increases early rehabilitation in ICU.
Methods: Prospective, single centre before and after
intervention study evaluating the efficacy and safety of
a mobility protocol in patients mechanically ventilated
for >48hours. Outcome measures included frequency
and type of mobilisation, adverse events, discharge
destination and global function using the Acute Care
Index of Function (ACIF).
Results: Daily targets for mobilisation were achieved in
30/47 (65%) patients pre-intervention and 39/46 (85%)
patients post-intervention (OR 3.2; 95% CI 1.2-8.6).
Mobilisation targets were more frequently exceeded
post-intervention (16% vs 40%). Mean ACIF was higher
in the post-intervention cohort (0.55 versus 0.39,
unpaired t-test, p=0.007). There were no serious adverse
events. Minor adverse events occurred in 5/118 (4%)
and 7/141 (5%) episodes respectively (p=1, Fisher’s
exact test). 33/44 (75%) patients commencing active
mobilisation in the first week of ICU admission were
subsequently discharged home.
Conclusion: Implementation of the GoSAM mobility
protocol safely increased rehabilitation opportunities
and was associated with higher functional scores at
ICU discharge.
ORAL PRESENTATIONS
63. Interactive visualization of deep knee
flexion, in four dimensions and in vivo
Jennie M. Scarvell1,2, Mark R. Pickering1,4, Diana M.
Perriman1,3, John Warmenhoven1, Paul N. Smith1,3
Trauma and Orthopaedic Research Unit at Canberra
Hospital, Canberra 2Faculty of Health, University of
Canberra, Canberra 3Australian National University
College of Medicine, Biology and the Environment
4
University of NSW at ADFA.
1
Introduction: Deep knee flexion is important for a
variety of functional and cultural reasons and previous
indirect measurements have estimated the degree
of both rotation and translation required. We aimed
to confirm these by direct visualisation of the bony
architecture using a dynamic registration model.
Method: Healthy participants performed a deep kneel.
Fluoroscopy images captured at 15 -30 frames/second
were registered to 3D CT data and used to create
dynamic 4D models. Confirmatory analysis of motion in
6 degrees of freedom was calculated.
Results: Kinematic analysis from 90⁰ to 140⁰ of flexion
required 70⁰ of rotation, 2⁰ of adduction, and 6.5 mm
of AP translation. This is more rotation than the 20 -30
degrees which has been previously described. Our study
confirmed previous findings of a reversal in condylar
translation at 120 degrees. The dynamic knee model
eloquently illustrates how the knee achieves deep knee
flexion with consistent joint conformity by allowing
the medial tibial condyle to describe an arc around the
medial femoral condyle to slot in between the condyles
at full flexion. The internal rotation of the tibia is
essential to this deep flexion lock.
Conclusion: This new tool has enabled us to better
understand how the knee joint accommodates
compression and extremes of motion, permitting a
better appreciation of the role of knee structure and the
potential impact of pathology affecting these structures
on knee function.
64. Mapping symptoms of
neurodegenerative disease to the brain:
a vision for a subcortical connectome
Jeffrey C.L. Looi11,3, Mark Walterfang2, Christer
Nilsson4, Brian D. Power5, Danielle van Westen6, Dennis
Velakoulis2, Lars-Olof Wahlund3, Paul M. Thompson7
Research Centre for the Neurosciences of Ageing,
Academic Unit of Psychiatry and Addiction Medicine,
Hospital, Canberra, ACT. 2Melbourne Neuropsychiatry
Centre and University of Melbourne, Melbourne,
VIC, Australia, 3Karolinska Institute, Department of
Neurobiology, Care Sciences and Society, Division
of Clinical Geriatrics, Stockholm, Sweden 4Geriatric
Psychiatry, Department of Clinical Sciences, Lund
University, Lund, Sweden 5School of Psychiatry and
Clinical Neurosciences, The University of Western
Australia & Peel and Rockingham Kwinana Mental
Health Service, Fremantle, WA, Australia 6Center for
Medical Imaging and Physiology, Skåne University
Hospital, Lund, Sweden & Diagnostic Radiology,
Department of Clinical Sciences, Lund University, Lund,
Sweden 7Imaging Genetics Center, Laboratory of Neuro
Imaging, Department of Neurology & Psychiatry, UCLA
School of Medicine, Los Angeles, CA, USA.
1
Introduction: We outline a conceptual clinical and
research framework to characterise and understand
the structural neural circuit basis of neurodegenerative
disease. We focus on in vivo studies of brain circuits in
neurodegenerative disease aimed to detect structural
change in the neuroanatomical basis of cognitive,
emotional, behavioural and motor dysfunction.
Methods & Results: We advocate study of strategic
‘hubs’ and ‘spokes’, such as recurrent parallel neural
circuits comprising key structural elements such as
grey matter bodies and white matter tracts, including
cortico-striato-thalamic circuits, corpus callosum,
hippocampus, cerebellum and the tracts connecting
them, as well as other measures of brain atrophy
including expansion of space, such as ventricular
shape. New structural magnetic resonance imaging
modalities and advanced image analytic methods
allow quantification of shape changes in these key
structures as we have demonstrated in our research to
date. Assembling quantified measures of subcortical
structures will potentially yield a map constituting a
subcortical connectome.
Conclusions: We propose mapping the progression
and ultimately, when disease-modifying agents are
available, treatment response for neurodegenerative
diseases in a form directly related to symptoms and
signs of cognitive, emotional, behavioural and motor
dysfunction: that is, the shape and volume of key
subcortical brain structures – a subcortical connectome.
August 12th – 15th, 2014 | 51
POSTER PRESENTATIONS
1. Extending the Physiotherapy
Repertoire: Ventilator Hyperinflation
allows more treatment of ICU
patients than Manual Hyperinflation—
an observational study
Vince Marzano1, Bernie Bissett1,2, Anne Leditschke3
Physiotherapy Department, Canberra Hospital, Canberra
ACT 2605 2Discipline of Physiotherapy, University of
Canberra, Canberra ACT 2617 3Intensive Care Unit,
Canberra Hospital, ACT Health, Canberra, ACT 2605
1
Introduction: Both manual hyperinflation (MHI) and
ventilator hyperinflation (VHI) have been shown to be
effective physiotherapy interventions to clear sputum and
reverse lung collapse in ventilated patients. However MHI
is often contraindicated. Due to maintenance of airway
pressure, VHI may allow treatment of more patients.
This study investigated whether introducing VHI would
increase physiotherapy treatment of ICU patients.
Methods: Using a quality improvement approach, two
3 month audist were performed before and after the
introduction of VHI practice into the ICU. Data collected
included frequency, contraindications and incidence
of adverse outcomes with MHI and VHI. All data
was extracted to a purpose-built database from ICU
electronic documentation software.
Results: Prior to implementation of VHI, MHI was
unable to be performed in 8/56 (14 %) of cases, mainly
due to patient intolerance. Following implementation of
VHI, all of 109 VHI treatments were well tolerated (OR
for intolerance 0.03 95% CI 0.002 -0.46). In addition,
86 episodes of VHI were performed where MHI was
contraindicated. Adverse outcomes reduced from 11% to
3% with the introduction of VHI. No clinically significant
adverse events occurred during either MHI or VHI.
Conclusion: The implementation of an evidencebased VHI guideline effectively increased the number
of physiotherapy treatments possible for ventilated
ICU patients in a 3 month period, with a lower rate of
adverse outcomes compared to MHI.
2. Caesarean Section Confers Survival
Benefit for Breech Premature Infants
< 29weeks
Tim Cochrane1, Abdel-Latif Mohamed1,2, Bruce
Shadbolt2,3, Alison Kent1,2
Dept of Neonatology, Canberra Hospital, ACT, Australia
3
Clinical Epidemiology Unit, Canberra Hospital, ACT
1
2
Introduction: Given improving survival of the extremely
premature neonate the mode of delivery may have
subsequently changed, with a lower threshold for
caesarean section (CS). The aims of this study were
to determine: the incidence of CS in neonates born
extremely premature (<29weeks gestation); and if CS is
associated with improved survival.
Methods: Retrospective analysis of prospectively
collected Australian and New Zealand Neonatal Network
(ANZNN) data 1995-2009. 5 year time epochs (19951999; 2000-2004; 2005-2009) and gestational age
groups 23-25 completed weeks and 26-28 completed
weeks were analysed.
Results: 16,570 babies were included in the study. The
CS rate increased from the first to second epoch, then
stabilised (48% for babies <26wks; 68% for 26-28wks).
Survival significantly improved over time 1995-1999
vs. 2005-2009 (62.6% vs. 71.4% for <26wks, p=0.002;
90.3% vs. 92.7% for 26-28wks, p=0.003). Delivery mode
for each gestational age group had no effect on overall
survival. Vaginal breech delivery increased mortality
when compared with Breech Caesarean in labour (46.1%
vs. 26.2% for 23-25wks, p=0.006; 12.6% vs. 7.8% for
26-29wks, p=0.006).
Conclusion: Caesarean section for premature babies
<29wks in breech position conferred survival benefit
over vaginal delivery. Therefore CS may be a reasonable
management option as it provides survival benefit.
August 12th – 15th, 2014 | 53
3. Preventing falls and harm from falls—
not just a national priority! Results of
the Falls Risk Assessment Pilot Project
4. Have we kept the pressure down?
Results from the 2014 pressure
injury audit
Irene J. Lake1, Linda Kohlhagen2, Todd Kaye3, Ramila
Varendran2, Sonia Hogan4Amanda Boers2,3, Nerri
Bullman2, Brett Jones5 and Veronica Croome51
Irene J. Lake1, Marian J Currie1, Veronica Croome2
Canberra Hospital, ACT Health. 2Rehabilitation, Aged
and Community Care (RACC). 3Community Rehabilitation
Team 4Quality and Safety Branch, 5Stroke Unit, Division
of Medicine, Canberra Hospital and Health Services.
6
Nursing and Midwifery Office, ACT Health.
Introduction: The Falls Risk Assessment Pilot Project
(February-March 2014) aimed to reduce the incidence of
falls/harm from falls at Canberra Hospital.
Method: A pre-post evaluation design was used to
test whether an education program + a Falls Risk
Assessment Tool (FRAT) reduced the incidence of falls
and harm from falls. Several methods were used to
collect data from 3 wards.
Results: The rate of falls/1000 occupied bed days
decreased on two wards and increased on one; falls
severity increased on one ward and was unchanged
on two. 96% of patients at high risk of falls had fallprevention strategies implemented/documented.
Erecting a Falls Risk sign above the patient’s bed,
intentional rounding and bathroom supervision were
the highest rated falls-prevention strategies. 84%
of staff found the FRAT easy to use; 76% completed
the e-learning package; there was no increase in the
proportion of staff knowing when to use bedrails, when
to report a fall or to whom. Falls entered into Riskman
decreased (90% to 72%, p>0.05).
Conclusion: Although the incidence of falls did
not decrease on all wards, the number of falls risk
assessments and associated interventions increased.
Staff knowledge increased by 15%. These findings support
the organisation-wide implementation of the tool.
Canberra Hospital. 2Nursing and Midwifery Office,
ACT Health.
1
Introduction: Pressure injuries (PI) remain a significant
healthcare issue. The audit aim was to determine the
point prevalence of PI at Canberra Hospital in 2014 and
compare it to prevalence in the previous 2 years.
Method: 64 trained surveyors audited all consenting
patients on all wards (excluding Mental Health) on one
day in March 2014. Auditors reviewed documentation,
completed a PI risk assessment, conducted skin
integrity check and photographed any suspected PI.
Results: 429 patients were audited and 27 patients
with 52 PI were identified. When photographs were
examined, 17 suspected PI were found to be skin
tears; incontinence associated dermatitis; bruising or
diabetes foot ulcers rather than PI. The remaining 35
PI provided prevalence of 6.3% overall and 4.4% for
hospital-acquired PI. The 25 hospital acquired PI (19
patients) were classified as stage 1 (n=13), stage 2 (n=6),
unstageable (n=1) and suspected deep tissue injury
(n=5). In respect to hospital-acquired PI, there has been
a 232% decrease in point prevalence since 2012 and a
further 38% decrease in point prevalence since 2013.
Conclusion: The ongoing reduction in point prevalence
of hospital acquired PI is pleasing, but can still be
improved. The audit will be conducted again in 2015.
5. Attitudes and knowledge towards
management of novel oral
anticoagulants (NOACs): a survey of
hospital clinicians
Sarah Smith and Emilie Nuck. Pharmacy Department,
Calvary Health Care ACT, Bruce, ACT.
Introduction: NOACs are not yet available on formulary
due to concerns surrounding clinician knowledge in their
use and monitoring.
Methods: A three part, anonymous, questionnaire
examining knowledge of, and attitudes towards NOACs
was developed. Descriptive and comparative analyses of
responses was conducted.
Results: 20 responses were received from ten junior
doctors (JMOs), three senior doctors and seven
pharmacists (50% response rate).
70% of JMOs and 67% of seniors had prescribed a
NOAC recently; however 50% of these JMO’s and
33% of seniors reported feeling uncomfortable doing
so. Of the JMOs, 10% felt confident in making NOAC
dose adjustments; none were confident managing
bleeding complications. Most JMOs reported that they
had poor understanding of NOAC PBS criteria (60%),
pharmacokinetics (50%) and drug interactions (90%).
Pharmacists rated themselves more confident in all
responses, excluding the management of bleeding.
MCQs and case studies identified inconsistencies in
NOAC management: only 40% of JMO’s were able to
identify the NOACs licensed in Australia and NOAC
contraindications. Open responses to case questions
reiterated JMOs lack of knowledge in prescribing and
initiating NOACs.
Conclusion: Knowledge gaps and a lack of confidence
concerning NOAC management exist. Targeted education
is required to ensure safe introduction onto formulary.
6. The Role of DOCK8 in antibody
formation and B cell memory response
Zahra Sabouri1, Katrina L. Randall1,2 and Chris C.
Goodnow1.
Medical Research, Australian National University, Canberra,
ACT. 2Department of Immunology, Canberra Hospital,
Canberra, ACT.
1
Introduction: DOCK8 deficiency in humans and mice
results in impaired antibody responses. DOCK8 mutant
B cells in mice have been shown that are able to initiate
a germinal centre (GC) response but they fail to persist in
GCs and undergo positive affinity-selection. We tested the
role of DOCK8 gene in the formation of long-lived plasma
cells, antibody responses and early memory B cells.
Methods: Immunoglobulin transgenic splenic B cells from
either wild-type (WT) or DOCK8 mutant mice along with
sheep red blood cells coated with antigens were adoptively
transferred into WT mice. Antibody formation and B cell
memory response were analysed in recipient mice.
Results: Experiments revealed that DOCK8-mutant B
cells initiated a normal humoral antibody response when
measured after 21 days, but this declined significantly by
day 28 and by that time there were greatly diminished
numbers of unswitched and IgG1-switched memory B
cells in spleen and bone marrow. Reimmunisation did
not restore the populations of SWHEL-derived cells with
mutant Dock8.
Conclusion: These results are consistent with analysis
of peripheral blood in people with DOCK8 deficiency,
where there is a profound decrease in the numbers
of switched memory B cells. Since the experiments
here limit DOCK8 deficiency to a discrete population of
antigen-specific B cells, the absence of memory B cells
in human DOCK8 deficiency is likely to reflect the need
for DOCK8 within responding B cells, either to form or to
maintain memory B cells.
August 12th – 15th, 2014 | 55
7. Herpes Simplex Virus Type I viral gene
expression and latency
Tiffany A. Russell and David C. Tscharke
Research School of Biology, Australian National
University, ACT.
8. Glutathione transferase Omega 1
is a novel redox regulator of TLR4dependent inflammatory signalling
in macrophages
Deepthi Menon1, Rebecca Coll2, Luke AJ O’Neill2 and
Philip G Board1
Department of Molecular Biosciences, The John Curtin
University, Canberra, ACT. 2School of Biochemistry and
Immunology, Trinity Biomedical Sciences Institute, Trinity
College Dublin, Ireland.
1
Introduction: Herpes Simplex Virus (HSV) type I causes
cold sores but is associated with severe outcomes such
as encephalitis and blindness. HSV initiates infection in
epithelial cells, with the virus quickly gaining access to
sensory neurons. This primary lytic infection lasts about
a week, but latent virus persists in neurons, reactivating
periodically. However, there remains concern that ‘true’
latent infection doesn’t occur in animal models within a
month of primary infection.
Methods: Using a murine model, we examined virus
activity between lytic (5 days) and latent infection
(30 days). Our model uses transgenic mice in which
β-galactosidase (β-gal) expression is switched on
permanently in cells experiencing HSV-driven Cre
recombinase expression. By placing Cre under the
control of various promoters in HSV we recorded cells
that have experienced different types of viral activity.
Results: This historical analysis found substantial lytic
gene expression and spread of virus occurring in the
PNS for 5 days beyond the peak of infectious virus load.
More strikingly, when Cre was driven by the promoter
for ICP47, a viral gene that inhibits adaptive immune
responses, the number of β-gal-expressing neurons
continued to rise until day 20 after infection.
Conclusion: Our data suggest that the period
immediately after the lytic infection is quelled remains
highly dynamic and this phase of infection may be
prolonged by HSV-driven immune evasion.
Introduction: Macrophages are key players mediating
innate immune responses that recognise foreign
pathogens. Inflammatory stimulants such as bacterial
lipopolysaccharide (LPS) have been shown to induce
the generation of reactive oxygen species (ROS) through
the activation of Toll like receptor 4 (TLR4) and the
recruitment of downstream signalling proteins resulting
in the subsequent induction of pro-inflammatory
cytokines such as IL-1β [1].
Methods: We generated GSTO1 knockdown J774.1A
macrophage cells using shRNA coding lentiviral
plasmids and TLR4 signalling was activated with 100ng/
ml LPS.
Results: We discovered that J774.1A macrophages
deficient in GSTO1-1 do not respond to LPS and fail
to elicit pro-inflammatory responses including the
generation of ROS via NADPH oxidase 1 and the
expression of pro-IL1β. In order to confirm that the
redox events unfolding in the presence of GSTO1-1
were due to its catalytic activity, we tested the GSTO1-1
inhibitor ML175 on wildtype J774 macrophages. The
production of ROS and the suppression of antioxidant
enzymes after LPS stimulus were blocked significantly
by pre-treating cells with ML175, clearly mimicking the
response of GSTO1-1 knockdown cells.
Conclusion: Taken together, our data demonstrate
the significant attenuation of ROS in GSTO1 deficient
cells, thus identifying GSTO1-1 as a novel component of
inflammation in macrophages.
References: [1] Maitra, U, Singh, N, Gan, L,
Ringwood, L and Li, L (2009) IRAK-1 contributes to
lipopolysaccharide-induced reactive oxygen species
generation in macrophages by inducing NOX-1
transcription and Rac1 activation and suppressing
the expression of antioxidative enzymes. Journal of
Biological Chemistry 284:35403- 35411
9. Comparison and synthesis of
current Australian guidelines on the
management of obese adult patients in
General Practice
10. A point prevalence survey of healthcare
associated urinary tract infections:
be cautious of cautis but not haughty
about HAUTIS
Elizabeth Sturgiss; Kirsty Douglas, Sonia Res, Rebecca
Kathage, Alex Stevenson.
Anne Gardner1, Brett Mitchell1,2, Wendy Beckingham3,
Oyebola Fasugba1
Academic Unit of General Practice, ANU Medical School,
Canberra, ACT.
1
Introduction: As more of the Australian population
becomes overweight, the day to day workload of GPs
includes a majority of overweight patients. In addition,
overweight and obese patients often present to their GP
for assistance in losing weight. The aim of this research
was to identify and synthesise current Australian
guidelines on the treatment of overweight and obese
adults for General Practitioners.
Methods: We reviewed the current Australian
guidelines for the management of overweight and
obese adult patients in Primary Care. The guidelines
were reviewed by three authors and recommendations
were amalgamated where possible. Any discrepancies
found between the guidelines were compared with best
available evidence and then discussed amongst the
research team.
Results: There are a number of guidelines for GPs
working with overweight and obese patients. Although
most guidelines focus on three main areas of: nutrition,
exercise and psychological strategies, each guideline
places a different emphasis on each area.
Conclusion: There are multiple Australian guidelines
for the treatment of obesity by GPS, but they are not in a
readily usable format for the GP setting. This synthesis
of current guidelines will form the basis for developing a
weight reduction program that can be delivered by GPs
in Australia.
Faculty of Health Sciences, Australian Catholic University,
Canberra, ACT. 2Faculty of Nursing and Health, Avondale
College of Higher Education, Wahroonga, NSW. 3Infection
Prevention and Control, Canberra Hospital, ACT.
Introduction: Urinary tract infections account for over
30% of healthcare associated infections. The study aim
was to determine the point prevalence of healthcare
associated urinary tract infections (HAUTIs) and catheter
associated urinary tract infections (CAUTIs) across six
hospitals to inform a national point prevalence process.
Documentation relating to catheter management was
also reviewed.
Methods: We estimated the point prevalence of HAUTIs
and CAUTIs across three public and three private
hospitals in Australia, using two internationally
accepted definitions.
Results: A total of 1109 patients were surveyed. The
median age was 64 years (interquartile range, 42-79
years). Overall HAUTI and CAUTI prevalence was 1.4%
(15/1109) and 0.9% (10/1109) respectively. One quarter
(26.3%) of all patients had a urinary catheter in place
with majority being indwelling catheters (88.7%). Less
than half of patients had appropriate documentation,
such as designation of person inserting catheter (28.8%)
and reason for insertion (38.7%).
Conclusion: While the overall level of HAUTIs is low,
there is a need for better documentation of catheterassociated health care delivery. Given the patient
burden and high risk of systemic sepsis from UTI, we
should aim for zero HAUTI prevalence. Data collection
processes developed provides a strong foundation for a
national point prevalence study.
August 12th – 15th, 2014 | 57
11. NODk compared to C57BL/10 Mice
are more Prone to Islet Beta-Cell
Failure Due to Greater Susceptibility to
Endoplasmic Reticulum Stress
Viviane Delghingaro-Augusto1, Luis A. Socha1, Ainy K.
Hussain1, Jeng Yie Chan2, Ross Laybutt, Christopher J.
Nolan1
Endocrinology and Diabetes Research Unit, Australian
National University, ACT. 2Garvan Institute of Medical
Research, Sydney, NSW.
1
Introduction: Intrinsic defects of islet beta-cells may be
important in the pathophysiology of both non-immune and
immune-mediated diabetes. We aimed to study NOD and
C57BL/10 inbred mice strains that share the autoimmune
diabetes-resistant H2k major histocompatibility complex
(NODk and B10k, respectively).
Methods: Both strains of mice were stressed with
either beta-cell transgenic (Tg) expression of hen
egg lysozyme (HEL) protein or high fat (HF) diet.
Measurements of body weight, blood glucose and
glucose tolerance test were performed. Pancreatic islet
mRNA expression was assessed.
Results: NODk mice stressed with either genetic
or HF diet develop non-immune diabetes, whereas
B10k do not. The ratio of proinsulin/c-peptide was
dramatically and similarly increased in both NODk and
B10k HEL Tg mice. HF diet increased the proinsulin/
insulin ratio. NODk HEL Tg mice had increased islet
mRNA expression of endoplasmic reticulum (ER) stress
markers compared to B10k HEL Tg mice.
Conclusions: The results show an enormous capacity
for islet beta-cell compensation for defects in insulin
processing without induction of ER stress and
preservation of glycemia in B10k HEL Tg mice. The
same insult does cause ER stress and diabetes in NODk
mice. Diabetes development in HF-fed NODk mice is not
associated with altered insulin processing.
12. Endothelial Connexin40 regulates
Activity-Dependent Blood Pressure
Susan K. Morton1,2, Lauren Howitt1, Brett Baillie1, Jillian
Heisler3, Bruce J. Nicholson3, Katherine Lau4, Anthony
Ashton4, Klaus I. Matthaei2, Caryl E. Hill1
Neuroscience, John Curtin School of Medical
Research, The Australian National University, Canberra,
Australia,2Molecular Bioscience, John Curtin School of
Canberra. 3Biochemistry, University of Texas Health
Centre, San Antonio,TX, 4Royal North Shore Hospital,
The University of Sydney, Sydney.
1
Introduction: Endothelial-specific deletion of Cx40
impairs conducted vasodilation, without altering blood
pressure, whereas global Cx40 deletion produces
renin-dependent hypertension. However, blood pressure
measurements were performed using radiotelemetry
within 24 hours of surgery, before return of circadian
rhythm and coordinate loss of endothelial Cx37 was also
reported. In order to selectively impair endothelial Cx40
function, we generated transgenic mice expressing a
mutant Cx40 (Cx40T152A) alongside native Cx40, under
control of the endothelial-specific Tie2 promoter. Our
aim was to investigate the role of endothelial Cx40 in the
regulation of blood pressure.
Methods: The effect of Cx40T152A on electrical and
chemical coupling was assessed using Xenopus oocytes
and endothelial cells. Vascular myoendothelial coupling
was assessed with pressure myography in mesenteric
arteries and conducted vasodilation was measured
following ionophoretically-applied acetylcholine in
cremaster arterioles. Expression of endothelial Cx37
was measured using immunohistochemistry. Blood
pressure was monitored with radiotelemetry 10 days
after surgery.
Results: Cx40T152A mice exhibited diurnal activitydependent hypertension (WT: 111.3±2.5mmHg;
Cx40T152A: 119.5±1.8mmHg; P<0.05), without change
in plasma renin concentration or endothelial Cx37
expression. Myoendothelial coupling was intact in
Cx40T152A arteries, while conducted vasodilation was
markedly attenuated.
Conclusion: We conclude that endothelial Cx40 is
crucial for the regulation of blood flow and pressure
during activity.
13. End of Life Care and ICU
Mardhie E Coleman1, Alice Chambers2, Tess Knight2
Discipline of Nursing, Faculty of Health, Canberra
University, ACT. 2Intensive Care, Canberra Hospital, ACT.
1
Introduction: This quality project was undertaken in the
Intensive Care Unit at Canberra hospital from 2012 to
2014. The intent was to identify the needs of the health
care professionals involved in End of Life Care in the
Intensive Care. The motivation for this project was based
on concerns regarding care of palliative patients, and
concerns regarding communication between doctors
and nurses with respect to palliative patients.
Methods: An extensive literature review was undertaken.
Then a survey consisting of demographics and seven
questions was circulated to 170 staff members (including,
nursing, medical and allied health persons), with the
intent of eliciting both statistical data and descriptive
responses in relation to communication, education,
support needs and experiences of End of Life care.
Results: Statistical analysis and thematic descriptive
analysis identified the following needs:
Communication between health care team; How to
approach family members; Information on the following;
coronial matters; funerals; multicultural beliefs; attitudinal
beliefs; and Organ Donation including further education.
Conclusion: The issues identified have been addressed
through the development of a Clinical Pathway, Clinical
guidelines resources (electronic) and an IT folder for
selfdirected learning. This has been evaluated and
modified with education sessions to address the ongoing
needs of the unit.
14. Developing trauma-informed and
trauma-specific services for child
and adolescents who access Mental
Health Services
Palfrey N3, Raphael B1, Reay R.E 1, Aplin V 1,3, McAndrew
V1,3, Cubis J.C.1, Preston W3, Riordan D3, Harris A2
Australian National Medical School, Canberra Hospital,
ACT, 2Australian Child and Adolescent Trauma Loss
and Grief Network, Australian National Medical School,
Canberra Hospital, ACT, 3Child & Adolescent Mental
Health Services, ACT Mental Health, Justice Health and
Alcohol and Drug Services (MHJHDAS), Canberra, ACT.
1
Introduction: Given the high prevalence of trauma and
adversity amongst mental health consumers, there
has been a call for more trauma-informed services.
This project aims to address this need within Child and
Adolescent Mental Services (CAMHS) through workforce
education, training and evaluation. The project also
involves the implementation of an evidence-based
approach to treatment of this vulnerable population.
Methods: Two levels of training were developed,
implemented and evaluated: Trauma-Informed Care (TIC)
and Trauma-Focussed CBT (TF-CBT). The aim of the overall
program was to increase clinican knowledge, awareness
of and confidence in the assessment and management of
trauma in young people attending CAMHS.
Results: Eighty-two clinicians participated in TIC
training, a further 40 clinicians completed online
and face-to-face in TF-CBT training. TIC training was
associated with a statistically significant increase
in mean levels of: confidence in assessment and
responding to disclosures; knowledge and skills in
working with traumatised individuals; and greater
awareness of resources. Post-training, clinicians viewed
TF-CBT an ethical, effective treatment which was
feasible to implement.
Conclusion: Training in trauma-sensitive approaches
is associated with an increase in clinian knowledge,
awareness of and confidence in the assessment and
treatment of children and adolescents’ exposed to
trauma and adversity.
August 12th – 15th, 2014 | 59
15. Characterizing epigenetic signatures
that mark transcriptional memory
responsive genes in human T lymphocytes
Wen Juan1 Tu, Jasmine Li1,2, Kristine Hardy1, Chloe
Lim1, Sudha Rao11
Centre for Research in Therapeutic Solution, Faculty
of ESTeM, University of Canberra, ACT. 2Department of
Immunology, The John Curtin School of Medical Research,
The Australian National University, ACT.
Introduction: Transcriptional memory is a feature
of immunological memory that allows key immune
genes to experience faster and more robust
transcription to launch a more effective secondary
immune combat against a re-infecting pathogen.
Recent findings from our laboratory show that the
Protein Kinase C-θ (PKC-θ) has a dual role in gene
regulation: both as a signaling kinase and an epigenetic
enzyme in T cells (1). This study aims to gain a
full understanding of the importance of chromatin
accessibility and chromatin-associated enzymes in
human T cell transcriptional memory in the context of
the immune system.
Methods: Formaldehyde-assisted isolation of
regulatory elements (FAIRE) assay was applied
to detect changes in chromatin accessibility of
immune-responsive genes that are associated with
transcriptional activation. siRNA based knockdown
strategies and potent, selective inhibitors were
employed to investigate the importance of PKC-θ in
the establishment of transcriptional memory.
Results: We show for the first time that PKC-θ is
important for maintaining the chromatin accessibility
of transcriptional memory responsive genes.
Importantly, this event is essential for transcription
of a distinct cohort of immune responsive genes,
including IL2, CD69 and TNF in ex vivo derived human
memory T cells.
Conclusion: This study will for the first time demonstrate
nuclear PKC-θ may play an important role in the
chromatin accessibility changes that are associated with T
cell transcriptional memory generation.
16. User friendly method of rat
kidney transplant
1
2
Victor G. Ilie , Eileen Morrisroe
1
Department
of Urology, Canberra Hospital, Canberra,
2
ACT, 2601 Department of Vascular Surgery, Canberra
Hospital, ACT.
Background: The rat kidney transplant (KTx) became
a classic experimental model for training purposes in
general microsurgical techniques. We present a modified
version of the arterial ‘sleeve’ (telescoping) anastomotic
technique.
Methods: A cohort of rat kidney transplants executed
with this modified anastomotic technique was audited
for execution times, long-term graft survival and
complications.
Results: The series comprises 70 KTx carried out by
one microsurgeon. The average warm ischaemic time
was 25.75± 3.8 min, with an arterial anastomotic time of
10.82±3.85 min. It decreased to less than 30 min (cut-off
for long-term graft damage) after nine transplants. The
long-term survival rate was 94.3 %, with no complication
in the surviving group; the deaths were due to
haemorrhage (1.42 %) and ureteric dehis- cence (4.28 %).
Conclusions: Telescoping the renal artery delivers good
results with a faster, less laborious technique, making it
a useful addition to the experimental surgery laboratory.
By contrasting our results with reported series, we
demonstrate that the model can make the rat kidney
transplant accessible for a wider variety of scientists.
17. Incorporating Advanced ThreeDimensional Left Ventricular Imaging into
Routine Clinical Practice (Baseline Study)
18. The evidence for cervical muscle
morphometric changes after whiplash:
A systematic review and meta-analysis
Cartwright Luke, Brown Christine, Giles Leah,
Meredith Tegan.
Daniel S Owers 2, Diana Perriman
Alexandra L Webb
Cardiology Department, Canberra Hospital ACT. E-mail:
[email protected]
1
Introduction: This study seeks to investigate how left
ventricular single-beat Real-time three-dimensional
echocardiography (LVRT3DE), which is a novel method
of non-invasive cardiac assessment, can be incorporated
into a tertiary public hospital. Compared to routine
imaging, research indicates single-beat LVRT3DE is
a superior diagnostic and prognostic tool for patient
care, though there is divergence on the accuracy and
application in clinical practice.
Methods: Fifty three patients were assessed with
trans-thoracic single-beat LVRT3DE during routine
echocardiography over 6 weeks up to May 2014.
Studies were performed on an ACUSON-SC2000
echocardiography machine using a volume transducer.
Images were acquired and analysed with a knowledge
based algorithm.
Results: Single beat LVRT3DE acquisition was
feasible in 100% of patients. The fully-automatically
left ventricular end-diastolic, end systolic and ejection
fraction measurements were considered by the operator
to be accurate in 36% of patients. There was no impact
on the number of studies performed per day: 9.4 v 8.9
(p=0.272).
Conclusion: The utilisation of Single-beat LVRT3DE
was highly feasible in the current patient cohort with
negligible impact on work flow and scanning time
allowing incorporation into clinical practice. Future
work will elucidate if fully automated measurements
are achievable routinely or if semi-automated
measurements are required to achieve acceptable levels
of accuracy and utility.
1,2
1,2,3
1,2,3
, Paul N Smith
,
Australian Capital Territory Health, Canberra Hospital,
ACT. 2Medical School, Australian National University,
Canberra, ACT, 2600 3Trauma and Orthopaedic Research
Unit (TORU), Canberra Hospital, ACT.
Introduction: Morphometric magnetic resonance image
(MRI) changes in patients with whiplash associated
disorders (WAD) may reveal the pathognomic entity
responsible for pain and disability in WAD. Cervical
muscle fat infiltrates (MFI) and cross-sectional area
(CSA) are possible entities but the studies to date have
been relatively small so a meta-analysis is arguably
required to address this question.
Methods: A systematic search was performed using
EMBASE, MEDLINE and The Cochrane Library. Inclusion/
exclusion criteria were applied to the retrieved studies.
Cervical muscle CSA and MFI of WADs and controls
were analysed using RevMan5 with results reported as
standard mean differences (SMD) or mean differences
(MD) with 95% confidence intervals (CI).
Results: No significant difference was observed
between WADs and controls for superior (SMD 0.49,
95% CI -0.05 to 1.02; 272 participants), inferior (SMD
-0.01, 95% CI -0.45 to 0.44; 272 participants) or
deep inferior (SMD 0.19, 95% CI -0.47 to 0.85; 272
participants) posterior muscle CSA. Anterior muscle
MFI demonstrated considerable differences between
WADs and controls (MD 0.09, 95% CI 0.08 to 0.10; 109
participants).
Conclusion: Minimal evidence exists to support the
presence of morphometric MRI changes in cervical neck
muscles after whiplash. However, MFI may provide a
pathological entity that warrants further investigation.
August 12th – 15th, 2014 | 61
19. Immunophenotyping of monocytic
myeloid-derived suppressor cells in
DLBCL and investigating its potential
association with lymphocytopenia—
a pilot study
Rowena Penafiel1, Josh Tobin1, Matthew Cook1,2, Bruce
Shadbolt3, Andrew Ziolkowski4, Dipti Talaulikar1,4
Australian National University Medical School, ACT.
Department of Immunology, ACT Pathology, Canberra
Hospital, ACT. 3Department of Epidemiology, Canberra
Hospital, ACT. 4Department of Haematology, ACT
Pathology, Canberra Hospital, ACT.
1
20. Neonatal mobile imaging: Establishing
consistency and reducing dose
Jan Hughes1, Dalia Hadaya2, Andrea Morris, Melanie
Egan1, Jane Coventry1, Donald McLean2 and Kelly
Munstermann3
Medical Imaging department, Canberra Hospital, ACT.
Medical Physics department, Canberra Hospital, ACT.
3
NICU department, Canberra Hospital, ACT.
1
2
2
Introduction: In Diffuse large B-cell lymphoma (DLBCL),
lymphocytopenia has been associated with decreased
survival. However, the mechanisms through which low
lymphocyte counts impact on outcome remain unclear.
Monocytic lineage myeloid-derived suppressor cells
(MDSCs) are immature myeloid cells that purportedly
suppress antitumour immunity. We aimed to resolve
monocytic MDSCs in a pilot cohort of DLBCL patients
and determine whether there is an association between
MDSCs and the absolute lymphocyte count.
Methods and results: The absolute lymphocyte count
in 258 patients was determined from medical records.
99 patients had a lymphocyte count <1 and 159 patients
had a lymphocyte count of >/= 1. Lymphocytopenia was
found to be associated with poor survival (p=0.034).
Monocytic MDSCs in peripheral blood (n=18) and bone
marrow (n=17) were defined on flow cytometry as
expressing CD34+, CD64+, CD14+, CD33low, CD13+,
HLA-DRlow and CD11b+. The median MDSCs was higher
in bone marrow (365 x 106/L) than peripheral blood
(6.7 x 106/L). There was no significant difference in
the median MDSC counts in patients with and without
lymphocytopenia.
Conclusions: Monocytic MDSCs were identifiable in
a pilot cohort of DLBCL. Larger studies are required
to establish whether MDSCs are associated with
lymphocytopenia and with survival.
Neonatal patients are highly sensitive to the effects of
radiation and may receive multiple x-ray examinations
whilst in the Neonatal Intensive Care Unit (NICU). Aiming
to determine neonatal dose and create evidence based
mobile imaging protocol; research was undertaken
to determine the entrance surface dose (ESD) of each
examination through the positive collaboration between
Medical Physics, Medical Imaging and NICU staff.
Radiographic and patient parameters were collected
for NICU mobile x-ray examinations. Challenges in this
phase included data analysis workload and availability
of radiographers to participate. Data analysis confirmed
significant variations in radiographic parameters
with no correlation to patient size or gestational
age. Radiographers were educated in three key
improvement areas, maximised focus to film distance
(FFD), minimised field of view (FOV) and optimal
exposure parameters (kVp and mAs). A second survey
demonstrated these areas had become more consistent
for all x-ray examinations with a maximum of 68% dose
reduction noted.
Research was implemented by developing a weightbased exposure chart to be used for all NICU
examinations. A third survey determined the efficacy
of the exposure chart. The overall methodology could
be employed in other departments to reach the ideal
balance between low dose and high image quality.
21. Cardiac Pacemaker Procedure and
Complications in Canberra Hospital
in 2012
Chun Seng, CSP, Phua; Darryl, DM, McGill
Department of Cardiology, Canberra Hospital,
Canberra, ACT.
Introduction: Pacemaker implantation is associated
with potential procedural complications. Audit,
benchmarking and feedback can improve patient care
and procedural outcomes. As a quality improvement
exercise we performed a pilot audit for benchmarking
and feedback purposes. This included a statistical
control process (SCP) as a quality control method for
pacemaker implantations.
Methods: Retrospectively obtained information
from discharge summaries, procedural records and
progress notes for all new pacemaker implants was
independently recorded in pass-word protected databases. Routine demographics, procedural details and
documented complications were analysed to obtain
descriptive and comparative statistics, including a SCP
of complications for all pacemaker implanters (controlrule of 3 standard deviations).
Results: All 202 new pacemaker implants in 2012 were
evaluated. The overall complication rate was 8.0%: lead
displacements were the most common complication
(7/202, 3.5%), followed by pneumothorax (3/202, 1.5%).
One pacemaker implanter demonstrated SCP rule
violation for late pacemaker-related complications, a
result supported by comparative statistical measures
(analysis of variance).
Conclusion: Complication rates are well within national
standards. Identification of an outlier allows feedback to
characterize improvement opportunities and subsequent
re-evaluation. This pilot quality-control evaluation
serves as a model and baseline from which future
practice outcomes can be evaluated and compared to
expected international standards.
22. Routine culture-based screening
versus risk-based management for
the prevention of early-onset group B
streptococcus disease in the neonate:
a systematic review
Ella Kurz1 RM, Deborah Davis2 RM PhD.
University of Canberra, ACT.
1
Introduction: Early-onset group B streptococcus disease
(EOGBSD) is recognised as the most common cause
of early onset neonatal sepsis in developed countries.
Two main methods, routine culture-based screening
and risk-based management are used in its prevention.
The routine culture-based protocol is not aimed at
preventing EOGBSD in early preterm infants though
many studies include preterm infants in their results. The
objectives were to identify the effectiveness of risk-based
management versus routine culture-based screening
in the prevention of EOGBSD in term and preterm
neonates and to compare rates of Intrapartum Antibiotic
Prophylaxis (IAP) and infant mortality in both groups.
Methods: A systematic review of the highest available
evidence. Studies were located via a multi-step search
strategy and assessed for inclusion independently
by two reviewers. Data were extracted with the
Joanna Briggs Institute (JBI) quality assessment for
observational studies tool.
Results: The odds of EOGBSD in term infants was
higher in cohorts exposed to risk based management
when compared to routine culture based screening (OR
0.45 95% CI 0.37, 0.53). The rate of administration of IAP
is 29 per cent in the culture-based protocol and 19 per
cent in the risk-based protocol.
Conclusions: This review provides important separate
EOGBSD data for the term and preterm neonate.
Statistical comparison favours the culture-based
protocol over the risk-based protocol. The difference
in EOGBSD incidence under each prevention strategy
is small. Factors to consider when selecting one
protocol over the other are a) EOGBSD incidence and
NNT b) rates of IAP and antibiotic exposure and c) the
medicalisation of birth.
August 12th – 15th, 2014 | 63
23. Research protocol on suicide and
contributing factors in the ACT
Alison Gee and Beverley Raphael
Introduction: Australian and international research
has identified factors associated with suicide. These
findings have informed Australian national and local
suicide prevention strategies. However, understanding
region-specific patterns of behaviour and issues of
concern is essential to meet the health needs of the local
community. Research is needed to understand suicide in
the Australian Capital Territory (ACT) and explore local
views in this small jurisdiction.
Methods: Mixed quantitative and qualitative research
methods across five studies will explore coronial data,
public health service activities in the years before
death, and views from clinicians, consumers and carers
about suicide prevention and support. Methodological
challenges in conducting and reporting suicide research
in a small jurisdiction include limited data, small group
sample sizes and ethical issues such as maintaining
privacy and confidentiality while appropriately reporting
research findings.
Results: Findings will be reported to the ACT Health
Directorate, submitted for academic publication and
disseminated to research, professional, consumer and
carer communities and the ACT public as appropriate.
Conclusion: The planned research will use multiple
research methods to explore suicide and suicide
prevention in the ACT community. The research team
invites discussion with other interested researchers,
professionals and organizations about this and other
suicide research in progress.
24. Redesigning ACT Health Psychology
workforce to meet National Psychology
Board Australia requirements
Jennie Gordon, Rebecca Lennie, Sally Goodyear, Joel
Madden. ACT Health, Canberra, ACT.
Introduction: (study objectives and brief background)
The Psychology Board of Australia (PsyBA) has created
new competencies for clinical practice, including
Area of Practice Endorsement and Board approved
supervision status.
A review of ACT Health Psychology duty statements
(DS) and selection criteria (SC) demonstrated a need
to align with the PsyBA’s regulations to ensure a
sustainable Psychology workforce who are
appropriately credentialed.
Methods: Investigative methods include:
• Local needs analysis completed through consultation
and an issues paper was sent to Health Workforce
Principal Committee (HWPC)
• Career Pathway process identified for psychology
workforce
• Draft duty statements to support ACT Health
Psychologists to meet the new competencies
for clinical practice, including Area of Practice
Endorsement and Board approved supervision status.
• Extensive consultation was carried out with
psychologists across all ACT Health Divisions
Results : Consensus gained on content and use of
revised duty statements
Duty Statements for Psychologists have been tested and
now support alignment with the PsyBA’s regulations
to ensure recruitment of Psychologists who are
appropriately credentialed.
Conclusion: ACT Health now has rigorous evidence based
duty statements to guide recruitment of psychologists and
grow an appropriately skilled psychology workforce to
deliver services to the ACT population.
25. Education of nurse practitioners:
findings of a project exploring advanced
specialty competence, clinical learning
and governance
26. FISH (Fluorescent In situ Hybridisation)
on trephine imprints to achieve
cytogenetic results on ‘dry tap’ bone
marrow collections
Anne Gardner1, Glenn Gardner2, Fiona Coyer2, Amanda
Henderson3, Helen Gosby4, Shane Lenson1
Fiona Webb1, Tasfia Khan1, Israfil Baluwala2, Maya
Latimer1,2,3,4 1
Australian Catholic University, Canberra, ACT.
Queensland University of Technology, Brisbane, QLD.
3
Metro South Health, Brisbane, QLD. 4Australian College
of Nurse Practitioners, North Sydney, NSW.
Cytogenetics, ACT Pathology ACT. 2Haematology, ACT
Pathology, ACT. 3Canberra Hospital, ACT 4Australian
National University, Canberra ACT
1
2
Introduction: There is a pressing need to clarify
accountability and the quality of clinical education
supporting development of specialty clinical expertise
for Australian nurse practitioner students. Learning and
teaching is concentrated in the workplace supervised by
clinicians but qualifications are awarded by universities.
This study identified metaspecialty areas (broad
specialist groups) and explored the governance of
learning and teaching of advanced specialty practice in
the workplace.
Methods: Following an extensive literature review a set
of metaspecialties was determined by expert consensus.
Then a case study approach was used to explore student
clinical learning and teaching.
Results: Six identified metaspecialties will provide
structure to clinical specialty learning and teaching. The
case study approach highlighted a lack of clarity about
how students and their supervisors identify learning
needs the need for greater collaboration with health
care team members and the university, and the value of
increasing dialogue with all the key stakeholders around
assessment processes.
Conclusion: Key structures were identified to address
gaps and inform development of an educational
governance framework and quality indicators to enhance
nurse practitioner clinical learning and teaching. The
findings have potential to influence specialty clinical
learning and teaching for other workforce reform
models, including pharmacists and physiotherapists.
Background: Cytogenetic studies for haematological
disorders are typically performed on bone marrow
aspirate (BMA) samples for diagnostic and prognostic
purposes. On occasion, bone marrow aspiration is
unsuccessful resulting in a “dry tap”. Trephine imprints
often contain abnormal cell populations and may be
amenable to cytogenetic analysis by Fluorescence in Situ
Hybridisation (FISH) therefore an alternative method
to investigate the cytogenetics of bone marrow was
investigated.
Methods: The trephine imprint was examined under
a phase contrast microscope in order to identify the
optimal area to apply the FISH probe. The slide was fixed
twice in Carnoy’s fixative and air-dried overnight. The
following day the FISH probes were applied, denatured
and hybridised as per manufacturer’s instructions.
Following overnight hybridisation, stringency washes
removed any unbound FISH probe. The slide was
counter-stained with DAPI anti-fade and visualised with
a fluorescent microscope.
Results: Analysis of 200 cells on the trephine imprint
showed IGH/CCND1 fusion was present in 50% of nuclei
scored, confirming the diagnosis of MCL.
Conclusion: We plan to undertake a study to validate
this technique by comparing FISH results on stored
trephine imprints to previously reported BMA FISH
results. We are also investigating the use of FISH carried
out on imprint slides from other sample types such
as lymph node smears which often fail to produce a
cytogenetics result.
August 12th – 15th, 2014 | 65
27. The treatment of community acquired
pneumonia in HITH
Dr Karyn E Cuthbert 1, Dr Lisa Bell 2
Health@Home Medical Director, The Calvary Hospital,
ACT; 2Health@Home Medical Specialist, The Calvary
Hospital, ACT.
1
Introduction: Whilst some HITH services treat patients
with community acquired pneumonia (CAP) there
is scarce evidence on best practice – both in how to
“choose” the correct patients and on which antibiotics to
use in the HITH setting.
Methods: HITH admission policy for CAP developed for
use in Winter 2013 for patients not improving on oral
antibiotics or unwell enough to require IV antibiotics from
diagnosis. Inclusion criteria included a SMART-COP score
of 2 or less. Antibiotic protocol was 4.8g of intravenous
benzylpenicillin infused over 24 hours via a peripheral
cannula using an elastomeric infusion pump plus an
oral macrolide or doxycycline. Study was observational
in terms of therapeutic outcomes and the use of the
peripheral IV benzylpenicillin infusion at home.
Results: 17 admissions over 16 weeks, 12/17 clearly
fitting inclusion criteria, 4/17 exclusion criteria
overruled, 1 (anticipated) death, average age 69,
7/17 patients on benzylpenicillin infusion, 10/17 on
ceftriaxone, avge/modal day of HITH transfer day 3,
average 6 days IV antibiotics (mode 4). Some wastage of
preordered benzylpenicillin infusors.
Conclusion: successful trial, continue CAP admission
to HITH in 2014, develop checklist to aid referral,
Calvary pharmacy loaded benzylpenicillin infusions in
2014 to expedite admission and prevent wastage of
elastomeric infusors.
28. Novel Biomarkers & Therapeutic
Targets for Systemic and Specialised
Vascular Diseases
Zuopeng Wu1, 6, Chandima Perera2, Giles D Walters3,
Walter P Abhayaratna1, 4,
Paul A Gatenby5, and Matthew C Cook5, 6
Clinical Trial Unit, 2Department of Rheumatology,
Department of Nephrology, 3Department of Cardiology,
& 5Department of Immunology, Canberra Hospital,
Canberra ACT. 6Translational Research Group,
Medical Research, Australian National University, ACT.
1
3
Introduction: Anti-neutrophil Cytoplasmic Autoantibody
(ANCA) associated vasculitis (AAV) and Cardiovascular
diseases (CVD) associated with inflammatory rheumatic
diseases (IRD) are distinctive but closely associated
conditions causing vascular damages in multiple organs
or specialized in the heart. Genetics, autoimmunity and
autoinflammation are important pathogenic factors but
the exactly mechanisms are not clear. Novel biomarkers
are required for early diagnosis and better therapies.
Methods: Two dedicated clinics have been built up to
deliver specialised multidisciplinary care to AAV and
IRD with CVD patients in TCH for last two years using
cutting-age techniques, including carotid-intima media
thickness (CIMT) and carotid-femoral pulse wave
velocity by tonometry to assess arterial stiffness and
atherosclerotic burden; polychromatic flow cytometry
for immunological and inflammatory phenotypes and
deep sequencing for genomic variations.
Results: Altered monocyte subsets with aberrant C-C
chemokine receptor (CCR) expression was seen in IRD
patients with early sign of CVD and associated with their
therapeutic response. We found antigenic cytoplasmic
proteinase 3 (PR3) expression but not its membrane
presentation or neutrophil specific antigen CD177 had
strong association with production of the causative
specific autoantibody in AAV patients.
Conclusion: Monocyte CCR5 and neutrophil PR3
expression are novel biomarkers and therapeutic targets
for IRD with CVD and AAV patients.
29. Reporting on a proof of concept
plan for national online surveillance
of healthcare associated urinary
tract infections
Anne Gardner1, Brett Mitchell1-2, Wendy Beckingham3,
Noleen Bennett4, Oyebola Fasugba1
Faculty of Health Sciences, Australian Catholic
University, Canberra, ACT 2602 2Faculty of Nursing
and Health, Avondale College of Higher Education,
Wahroonga, NSW 2076 3Infection Prevention and
Control, Canberra Hospital, ACT 2605 4Victorian
Hospital-Acquired Infection Surveillance (VICNISS),
Melbourne, VIC 3000
1
Introduction: This is the second phase of a three Phase
project. Our preliminary findings from Phase I were used
to develop a national protocol which has recently been
published. Phase II is to provide proof of concept by testing
our protocol using an online process.We present the
protocol of a study which aims to develop a website and
pilot an online process for conducting point prevalence
survey of healthcare associated urinary tract infections
(HAUTIs) including catheter associated urinary tract
infections (CAUTIs) and to establish usability of a national
protocol for HAUTIs in residential aged care facilities
Methods: Stage 1: A website and online database will
be developed to enable institutions to conduct and
record data from point prevalence surveys of HAUTIs
and CAUTIs. Stage 2: A web based point prevalence of
HAUTIs and CAUTIs will be conducted in participating
Australian hospitals and residential aged care facilities
to test online data collection processes.
Conclusion: The study outcomes have the potential
to make available a centralised web-based system for
health facilities in Australia to report point prevalence
of HAUTIs and CAUTIs. The results will contribute to
the development of a national strategy and surveillance
system to address HAUTIs and CAUTIs.
30. Phenibut – a legal toxidrome
John Wsol1 and David Caldicott2
Pharmacy Department and 2 Emergency Department,
Calvary Health Care ACT,
1
Introduction: Toxicity associated with consuming
unregulated substances in combination with prescribed
medications is increasingly being seen in hospital
Emergency Departments (ED). We present the case of
an 18 year old male who was brought to ED after being
found collapsed and thrashing violently. Witnesses
report consumption of alcohol, marijuana and a
white powder called ‘phenibut’. The patient was also
prescribed the monoamine oxidase (MAO) inhibitor
tranylcypromine for major depression.
‘Phenibut’ is β-phenyl-γ-amino butyric acid which
exhibits anxiolytic, tranquilizing and nootropic effects,
likely mediated through GABA and dopamine pathways.
It is marketed online as a nutritional supplement.
Phenibut’s’ metabolism and actions are not entirely
understood. Urinalysis in ED detected tranylcypromine
and phenylethylamine. This posed the question whether
the detected phenylethylamine was an active metabolite
of ‘phenibut’.
Phenylethylamine is a naturally occurring
sympathomimetic and a main constituent of various
illicit drugs such as amphetamine. Phenylethylamine
is metabolised by MAO type B, thus its actions may be
prolonged by drugs such as tranylcypromine.
Post-recovery the patient admitted to deliberately using
tranylcypromine to enhance the effects of ‘phenibut’.
Conclusion: This case highlights an ongoing evolution
of drug use, including use of substances freely
available online and combining prescription drugs with
unregulated substances.
August 12th – 15th, 2014 | 67
31. Flexible Fibre-optic Bronchoscopy,
Obesity and Sleep Disordered
Breathing: Patients Characteristics and
Complications in 221 Cases
Terence Ting, Carol Huang
Department of Respiratory and Sleep Medicine, Canberra
Hospital, ACT.
Introduction: Fibre-optic bronchoscopy (FOB)
is an essential diagnostic and therapeutic tool in
Pulmonary Medicine. There are limited data on patients
characteristics including body mass index (BMI) and the
presence of obstructive sleep apnoea (OSA) in relation to
bronchoscopic complications.
We aim to evaluate patients characteristics, types of
sedation, diagnostic yield and complications in FOB in a
non-intensive care unit (ICU) setting.
Method: Retrospective chart review of consecutive
patients undergoing FOB over a twelve month period.
Patients characteristics, sedation details, endobronchial
interventions, diagnostic outcome, and adverse events
were reported.
Results: 227 patients underwent FOB from 1st January
to 31st December 2012. Six patients were excluded
from analysis because FOB was performed in ICU. 98% of FOB sedation were performed by trained nurse
sedationists. 0.9% of FOB (2/221) were associated with
adverse outcomes. Both patients did not have OSA and
had BMI <30. The overall mortality rate was 0%.
Conclusion: FOB appears to be a valuable diagnostic
tool with a low rate of complications. Our chart review
did not find an association between obesity and presence
of OSA with adverse outcome in FOB.
32. Spirituality in Successful Aging: Data
from the Singapore Successful Aging
Study (SSOSA)
Jocelyn, Chan1, Nicolas Cherbuin2, Beverley
Raphael1, Rajeev Kumar1
Academic Unit of Psychiatry and Addiction
Medicine, 2Centre for Research on Aging, Health
and Wellbeing, College of Medicine, Biology and
Environment, Australian National University,
Canberra, ACT.
1
Introduction: ‘Successful aging’ was first defined by
Rowe and Kahn as avoidance of disease and disability,
maintenance of physical and cognitive function and
engagement in social and productive activities. More
recently, spirituality has been recognised as an important
contributor to successful aging. However, most of the
existing studies on spirituality and successful aging
have been performed outside Asia. This study examined
the role of spirituality in successful aging in Asia. We
hypothesized that spirituality is positively correlated with
attributes of successful aging (resilience, better cognitive
functions, optimism, mastery, satisfaction with life, and
self-rated successful aging)
Methods: SSOSA is a sub-study added to the second
wave of a large population-based study of aging and
health (Singapore Longitudinal Aging Studies-SLAS).
This cross-sectional study surveyed 489 communityliving Singaporeans aged 65 years and older. We
collected data on sociodemographic characteristics,
spirituality, cognitive status, depression, resilience,
optimism, mastery, satisfaction with life, and self-rated
successful aging.
Results: Our sample comprised Chinese (85%),
Malay (10%), and Indians (5%). On linear regression
analysis, spirituality was significantly associated
with gender (female), ethnicity (Malays and Indians),
resilience, optimism, and better cognitive functions
after controlling for age, marital status, education,
income, depression, and chronic medical conditions. The
association explained 33% of the variance of spirituality
in successful aging.
Conclusion: Spirituality is one of the major
determinants in the attributes of successful agingoptimism, resilience, and better cognitive functions.
More importantly, gender and ethnicity play a key role in
the expression of these attributes.
33. High dietary iron synergises with high
fat feeding in causing acute pancreatitis
in Sprague-Dawley rats
34. Compliance with international
guidelines and readability of informed
consent forms for cancer clinical trials
Ayumi Hosaka1,2, Jane E. Dalhstrom,3,4, Christopher J.
Nolan1, Viviane Delghingaro-Augusto1
J C Kuo,1 L Malik,2 A Mejia,2 D Yip1,3
Endocrinology and Diabetes Research, Canberra
Hospital, ACT 2Faculty of Veterinary Science, University
of Sydney, Sydney, NSW 3Australian National University,
ACT 4Anatomical Pathology, Canberra Hospital, ACT.
1
Introduction: Haemosiderosis associated with
inflammatory islet injury was observed in intrauterine
growth restricted (IUGR) and high fat (HF) fed Sprague
Dawley (SD) rats. We aimed to investigate the effect
of iron concentration in HF feed IUGR and shamoperated rats.
Methods: Male SD offspring of IUGR and sham-operated
dams were fed HF diets containing low iron (LI, 20mg/
kg) or high iron (HI, 500mg/kg) from weaning. Glucose
tolerance tests (ip) were performed at 13 weeks of age.
At 14 weeks, pancreases and livers were harvested. Due
to low numbers in what are preliminary results, most
data presented relates to the Sham offspring.
Results: Sham HF-HI rats (n=6) develop excess
weight gain and glucose intolerance compared to
counterparts fed on Sham HF-LI (AUC 2438±179 vs
1765±167, p<0.05). Non-fasting plasma triglyceride
were moderately higher at 14 weeks of age in the
Sham rats fed HF-HI compared to HF-LI (8.0±0.6 vs
5.6±0.6mmol/L). Macroscopic and histological evidence
of acute pancreatitis with necrosis, and saponification of
adjacent adipose tissue was observed in 3/6 Sham HFHI, 0/6 HF-LI rats and 2/2 IUGR HF-HI rats.
Conclusion: These results suggest HF diet and high
dietary iron have a synergistic effect in causing glucose
intolerance and acute pancreatitis in SD rats.
Department of Medical Oncology, Canberra Hospital,
ACT 2Institute for Drug Development, Cancer Therapy
and Research Center, University of Texas Health Science
Center, San Antonio, Texas, USA 3Australian National
University Medical School, ACT
1
Introduction: Informed consent forms (ICFs) provide
information about clinical trials and assist patients in
making a decision regarding their participation. The
International Conference on Harmonization guidelines
for Good Clinical Practice (ICH-GCP) recommended
addressing 20 aspects of the consent process in ICFs
and using layman’s language in a document less than
15 pages. We analysed the content of ICFs for cancer
clinical trials to determine their compliance with ICHGCP guidelines and readability.
Methods: Contents of ICFs for metastatic cancer trials
conducted at two institutions between 2011 and 2013
were reviewed for inclusion of elements recommended
by ICH-GCP. Page count and Flesch-Kincaid Reading
Ease (FRE) score were used to assess readability.
Results: A total of 112 ICFs were reviewed. All ICFs
explained the voluntary nature of participation, the
purpose and the experimental aspect of the trial,
confidentiality issues, and the potential risk and benefit.
Fourteen of the 20 recommended elements were
addressed by all ICFs. The median length of ICFs was 20
pages. The median FRE score was 55.5, equivalent to a
10th grade reading level.
Conclusion: ICFs for cancer clinical trials were mostly
compliant with ICH-GCP guidelines. However, these ICFs
were lengthy and fairly difficult to comprehend.
August 12th – 15th, 2014 | 69
35. The importance of the 6 minute walk
test in cardiac rehabilitation
Caitlin Patat, Margaret Flaherty , Sarah McGrath
Chief Allied Health Office. Canberra Hospital, ACT.
Exercise Physiology Department, Canberra Hospital,
ACT. Cardiology Department, Canberra Hospital, ACT.
Physiotherapy Department, Canberra Hospital, ACT.
Introduction: The 6MWT is the safest, easiest,
most tolerated, and most functional assessment
of cardiovascular fitness compared with other
walk tests (6), therefore it is the preferred test for
cardiac rehabilitation (CR). The 6MWT accurately and
independently predicts morbidity and mortality (6), and
provides useful data for health professionals to identify
areas of the program that require development.
1.To analyse and demonstrate the quantitative
outcomes according to specific populations;
2.To ensure that the exercise prescription produces
desired results
3.To highlight the need for CR and identify areas of the
service requiring improvement.
Methods: The test is administered at the
commencement and completion of the program, with
standardised instructions. Data was collected for 300
patients and comparison were made.
Results: 270 patients achieved a greater walking
distance. Average distance prior to commencing CR was
439.9m, and at completion it was 506.77m. The mean
improvement was 66.87m (p= <0.005). Patients under 40
walked further (79.9m), but those aged 40–50 showed
greater improvements (86.69m).
Conclusion: The CR program produces improvements
in 6MWT distances, which can be linked to reduced
morbidity and mortality. Whilst some areas of
improvement were identified, this multidisciplinary
program has the potential to help reduce the burden of
chronic disease on the ACT.
36. The 6 minute walk test in cardiac
rehabilitation; differences between
surgical and non-surgical populations
Caitlin Patat, Margaret Flaherty , Sarah McGrath
Chief Allied Health Office, Canberra Hospital, ACT.
Exercise Physiology Department, Canberra Hospital
ACT. Cardiology Department, Canberra Hospital, ACT.
Physiotherapy Department. Canberra Hospital, ACT.
Introduction: The six-minute walk test (6MWT) is a tool
used to guide exercise prescription and monitor patient
progress. There is limited research comparing surgical
vs. non-surgical populations 6MWT results in CR.
1.To analyse and demonstrate the quantitative
outcomes of the 6MWT according to specific
populations;
2.To ensure that the exercise prescription being used
in CR produces desired results; to enhance walking
distance and exercise tolerance;
3.To highlight the need for CR and identify areas of the
service requiring improvement.
Methods: The test is administered at the
commencement and completion of the program, with
standardised instructions. Data was collected for 300
patients and comparison were made.
Results: Patients who did not have a surgical procedure
walked longer distances than those who did. When
comparing individual pre and post distances, those
who had sternal surgery demonstrated greater
improvements. Surgical patients average improvement
was 83.77m (p=0.05) and non-surgical patients average
improvement was 62.02m (p=0.05).
Conclusion: The CR program at the Canberra Hospital
is producing significant improvements, supporting the
need for such a program. These findings may indicate
that exercise prescription for surgical patients is too
conservative and should become more of a focus.
37. “Timed Up and Go” results in the
Exercise Physiology Department
Rebecca L. Cesnik
Exercise Physiology Department, Canberra Hospital, ACT.
38. Clinical characteristics and outcome in
a series of patients with psychogenic
(conversion) movement disorders in a
neuropsychiatry clinic
Rajeev Kumar1 and Christian Lueck2
Consultation-Liaison Psychiatry Unit & Neuropsychiatry
Clinics, 2Department of Neurology, Canberra Hospital,
ANU Medical School, College of Medicine, Biology, and
Environment, Canberra, ACT.
1
Introduction: Exercise programs focusing on strength
and balance assist with decreasing the risk of falls. As
the Exercise Physiology Department (EPD) sees many
patients at risk of falling, inclusion of balance exercises into
the program is a regular occurrence. The “Timed Up and
Go” (TUG) is a validated test, measuring time taken for a
client to rise from a chair, walk three meters, and return. It
examines balance, gait speed and functional ability.
Aims of the program are:
1. To ensure the EPD assists to decrease falls risk;
2.To determine any changes required within the EPD to
improve balance, mobility and risk of falling.
Methods: The sample included patients who
completed a program within EPD in 2013, who were
deemed a falls risk and/or identified improving mobility
as a personal goal. Pre and post program results were
collated and analysed.
Results: Patients demonstrated a significant (p<0.0005)
reduction in TUG times (average reduction 15.30%).
87.32% of patients improved their TUG times. Pre test
results indicated that 23.94% of patients were at a high
risk of falling, whilst following the intervention 11.27%
scored greater than 13.5 seconds, indicating 12.67% of
patients moved from high to low risk.
Conclusion: Significant improvements in balance,
and decreasing risk of falls for patients with impaired
mobility were made. Individuals >80 years improved
insignificantly, as did those diagnosed with cancer and
cardiopulmonary conditions.
Introduction: Medically unexplained neurological
symptoms (MUNS) constitute about 30% of patients
attending neurology outpatients clinics. These patients
are challenging both in terms of diagnosis and
management. About 5.6% of these patients will receive
a diagnosis of conversion disorder, of which 0.3% will
have various forms of psychogenic movement disorders
(PMD). Further, it has been shown that more than 90%
patients with PMD remain chronic and a significant
number of such patients have other psychiatric
comorbidities. The objectives of this study were to
evaluate the pattern of neuropsychiatric referrals by
neurologists and to specifically look at the clinical
characteristics and outcome of patients with PMD in a
series of cases.
Methods: Retrospective case record reviews of
neuropsychiatric patients over a period of 2 years (20102012) seen at the Canberra hospital neuropsychiatry clinic.
Results: A total of 73 patients were seen during the
period. There were 47 female and 26 male patients.
Forty (55%) patients had MUNS, 25 (34%) had a
neurological disorder a psychiatric disorder, and
8 (11%) had chronic headache. The mean age of
patients with MUNS was 44 years and they were much
younger than the other two groups. Of the 13 cases
with PMD, outcome data were available in 9 cases. As
predicted, psychiatric comorbidity was high in these
patients and all patients were symptomatic at follow
up. However, 7 patients regained adequate functions
with neuropsychiatric interventions at follow up,
which included psychotherapy, antidepressants, and
physiotherapy.
Conclusion: We conclude that in a selected series of
cases, despite the persistence of symptoms, adequate
global functioning was achieved with neuropsychiatric
interventions.
August 12th – 15th, 2014 | 71
39. miRNA biomarkers for early prediction
of adverse pregnancy outcomes in
obese pregnant women
40. Increasing physiotherapy treatment
time for stroke patients in acute care at
Canberra Hospital and Health Services
Erandi Hewawasam¹, Carina Bertoldi Franco¹, Ryan
Farr³, Cameron Kos¹, Viviane Delghingaro-Augusto¹,
Anand Hardikar³, Christopher Nolan¹ Stefan Broer²
Megan Girdlestone, Tayne Ryall & Kathy Terrell
Endocrinology and Diabetes research group, Australian
National University, Canberra Hospital, ACT. ²Biomedical
Science and Biochemistry, Australian National
University. ³Diabetes and Islet biology Group, Sydney
University, NSW
Introduction: Following the release of the Clinical
Guidelines for Stroke Management 2010, National
Stroke Foundation, it was identified that stroke patients
at The Canberra Hospital were potentially receiving
insufficient therapy time to achieve optimal outcomes.
A time audit study confirmed that acute stroke patients
were receiving approximately 14 minutes of meaningful
therapy time per day. As per the guidelines stroke
patients should be receiving a minimum of 60 minutes of
active practice per day at least 5 days a week.
¹
Introduction: microRNAs (miRNAs) are a potential
source of novel biomarkers for medical complications
of obesity and diabetes, including during pregnancy.
They are small, non-coding RNAs that can modify the
post-transcriptional regulation of target mRNAs and,
consequently, the expression of their proteins. The overall
objective of this project is to determine starting with in
vitro experiments placental-derived miRNAs that may be
indicative of placental metabolic injury and predictive of
adverse pregnancy outcomes in obese mothers.
Methods: Three placentas were collected from normal
weight women undergoing elective caesarian sections.
Trophoblasts were harvested and established in primary
culture with low and high glucose with and without fatty
acids (FA). The cell culture media was collected and used
for miRNA analysis.
Results: In discovery phase experiments, trophoblasts
cultured in the nutrient-toxic condition of high glucose
with FA (25mM G, 0.25mM palmitate:oleate) compared
to the basal condition of low glucose without FA (5.5mM
G) released 10 miRNAs into the media at quantities that
were greater than 5 fold increased (2 miRNAs were >100
fold increased).
Conclusion: Interestingly, the majority of these miRNAs
from the discovery phase analysis are involved in the
regulation of genes involved in cellular stress, cell
proliferation and migration pathways.
Methods: This project involved increasing the hours
of inpatient therapy gym from 3 to 7.5 hours per/day.
Patients were no longer treated in a gym group format
rather they came to the gym at staggered intervals
throughout the day. This meant that there was a
constant flow of patients through the facility rather than
8 arriving all at the same time for treatment.
A second allied health assistant was added to the
neuroscience team to supervise prescribed exercise
programs and to assist with patient transport.
Results: Six months later a post-implementation time
audit study was completed. It was found that meaningful
therapy time increased from 14.12 minutes/day to 43.97
minutes/day.
Conclusion: The implementation of a new
physiotherapy service delivery model has lead to
significant increases in meaningful therapy time for
acute stoke patients at Canberra Hospital.
41. The impact of moderate chronic kidney
disease on 1 year outcomes after
percutaneous coronary intervention
Nicolas Grandjean-Thomsen (The Australian National
University, Canberra, ACT. ), Paul Marley (Cardiology
Unit, Canberra Hospital, Canberra, ACT. Ahmad Farshid
(Cardiology Unit, Canberra Hospital, Canberra, ACT.
[email protected]
Introduction: Patients with end-stage Chronic Kidney
Disease (CKD) have worse outcomes after Percutaneous
Coronary Intervention (PCI). However, outcomes after
PCI in patients with moderate CKD have not been well
studied. This study aims to investigate this relationship.
Method: The PCI database of Canberra Hospital was
analysed to determine demographic, procedural and
outcome variables for 1960 consecutive patients (Oct
2009- Oct 2012). Patients were followed up at 12 months
via letter, phone call and review of medical records.
CKD was defined as estimated glomerular filtration rate
(eGFR) < 60.
Results: After multivariate analysis, it was found that
age >64 (Hazard Ratio (95% CI) 1.06 (1.03-1.08), three
vessel disease (1.86 (1.15-3.02) and declining eGFR were
significant risk factors for mortality. Mortality was shown
to increase progressively with worsening eGFR starting
from non CKD levels. A scoring system incorporating
these factors was devised to predict mortality.
Conclusion: Severity of CKD (eGFR) is an independent
predictor of mortality following PCI. A risk score
incorporating age, eGFR, and 3VD is highly predictive of
mortality risk at 1 year after PCI.
42. Patients’ quality of sleep at
Canberra Hospital
L.J. Delaney1,2,3, M. Currie1, J. Parke1& V. Lopez1,4
ACT Health Research Centre for Nursing and Midwifery
Practice, 2Faculty of Health: Nursing and Midwifery,
University of Canberra, 3PhD scholar: Medical School,
Australian National University, 4Medical School,
Australian National University, Canberra, ACT
1
Background: Sleep is considered to be an essential
biological function; however sleep disturbance is widely
reported by patients.
Aim: To investigate the factors contributing to poor
quality of sleep for patients at Canberra Hospital.
Methods: An observational study involving 15 clinical
areas was conducted between May and October
2013. Environmental factors including noise, light,
temperature and humidity were monitored at 5 second
and 30 second epochs. A nursing staff questionnaire was
distributed regarding factors they believed disturbed
patient sleep, and patients were interviewed about their
perception of sleep quality and factors that disturbed
their sleep.
Results: The mean duration of sleep was 5.3 hours
per night (Std. D 2.33hrs, range 0-10 hrs) and 41.4%
of patients reported their sleep to be of poor quality.
Nocturnal noise levels in the 15 clinical areas were
between 37% and 83% higher than those recommended
by the World Health Organisation. Triangulation of the
three data sources revealed that the primary factors
contributing to sleep disturbance were noise, clinical
care and pain.
Discussion: Patients do experience sleep disturbance
in hospital, with the main sources of disturbance
amendable to behaviour modification. Eleven
recommendations have been made from this study to
reduce sleep disturbance for hospitalised patients.
August 12th – 15th, 2014 | 73
43. The effect of noise on patient sleep
within Medical Wards
44. How can we look after ICU survivors
better? A benchmarking study.
N. DaFonte1 & L.J. Delaney1,2
Ashley Wiley1, Cyd Soriano1, David Witheridge1, Isabella
Toole1, Nikki Harte1 & Bernie Bissett1,2,
Canberra Hospital 2University of Canberra
1
Background: Hospital patients frequently experience
sleep disturbance with noise being identified in
both subjective and objective studies as the major
contributing factor.
Aims: To investigate and report the nocturnal noise
levels within medical wards and identify the major
sources of nocturnal noise.
Method: An observational study was conducted within
6 medical wards of Canberra Hospital. Nocturnal noise
levels were recorded at 5 second epochs with Extech
(SDL600) sound loggers in the A weighted decibels
(dB(A)) scale between 22:00 and 07:00 hours. Clinical
observations were conducted in four 1 hour intervals
to record the sources of noise within the clinical
environments.
Results: Noise levels within medical wards exceeded
WHO recommendations by 17.42 dB(A), with the mean
noise level recorded being 47.42 dB(A) (Std D. 3.84,
range 31.2 -103.3 dB(A)). Peak noise levels in excess of
70 dB(A) were found to occur 4.49 times/hour. Disruptive
noise generated by staff occurred 23.48 times/hour.
Discussion: Noise levels within the Medical wards
exceed the recommendations made by the WHO
(<40dB(A)), and can prohibit patient sleep which is
required to expedite their recovery. The primary sources
of nocturnal noise levels were attributed to clinical staff,
who may be unaware of their impact on patient sleep.
Disciplines of Physiotherapy, Pharmacy & Occupational
Therapy, University of Canberra, Canberra ACT
2
Health, Canberra ACT.
1
Introduction: Intensive Care Unit (ICU) survivors often
endure physical, psychological and cognitive problems
up to 2 years following hospital discharge. However
Canberra Hospital does not currently provide any specific
follow-up for ICU survivors beyond their hospital stay.
This benchmarking project aims to explore existing
Australian and international follow-up services to inform
a model for Canberra.
Methods: A purpose-built online survey was distributed
to health professionals from ICUs around Australia and
worldwide via email in May 2014, using established
professional networks. The 15-question survey
focused on the presence, type, frequency, duration and
perceived quality of any ICU follow-up services provided.
Respondents were also invited to comment on how
follow-up services could be improved.
Results: A total of 30 responses (87% Australian) were
received and analysed. 83 % were from public hospitals,
80% of respondents were nurses. Mean rating of quality
of ICU follow up = 3.73 /10 (poor). No respondents
provided specific follow-up beyond 1 month of hospital
discharge. Those that did follow-up survivors at 1 month
typically provided 1 contact visit or phone call.
Conclusion: In the absence of a well-established
comparison service, we recommend (based on
NHS Guidelines and feedback from respondents)
establishment of a multidisciplinary ICU survivor followup clinic to address patients’ physical, psychological and
cognitive needs. This should occur following hospital
discharge at 1 week, 4 – 6 weeks, 6 months and up to 2
years as required.
45. MaskED Simulation in the
Health Classroom
Jane Frost1 & Bernie Bissett2,3
School of Nursing and Midwifery, University of
Canberra, Canberra, ACT 2 Physiotherapy Department,
Canberra Hospital, Canberra ACT 3 Discipline of
Physiotherapy, University of Canberra, Canberra ACT.
1
Introduction: In 2013 both nursing and physiotherapy
students were introduced to MaskED simulation, where
the classroom educator wears a high-quality silicone
mask to become an authentic older character who
can engage with students in a realistic way. Through
classroom encounters with these characters, students
have developed technical skills as well as skills in
communication, manual handling and problem-solving.
We sought to evaluate the students’ perceptions of the
value of MaskED simulation.
Methods: Immediately following classroom encounters
with MaskED characters in 2013, students in both
Nursing and Physiotherapy classes were invited to
complete a written survey regarding their experience.
Both qualitative and quantitative questions explored
whether students’ felt engaged by the MaskED
character, and whether it assisted their learning.
Results: The surveys yielded a 100% response rate.
Across nursing and midwifery, students were very positive
about their experiences of MaskED simulation, with
100% expressing their desire to work with the character
again. 95% reported that they felt engaged by the MaskED
character, while 92% felt that the MaskED session assisted
learning of concepts presented in the unit.
Conclusion: MaskED simulation is a useful addition to
both Nursing and Physiotherapy classrooms. Students
enjoy MaskED simulation and recognise that it enhances
their learning and understanding of concepts.
46. Trichofolliculoma-like lesion of the vulva
associated with vulvar intraepithelial
neoplasia – a case report
Namita Mittal1, Sanjiv Jain1,2, Neil Lambie3, Robyn
Sayer4, Millie Lui1
Department of Anatomical Pathology, ACT Pathology,
Canberra Hospital, ACT; 2Australian National University
Medical School, ACT; 3 Prince of Wales Hospital, Sydney,
NSW; 4Gynaecology Cancer Centre, Royal Hospital for
Women, Sydney, NSW.
1
Aim: Only 3 cases of vulval trichofolliculoma-like lesion
associated with vulvar intraepithelial neoplasia (VIN)
have been previously described in the English literature
associated with. This is the fourth reported case of
trichofolliculoma-like lesion associated with VIN.
Case Presentation: A 39 years old female presented
with a white plaque in vulva. She had a history of radical
hysterectomy for invasive squamous cell carcinoma
(SCC) of cervix 8 years ago and posterior vulvectomy for
invasive SCC 2 years ago.
The anterior vulval biopsy showed VIN 3 and a
dermal trichofolliculoma-like lesion colonized by
dysplastic squamous cells. The lesion showed positive
immunoperoxidase staining with p16, as seen in
overlying VIN 3. This colonized lesion easily mimics an
invasive SCC.
Discussion: Trichofolliculoma is a rare benign pilar
neoplasm of the skin usually found on the scalp, face, or
neck. It is an exceedingly rare finding in the genital area.
Its histogenesis is unknown. It is not associated with a
family history or with other abnormalities. Juxtaposition
of trichofolliculoma with VIN 3 in our and previously
reported cases is likely to be coincidental.
Recognition of benign appendageal tumours in an
unusual site allows one to reach the correct diagnosis,
and not to misdiagnose them as malignant process.
August 12th – 15th, 2014 | 75
47. Myoepithelial carcinoma ex
pleomorphic adenoma – case report
Namita Mittal1, Sowmya Sharma1
ACT Pathology, Canberra, ACT
1
Aim: We present a case emphasizing the consideration
of myoepithelial carcinoma as a differential diagnosis
for spindle cell neoplasms arising within a long standing
pleomorphic adenoma.
Case Presentation: A 26 year old man presented
with a nodule at the angle of his right jaw growing
slowly for the last 10 years. 2 years ago, the mass had
been evaluated clinically, radiologically and by fine
needle aspiration and features suggested pleomorphic
adenoma. Increasing pain and enlargement of the gland
led to current superficial parotidectomy.
At histopathology, a multilobulated, unencapsulated
myoepithelial carcinoma was seen arising from
pleomorphic adenoma. Necrosis was absent but
mitoses ranging from zero to 3/10 hpf was noted.
Tumour was present at inked resection margins.
Follow up PET scan showed no residual tumour
or abnormal lymphadenopathy. Ongoing tumour
surveillance has been planned.
Discussion: Myoepithelial carcinoma ex pleomorphic
adenoma is rare. Clinical follow-up is critical in these
low-grade but locally aggressive tumours that often
recur and/or metastasize late in the course of the
disease. Recognition of this entity is crucial for the
patient to receive appropriate follow up and clinical care.
We highlight important clinical and histological findings
that are helpful in the diagnosis of these rare tumours.
48. Provision of a Physiotherapy Service at
the Alexander Maconochie Centre:
A Scoping Project
Dominic, P, Furphy
Community Care Program Physiotherapy Service,
Rehabilitation Aged and Community Care, ACT Health
Canberra City, ACT.
Introduction: Prisoners detained in the Alexander
Maconochie Centre (AMC), ACT, can access ACT Health
physiotherapy services at Community Health Centres.
The availability of appointments is dependent upon
security requirements for scheduling, escort and
transportation. Physiotherapy is currently not part of the
multidisciplinary health team working on site at Hume
Health Centre and co-ordinated care is challenging.
This project investigated and scoped an appropriate
model of care for a site based physiotherapy service.
Examination of similar on-site services in other
jurisdictions demonstrated this was a best practice
approach that met human rights principles.
Methods: A systematic review of the available literature
was conducted to identify physiotherapy management
in other correctional facilitates. The following databases
were used: CINAHL, PubMed, Embase and MEDLINE®.
Site visits to AMC, Port Phillip VIC and Long Bay NSW.
Focus groups with Correctional Officers and prisoners.
Results: Literature relating to physiotherapy in prisons
is limited. Site visits provided an opportunity to visualise
what currently exists in other facilities and to engage
with staff. Focus groups provided valuable information
from the perspective of prisoners and Correctional Officers.
Conclusion: An on-site physiotherapy service at AMC
would improve care and access for prisoners.
49. Compartment Syndrome –
Presentations and Principles
50. Shifting targets: microRNA and mRNA
3’-end variants in cardiac hypertrophy
Krishanth Naidu1, Naveen Narayanasamy2
Rina Soetanto1, Carly J. Hynes1, David T. Humphreys2,
Nicola J. Smith3, Hardip R. Patel1, Brian J Parker1,
Robert M. Graham3, Jennifer L. Clancy1, Thomas Preiss1
Canberra Hospital Yamba Drive, ACT. 2Department of
Orthopaedic Surgery, Canberra Hospital Yamba Drive, ACT.
E-mail address: [email protected]
1
Introduction: Despite the invent and progress of
glorious investigative, diagnostic and imaging modalities
through the turn of the century, compartment syndrome
(CS) is still regarded a shadow in the darkness given its
lack of awareness. The gravity of dealing with such an
elusive diagnosis culminates in high rates of litigation.
Methods: A review of published literature in the last 10
years has been reviewed. Databases such as EMBASE,
PUBMED, Google Scholar have been used.
Results: Large degree of variance exist in the incidence
of CS with a multitude of causative factors. The former
is directly proportional to the nature and severity of
injury sustained. The prognosis of CS is dependent on
two interrelated entities – diagnosis and duration from
injury to instituting intervention. The locations to which
CS occur has expanded exponentially since conception
in the nineteenth century. Fasciotomies of the lower
limb posterior compartment have shown to have poorer
outcomes than those in an anterior CS secondary to
the morbidity associated with a complete posterior
decompression. In the event of failure to institute any
form of intervention, Volkmann’s contractures have been
approximated to occur in up to 10% of patients within a
short duration of weeks to months.
Conclusion: Despite its immemorial descriptions and
characterization as a surgical emergency, CS remains an
elusive diagnosis given its lack of awareness.
Genome Biology Department, The John Curtin School
ACT. 2Molecular Genetics Division, 3Molecular Cardiology
and Biophysics Division, Victor Chang Cardiac Research
Institute, Darlinghursrt, NSW.
1
Introduction: It is now emerging that cells typically
co-express microRNAs and their mRNA-3’end
targets as multiple processing variants. We aim to
comprehensively document these processing variants in
the heart and determine whether they are altered during
cardiac hypertrophy.
Methods: RNA from normal, prehypertrophic (2
days after Transverse Aortic Constriction (TAC)), and
hypertrophic (7 days after TAC) cardiomyocytes were
subjected to next generation sequencing of microRNA
and mRNA 3’ends. The datasets were mined for the
presence of processing variants.
Results: There is a widespread occurrence of microRNA
processing variations in the cardiomyocyte, the relative
proportions of which, however, remained largely
unchanged during hypertrophy. Our mRNA 3’endsequencing data revealed 213 (48%) hypertrophy-related
genes with novel 3’UTRs. Moreover, we found that the
3’UTRs of mRNAs were generally shortened during
hypertrophy. 101 mRNAs had a significant change in
proportion of 3’ UTR variants during hypertrophy, 7 of
which we have now validated through qPCR.
Conclusion: We have documented the widespread
presence of microRNA and mRNA 3’end processing
variants in healthy and hypertrophic cardiomyocytes.
Collectively, our datasets should allow us to build a
systems-level understanding of microRNA-mediated
regulation during normal and hypertrophic states of the
heart, which will aid in the development of microRNAbased therapy for cardiac disease.
August 12th – 15th, 2014 | 77
51. ACT Health Extended Scope
Physiotherapy: “Perspectives Matter”
Jo Morris1, Karen Grimmer2, Bryan Ashman3, Lisa
Gilmore1, Greg Kyle4, Karen Murphy5, Chandima Perera6,
Gordon Waddington7
Department of Physiotherapy (Acute Support), Canberra
Hospital, Canberra ACT 2 International Centre for Allied
Health Evidence, University of South Australia, Adelaide
SA 3 Department of Surgical Services, Canberra Hospital,
ACT. 4 Discipline of Pharmacy, University of Canberra, ACT
5
Chief Allied Health Officer, ACT Health, ACT 6 Department
of Rheumatology, Canberra Hospital, ACT.7 Discipline of
Physiotherapy, University of Canberra, ACT.
52. Plastics Outpatient Clinic X-Ray On
Admission Ordering Procedures:
A Clinical Audit
Gaughwin P, Chopra S, McCarten G
Plastic Surgery Unit, The Canberra Hospital, ACT.
1
Introduction: Extending the scope of practice (ESP) of
physiotherapy services is a health workforce reform
initiative which has attracted attention round the world.
This new service delivery model has the potential to
reduce waiting lists and waiting times, and improve cost
effectiveness, patient satisfaction and health outcomes.
Extended scope physiotherapy services are relatively
new in Australia, and are therefore its roll out in one
large Australian hospital in the orthopaedic outpatient
department in 2010, and the emergency department in
2011, involved sailing in unchartered waters. This poster
reports on key stake holder perspectives.
Methods: Key stakeholders were identified as
all individuals who had played a role in service
conceptualisation, organisation and / or implementation.
Data was collected using interview and / or written
reflections on the roll-out.
Results: Seven discrete themes were identified,
including careful marketing of the new service to other
healthcare providers; developing appropriate curriculum
to support ESPs to work safely outside scope; backfilling
positions and mapping career pathways; addressing
complexities of legislation, enterprise bargaining and
insurance; demonstrating quality and safety; identifying
potential barriers; and ensuring progression to longterm adoption.
Conclusion: The range of issues identified provides a
useful framework for implementing future Australian
out-of-scope workforce initiatives.
Introduction: To reduce the number of inappropriately
ordered X-rays for Plastics Outpatient clinics, an audit
of the effectiveness of the X-ray on admission (XROA)
ordering procedure was performed.
Method: Retrospective, observational study. Nineteen
X-ray ordering sessions across nine weeks (from
01/02/2014 to 23/04/2014) were audited across nine
sequential sessions of XR ordering. For the audit period,
approximately 100 patients were seen per week (100.63
± 10.2 patients per week), of which an XROA request
was appropriately documented for approximately 10%
(11.1 ± 3.87 patients per week).
Results: X-rays were ordered as per the standard
procedure for only 34% ± 14% (mean ± standard
deviation, SD) of patients presenting to the Plastics
outpatient clinic. The remainder were ordered by the
Junior Medical Officer (JMO) after spending additional
time reviewing clinical records (not the normal
procedure).
Conclusion: On average, approximately two thirds of
X-rays ordered for the Plastics Outpatient Clinic were not
initially specified through an XROA request. This audit
has identified an opportunity to reduce inappropriate
patient X-ray exposure through improved adherence to a
documented XROA request procedure.
53. Predictors of slow colonic transit
in children
Z Ridha, R Quinn, GDH Croaker,
Department of Paediatric Surgery, Canberra Hospital,
Canberra, ACT.
Background/ Aim of study: Constipation is a frequent
cause of referral to specialist clinics. Prediction of those
who need investigation would be useful. Previous
literature has looked at both autism and allergy as
potential aetiologic factors in constipation. We studied
factors predicting transit study results.
Methods: Retrospective review of 90 consecutive colon
nuclear transit studies in children. Clinical data as well
as transit study results were reviewed.
Main results: A significant minority had a history of
delayed passage of meconium. These children tended to
be smaller (Z score average-0.15) than both the general
population and the overall group (NS). Moreover children
with a history of delayed passage of meconium were
more likely to have an abnormal study than those without
a history of delayed passage of meconium. All children
had a rectal biopsy, none had Hirschsprung disease.
The constipated group generally were more obese than
the national average.
Overall 40.7% had diffuse slow transit; 38%had
rectosigmoid retention and 22.3% were normal.
An allergic history was present in one third, but did not
predict the study result.
38% had an underlying neuropsychiatric problem, and
these children were slightly less likely to have a normal
study than neurotypicals: 13% versus 30% (p = 0.0634
Fisher exact test).
Conclusion: Early onset of symptoms (delayed passage
of meconium) and a neuropsychiatric disorder both
seem to predict abnormal transit study results. Food
allergy is clinically relevant, but our data does not show
an association with the outcome of the transit study.
54. Developing a model for studying
late effects of ednrb malfunction on
brain development
David Croaker, Dan Xie, Kristie Stefanoska, Zan-Min Song
John Curtin School of Medical Research, Australian
National University Department of Paediatrics & Child
Health, Canberra Hospital
Background: The sl (spotting lethal) rat is a rodent
model of human Hirschsprung’s disease. We have
previously shown that as well as having long segment
Hirschsprung disease, these animals suffer from a
variety of neurologic changes.
It would be useful to study the clinical correlates of these
anatomic brain changes on functional development, but
to do this the animals need to survive.
Aim: To develop a colostomy technique that allows
survival and growth of the sl rat.
Materials and methods: Animals are bred by
heterozygous mating using a standardised genotyping
method. Newborn pups are then genotyped. So far the
colostomy has been formed between postnatal days 6 to
19 (all genotypes). In operating on homozygous sl/sl rats
operation must be performed in the first week to avoid
symptomatic bowel obstruction and death. The operation is carried out under general anaesthetic
using inhaled isoflurane carried in O2 0.3L/min through
facial mask. For the actual operation a midline incision is
used. The gut wall is sutured to abdominal wall muscle
using 8/0 absorbable sutures, and the gut wall is sutured
to skin using 6/0 polypropylene monofilament sutures.
The distal segment can be closed. Cannibalism is prevented by rubbing the pup’s skin with
the dam’s faecal extract. Results: 26 rats have been operated on. Animals have
survived between one and 34 days post operatively. 80%
were sacrificed at post-op day 28 to obtain brain tissue
for histological study. Two died of cannibalism within
two days of surgery.
We have noted that the size of the stoma is crucial: too
small tends to block, but too large is prone to prolapse,
and this sometimes occurs after weaning when normal
chow is started. The distal colonic segment can be
closed without adverse effect. Cannibalism of operated pups has been prevented by
rubbing pup’s skin with dam’s faecal extract
Discussion: Performing a colostomy on a 6 g animal
is not easy, especially so as the animal needs to
feed immediately, and injured rat pups tend to be
cannibalised by their mothers. In addition it was not
clear that we would not have small-bowel transitions
in some animals. If that was the case, even proximal
colostomy might not save their life. These problems
seem to have been largely overcome, and we are now
in a position to be able to study central neurological
development in this fascinating animal.
The study was carried out under ethics protocol number
2012/50.
August 12th – 15th, 2014 | 79
55. Increased use and decreased cost
effectiveness of ultrasound in
abdominal pain: changes over a decade
David Croaker , Christian Beardsley , Alex Dillon
12
13
4
Australian National University, 2Paediatrics & Child
Health, 3Department of Surgery, Canberra Hospital,
Canberra, 4Department of Surgery, Hawkesbury
Hospital, Penrith, NSW
1
Background: Rising demand for emergency services
combined with an increasingly litigious population
has meant that more investigation for symptoms
than in previous times. Previous work has shown
that appendicitis occurs in about 8% of children with
abdominal pain in our institution. Diagnostic ultrasound
is a cheap, versatile and increasingly ubiquitous modality
to potentially find that 8%.
Aims: We asked whether the rate of use of ultrasound
had changed over the last decade, and whether
any changes in use had associated changes in cost
effectiveness. The study addresses these two questions.
Methods: A retrospective review of all cases of acute
paediatric abdominal pain referred for diagnostic
ultrasound over the ten year period 2002–2012.
Absolute numbers, appendiceal visualisation rates
from the radiology report, and rates of appendicitis on
discharge summary were abstracted.
Results: A total of 737 abdominal ultrasounds were
included, with a threefold increase in the annual rate of
ultrasound. The overall incidence of appendicitis in the
studied group has fallen from 28% in 2002, to 18% in 2012.
The rate of visualisation of the appendix on ultrasound
has fallen from 40% to 25%, and the rate of appendicitis in
non visualised appendices has fallen from 18% to 4% The
background total rate of appendicitis is steady.
Conclusion: The falling rate of appendicitis in the
investigated group, and in particular the falling rate of
appendicitis in the group in whom the appendix is not
seen suggest less rigorous triage for ultrasound. The
falling rate of appendix visualisation shows the effect
of increasing demand for a service that is less often
positive: probably less time and effort is spent on each
scan. Ultrasound costs both time and money. This
study provides evidence that effort needs to be made to
optimise its use.
56. Closed gastroschisis as a cause of
midgut atresia: report of two cases
Michelle Maddock , Liam Quinn, Erroll Simpson,
David Croaker
Department of Paediatric Surgery, Canberra Hospital,
Canberra, ACT, Australia.
Background / Aim of study: About 15% of
gastroschisis is associated with gut atresia. Mark
Davenport coined the term “closed gastroschisis” in
2001 to describe those cases in which the umbilical
defect closed around the herniated gut.
Methods: We describe two recent similar cases who
presented in a short space of time to unrelated mothers.
Main results: Both children were diagnosed
antenatally, at routine ultrasounds. Antenatally
dilated bowel was diagnosed. The children were born
at 35 weeks gestation, and delivered vaginally.
Postnatally the appearance in both was of a closed
umbilical defect around the herniated midgut, leading to
infarction and atresia.
At laparotomy child one was shown to have 27cm of
viable intra-abdominal small bowel, while child two
possessed 35 cm of intra-abdominal small bowel. In
the children, laparotomy demonstrated a fibrous cord
from the blind end of the distal jejunum connecting with
a necrotic nubbin sitting next to the umbilical cord, and
from this a distal fibrous cord attached to a microcolon.
A Bishop-Koop procedure was performed in both
neonates, to accommodate the large size discrepancy in
bowel. No other abnormal features were identified either
antenatally or postnatally.
Conclusion: Two cases of Gastroschisis are described
in which there was antenatal closure of the abdominal
wall defect strangulating the prolapsed midgut. It is
proposed that with only a little more time in utero the
prolapsed bowel would have reabsorbed completely,
and the appearance would have been of an idiopathic
midgut atresia.
57. Familial Chronic Intestinal PseudoObstruction presenting as Sigmoid
volvulus segregates with an enteric
actin mutation
58. Antimicrobial resistance among
urinary tract infection isolates of
Escherichia coli in an Australian
population-based sample
F Ngu, D Mackay, C Kennedy, L Hallam, M Koina, E
Simpson, GDH Croaker
Oyebola Fasugba1, Anne Gardner A1, George
Mnatzaganian2, Brett Mitchell1, 3
Canberra Hospital and Austalian National University
Medical School
1
Aim: An 11-year-old boy presented with acute sigmoid
volvulus secondary to chronic intestinal pseudoobstruction. Because of clinical and pathological
similarities we speculated that our kindred segregated
a mutation in the same gene, the enteric actin (ACTG2)
gene, as that described in December 2012 in Lehtonen et
al. The aim of the study was to disprove the hypothesis.
Methods: A careful clinical history was taken from the
proband, and from all relatives contacted. Genomic DNA
was extracted from the proband, and 12 of his relatives.
In the first instance PCR of exon five was performed
and sequenced using standard techniques. Sequencing
was then extended to all relatives from whom DNA was
obtained, including three other affected so far.
Results: Chronic intestinal pseudo-obstruction in this
family in most cases has a relatively late onset and is not
associated with involvement of the urinary tract.
Sequencing of exon five of the ACTG2 gene revealed a
sequence variant c. 443G > T, causing Arg148Phe. This is
a significant amino acid change at the same spot is that
described in Lehtonen et al, but a different in amino acid
substitution. It appears to be inherited in an autosomal
dominant pattern.
Conclusion: Actions are widespread proteins in a multimember family with many functions. Actin mutations
may be more important in disordered bowel function
than previously appreciated, and codon 148 may be a
mutation hotspot.
This project was carried out with the approval of the ACT
Human Research Ethics Committee approval number
ETH.8.13.213 of 2013.
Faculty of Health Sciences, Australian Catholic
University, ACT. 2Faculty of Health Sciences, Australian
Catholic University, Fitzroy, VIC. 3Faculty of Nursing
and Health, Avondale College of Higher Education,
Wahroonga, NSW.
Introduction: Escherichia coli (E. coli), the pathogen
most frequently implicated in urinary tract infections
(UTIs), is becoming increasingly resistant to current
antimicrobials. Whilst prevalence rates for urinary
E. coli resistance have been reported in Australia, to
our knowledge there are no published incidence data.
Available data do not adjust for variables like age and
sex. Also, no data compare resistance patterns for
healthcare associated and community acquired UTIs.
This study will evaluate the incidence and antimicrobial
resistance (AMR) trends of E. coli UTIs and compare
prevalence of AMR in healthcare associated and
community acquired isolates.
Methods: Cohort and cross sectional designs will be
used. In the cohort study, we retrospectively review
urine samples processed at the regional laboratory
to determine the cumulative incidence and AMR trend
of urinary E. coli isolates over five years using ACT
population as the denominator. In the cross sectional
study, we review data from Canberra Hospital and
general practices to compare prevalence of AMR in
healthcare associated and community acquired isolates.
Outcomes: These studies will provide incidence and
prevalence data on UTI E. coli resistance to help inform
treatment guidelines. They will also provide research
data for ongoing surveillance of AMR in E. coli.
August 12th – 15th, 2014 | 81
59. Family Centred Developmental Care:
A New Beginning for Neonatal Intensive
Care and Special Care Nursery
Gore, Vicki , Abad Fay , Carlisle, H Broom, M
¹
¹
1, 2
Cathy Watson and Jennie Gordon
1, 3
Centenary Hospital for Women and Children,
Department of Neonatology. 2 School of Clinical
Medicine, Australian National University, ACT, Australia.
3
Australian Catholic University, Canberra, ACT.
1
Introduction: The global emergence of modifying
the physical environment for better patient outcomes
has paved the way for Canberra Hospital to move
from an open plan to a two cot room NICU. We are
keen to develop practice to support family centred
developmental care (FCDC) in our new environment.
Method: During the transition to the new unit two
new groups: Family Centred Care (FCC) and
Developmental Care Team (DCT) were formed to
enhance current FCDC and family involvement in the
unit. They are guided by the NICU’s mission statement
of providing care that is developmentally appropriate,
family centred, safe and functional.
Results: The FCC group is a multidisciplinary team
including parent representatives. They have been at the
forefront of organising weekly information sessions and
improving the new surroundings for families. The DCT
provides clinical support for staff including implementing
practices such as: covering isolettes for immature eyes,
skin to skin contact, using a mirror for behavioural cues,
baby rest time, and upgrading our webcam which allows
families to view their babies from home.
Conclusion: The two groups are working towards
maximising the developmental trajectory of the infant
and the nurturing role of family, achieving the best
outcome for each baby.
60. Planning a sustainable health workforce
for ACT Health
Workforce Policy & Planning Unit, ACT Health,
Canberra, ACT.
Introduction: Evidence based workforce planning
enables the right person, with the right skills to deliver
the right services at the right time to the right person,
within budget.
The objective was to develop an evidence- based plan to
guide ACT Health through these challenges to 2018.
Methods: A literature review indicated increased
service demand, an ageing workforce and increasing
competition for skilled workers as an increasing
challenge for all health sectors when the ACT Health
workforce plan required renewal.
A discussion paper was developed following extensive
consultation with stakeholders across the ACT public
and private health sectors.
National framework domains were used to link local
planning strategies with national priorities to develop a
health workforce plan for ACT Health.
Results: The plan contains 17 evidence-based
strategies classified under the five national focus areas
of Health Workforce: Reform, Development, Leadership,
Planning and Policy.
The governance structure provides executive leadership
of the implementation of the Plan and a framework
for monitored reporting requirements enables easy
identification of progress and gaps.
Conclusion: ACT Health now has a firm evidence base
to guide and monitor activities in workforce planning
and grow an appropriately skilled workforce to deliver
services to 2018.
61. Helicobactor-induced gastric cancer:
Identification of ER stress effectors
associated with the development of
precancerous disease
62. Comparison of short term outcomes of
extremely premature neonates with
Patent Ductus Arteriosus in surgical
and non-surgical centres
Daohai Zhang, Idit Ziv, Mhairi Baird, Doug Taupin
Wing Sze L Chan1, Mohamed E Abdel-Latif1, 2, Karen
Walker3, Nadia Badawi3, Hazel Carlisle1,2, NSW and the
AfyepCT Neonatal Intensive Care Units (NICUS) Group
1
Australian National University Medical School, ACT.
2
Department of Neonatology, Centenary Hospital for
Women and Children, ACT 3Department of Neonatology,
Grace Centre for Newborn Care: The Children’s Hospital
at Westmead, Sydney, NSW.
Cancer Research Group, Canberra Hospital, ACT.
Introduction: Helicobacter–induced gastric cancer (GC)
develops in stages of chronic inflammation, intestinal
metaplasia and dysplasia. The precise mechanisms
of how Helicobacter initiate tumour development at
early stage have not been elucidated. Recent studies
have demonstrated that H. pylori infection can induce
endoplasmic reticulum (ER) stress. This work aims to
identify the individual ER stress effectors that associate
with the development of Helicobacter-induced GC.
Methods: Wild type (C57Bl/6) and transgenic (Winnie
and GRP78+/-) mice were infected with H. felis and
histologic progression was analyzed at 5, 10 and 15
months postinfection. Protein expression was analyzed
using Western blot.
Results: H. felis infection caused chronic inflammation
and dysplasia in both WT and transgenic mice as
expected. Intrinsic ER stress activation in Winnie or
attenuation in GRP78+/- mice did not affect dysplasia
formation compared to infected WT mice. H. felis
infection upregulated the expression of trefoil factor 2
(TFF2) and the ER stress downstream effector CHOP, but
not GRP78. Further, in vitro infection of AGS cells with
H. pylori caused nuclear translocation NF-κB/p50 and
ATF6α and upregulation of CHOP and TFF2.
Conclusion: Helicobacter infection directly induces
ER stress cascades. We identify CHOP as a likely key
regulator of Helicobacter-induced GC.
Introduction: Patent ductus arteriosus (PDA) is an
incompletely understood condition in preterm infants.
There is no consensus regarding its management.
Surgical ligation is often reserved for failed medical
treatment in symptomatic infants.
It is uncertain whether transport to access ligation
facilities has an impact on treatment selection and infant
outcomes.
This study aims to compare treatment practices and
short term outcomes of extremely premature infants
managed in hospitals with (CTC) and without (NCTC) colocated neonatal cardiothoracic surgical facilities.
Method: Retrospective audit of infants <29 weeks
gestation born between January 2007 and December
2011 from 10 NICUs in NSW and ACT.
Results: Of 1817 infants studied, 26.7% were managed
in CTC and 73.3% in NCTC. PDA treated infants
were younger, smaller, had increased ventilation
requirements and had more comorbidities than
untreated controls(p<0.001). In CTC, ligation was
more common (8.0%vs.4.4%; p=0.004) and performed
earlier(p=0.038). Mortality was lower in ligation groups
compared to controls(p<0.05). However, mortality rates
in ligated infants were comparable between CTC and
NCTC(p=1.00).
Conclusion: This study confirms that infants managed
for PDA have more morbidities than untreated infants.
Ligated infants have good short term survival irrespective
of the need for transport. Further research is required to
determine long term outcomes of these infants.
August 12th – 15th, 2014 | 83
63. Improving the Management of Pelvic
Inflammatory Disease Through
Clinical Audit
Shannon C Woodward Angela F Knight Fiona
McDonald3 Sarah J Martin1, 2
1
64. ERp29\MGMT axis confers resistance to
ionizing radiation in breast cancer cells
Daohai Zhang
1
Canberra Sexual Health Centre, Canberra Hospital,
ACT 2Academic Unit of Internal Medicine, Australian
National University Medical School, Canberra Hospital,
ACT 3Australian National University Health Service,
Australian National University, Canberra.
Cancer Research Group, Canberra Hospital, ACT.
1
Introduction: Pelvic Inflammatory Disease (PID)
predominantly affects young women. Prompt diagnosis
and treatment reduces the likelihood of serious longterm consequences. Canberra Sexual Health Centre
(CSHC) conducted a quality improvement exercise to
support consistency in assessment, treatment, patient
information and follow-up of women diagnosed with PID.
Methods: Six key criteria for optimal PID management
were identified by literature review. Audit cycle 1
reviewed medical records of 56 patients diagnosed with
PID in 2012 and early 2013 and revealed inconsistencies
in management and gaps in documentation. CSHC
clinical staff were provided with results and education
on optimal documentation and management of PID. Audit cycle 2 reviewed the medical records of 43 patients
diagnosed with PID over the subsequent 12 months.
Results: Improvements occurred in documentation in
5 of 6 key criteria. Documentation of PID symptoms
and signs, pregnancy testing, medication regimen and
patient information all improved.
Conclusion: Audit can be a useful tool in improving
patient care and medical record documentation. To
support sustained improvement, a PID management
flow chart was developed. This has been incorporated
into Registrar and Nurse Practitioner orientation and is
available as a reference and teaching resource in each
clinic room.
Introduction: Resistance of cancer cells to chemo- or
radio-therapy is a major clinical problem in cancer
treatment. Therefore, understanding the molecular basis
of cellular resistance and identification of novel targets
are essential for improving treatment efficacy for cancer
patients. Our previous studies have demonstrated a
significant role of ERp29 against doxorubicin-induced
genotoxic stress in breast cancer cells. This work aims
to study the potential role and mechanism of ERp29 in
radioresistance of cancer cells.
Methods: DNA methylation PCR array, gene knockdown
by short interfering RNA (siRNA), ionizing radiation and
Western blot were used.
Results: ERp29 expression in MDA-MB-231 breast
cancer cells increased cologenic cell survival against
irradiation compared to the control cells. Mechanistic
studies revealed that ERp29 expression remarkably
activated the DNA repair gene, MGMT, by promoter
hypomethylation. Knockdown of MGMT in ERp29transfected cells resulted in re-sensitization to
irradiation and facilitated cell apoptosis. Radiation
treatment in ERp29- or MGMT-knockdown cells
elevated expression of gamma-H2AX and cleavage of
PARP. Thus, depletion of ERp29 or MGMT accelerates
radiation-induced DNA damage and reduces DNA repair
capacity.
Conclusion: Our studies have demonstrated a novel
function of ERp29\MGMT in modulating radioresistance
in cancer cell. Targeting the ERp29\MGMT axis may
improve treatment efficacy in combination with
radiotherapy.
65. Nurse Led Clinic For Patients Post
Radiation Therapy
Maureen Burnell
Clinical Development Nurse, Radiation Oncology,
Introduction: A great deal of nursing hours was spent
taking phone calls and reviewing patients who would
present to the department unexpectedly concerned with
ongoing side effects of radiotherapy. These patients
were not recorded as an occasion of service and often
had to wait until a nurse or doctor was available.
Objectives: To set up a Nurse Led Clinic providing a
continuation of care service, to decrease the number of
hospital admissions post-radiation therapy and to have
these visits recorded as an occasion of service.
Methods:
1. Establishment of a working party;
2.Collection of data regarding walk in and telephone
enquiries by patients post-radiation therapy;
3.Setting up a method for booking as an occasion of
service;
4. Establish a Nurse Led Clinic as a pilot study.
Results: The patients were seen promptly and
received a thorough nurse review allowing for timely
interventions of post-treatment complications, reducing
the need for hospital admissions.
Conclusion: There was a need for the establishment
of a Nurse Led Clinic in Radiation Oncology. Patient
outcomes were improved, nursing staff were able to
allocate time to work in the Nurse Led Clinic and provide
care in a timely manner. Recording these visits as an
occasion of service accurately demonstrated the activity
within the department.
66. Effects of elevated fatty acids and/
or glucose on glucose metabolism
pathways in human trophoblasts
Carina B Franco1.3, Cameron Kos1,3, Viviane
Delghingaro-Augusto1.3, Jane E Dahlstrom2,3,
Christopher J Nolan1,3.
The Endocrinology and Diabetes Research Unit and the
Anatomical Pathology Department, Canberra Hospital
and the 3Australian National University Medical School,
Canberra, ACT.
1
2
Introduction: Maternal diabetes and/or dyslipidaemia
are associated with adverse outcomes. The placenta
may adapt to protect the fetus or become dysfunctional
contributing to poor outcomes. The study aim was
to evaluate interactions between glucose and lipid
metabolism in trophoblasts from normal placentas.
Methods: Glucose uptake, glycolysis, glycogen
synthesis, glucose and palmitate oxidation were
assessed after 36h of culture using radio-labelled
glucose or palmitate tracers at various cold glucose
concentrations +/- 0.25mM non-esterified fatty acids
(NEFA). Lactate synthesis was measured using a
colorimetric assay. Cells were also cultured for 3 days
+/- epidermal growth factor (EGF) +/-0.1mM NEFA to
measure effects on syncytialisation using E-cadherin
immunofluorescence. Lipid droplets were assessed by
oil red O.
Results: Glucose uptake and glycogen synthesis
increased with increasing glucose concentrations
without reaching plateau. Glycolysis, lactate release and
glucose oxidation were limited. Palmitate oxidation was
reduced in presence of high glucose concentration. Lipid
droplets formation and syncytialisation were stimulated
by NEFA plus EGF.
Conclusion: Glucose uptake and glycogen synthesis
increase across a wide range of glucose concentrations,
unlike glycolysis, lactate production and glucose
oxidation rates, which plateau at 5mM. High
concentrations of glucose reduce lipid oxidation. EGF
may enhance lipid droplet formation. EGF and NEFA may
increase syncytialisation.
August 12th – 15th, 2014 | 85
67. Improving Sexual Health Care for
Aboriginal and Torres Strait Islander
Youth in the ACT
Morgan DJ , Tyson AH , Martin SJ
1
1,2
1,2
Canberra Sexual Health Centre (CSHC), Canberra
Hospital, ACT. 2Academic Unit of Internal Medicine,
Hospital, ACT.
68. Comparison of staff walking distances:
Open plan vs two cot design
Margaret Broom1, 2, Anne Gardner2, Shadbolt Bruce1, 3
Kecskes Zsuzsoka ¹, 4
Department of Neonatology, Canberra Hospital.
2
Australian Catholic University, Canberra, ACT. 3Centre
for Advances in Epidemiology and IT, Canberra Hospital,
ACT. 4Australian National University Medical School,
Canberra, ACT.
1
1
Background: Throughout Australia, Aboriginal and
Torres Strait Islander people have proportionately higher
rates of sexually transmitted infections (STIs). Canberra
Sexual Health Centre (CSHC) joined the Antenatal Care,
Pre-pregnancy and Teenage Sexual and Reproductive
Health Project in 2012. Project aims are to reduce rates
of STIs and to increase service provision for antenatal
care and sexual health testing for Aboriginal and Torres
Strait Islander youth in the ACT.
Background: Canberra Hospital NICU relocated from
an open plan (OP) to a two cot room (TCR) design in
2012. Literature has debated changing NICU design
from (OP) to (SRD) may increase staff workload due to
increased walking distances in the new design, with staff
highlighting the need to walk further to provide patient
care, or obtain stores and equipment.
Method: A sexual health nurse from CSHC has been
working with community organisations, schools and
other youth facilities to provide education, training
and opportunistic STI testing. Aboriginal and Torres
Strait Islander youth have been a priority group for
these activities.
Results: In 2013, 27 sexual health education sessions
were held. A total of 397 students participated and
111 identified as being of Aboriginal and Torres Strait
Islander descent. Twenty-six young people were
tested during outreach, with follow-up treatment and
vaccinations as required.
Conclusion: The project has been fostering knowledge
and education to encourage confidence to seek sexual
health care at a range of services across the ACT. From
December 2012 to December 2013 CSHC has seen a
220% increase in the number of Aboriginal and Torres
Strait Islander people accessing services.
Method: A pre and post-move prospective comparative
study comparing staff walking distances in the OP and
TCR NICUs was undertaken during 2012 and 2013.
Participants were allocated a pedometer for the duration
of their shift. At the completion of their shift, recorded
steps were checked and documented by the research
team. Data was transcribed into SPSS: univariate
analysis and pairwise comparisons were used to assess
estimated marginal means of SWD.
Results: 65 (OP) and 98 (TCR) SWD were recorded.
Study participants walked on average 402 m/hr (OP)
and 415m/hr (TCR) p=0.688. Whereas clinical nurses
walked 362 m/hr (OP) and 358m/hr (TCR) p=0.903.
Showing no significant difference in SWD when
comparing OP or TCR design.
Conclusion: By interlinking rooms, as well as
decentralising equipment and stores the impact of
moving to a larger unit on SWD has been negated.
69. Participating in clinical bedside rounds:
Staff and parent focus groups
Broom Margaret1, 2, Deborah Davies3, Smith Judith¹,
Mohamed E Abdel-Latif 1, 4
Department of Neonatology, Canberra Hospital.
2
Australian Catholic University, Canberra, ACT. 3Faculty
of Health, University of Canberra, ACT. 4School of Clinical
Medicine, Australian National University, ACT.
1
Background: During 2011-12 a randomised crossedover controlled trial: Parental presence on bedside
clinical rounds (PPBCR) was conducted in the Neonatal
Intensive Care Unit. We were keen to add depth to the
study by exploring the participant’s experiences at
clinical rounds.
Method: To expand our knowledge of staff and parents
perceptions of PPCBR, two focus groups; one with
parents (n=7) and one with staff (n=9) were held.
Results: Two main themes were highlighted by parents
and staff were communication and philosophy of family
centred care (FCC). PPCBR was seen as a time saving,
effective method of providing high quality information.
Staff also thought it improved consistency of information
given to parents and allowed parents to build a rapport
with the team. PPCBR had some disadvantages for
staff including decreased opportunity for education
and increased time involved in the round, but PPCBR
supported the unit’s philosophy of FCC. It wasn’t about
philosophy for parents but about participating in the
decisions concerning their baby.
Conclusion: This study has provided insight and
depth of the experiences of parents and staff involved
in PPCBR. It has highlighted the benefits of including
qualitative data to add depth to a RCT.
70. Canberra Hospital Cardiology
Outpatients “Patient Experience
Survey” (Pilot Study)
Scott J Laffey
Cardiology Outpatient Department, Canberra Hospital
Health Services (CHHS), ACT.
Introduction: Patient experience is defined as “the sum
of all interactions, shaped by an organisation’s culture,
that influence patient perceptions across the continuum
of care”. Cardiac Health Professionals value a patient
centred approach to health care. Gauging the patient
experience with a ‘patient experience survey (PES) is an
important measure to determine patient’s perceptions
of the quality of care provided in Canberra Hospital and
Health Services (CHHS).
Methods: Thirty patients of CHHS were sampled for a
pilot study. Patients were selected in sequential order at
time of presentation over one 24hr period. Participants
completed the survey of 10 questions regarding their
experience at CHHS. Results were analysed using an
online SurveyMonkey database.
Results: Patient response rate was 80%, 45% female.
Response rates for individual PES items ranged from
88-96%. Participants indicated they were seen on time
or within 10min of their scheduled appointment 78%
of the time, with 95% of participants indicating their
experience was pleasant. The average overall experience
rating was 8.6/10.
Conclusion: The results of the PES demonstrate
the passion and commitment of Cardiac Health
Professionals to ensuring a positive patient experience.
Future work will elucidate the experience of a more
diverse patient group and allow targeted patient
experience enhancement strategies.
August 12th – 15th, 2014 | 87
71. Carbon nanotube/ultrahigh molecular
weight polyethylene composite as a
novel electro-active sensing material
for orthopaedics applications
Quyen T.X Do, Rhys W. McCormack, Sean O’Byrne
School of Engineering and Information Technology,
University of New South Wales, Canberra, ACT.
Introduction: The inspiration for this project is to
transform the normal Ultra High Molecular Weight
Polyethylene (UHMWPE), which is used as a surgical
bearing material, into a smart sensing polymer whose
sensitivity can be systematically tailored for orthopaedics
applications. In order to achieve that, multi walled carbon
nanotubes (MWNTs), a super light-weight yet extremely
strong and highly electrical conductive nano-filler, were
chosen to be embedded in a UHMWPE matrix.
Methods: The MWNT was ultra-sonicated in ethanol
to release its entanglement form and ball milled with
UHMWPE to create a uniformly dispersed mixture.
The powder was then compression moulded under
170°C and 10 MPa to form a solid sensing material.
A compressive force of 0.1 – 2 kN, which is a typical
range of applied force on the knee insert during daily
movements, was applied to the sensor and in-situ
resistance change was captured.
Results: Sample with 1wt% MWNT was observed
to have a linear resistance change over the range of
4 – 54 MPa pressure, equivalently to a sensor with
piezoresistivity coefficient of -0.024 MPa-1. With a
typical Young’s modulus of 900 MPa, the equivalent
strain gauge factor of composite is 21.6. The decreasing
resistance with increasing stress is mostly attributed
to the change in filler network formation and tunnelling
resistance between nearby inclusions under mechanical
loading.
Conclusion: The CNT/UHMWPE sample was shown
to have high sensitivity over a board range of applied
stresses comparable to those experienced by a loaded
tibial insert. This sheds light on its various applications
in the field of nano-sensing. Together with the highly
bio-compatible nature of UHMWPE, the composite
sensor shows promise as a tibial insert that is capable of
monitoring in-vivo kinematics.
72. Improved flow associated with
streaming in an enlarged ED without
changes in staffing
Drew Richardson1, Michael Hall2
School of Clinical Medicine, Australian National
University, ACT. 2Director of Emergency Medicine,
1
Introduction: Streaming has been shown to improve
ED patient flow but the optimum size and number of
streams is unknown. This study aimed to describe the
effect of a change in streaming practice in TCH.
Methods: Prospective quasi-experimental before-after
study. The intervention was an increase of 8 trolley
spaces combined with a reorganisation from a large ED
with 30% fast-track to two roughly equal streams. For
42 consecutive days (starting 0500) before and after, the
workindex, a previously validated measure of crowding
in this ED, was calculated. Days were categorised by
workindex quartiles and performance measures of
Did-not-wait (DNW) and Waiting time less than triage
threshold (WAIT) were calculated for each quartile.
Results: DNW fell from 8.4% (95%CI 7.8-9.1) to 6.2%
(5.7-6.7) (p<10E-7) and WAIT improved from 47.5%
(46.4-48.6) to 52.2% (51.1-53.3) (P<10E-8). DNW and
WAIT improved at all workindex quartiles, especially
the top quartile. The mean number waiting at any time
increased by 1% (p=NS) but the mean number tracked to
a waiting area rather than a clinical space fell by 36%.
Conclusion: Increasing the size of the ED and
reorganising into two streams was associated with a
small increase in workload and a marked improvement
in performance.
73. The perspectives of obese women
receiving antenatal care: A qualitative
study of women’s experiences
Catherine R. Knight-Agarwal1, Lauren Williams2,
Deborah Davis1, Rachel Davey1, Rebecca Shepherd1,
Alice Downing1 and Kathryn Lawson1.
74. Intravesical gemcitabine (GEM) versus
bacillus Calmette-Guérin (BCG) for
the treatment of non-muscle invasive
bladder cancer
Thiru Prasanna1, James C Kuo1, Megan Hickie1,2 ,
Benjamin W.C Sim1, Ganes Pranavan1,2 1
Department of Nutrition and Dietetics, University of
Canberra, ACT. 2Department of Nutrition and Dietetics,
Griffith University, QLD.
1
Introduction: Maternal obesity has implications for
both mother and baby including increased health risks
from gestational hypertensive disorders, caesarean
section and stillbirth. Despite the increasing prevalence
of maternal obesity little is known of the experiences of
these women within the health care system. The aim of
this research was to investigate the views and attitudes
of pregnant women with a Body Mass Index (BMI) of
≥30kg/m2 receiving antenatal care.
Introduction: A considerable proportion of patients with
non-muscle invasive bladder cancer experience disease
recurrence after tumour resection. Adjuvant intravesical
GEM and BCG had both been shown to reduce disease
recurrence.
Methods: A qualitative study using individual interviews
was undertaken at a large teaching hospital in south
eastern Australia. Sixteen pregnant women with a BMI
≥30 kg/m2 were recruited to the study. Interviews were
audio recorded, transcribed verbatim and then data
was analysed for recurrent themes using Interpretative
Phenomenological Analysis (IPA).
Results: Four major themes emerged from the data: (1)
Judgemental attitudes abound (2) Poor communication
exists (3) More resources are required (4) Maternal
motivation is the key.
Conclusion: Specialist dietary interventions for obese
women should be a priority in antenatal care. Health
professionals should approach the issue of maternal
obesity in an informative but non-judgemental way.
Extra support is required to assist obese women in
pregnancy achieve recommended nutritional and weight
gain goals.
Department of Medical Oncology, Canberra Hospital,
ACT. 2Australian National University Medical School,
Australian National University, Canberra.
Methods: Patients with non-muscle invasive bladder
cancer treated with GEM or BCG at Canberra Hospital
between 2010 and 2013 were identified. Relevant
information including patient characteristics, findings of
serial surveillance cystoscopies, documented disease
recurrence and incidences of adverse events were
extracted for analysis. Patients were followed up until
disease recurrence, or two years after completion of
treatment, whichever occurred earlier.
Results: 68 patients were included: 37 received BCG and
31 received GEM. At a median duration of 24-month followup, 1-year recurrence rate was significantly better with
GEM (30.8% vs 60.7%, p=0.0033). One-year follow up was
not reached for 26 (38.2%) patients. Disease clearance was
numerically better with GEM. Overall incidence of adverse
events was significantly lower with GEM.
Conclusion: The interim results suggested the efficacy
of GEM and BCG to be comparable. GEM had a better
tolerability. Intravesical GEM is therefore a valid
alternative to BCG. The two-year recurrence rate will be
updated once a longer term follow-up is completed.
Funding Source: A small amount of government RTS
funding was used.
August 12th – 15th, 2014 | 89
75. Determinants of Road Crash Severity
in the ACT
76. The Emergency Department
Post-admission Round Pilot Project
Miriam Saffron1 and A/Prof Drew Richardson2
David P Phillips and Mark D Russell
Medical Student, Australian National University, Acton
ACT. 2Road Trauma and Emergency Medicine, Canberra
Hospital, ACT
Emergency Department, Canberra Hospital, Canberra,
ACT.
1
Introduction: Understanding important severity factors
is crucial for injury prevention policies and project
decisions.
The objective was to identify significant determinants of
road crash severity in the ACT.
Methods: Police crash data and hospital data from 2001
to 2003 had been previously collected and matched.
These data were analysed using ordinal logistic
regression. Severity was based on length of stay in
hospital.
Results: Statistical significance (p values) is shown
in parentheses.Factors increasing the odds of more
serious injury:
• Older casualty (p=0.000)
• Motorcyclist, pedal cyclist, and pedestrian casualties
more serious than driver (all p’s < 0.015)
• Head-on, overturned and struck object more than
right angle collision (all p’s < 0.045)
• Crashes in darkness more serious than those in
daylight (p=0.000)
• Factors decreasing the odds of more serious injury:
• Rear end and animal collision less serious than right
angle collision (all p’s < 0.018)
• Suburban road crashes less than main road (p=0.050)
• Wet surface crashes less than dry surface (p=0.011)
• Intersection crashes, particularly roundabouts
(p=0.000) less than non-intersection (all p’s < 0.050)
Conclusion: Severity factors for ACT road crashes have
been identified.
Introduction: The Emergency Department PostAdmission Round (EDPR) was created to determine if ED
junior doctors may benefit from structured follow up of
their patients post-admission to hospital.
Methods: Residents at Canberra Hospital ED in term
one 2014 were offered to take part in the project. Eleven
residents participated and conducted weekly one-hour
ward rounds to visit patients they had managed in ED
1-3 days post-admission to hospital. Verbal consent
was obtained with patient progress recorded on a
standardized pro-forma. The residents additionally
prepared case presentations for the group with EDConsultant led feedback and discussion. Finally,
participants took part in feedback sessions.
Results: All participants found the exercise rewarding and
beneficial for their learning with the case presentations
particularly well received. Main study critiques were as
follows. Firstly, while all completed the exercise, many
found undertaking the ward-rounds difficult due to other
time commitments and lethargy post-ED shifts. Secondly,
several participants found reviewing patient discharge
summaries provided similar educational benefit in less
time. Thirdly, there was a desire for more frequent ED
Consultant led sessions if possible.
Conclusion: The EDPR pilot project enhanced
junior doctor education in ED but with notable
drawbacks. Recommendations from this study may
shape future studies.
77. Project Venturi: Discharge Summary
and Medication Prescriptions Survey
Chun Seng Phua1, Alison Kingbury2 and Miriam
Lawrence3
Resident Medical Officer; 2Project Manager; 3Director of
Pharmacy; Canberra Hospital, Canberra, ACT.
1
Introduction: Effective discharge planning is crucial
to better hospital patient flow and has been shown to
reduce re-admission rates. We performed a survey to
better understand barriers junior doctors face when
completing discharge summaries and medication
prescriptions.
Methods: A 16 question survey with short answer
and multiple choice questions was distributed to all
intern and resident doctors at Canberra and Calvary
Hospital. Responses were gathered from hard copy
survey and electronic forms using the SurveyMonkey
online tool. A reminder to complete the survey was sent
after one week.
Results: 62 doctors responded to the survey. Main
barriers to completing discharge summaries and
medication prescriptions were other tasks (70.0%),
lack of time (68.3%) and interruptions (65.0%). 72.9%
respondents requested better computer access, and
59.3% respondents wanted a dedicated time to complete
discharge-related paperwork. Junior doctors rated
the summary of in-patient management and followup plan as the two most challenging aspects of
completing a discharge summary.
Conclusion: This survey has highlighted the varied
barriers junior doctors face when undertaking
discharge planning and tasks. The findings allow
prioritisation of strategies to discharge-related
processes and systems that ultimately will improve
patient flow and the patient experience.
78. Sarcomatoid Hepatocellular
Carcinoma—An Aggressive Tumour
Diagnosed in a Young Female
Ayesha Ajmal and Millie Lui
ACT Pathology, Canberra Hospital, ACT.
Introduction: Sarcomatoid hepatocellular carcinoma
(HCC) is a rare entity. The tumour is often associated
with cirrhosis and seen in elderly males. Pathogenesis of
sarcomatous change is unclear. Prognosis is often poor
due to increased risk of extrahepatic metastasis.
Methods: A 34 years old female was admitted to the
hospital with abdominal pain. An abdominal CT scan
showed a massive tumour, 14x13x8cm, in the right lobe
of liver. Her serology for viral hepatitis was negative.
There was no family history and no other relevant
medical history. Right lobectomy of liver was performed.
The resected specimen was fixed in 10% formalin.
Tumour blocks were embedded in paraffin and stained
with haematoxylin and eosin. Immunohistochemistry
was also performed.
Results: Macroscopic examination showed a lobulated
necrotic tumour. Microscopic examination showed a
HCC with variable differentiated components ranging
from well to poor to sarcomatoid. The uninvolved hepatic
parenchyma showed normal morphology. Resection
margins were negative. Immunohistochemistry showed the
sarcomatoid component lacked staining for epithelial and
hepatic markers, and had high Ki-67 proliferative activity.
Conclusions: We reported a rare case of sarcomatoid
HCC in a female patient who presented at unusually
young age and with no known risk factors. She is
currently disease free 6 weeks post surgery.
August 12th – 15th, 2014 | 91
79. Growth and development follow up:
Making a difference in a baby’s future!
Allana Carter¹, Catherine Maher¹, Hazel Carlisle¹, 2,
Margaret Broom¹,3
Dept of Neonatology, Centenary Hospital for Women
and Children, Canberra. 2Australian National University
Medical School, Canberra. 3Australian Catholic
1
Background: The Growth & Development Clinic (GDC) at
the Centenary Hospital for Women and Children provides
an audit and screening service for high risk babies from
Canberra and regional NSW. The GDC’s function is to
collect data for audit, screen for developmental delays,
and coordinate the provision of early
intervention services.
Aim: To review the service provided by the GDC during
2011-2013: with the aim to identify the future role and
service provision of the GDC.
Method: A biannual audit was completed by the GDC
Coordinator using data collected from the GDC utilising
excel spreadsheets.
Result: During 2011-2013 653 babies required
appointments for 8, 12 and 36 month follow up with 527
(80.7%) attending. Of the GDC attendees 402(76.2%)
were < 32 weeks. Over the two year period the clinic has
facilitated 119 referrals to multidisciplinary services,
these included; Physiotherapy 37 (7%), Speech 41
(7.7%), Early Intervention Services 11(2.0%), Cerebral
Palsy clinic 6 (1.1%), Paediatrician 20 (3.7%) and Autistic
Spectrum 4 (0.75%).
Conclusion: The GDC ensures high risk babies born in
the ACT and regional NSW obtain appropriate follow
up and support services. This audit will provide the
necessary statistic data required for future development
and infrastructure.
80. Importance of regular postassessment in a new Heart Failure
Rehabilitation Course
Tarryn Mair; Helen McFarlane; Peter Loa and Jody
Hook
Exercise Physiology Department, Canberra Hospital,
Canberra, ACT. Chronic Disease Management Unit,
Canberra Hospital, Canberra, ACT.
Introduction:Chronic heart failure (CHF) is a complex
syndrome that affects 1.5-2.0% of Australians and
is characterised by progressive decline in ventricular
function, low exercise tolerance and increased mortality
and morbidity. Best practice management of CHF
involves specialised multidisciplinary care. Access
to services for people with CHF in the ACT has been
limited. In June 2011 a dedicated multidisciplinary
heart failure program was implemented. The Heart
Failure Rehabilitation Course (HFRC) is a 12 week
program consisting of exercise sessions tailored to meet
patients’ needs and education sessions conducted by
Heart Failure nurses and allied health professionals.
Reassessment is conducted 3, 6 and 12 months post the
completion of the program to assess self-management
and adherence.
Methods: 6MWT data was collected and collated from
23 patients pre program, post program, 3, 6 and 12
months post completion of the program. Data was
analysed using Microsoft Excel.
Results: 6MWT results indicated that an average
improvement of 78 metres was obtained at the end of
the course, 83 metres at 3 months, 92.5 metres at 6
months and 83 metres at 12 months.
Conclusions: CHF is a progressive condition that is
characterised by periodic acute exacerbations, therefore
regular assessment of symptoms and adherence to
lifestyle changes, such as physical activity is necessary.
Continued resources are necessary to maintain a
coordinated, systematic approach to quality patient care.
81. Autosomal dominant B cell deficiency
with alopecia due to a mutation in NFKB2
that results in non-processible p100
82. Establishment of a Tissue Viability
Unit at Canberra Hospital—Nurse Led
Advancement in Health Services
Cindy Eunhee Lee1 2, David A Fulcher4, Belinda
Whittle3, Rochna Chand1,2, Nicole Fewings4, Matthew
Field1,3, Daniel Andrews1,3, Christopher C Goodnow1,3,
Matthew C Cook1 2
Ann Marie Dunk
Department of Immunology, John Curtin School of
Medical Research, Australian National University, ACT.
2
Translational Research Unit, Canberra Hospital, ACT.
3
Australian Phenomics Facility, Australian National
University, Canberra ACT. 4Department of Immunology,
Westmead Hospital, NSW.
Introduction: Diversity of the nursing profession
in today’s health system has broadened with
advancements in choices of specialities within clinical
practice. Changing patterns of health care are forcing
service planners to examine new delivery models. An
additional concern is the significant gaps in teaching
of wound management within undergraduate and post
graduate curricula pose an unprepared workforce in
delivering a level of expertise in this clinical speciality.
1
Most genetic defects that arrest B cell development
in the bone marrow present early in life with
agammaglobulinemia, while incomplete antibody
deficiency is usually associated with circulating
B cells. We report a novel form of severe B cell
deficiency associated with partial persistence of
serum immunoglobulin, due to a missense mutation
in NFKB2. Significantly, this point mutation results
in a failure of p100 phosphorylation that blocks its
processing. Severe B cell deficiency affects mature and
transitional cells, mimicking the action of Rituximab.
This phenotype appears to be due to disruption of
canonical and non-canonical NF-kB pathways. These
findings could be informative for therapeutics as well as
immunodeficiency.
Tissue Viability Unit, Canberra Hospital, Canberra ACT.
Methods: This model is a six month rotational
mentorship programme for Registered Nurses (RN)
in clinical practice designed around multi-disciplinary,
broad-based clinical review service. This model provides
a comprehensive educational framework and grounding
for their development in wound expertise.
Results: Over a 12 month period, four six month
RN rotations completed. Providing direct and
comprehensive care: 1960 reviews wound types, a
continual reduction of pressure injury. Increasing the
access to educational, research and quality projects,
whilst developing as a Advance Practice Nurses (APN).
Conclusion: This model for APN in wound care has
demonstrated the value of this approach for individual
nurses and for the health system generally in enhancing
wound care.
August 12th – 15th, 2014 | 93
83. Pyloric Stenosis in Preterm Twins—
Three Case Histories
Glen Yepes and Leanne Ehrlich
Department of Neonatology, ACT.
Introduction: In 2013 3 infants presented with pyloric
stenosis during the neonatal period. All infants were
premature twins and 2 infants had other congenital
abnormalities. Infantile pyloric stenosis (IHPS) is a
disorder that can occur in neonates three to eight
weeks after birth. It is characterised by hypertrophy and
hyperplasia of the pylorus muscles.
Case 1: Premature infants are usually diagnosed with
IHPS at a later age than non-premature infants. Case 1
was born at 30 weeks gestation and following a complex
course in the NICU, developed intermittent projectile
vomiting at 2 months of age. Ultrasound on day 63
showed pyloric hypertrophy.
Case 2: a 31 week gestation infant with antenatally
diagnosed tetalogy of fallots which was repaired at birth.
The infant presented at 4 months of age with projectile
vomiting and weight loss. There was a history of feeding
via transpyloric tube.
Case 3: An infant was born at 36 weeks gestation with
tracheo-oesophageal fistula which was repaired on
day 2. The infant continued to have effortless vomiting
following establishment of full oral feeds at 3 weeks.
Ultrasound and clinical examination were consistent
with IHPS.
The aetiology of IHPS remains a mystery. Suspected
risk factors include birth rank, maternal age, sex,
family history and there is an increased incidence in
twins. Males have a higher risk (four to five times) of
developing IHPS than females.
Conclusion: The usual symptoms of IHPS present in
term infants are not usually seen in preterm infants
with IHPS. The diagnosis of IHPS should always be
considered in premature infants, particularly twins with
vomiting and poor weight gain.
84. What are the clinical and workforce
impacts of Unplanned Personal
Leave (UPL ) in the nursing
population at Canberra Hospital
Intensive Care Unit (ICU)?
Jenny, J Rochow
Introduction: UPL in nursing is a problem for health
organizations. Canberra Hospital ICU has on average 8
FTE amounting to 150 shifts of UPL monthly. This is more
than double the budgeted FTE and one of the highest in
ICUs around Australia. The aims were to identify reasons
and patterns of UPL, benchmark to similar size ICUs and
identify impact on staff and patients.
Method: A survey was distributed to all ICU nursing staff
in August 2013 and benchmarking data was collected.
Results: Half of UPL is explained by immediate family
illness, combined personal factors of stress, redeployment, morale, and fatigue explained 24% of the
remainder of UPL. The qualitative data was separated
into 2 categories; imperative and reactionary. Imperative
factors were leave for family crisis and sick children.
Reactionary factors made up the majority of reasons.
This category was subdivided into situational and
consequential.
Conclusion: Common themes identified will be used
to potentially reduce UPL including fairer rostering
systems, improved culture, monitoring redeployment
and fairer annual leave allocation.
85. CeasIng Cpap At standarD criteriA
(CICADA): Implementing CICADA
reduces CPAP duration
Rachael Heath Jeffery 1, Margaret Broom 2, Bruce
Shadbolt 1,3, David A Todd 1,2
Australian National University Medical School,
Canberra. 2Department of Neonatology, Centenary
Hospital, Canberra, Australia, 3Centre for Advances in
Epidemiology and IT, Canberra.
1
Introduction: In a multicentre randomized controlled
trial (RCT) on premature babies (PB’s) <30 weeks
gestational age (GA) for ceasing continuous positive
airway pressure (CPAP), we showed that CeasIng Cpap
At standarD criteriA (CICADA) significantly reduced
CPAP duration. (ref) Post RCT the CICADA method was
implemented into our Neonatal Unit. We hypothesised
CPAP duration would reduce post introduction of
CICADA as standard practice.
Methods: We compared prospectively collected data
on PB’s <30 weeks GA prior to the RCT (2004-2006),
during the RCT period (2007-2009) and post RCT
implementation (2010-2012). We compared baseline
characteristics and respiratory outcomes including
CPAP duration. Data were compared with general linear
models (SPSS).
Results: Survival rates were 85/105(80.9%),
96/111(79.2%), and 111/127(80.3%) respectively.
No significant differences were recorded in baseline
characteristics for GA (27.9±1.3, 27.7±1.4, 28.0±1.3
[weeks] {mean±SD}; ns) or birth weight (1100±252,
1086±251, 1094±320 [grams] {mean±SD}; ns)
respectively. CPAP duration was significantly shorter
post implementation of CICADA (493±50, 506±51,
395±43 [hours] {estimated marginal mean±SE}; p=0.006)
respectively.
Conclusion: The introduction of CICADA into our Neonatal
unit at Canberra for ceasing CPAP has significantly reduced
CPAP duration in PB’s <30 weeks GA.
86. Are there benefits to having onsite
blood borne virus screening at an opioid
treatment service? A review of data
collected during the implementation of
interagency collaboration
Catherine A Brown1, Tasha Lutz1, Cassandra Beaumont1,
Alexandra Tyson2, Sarah Martin2, Jill Hughes3
Clinical Forensic Medical Services (CFMS), 2Canberra
Sexual Health Centre (CSHC), 3Alcohol and Drug Services
(ADS) – Canberra Hospital & Health Services (CH&HS),
Canberra, ACT.
1
Introduction: In March 2012 ADS within the Opioid
Treatment Service (OTS) at the CH&HS conducted an
internal review of the number of clients accessing
baseline blood borne virus (BBV) screening. It was found
that despite new program clients being referred to ACT
Pathology the majority never attended. To rectify this
there was agreement to provide onsite BBV and sexual
health screening clinic to the ADS / OTS clients who often
have a history of, or are continuing intravenous drug
users and therefore at higher risk of BBV transmission
and infection.
Methods: A 24 month review (April 2012-March 2014)
of BBV clinic pathology was conducted focusing on
the number of clients screened and number of positive
results for hepatitis.
Results: Of the 74 hepatitis C tests performed 35 (47%)
returned a positive antibody result with 17 (48%) positive
PCR’s, of those with positive PCR 7 were not immune
for hepatitis B (titre <10 IU/ml). 77 hepatitis B antigen
tests were performed with 5 positives (6.25%). 26 clients
commenced hepatitis B vaccination, 10 schedules being
completed.
Conclusion: There are benefits of having convenient
access to BBV screening to identify acute and chronic
hepatitis infections and to provide immunisation to this
high risk population.
Reference: Todd et al. Methods of weaning preterm
babies <30 weeks gestation off CPAP: A multicentre
randomised controlled trial. Arch Dis Child Fetal
Neonatal 2012: doi:10.1136/F2 of F5 adc.2011-300133:
Vol 97 (4) F236-240.
August 12th – 15th, 2014 | 95
87. Is there functional quality of life after
ICU? A systematic review
Cherie Smith1, Emil Tow1, Courtney Hall1, Karen Clarke2
& Bernie Bissett1,3,
Discipline of Physiotherapy, University of Canberra,
Canberra ACT. 2Discipline of Occupational Therapy,
University of Canberra, Canberra ACT. 3Physiotherapy
Department, Canberra Hospital, ACT Health, Canberra ACT.
1
Introduction: With more patients surviving complex
illness through intensive care (ICU), there has been
increased interest in the long term outcomes of ICU
survivors. This systematic review sought to examine
the impact of ICU admission on health-related quality of
life (QOL), with focus on functional status and activities
of daily living, which could be potentially enhanced with
therapeutic intervention.
Methods: Following prospective registration on the
PROSPERO database, pre-specified search terms were
entered into major databases, with 2 researchers
independently screening each abstract for eligibility.
Eligible studies included those specifically focused on
ICU patients, with at least one measure of quality of life
or function following ICU discharge (eg SF36, EQ5D, 6
minute walk test).
Results: Initial database search returned 500 articles,
of which 47 were potentially eligible and retrieved as
full text articles. Following removal of duplication,
27 studies (typical methodological quality level III-2)
were included. Differences in outcome measures used
prevented meta-analysis, however 11 studies reported
worse functional outcomes between 4 and 12 months
following ICU discharge. Few studies indicated full
recovery of QOL following ICU discharge.
Conclusion: Based on the limited evidence available,
ICU survivors typically have poor quality of life following
discharge, particularly regarding physical function.
Future studies should explore whether targeted
therapeutic intervention can improve these outcomes in
this population.
88. Feasibility and accuracy of a novel
right ventricular real time threedimensional Echocardiograph tool
within a clinical setting
Leah Giles, Christine Brown, Luke Cartwright, Tegan
Meredith
Cardiology Department, Canberra Hospital and Health
Services, ACT.
Introduction: Traditional volumetric and functional
echocardiographic assessment of the right ventricle
(RV) is challenging due to its complex anatomy. Real
time three-dimensional transthoracic echocardiography
(RT3DE) is a novel tool which can overcome the
geometric limitations of traditional techniques. This
study used RV-RT3DE to determine the feasibility and
accuracy of measuring RV volume and systolic function
within a clinical setting. This is the only single-beat
real time non-invasive quantitative assessment for
the measurement of RV volume and systolic function
currently available.
Methods: Nineteen patients underwent a routine 2D
transthoracic echocardiograph and RV-RT3DE (Siemens
SC2000 machines) over a six week period. RV volumetric
quantification was analysed using semi-automated 3D
border detection for RT3DE.
Results: Adequate RV-RT3DE data sets were obtained
in 13 of 19 (68%). Data sets were considered accurate
by the operator if the RV ejection fraction, volume
and stroke volume obtained correlated with other 2D
echocardiographic measurements and images obtained.
There was no impact on studies performed per day
compared to the prior 6 week period 8.5/day v 9.2/day
(p=0.538).
Conclusion: RV volume and function can be acquired
and analysed with acceptable feasibility using RT3DE
software in routine clinical patients. Utilisation of RT3DE
software involves an initial steep Sonographer learning
curve and potentially ongoing image quality dependency.
89. Communicating endometriosis
with young women to decrease
diagnosis time
90. Incorporating Velocity Vector Strain
Imaging into Routine Clinical Practice
(Baseline Study)
Naomi A Shadbolt1, Melissa A Parker2 and Lindy A Orthia3
Christine Brown, Luke Cartwright, Leah Giles, Tegan
Meredith
Colleges of Sciences, Australia National University,
ACT. Canberra Endometriosis Centre, Department of
Obstetrics and Gynecology, Canberra Hospital, ACT.
Australian National Centre for the Public Awareness of
Science, Australian National University, ACT.
Introduction: Communicating endometriosis to young
women for early diagnosis and timely treatment could
be important for long term disease outcomes. Our
objective was to determine what young women know
about endometriosis, what young women want to know
about endometriosis and how this is best communicated
to promote early detection.
Methods: A pilot focus group was conducted to trial
questions. A population based sample (N=131) of young
women aged 16-25 years completed a short online
survey advertised through schools, university and social
media. The survey asked what they wanted to know about
endometriosis, who should be targeted, mediums for
obtaining information and who they would discuss with.
Results: 51% of participants had heard of
endometriosis with a greater proportion being older
participants; 89% thought teenagers should know about
endometriosis with 78% agreeing that young men
should also be aware; school was the most popular
nominated source for viewing/discussing endometriosis
information (40%) followed by the internet (22%) and
magazines (13%). Young women were more comfortable
talking to a doctor (75%) about endometriosis, followed
by a parent (59%) or friend (51%). Participants wanted
to know identifying symptoms, the disease definition,
commonality, risk factors, causes, prevention, treatment
and diagnosis. Participant’s descriptions of the disease
were vague and sometimes confused.
Cardiology Department, Canberra Hospital and Health
Services, ACT.
Introduction: Numerous methods for assessing strain
and strain rate have been developed to quantify regional
and global cardiac mechanics. Velocity vector imaging
(VVI) is a novel echocardiographic imaging technique
based on routine two-dimensional gray scale which
is angle independent and can be used for measuring
longitudinal, circumferential and radial strain.
Methods: Sixty patients were underwent routine
clinical echocardiography using VVI with a frame rate
of 60–70Hz. Endocardial and epicardial walls were
tracked using point click method in the three standard
apical views. Tracking accuracy and numerical data were
subjectively reviewed for accuracy by the operator.
Results: VVI was attempted on 60 patients it was
feasible and accurate in 42 patients (70%), feasible
and somewhat accurate (tracking was achieved in at
least one view) in 8 patients (13%) and not feasible
in 9 patients (15%). To determine any difference in
time taken to perform echo 10 random studies were
measured: 35.6 mins v 33.3 mins (p=0.56).
Conclusion: VVI was easily integrated into clinical
practice without increasing time taken to perform scan
and operators found the method feasible and accurate in
assessing cardiac function. This novel tool will enhance
diagnostic accuracy and confidence in assessing cardiac
mechanical function.
Conclusion: In this study, most young women want
to learn about endometriosis, think that young men
should also be educated, and are most likely to access
information through school based programs and the
internet. For early education regarding endometriosis,
health promotion activities should be directed towards
sources that young women prefer.
August 12th – 15th, 2014 | 97
91. Improved energy and protein
provision for critically ill patients in
Canberra Hospital
92. CPAP usage patterns in a consecutive
series of patients during and after
physician -led acclimatisation programme
Louise K Herlihy1, Sumeet Rai2, Helen Rodgers3, Amy
Harney3,Frank M van Haren2
Sharma R, Cooper M, Bartlett H, Wyatt B, Dr.Wee R,
Pak A, Carroll A, Dr.Huang C
Nutrition Department, Canberra Hospital, ACT.
Intensive Care Unit, Canberra Hospital, ACT. 3Research
Office, Intensive Care Unit, Canberra Hospital, ACT.
Respiratory and Sleep Medicine, Canberra Hospital, ACT.
1
2
Introduction: Canberra Hospital Intensive Care Unit
(ICU) participated in the 2011 and 2013 International
Nutrition Survey (INS). INS is a worldwide prospective
survey of nutrition practices comparing a ICUs
performance against the recommendations of the
Canadian Critical Care Nutrition Clinical Practice
Guidelines (1).
Methods: Data including ICU and patient characteristics,
type of nutrition received, length of stay, and mortality
was collected for 20 adult ventilated patients in 2011 and
2013. Participating ICUs received individual site reports
for benchmarking and quality improvement purposes.
The 2011 INS site report highlighted the need to improve
time to initiation of enteral nutrition (EN) and adequacy
of nutrition delivery. A review of the literature facilitated
the development of a new enteral feeding protocol which
was implemented in 2012.
Results: Time to initiation of EN improved with 89% of
patients receiving EN within 24hrs from ICU admission
in 2013 compared to 44% of patients in 2011. Mean
adequacy of nutrient delivery improved from 47% to
56% of target for calories, and from 18% to 74% for
protein. With Canberra Hospital being the top performing
site within Australia and New Zealand for protein
provision from EN.
Conclusion: Participation in international benchmarking
and quality improvement initiatives have improved
adequacy of nutrition delivery within Canberra Hospital
ICU and identified further areas for improvement.
References: (1) Heyland DK, Dhaliwal R, Drover JW,
Gramlich L, Dodek P and the Canadian Critical Care
Clinical Practice Guidelines Committee (2003) “Canadian
Clinical Practice Guidelines for Nutrition Support in
Mechanically Ventilated, Critically Ill Adult Patients”. J
Parenter Enteral Nutr 27;355-373. For current version of
the Guidelines, see www.criticalcarenutrition.com
Introduction: Intensive support in early continuous
positive airway pressure (CPAP) acclimatisation may
improve subsequent usage. We reviewed CPAP usage
patterns of a consecutive patient series presenting to a
tertiary hospital sleep clinic for structured physician-led
acclimatisation program.
Methods: CPAP usage patterns were collected
prospectively into a Registry during the process of
acclimatisation at the Canberra Hospital. A retrospective
chart review was carried out to assess whether this
cohort of patients attended scheduled clinic appointments
and whether they continued with CPAP therapy.
Results: 167 patients were entered into Canberra
Hospital PAP Acclimatisation Registry over a 12-month
period. The mean age is 55.2 ± 13.8 years with median
BMI 32.4kg/m2 (IQR 27.8-39.9). Most had moderate
to severe obstructive sleep apnea (median AHI 33.1/
hr, IQR 17.3-58.9). All patients attended fortnightly
clinics delivered by sleep physician and scientist/
nurse to assess usage and troubleshoot CPAP
therapy after starting CPAP. 122/169 (72%) expressed
desire to pursue long term therapy and this group
has demonstrated higher CPAP usage. 99/169 (58%)
attended sleep clinic after acclimatisation of which 85
pursued long term CPAP use. 77 are still using CPAP
at time of clinic visit whilst 8 have discontinued CPAP.
Patients who continued to use CPAP demonstrated
increasing usage per night during the acclimatisation
visits (295 to 333 minutes/night) while those who
subsequently stopped CPAP after acclimatisation have
decreasing usage (210 to 188 minutes/night). The group
remaining on CPAP maintained mean usage of 330
minutes/night by the time of clinic visit.
Conclusion: Early CPAP usage pattern appears
to determine long term CPAP usage. Decreasing
CPAP usage during acclimatisation is associated
with subsequent CPAP discontinuation at follow-up.
Interventions to increase early CPAP usage may improve
long term CPAP usage.
93. The Burden of Geriatric Readmissions
in Canberra Hospital
Htun Htun Naing1, Alexander Fisher1, 2
Department of Geriatric Medicine, Canberra Hospital
and 2Australian National University Medical School, ACT.
1
94. Identifying and tracking autoimmune—
inducing T cell clones in Aire-/- Cblb/- mice
Manu Singh1, Charis Teh1, Anselm Enders1 and
Christopher C Goodnow2
Ramaciotti Immunization Genomics Laboratory,
Department of Immunology, The John Curtin School
Canberra, ACT. 2Department of Immunology, The John
1
Introduction: Although readmissions have been identified
as an important hospital problem, Australian data are
very limited. We aimed to assess the burden of geriatric
readmission to Canberra Hospital within 180 days.
Method: Using the electronic database, an analysis was
performed for 328 consecutive patients (aged ≥65 years)
admitted to the geriatric unit (01/01/2013 – 30/06/2013).
Result: Of 328 patients 69 (21%, 32 males and 37
females) were readmitted. Readmission rate was 28%
(98 of 348 admissions). These patients consumed 1722
patient-bed days. Comparison of the readmitted group
with the rest of the cohort showed that the mean age
(85.2 ± 7.3 vs. 85.0 ± 6.3 years) and gender distribution
(32 (46%) vs. 104 (40%) males) were similar. However
the mean length of stay in the readmitted patients was
significantly lower than in the rest (14.2 ± 15.6 vs. 20.0
± 25.1 days, p=0.01). Of 98 readmissions, 34 (35%) were
within 30 days and 78 (80%) within 120 days.
Conclusion: In 2013, geriatric readmission rate was
28% and about one third of readmissions were within
30 days. One in five geriatric patients was readmitted
within 180 days. Further investigation should focus
on identifying risk factors for readmission, including
medical and socioeconomic conditions, medication
exposure and primary care use.
Introduction: Why certain autoimmune diseases
target specific organs remains obscure. The prevailing
explanation is that T and/or B lymphocytes capable of
recognizing a specific self-antigen somehow escape
the normal network of central and peripheral tolerance
mechanisms. When two such checkpoints were crippled
by crossing Aire-deficient mice, which have a profound
defect in thymic deletion, to Cblb-/- mice, which display
a defect in T cell anergy, the offspring develop an infantlethal autoimmunity directed exclusively against the
exocrine pancreas and salivary glands.
Methods: A multiplex nested RT-PCR method was used
to profile the TCR of individual CD4+ and CD8+ T cells to
identify potential autoimmune-inducing T cell clones. To
confirm if certain clones cause autoimmunity, retrogenic
mice were generated so that they only express the
specific clonotype TCR of interest.
Results: Analysis of the Aire-/-Cblb-/- repertoire
displayed a striking expansion of two dominant
CD8+ clones in the pancreas, and to a lesser extent
in the spleen and salivary glands. TCR retrogenic
mice expressing the TCR of the dominant pancreasinfiltrating CD8+ clone were able to recapitulate the
Aire-/-Cblb-/- autoimmune pancreatitis phenotype.
Conclusion: Aire-/-Cblb-/- mice have an enrichment
of specific CD8+ and CD4+ T cell clones and a
single CD8+ clone can induce a pancreatic specific
autoimmune disease.
August 12th – 15th, 2014 | 99
95. Changing epileptic activity in the
primary olfactory cortex: what a shock!
Jennifer J Robertson and John M Bekkers
Eccles Institute of Neuroscience, Australian National
Introduction: Life-threatening epileptic seizures are
the result of an imbalance of excitatory and inhibitory
electrical activity in the brain. It is well established that
“seizures beget seizures”, however, the mechanisms
are poorly understood. The primary olfactory cortex
(POC) was recently shown to be involved in the spread
of seizures in humans. In our research, we aim to
determine how and why the POC changes following
seizures.
Methods: Parasagittal brain slices of the POC (450 µm
thick) were prepared from 18-25 day-old mice. Three
different commonly-used in vitro methods were used to
model epileptiform activity in the brain slices (0Mg2+/
High K+, 4-aminopyridine, or reduced inhibition). Twophoton Ca2+ imaging was used to record the activity
of cells in the POC before, during and after electrical
stimulation in layer 3.
Results: Before electrical stimulation, each in vitro
epilepsy model produced different patterns of
spontaneous electrical activity in the POC. During
electrical stimulation, seizure-like responses were
evoked in each model. Following electrical stimulation,
the pattern of spontaneous activity changed in
characteristic ways in the different models (p<0.001).
Conclusion: “Seizure-like” electrical stimulation
changes patterns of spontaneous seizure activity in
the primary olfactory cortex. These findings suggest a
mechanism for the generalisation of seizures through
this cortical region.
96. An evaluation of the antimicrobial
activity of kunzea oil, in comparison
with other commercial myrtaceous
essential oils
J Thomas1, G Peterson2, G Jacobson2 and C Narkowicz2
University of Canberra, Faculty of Health, Bruce,
Canberra, ACT. 2Faculty of Health, University of
Tasmania, Hobart, Tasmania.
1
Introduction: This study compared the antimicrobial
activity of kunzea oil and its volatile fractions with
medicinally and commercially important myrtaceous
essential oils (cajuput oil, niaouli oils, kanuka oil,
manuka oil and tea tree oil).
Methods: The essential oils were first analysed by GC/
MS and then screened against various bacteria (n=8)
and fungi (n=9) of medicinal importance by using a
disc diffusion assay. Minimum Inhibitory Concentrations
(MICs) for ten microorganisms (bacteria [n=5];
fungi [n=5]) were determined using an agar dilution
technique.
Results: Disc diffusion tests demonstrated comparable
antimicrobial activity for kunzea oil and tea tree
oil. However, tea tree oil displayed the best overall
antimicrobial activity in agar dilution tests. Manuka
oil showed the overall highest antibacterial activity
against Gram-positive bacteria. Of the kunzea
oil fractions (n=6), the least volatile fraction
demonstrated comparable antibacterial activity to that
of manuka oil against B. cereus and Staphylococcus spp.
Conclusion: Comparative analysis of the data
revealed comparable antimicrobial activity of kunzea
oil and its volatile fractions with tea tree oil against
various pathogens of clinical significance (T. rubrum,
S. epidermis, S. aureus) exhibited promising results.
This warrants further research into a wider preclinical
screening against antibiotic resistant bacteria including
MRSA (Methicillin-resistant S. aureus).
97. The therapeutic potential of
glutathione transferase M2-derived
peptides to treat heart failure through
cardiac ryanodine receptor Ca2+
channel inhibition
Kaveenda Samarasinghe , Dan Liu , Padmaja
Tummala1, Leonard Arnolda2, Angela F Dulhunty1 and
Philip G Board1
1
1
Department of Molecular Bioscience, The John Curtin
University, Canberra, ACT. 2Cardiology Department,
1
Introduction: Ca2+ release from the sarcoplasmic
reticulum through the cardiac ryanodine receptor (RyR2)
is essential for heart function but excess Ca2+ release
due to overactive RyR2 can cause fatal arrhythmia. The
carboxy terminal domain of glutathione transferase M2
(GSTM2C) inhibits RyR2 activity and we aim to improve
this inhibition and assess the therapeutic potential of
GSTM2C based peptides in treating arrhythmia- based
heart failure.
Methods: Random and directed mutagenesis was used
to generate numerous GSTM2C mutants and their RyR2
inhibitory capability was measured using caffeine induced
Ca2+ release and single channel bilayer assays. Flow
cytometry, confocal microscopy with field stimulation
are being used to assess the ability of these mutants to
efficiently translocate and modify the function of isolated
adult mouse cardiomyocytes. In vivo therapeutic effects
of these mutants will also be investigated using a
mouse model for heart failure.
Results: We have generated several GSTM2C mutants
that show significantly higher in vitro RyR2 inhibition
than the wild type. We have also confirmed the ability
of one mutant to significantly inhibit RyR2 and improve
Ca2+ cycling in adult mouse cardiomyocytes.
Conclusion: Specific GSTM2C mutations improve its
RyR2 inhibition and may provide the basis for a novel
therapeutic agent for cardiac disorders.
98. Further evidence of a lack of interaction
between APOE and late-life blood
pressure in predicting cognitive decline:
The PATH Through Life Study
Shea Andrews1, Debjani Das1, Kaarin Anstey2 and
Simon Easteal1
The John Curtin School of Medical Research, Australian
National University, Canberra, ACT. 2Centre for Research
on Ageing, Health, and Wellbeing, Australian National
1
Introduction: The apolipoprotien E(APOE) *e4 allele1,2
and hypertension3,4 are two of the most prevalent genetic
and environmental risk factors associated with cognitive
decline in latter life. Genetic and environmental risk factors,
however, do not act in isolation and interactions between
these risk factors may modify the rate of cognitive decline5.
The present analysis examines whether the APOE *e4
allele moderates the association between late-life high
blood pressure and cognition inlater life.
Methods: Cognitive function was assed at three time
points over a period of 8 years in 1,741 cognitively
normal community-dwelling adults aged 60-64 years at
baseline. Multilevel Modeling was used to investigate
associations between hypertension or mean arterial
pressure-APOE interaction with rate of change in short
term memory, episodic memory, working memory,
perceptual speed, vocabulary, manual dexterity and a
global cognition score.
Results: It was found that APOE genotype did
moderate the association between late-life high
blood pressure on some cognitive tests; however,
the inclusion of the interaction term either did not
significantly improve model fit or explain any additional
variation in the models.
Conclusion: These results suggest that APOE
genotype does not moderate the association between
late-life blood pressure and cognition in later life.
Reference: (1) Small BJ, Rosnick CB, Fratiglioni L,
Bäckman L (2004) Apolipoprotein E and cognitive
performance: A meta-analysis. Psychology and Aging
19:592–600. (2) Wisdom NM, Callahan JL, Hawkins KA
(2011) The effects of apolipoprotein E on non-impaired
cognitive functioning: A meta-analysis. Neurobiology
of Aging 32:63–74. (3) Novak V and Hajjar I (2010)
The relationship between blood pressure and
cognitive function. Nat Rev Cardiol 7:686–698. (4)
Gasecki D, Kwarciany M, Nyka W, Narkiewicz K (2013)
Hypertension, brain damage and cognitive decline. Curr
Hypertens Res 15:547–558. (5) Payton A (2009) The
Impact of Genetic Research on our Understanding of
Normal Cognitive Ageing: 1995 to 2009. Neuropsychol
Rev 19:451–477
August 12th – 15th, 2014 | 101
99. Characterisation of Escherichia coli B2
strains from waters of Sydney and Gold
Coast regions
Angelingifta Robinsonm and David M Gordon
Research School of Biology, Australian National
University, ACT.
Introduction: Escherichia coli has a highly clonal
population structure, which allows it to be delineated
into phylogroups (A, B1, B2, C, D, E, F). Strains of
different phylogroups differ in their ecological niche,
life history characteristics, and propensity to cause
disease. Of all the phylogroups, B2 is most clinically
significant, as strains belonging to this phylogroup
relative to the rest are often the cause of extra-intestinal
infections. While the phylogroup B2 are highly diverse,
relatively few B2 lineages represent the great majority
of B2 strains isolated from humans.
Methods: The aim of this study was to determine
what fraction of phylogroup B2 strains isolated from
water samples belonged to human associated lineages.
To this end, over 10,000 isolates of E. coli from more
than 900 water samples collected in Sydney and Gold
Coast regions were characterised for their phylogroup
membership. A total of 825 strains belonging to
phylogroup B2 were assigned to one of the human
associated B2 lineages.
Results: Overall, 40% of the isolates were found
belong to one of the human associated lineages.
However, only 12% represent three of the human
associated B2 lineages (ST 73, ST 95 and ST131)
that are greatly over represented by 70% among
human B2 isolates.
Conclusion: This study demonstrates that human
associated phylogroup B2 strains represent a small
fraction of the E. coli strains present in Australian waters.
100. Escherichia Coli in poultry meat:
Prevalence, resistance and virulence
Belinda L Vangchhia and David M Gordon
Evolution, Ecology and Genetics, Research School of
Biology, Australian National University, Canberra, ACT.
Introduction: The intensive use of antibiotics in both
public health and animal husbandry has selected for
antibiotic-resistant bacteria. This has raised concern
about the transmission of antibiotic resistant bacteria to
humans via the food supply.The aim of the study is
to determine the antibiotic resistance profiles of E.
coli isolated from poultry products sold in Canberra retail
outlets.
Methods: Poultry meat samples were collected from
three major supermarket chains and an independent
butchery located in each of the four major Canberra
town centres. All isolates were fingerprinted by
repetitive element palindromic PCR (REP- PCR). The
antibiotic susceptibility profile was determined for a
representative of each fingerprint type.
Results: Of the 281 isolates, 61% were found to be
resistant to one or more antibiotic, with each isolate
being resistant to an average of 2.2 antibiotics. The
antibiotic resistance profile of the isolates varied
with respect to town centre and retailer, but not with
respect to meat type. Alarmingly, a few fluoroquinolone
resistant isolates were observed, despite the fact that
fluoroquinolones use in animals has been banned in
Australia for more than 20 years.
Conclusion: The results of this study provide further
evidence that the food we consume is a significant
source of antibiotic resistant E. coli. The results also
suggest that some post processing contamination of
poultry products may be occurring.
101. Enzymology and molecular function
of 5-methylcytosine (m5C) as a
modification of human RNA
Andrew M Shafik1, Tennille Sibbritt1, Hardip R Patel1,
Natalie Beveridge1, Susan J Clark2, Jiayu Wen2, Brian J
Parker1 and Thomas Preiss1
Department of Genome Biology, The John Curtin School
Canberra, ACT. 2Cancer Program, The Garvan Institute of
Medical Research, Darlinghurst, NSW. 3Memorial SloanKettering Cancer Center, New York, NY, USA.
1
Introduction: NSUN2 and TRDMT1 are eukaryotic
tRNA:m5C methyltransferases (MTases). Our group
presented a first transcriptome-wide map of m5C sites
revealing that most RNA biotypes are modified and
NSUN2 can target other transcript types. NSUN2 has also
been implicated in neurodevelopmental disorders, cancer
and stem cells, suggesting a greater role for m5C than the
mere decorative. m5C sites were enriched upstream of
Argonaute footprints within mRNAs, linking methylation
to miRNA function (1). Our current work is focused on
the mapping of targets for the RNA:m5C MTases NSUN2,
TRDMT1, NSUN4 and NSUN5.
Method: We coupled bisulfite treatment of RNA
extracted from RNAi-treated HeLa cells, with RNAseq (bsRNA-seq). Computational analyses were
performed to filter high confidence m5C sites and study
their biased distribution within RNA. The relationship
between Argonaute and NSUN2 was explored by coimmunoprecipiation.
Results: We identified hundreds of novel sites
for NSUN2 and TRDMT1 across different RNA
biotypes. m5C sites were depleted within conserved
microRNA seed matches. This pattern persisted
in the NSUN2-modifed subset. NSUN2 reciprocally
immunoprecipitates with Argonaute in HeLa cells in an
RNase-sensitive manner.
Conclusion: We identified hundreds of novel NSUN2
and TRDMT1 controlled m5C sites in mRNAs, noncoding RNAs and tRNAs. The link between m5C and
miRNA function deserves further exploration.
102. Characterization of the interactions
between RNA and ‘moonlighting’
metabolic enzymes in rodent
cardiomyocytes and their change in
response to stress
Hao Yang1, 3, Yalin Liao1, 3, Eloisa Pagler1, Guowen Duan1,
Matthias Hentze2 and Thomas Preiss 1
RNA Biology Group, Department of Genome Biology,
National University, Canberra, ACT. 2European Molecular
Biology Laboratory (EMBL), Heidelberg, Germany. 3These
authors contributed equally to this work.
1
Introduction: Cardiomyocytes must constantly adjust
their gene expression and metabolic state to ensure
proper function of the beating heart. Our group has
shown that several house-keeping metabolic enzymes
can moonlight as RNA-Binding Proteins (RBPs). In the
present work, we systematically study the RNA-binding
functions of these enzymes in cardiomyocytes.
Methods: We applied the mRNA interactome capture
approach to the beating murine cardiomyocyte (HL1) to obtain a virtually complete cellular repertoire
of RBPs. Plasmids were constructed to express
candidate enzymes with a c-terminal eGFP tag.
Expression and localization of tagged enzymes were
examined by western blotting and confocal microscopy.
Immunoprecipitation combined with RNA- Seq will be
performed to detect the RNA targets of these enzymes,
under normal and stress conditions.
Results: 58 metabolic enzymes (6% of the
cardiomyocyte interactome proteins) were identified as
RBPs. KEGG pathway analyses showed enrichment of
energy metabolism pathways, e.g. glycolysis, fatty acid
synthesis, TCA cycle, and oxidative phosphorylation. 12
selected EGFP fusion enzymes showed the expected
molecular weight and proper subcellular localization.
Conclusion: Determining RNA-enzyme complex
composition will reveal wider networks of interaction
between RNA, enzymes and metabolites (REM
networks) in cardiomyocytes, as well as the potential
role of this gene regulatory mechanism in heart disease.
Reference: (1) Squires, JE, et al. (2012) Nucleic Acids
Res, 40:5023-5033
August 12th – 15th, 2014 | 103
103. Identifying the drug binding sites of the
mulit-drug efflux pump, P-glycoprotein
Rituparna Mittra1, Ian Kerr2, Fraser MacMillan 3, Megan
O’Mara4 and Richard Callaghan1
Resesarch School of Biology, Australian National
University, Canberra ACT. 2University of Nottingham
Medical School, Queen’s Medical Centre, Nottingham,
UK. 3School of Chemistry, University of East Anglia,
Norwich,UK. 4School of Chemistry and Biosciences,
University of Queensland, Brisbane, QLD.
1
glycoprotein (P-gp) utilizes ATP to actively efflux a broad
range of hydrophobic compounds from the lipid bilayer
into the extracellular environment. It is implicated in
conferring multidrug resistance in a number of types of
cancer. The location(s) of the drug binding sites on P-gp
is unknown, as are the molecular mechanism of drugprotein interaction. There is a pressing need to identify
them in order to design compounds that avoid efflux by
P-gp or those that inhibit its function. Recent structural
data has implicated a region within the transmembrane
domains in drug binding, at least for two stereoisomers
of cyclic hexopeptide inhibitors QZ59-RRR and QZ59-SSS
[1]. We have mutated 9 residues within this implicated
domain to cysteines and expressed each isoform in insect
cells. Membranes expressing 8 of the 9 mutants have
been successfully purified, with their ATPase activities
measured. The ability of a P-gp substrate (Vinblastine)
and a modulator (Nicardipine) to stimulate ATPase activity
have been identified. Subsequent studies will focus on
characterizing drug binding to the mutant isoforms.
Reference: [1] Aller, SG et al. (2009) Science, 323:5922
104. An exploratory study on the safety
and efficacy of kunzea oil containing
formulations for the management
of psoriasis
J Thomas1, G Peterson2, S Basson2, G Jacobson2, and C
Narkowicz2
University of Canberra, Faculty of Health, Bruce, ACT.
Faculty of Health, University of Tasmania, Hobart, TAS
1
2
Introduction: This study compared the clinical
efficacy of kunzea oil (20%) and Liquor Carbonis
Detergens (LCD; 5%) containing formulations in mild
to moderate psoriasis affecting at least 10% of arms,
head, legs and trunk.
Methods: A randomised, comparative, double-blind,
8-week study was undertaken. Thirty patients (mean
age±SD [53.5±13.2]; range [25-74]) randomly received
pre- coded 100 g ointment and/or 100 ml scalp lotion
cont-aining 20% kunzea oil (test group) or control
medications not containing kunzea oil (control group).
The clinical responses were evaluated by using the
Psoriasis Area and Severity Index (PASI), by the
clinical investigator.
Results: After 8 weeks of treatment, both test and
control groups demonstrated a significant (P<0.05)
improvement in PASI scores. Subjects in the test
group had a decrease in mean±SD PASI score
from 12.7±7.9 to 6.7±7.2, an improvement of 51%.
The control group showed a decrease in PASI score
from 8.1±4.6 to 3.5±4.7, an improvement of 60%.
Comparative efficacy analysis between the test and
control groups did not reveal any significant difference
(P>0.05). There was no follow-up period after the
8-week treatment.
Conclusions: The inclusion of kunzea oil made no
difference to the efficacy of topical formulations containing
LCD and salicylic acid for the treatment of psoriasis.
105. Mahara an electronic portfolio system
for recording of continuous professional
development (CPD) and competency
for nurses
Louise J L Botha
Staff Development Unit, People Strategy and Service
Branch, ACT Health, ACT.
e-mail: [email protected]
Introduction: To maintain registration all nurses
must complete 20 hours of Continuous Professional
Development (CPD) annually. The aim of this project was
to introduce an e-portfolio to newly graduated nurses to
manage documentation of their CPD including outcomes
and hours spent on each activity.
Methods: A literature search and stakeholder meeting
were conducted to identify the preferred e-portfolio.
The concept of the e-portfolio was introduced into the
Graduate Orientation Program at Calvary Healthcare.
Budgetary constraints did not allow for paid hosting of
Mahara, so graduates were encouraged to choose their
own e-portfolio. Education in the use of Mahara was
offered, highlighting free hosting options. Participants’
e-portfolios were reviewed by the graduate team as a
form of assessment.
Results: 60% of new graduates (n=21) signed up to the
Mahara e-portfolio. Exploration of their experiences
demonstrated that some participants found the
technology intimidating. Other challenges were finding
hosting options for a small number of accounts and
creating rubrics for assessment.
Conclusion:Commencing and maintaining an e-portfolio
is new for graduate nurses, and more education on its
use is required. The system has not yet been taken up at
Calvary Healthcare, but a similar project is planned for
Canberra Hospital and Health Services.
106. Results from the introduction of a
Nurse Led Clinic for Patients after
Radiation Therapy
Maureen Burnell
Radiation Oncology, Canberra Hospital PO Box 11
Woden ACT.
e-mail: [email protected]
Introduction: Patients presenting unannounced at
Radiation Oncology waited to be seen and were not
recorded as an occasion of service (OOS). The aim of this
project was to determine if a new nurse-led clinic (NLC)
decreased the number of hospital admissions
after radiation therapy and to have walk-in visits
recorded as OOS.
Methods: Data concerning pre-NLC walk-in
presentations were collected January- April 2013 and
again following the establishment of the NLC (including
a booking process) July-December 2013.
Results: Pre-NLC, 42 walk-in patients from different
tumour groups presented. Common presenting issues
were skin infection and need for a catheter; 48% of
patients were seen by nurses alone, 33% required medical
intervention, 9% needed assistance with palliative care
and 5% were admitted. Post introduction of the NLC,
62 patients created 73 occasions of service. Common
presenting issues were skin checks, peg tube removal, IV
fluids or hormone injections. Patients were seen promptly
and timely interventions to resolve post-treatment
complications reduced the need for hospital admissions.
Conclusion: The NLC allowed patients to be seen
in a timely manner and may have reduced hospital
admissions. Recording these visits as an occasion of
service more accurately demonstrated the activity within
the department.
August 12th – 15th, 2014 | 105
107. Evaluation of the one-day Questionnaire
Design Introductory Course (QDIC)
108. Translating evidence into practice: An
action plan for promoting patients’
sleep at Canberra Hospital
Marian J Currie and 2Helen Lilley
1
1
Canberra Hospital and the ANU [email protected].
au 2Health Improvement Branch, Population Health
Division, ACT Health [email protected] 3Melbourne
School of Population and Global Health, the University
of Melbourne.
1
Introduction: The need to improve the quality of
questionnaires used to collect research and evaluation
data was identified. A one day course was developed,
piloted and evaluated.
Method: Questionnaires determining participants’
confidence in questionnaire design before and after
attending the QDIC using 5-point Likert Scales were
introduced in 2013.
Results: 74/86 (86%) participants completed both the
pre and post course questionnaires in 2013-2014.
Levels of confidence before and after attending the
course are presented.
% of participants
reporting feeling
confident/very
confident
Marian J Currie, 1,2Lori Delaney, 3Veronica Croome
Disciplines of Nursing and Midwifery, University of
Canberra, PhD scholar Australian National University
. 2Research Centre for Nursing and Midwifery Practice
(RCNMP) ACT Health, Australian National University and
University of Canberra. 3ACT Chief Nurse, Nursing and
Midwifery Office, ACT Health.
1
Background: Hospital in-patients experience sleep
deprivation/fragmentation which can protract recovery
and increase mortality. The Patients’ Quality of Sleep
at Canberra Hospital study used patients’ and nurses’
reports, observation and environmental monitoring
to assess patient sleep in 15 clinical areas. 76% of
patients rated their sleep as fair/poor. Noise levels were
37%83% higher than the WHO recommendations. Noise,
clinical care and pain were the main causes of sleep
disturbance.
Methods: An action plan was drafted to address 10 study
recommendations.
Pre-course
Postcourse
Overall ability to design a
questionnaire
28.4
85.1
66.6
Planning a questionnaire
18.9
90.5
84.1
What to include in an
information page
44.6
89.2
52.4
Avoiding problems in
question wording
21.6
83.8
73.1
Framing the language to
suit the audience
14.9
86.5
84.1
Plan objectives are to:
• Assemble an Implementation Team (key
stakeholders)
• Employ a Project Officer
• Identify resources/mechanisms to implement
recommendations.
• Identify strategies to overcome any barriers
• Draft an evaluation framework
• Implement the recommendations in order of priority
and feasibility.
• Evaluate and adjust actions
Deciding when to use
open or closed questions
43.2
93.2
58.8
Results:The draft plan includes the following actions:
Designing scales
25.7
82.4
66.6
Questionnaire layout/
formatting
40.5
81.1
47.7
• Purchase and deploying noise abatement devices
(e.g. Yakker Trackers)
Planning data analysis
24.3
56.8
38.2
• Educate staff about sleep/ways to enhance patient sleep
Giving feedback on a
simple questionnaire
48.6
89.2
47.7
Area of questionnaire
design
%
increase
*All X2 p values = 0.0001
Conclusion: Participants in the QDIC reported increases in
confidence in all areas of questionnaire design. It is hoped
that this translates into better quality questionnaires.
• Institute tailored individual clinical care
• Review pain management
• Ensure existing facilities/equipment promote sleep.
• Ensure new/refurbished facilities/equipment
promote sleep.
Conclusion: Implementation of the actions, coupled
with a hospital wide approach involving all major
stakeholders, should result in improved patient sleep.
109. The effect of noise on patient sleep in
the Medical Wards at Canberra Hospital
Nadine DaFonte1,2, Lori J. Delaney2,3, M. J. Currie2, Jill
Parke1 and Violeta Lopez4,5
Private Practice Trust Fund Vacation Scholar, ACT
Health. 2Research Centre for Nursing and Midwifery
Practice (RCNMP) ACT Health, Australian National
University CMBE 3Disciplines of Nursing and Midwifery,
University of Canberra. 4Australian National University
Medical School, CMBE. 5National University of Singapore.
1
Introduction: Hospital patients frequently experience
sleep disturbance with noise being identified in
both subjective and objective studies as the major
contributing factor. The aim of this study was to
investigate the nocturnal noise levels in medical wards
and identify the major sources of nocturnal noise.
Methods: An observational study was conducted in 6
medical wards. Nocturnal noise levels were recorded
between 22:00 and 07:00 hours at 5 second epochs
using Extech (SDL600) sound loggers in the A weighted
decibels (dB(A)) scale. Clinical observations were
conducted in 4 one hour intervals to record the sources
of noise within the clinical environments.
Results: Noise levels in medical wards exceeded WHO
recommendations by 17.42 dB(A) with the mean noise
level recorded being 47.42 dB(A) (Std D. 3.84, range 31.2
-103.3 dB(A)). Peak noise levels in excess of 70 dB(A)
were found to occur 4.49 times/hour. Disruptive noise
generated by staff occurred 23.48 times/hour.
Conclusion: Noise levels in the medical wards exceeded
the recommendations made by the WHO (<40dB(A)).
This can inhibit patient sleep which is required to
expedite their recovery. The primary sources of
nocturnal noise levels were attributed to clinical staff
who may be unaware of their impact on patient sleep.
110. Behavioural modification of healthcare
professionals in an adult critical care
unit to reduce nocturnal noise: An
evidence based implementation project
1,2,3
Lori J Delaney
1
2
ACT Health, Faculty of Health: Nursing and Midwifery,
3
University of Canberra, PhD scholar: Medical School,
Australian National University.
Introduction: Hospital patients frequently experience
sleep disturbance. Noise is a major contributor to sleep
disruption, with the primary sources of noise in hospitals
being staff and alarms. The aim of this study was to
implement a behaviour modification program to reduce
nocturnal noise levels within an Intensive Care Unit.
Methods: The project used the Joanna Briggs Institute’s
Practical Application of Clinical Evidence System
(PACES) and Getting Research into Practice (GRiP)
audit tool for promoting change in health practice. A
knowledge promotion strategy targeted at clinicians
was devised and pre and post implementation audits
conducted to determine compliance with evidencebased recommendations on patient sleep promotion.
Results: How many participants?? Compliance with the
evidence-based recommendations increased from 8%
to 10% post the knowledge promotion program – how
measured???. This did not correspond to a measurable
reduction in nocturnal noise levels.
Conclusions:A knowledge promotion strategy did
not increase compliance with evidence-based sleep
promoting guidelines. Further research is needed to
identify strategies which clinical staff will readily adopt
and implement to reduce nocturnal noise levels.
August 12th – 15th, 2014 | 107
111. What hath night to do with sleep: Noise
levels in the ICU
1, 3,4 1
2
Lori J. Delaney , Jill Parke, Richard Robinson ,
2
1,5
6
Nadine Da Fonte , Violeta Lopez and Veronica Croome
1
ACT Health Research Centre for Nursing and Midwifery
Practice (RCNMP), ACT Health and Australian National
2
University, Private Practice Trust Fund Vacation scholar,
3
RCNMP. Faculty of Health: Disciplines of Nursing and
4
Midwifery, University of Canberra. PhD scholar: Medical
5
School, Australian National University. Medical School,
6
Australian National University, Canberra, ACT. Nursing
and Midwifery Office, ACT Health.
Introduction: Noise emanates from a plethora of
sources in Intensive Care Units (ICU). As a result, ICU
patients’ experience fragmented sleep, which has
deleterious effects on their physiological recovery,
neurocognitive function, and increases morbidity and
mortality. The aim of this study was to quantify the noise
levels in ICU at Canberra Hospital.
Methods: In this observational study, noise levels in
the ICU were recorded in decibels (dB(A)) using Extech
(SDL600) sound meters at 5 second epochs on 2 nights
between 2200-0700 hours.
Results: Noise levels exceeded WHO recommendations
by 37%, with a mean sound level overnight of 54.89
dB(A) (S.D. = +/- 6.08). Recorded noise levels within the
ICU ranged between from 41.2 to 96.1 dB(A), with noise
escalations > 70 dB(A) occurring 6.78 times per hour.
Peak noise levels > 90 dB(A) were recorded in a number
of locations, including the nursing station and isolation
rooms. Both the two-bedded and four-bedded bays had
peak noise levels > 85 dB(A).
Conclusion: The noise levels generated within this
ICU are at a volume that is likely to be disruptive to
patients sleep. Nursing education regarding the psychophysiological effects of prolonged noise exposure and
sleep deprivation is required to change clinical practices.
112. Supporting parents during neonatal
transfer: development of the ACT
NETS brochure
Julia Divall and Wendy Burton
Neonatal Intensive Care (NICU) and Newborn Emergency
Transport Service (NETS) ACT. Centenary Hospital for
Women and Children (CHWC), Canberra, ACT.
Introduction: The birth of an infant who is unwell can be
a very stressful time for parents, especially if there is a
need for transfer to another hospital. Timely and effective
nursing interventions can reduce parental anxiety. NETS
ACT staff identified the need to provide clear and concise
written information about their service and applied for a
Practice Development Scholarship to develop, test and
publish an information brochure for parents.
Methods:The project was undertaken in 2012-14 by
two senior NICU nurses who work for NETS ACT. Data
to inform brochure development were collected from a
review of the literature, hospitals to which NETS refers
patients as well as NETS NSW and NETS Victoria staff
and publications. Extensive consultation with parents
and neonatal retrieval staff was undertaken at different
stages of brochure development. A small sample of
NICU parents provided feedback.
Results: The NETS ACT brochure presents information
about the service, the team and equipment, the NICU
and contact information including a campus map.
It provides a standardised approach to information
provision and increases the evidence base of Nursing
and Midwifery practice.
Conclusion: The NETS ACT brochure is being published
and an evaluation of its usefulness to parents is planned.
113. The emotional wellbeing of women after
cardiac surgery
114. Implementing the National Perinatal
Depression Initiative in the ACT
Margaret A. Flaherty1, Jill Parke2, Barbara K. Conroy2
and Marian J. Currie2
Sally Haseler1, Marian J Currie2 and the NPDI
Steering Committee
Cardiology Department, Canberra Hospital, ACT.
(RCNMP) ACT Health, Australian National University,
Canberra Hospital PO Box 11 ACT.
1
1
2
Introduction:Women who have cardiac surgery are
less likely than men to attend the Cardiac Rehabilitation
Program (CRP) at Canberra Hospital and frequently
report emotional difficulties to staff. The aim of this
study was to determine the effect of cardiac surgery on
women’s emotional wellbeing.
ACT Project Officer National Perinatal Depression
Initiative. Division of Women, Youth & Children
Community Health Programs, ACT Health. 2Research
Centre for Nursing and Midwifery Practice (RCNMP) ACT
Health, Australian National University.
Background: The aim of the Australian Government’s
National Perinatal Depression Initiative (NDPI) was to
improve perinatal mental health services.
Aim: To determine the success of the NDPI in the ACT –
July 2009 to June 2014.
Methods: Women who attended the CRP at Canberra
Hospital between 2007 and 2012 were mailed a
questionnaire which included questions about their
physical and emotional health after surgery. Those who
completed the questionnaire were invited to participate
in one of 2 focus groups.
Methods: Progress against the 5 tenets of the NDPI was
investigated: Routine and universal screening; Follow up
support and care for women at risk; Workforce training
and development; Research and data collection and
Raising community awareness.
Results: 25/80 (31%) eligible women returned the
questionnaire and 52% of these attended a focus group.
Mean age of respondents was 73 (range 51-91), 76%
were retired and 44% described themselves as primary
carers. 36% of respondents reported short-term
emotional effects such as feeling weepy and losing
confidence. 6/25 (24%) reported longer-term emotional
effects including depression, anxiety, memory and
energy loss and concerns about weight gain. The mostly
commonly occurring themes in the data from the 13
focus group attendees were expectations (own and
family’s) and the lack of family/friend support received
at home.
Results: Screening: 51% increase in EPDS and PPSA
screening. Follow up and support: 32% and 20%
increases in referrals to the Perinatal Mental Health
Consultation Service and the support organisation
PANDSI respectively, implementation of the Care
Pathway. Workforce training: face-to-face training and
development of an e-learning package for clinicians.
Research and data collection: RCT of exercise and
support to management PND symptoms and a
prevalence study of trauma and posttraumatic stress
disorder symptoms and an audit of clinical files.
Community awareness: extensive health promotion
activities (seminars, fundraising, z-card, merchandise).
Conclusions: Women experience a range of emotional
issues after cardiac surgery. This has implications for
cardiac rehabilitation programming.
Conclusion: Increases in women accessing services,
health professionals’ understanding of the disorders and
how to manage them and greater community awareness
of perinatal mental health issues are testament to the
success of the NDPI implementation in the ACT.
August 12th – 15th, 2014 | 109
115. Nurses and Midwives perceptions of
their rosters at an acute public hospital
Casey Hill1, Marian J Currie2, Ann Burgess3, Jill Parke1,
Veronica Croome4
Private Practice Trust Fund Vacation Scholar, RCNMP,
University of Canberra, ACT. 2Research Centre for
Nursing and Midwifery Practice (RCNMP) ACT Health,
Australian National University. 3Nursing and Midwifery
Office, ACT Health. 4ACT Chief Nurse, Nursing and
Midwifery Office, ACT Health.
E-mail [email protected]
1
116. Evaluation of the University of
Canberra’s Academic Mentor Model
(UCAMM) for clinical supervision of
student nurses
Arju Pradhanaga1, Rowena King2, Barbara Newman3,
Ann Burgess4, Marian J Currie1
Background: Effective rostering enables the provision of
safe, quality care health care.
Research Centre for Nursing and Midwifery practice
(RCNMP) ACT Health, Australian National University –
Private Practice Trust Fund Vacation Scholar, student
Australian Catholic University, ACT. 2Student Clinical
Placement Unit, ACT Health. 3Disciplines of Nursing
and Midwifery, University of Canberra. 4Nursing and
Midwifery Office, ACT Health
Methods: In November 2013, all Level 1 and Level 2
Nurses, Midwives and Enrolled Nurses employed at the
hospital were offered the opportunity to complete an
anonymous questionnaire.
Introduction:As universities find it increasingly difficult
to secure clinical placements for student nurses,
different models of clinical supervision have been
trialled. The study aim was evaluate the UCAMM.
Results: Of the 399/1,650 (24%) respondents, 83% were
Registered Nurses; 89% female; 77% aged <50 years;
23% qualified overseas; 61% worked full-time; 52%
worked rotating shifts and 7% permanent night shifts.
Methods: Student and staff surveys were conducted.
Questions (responses 5 point Likert scales) concerned
the main aspects of clinical placement: administration,
support and clinical learning.
Three rostering patterns contravened the accepted
Rostering Guidelines: working the late/early shift at
least once a week (68%); being rostered on duty for >7
consecutive days (7%) and not always having a 9-hour
break between shifts (12%).
Results: 53 (51%) students and 120 (30%) staff
responded. Administration: 76% of students and 64%
of staff felt prepared for the placement; 36% of staff and
26% (p = 0.05) of students were unaware of who was
responsible for completing assessments. Support: 81%
of students and 97% of staff reported that students were
welcomed; 20% of students reported feeling unsupported
in the clinical area compared to 3% of staff (p = 0.08).
Clinical learning/teaching: 48% of students agreed
that the placement gave them opportunities to develop/
advance their skills; 59% felt their time management had
improved. 92% of staff and 70% of students reported the
placement met their expectations. 59% of students were
pleased to have experienced night duty.
33% reported rostering practices as fair and 38% as
unfair; 63% thought penalty shifts were distributed fairly.
In respect to leave, respondents reported requests for
particular shifts (64%), annual leave (68%), particular
days off (62%) and professional development (59%) were
met. Caution should be taken in interpreting the results
because of the low response rate.
Conclusion: While the majority of respondents were
satisfied with their rosters, some issues were identified.
Those who write rosters must take care to comply
with the Rostering Guidelines. Ongoing evaluation of
rostering practices is required under the EBA.
1
Conclusion: The UCAMM is feasible and was acceptable
to the majority of students and clinical staff. Channels of
communication and access to an academic mentor could
be improved.
117. Introduction of a General Medicine
Unit to a Tertiary Hospital and Effects
on Length of Stay in the Medical
Assessment and Planning Unit
Peta Pentony, Sam Kashkaviji, Ashwin Swaminathan
118. A Case of Cytogenetic evidence
supporting the diagnosis of Double-Hit
(DH) Lymphoma
Fiona Webb1, Monica Armstrong1, Michael Pidcock1,2,3,4,
Maya Latimer1,2,3,4
Department of General Medicine, Canberra Hospital,
Canberra, ACT.
1
Introduction: A General Medicine Unit (GMU) was
introduced at Canberra Hospital (TCH) in February 2014
for patients admitted through the Medical Assessment
and Planning Unit (MAPU) that required inpatient
workup or management of greater than 72 hours
duration and who were not suitable for transfer to a subspecialty Unit. We aimed to assess the impact of GMU
introduction on patient flow parameters related to MAPU
and the characteristics of GMU patients.
Background: B-cell Lymphomas often have
chromosomal translocations in up to 40% of cases.
Recurrent chromosomal breakpoints activating multiple
oncogenes such as MYC are seen in Double-Hit (DH)
Lymphomas.
Methods: Analysis was conducted on a patient database
updated contemporaneously for the first 100 GMU
in-patients. Comparative MAPU admission data was
obtained from the TCH Patient Admission System.
Results: The average length of stay (LOS) of MAPU
patients in 2012 was 4.95 days (median 4; range 0 – 30).
Following the introduction of GMU, the MAPU length of
stay was reduced to 4.24 days (median 3; range 0 – 28
days). The average LOS within the GMU was 12.5 days
(median 8; range 1-71). Patients transferred to the
general medicine were complex with an average of 3.7
active medical issues and 2 consults. Transfer to the
GMU was deemed appropriate in 88% of cases.
Conclusion: The introduction of a GMU has decreased
the LOS in MAPU. The majority of patients transferred
to GMU were appropriate and could not have been
transferred to a subspecialty unit for the remainder of
their stay. By decreasing LOS in MAPU, the introduction
of a GMU has decreased bed block within MAPU, thus
facilitating patient flow.
Cytogenetics, ACT Pathology, ACT. 2Haematology, ACT
Pathology, ACT. 3Canberra Hospital, ACT. 4Australian
National University, Canberra ACT.
Method: A 58yo male was diagnosed with Diffuse
Large B-cell Lymphoma (DLBCL). Staging PET/
CT showed extensive disease including bony and
skeletal involvement. Bone marrow biopsy showed
advanced, diffuse marrow involvement with DLBCL.
Cytogenetic investigations including Fluorescent InSitu Hybridization (FISH) were requested. Conventional
karyotyping and FISH for MYC/IGH (t(8;14)) and IGH/
BCL2 (t(14;18)) rearrangements were performed on the
marrow sample as per the laboratory’s methods and the
manufacturer’s protocol.
Results: FISH analysis did not detect fusion of MYC/
IGH or IGH/BCL2, however, conventional cytogenetics
showed multiple structural and numerical chromosomal
rearrangements, including the t(8;22) and t(14;18) . The
t(14;18) is observed in 30% of DLBCL and the t(8;22)
is observed in Burkitt Lymphoma (BL). These results
confirm a DH Lymphoma.
Conclusion: The rearrangements observed in
this patient together with the additional complex
karyotype abnormalities confirm a DH Lymphoma
with a poor prognosis due to the synergistic actions
of multiple oncogenes. DH Lymphomas such as this
case are classified by the WHO as B-Cell lymphoma
unclassifiable, with features intermediate between
DLBCL and BL.
August 12th – 15th, 2014 | 111
119. Reduced Adipose Inflammation through
Exercise Improves Insulin Sensitivity
and Confers Hepatoprotective Effects in
Hyperphagic Obese Mice
120. Sunitinib therapy for metastatic renal
cell carcinoma (mRCC) in elderly
patients (age 70 and older): a multiinstitutional Australian experience
Fahrettin Haczeyni1, Vanessa Barn1, Auvro Mridha1,
Matthew M. Yeh2, Emma Estevez3, Mark A. Febbraio3,
Narci Teoh1, Geoffrey C. Farrell1
Yada Kanjanapan1, Daphne Dai2, Edmond Kwan2,
Nathan Lawrentschuk3, Miles Andrews4, Ian Davis5, Arun
Azad3, Mark Rosenthal2, Shirley Wong4, Shams Arifeen6,
Mahmood Alam6, Peter Gibbs2, Ben Tran2, Desmond Yip1
Australian National University, Medical School,
Canberra, ACT. 2University of Washington, Medical
School, Seattle, WA, USA. 3Baker IDI Heart and Diabetes
Institute, Melbourne, VIC.
1
There is rising evidence linking adipose inflammation
to obesity complications, such as non-alcoholic fatty
liver disease (NAFLD). Physical inactivity worsens
this effect. In this study, we examined whether WAT
inflammation is related to the development of peripheral
insulin resistance and NAFLD, and whether this
effect is reversed by exercise. Alms1 mutant (foz/foz)
hyperphagic mice develop obesity and hyperglycemia,
particularly on an atherogenic (Ath) diet. From weaning,
female wild type (WT) or foz/foz NOD.B10 mice fed chow
or Ath were caged in pairs with/without a wheel (EW)
for 12 wks (n=8/gp). To determine insulin sensitivity,
anesthetized mice were given intra-aortic insulin
injection. Liver, WAT, gastrocnemius muscle samples
were collected before and after (3 min.) insulin injection.
EW slowed weight gain in foz/foz mice but did not
prevent obesity. Fasting blood glucose reduction was
not significant with exercise but muscle mass increased
in foz/foz mice. Exercise abolished liver steatosis in Athfed WT and chow-fed foz/foz mice. In diabetic Ath-fed
foz/foz mice, presence of EW improved liver fibrosis,
steatosis, necroinflammatory and ballooning scores,
indicating less hepatic injury. WAT crown-like structures
reflecting inflammation decreased with EW in Ath-fed
foz/foz mice. Further, post-insulin injection phospho-Akt
in muscle was strikingly higher in exercising groups.
Medical Oncology, Canberra Hospital, Canberra ACT.
Medical Oncology, The Royal Melbourne Hospital, VIC.
3
Olivia Newton-John Cancer Centre, Austin Hospital,
Melbourne, VIC . 4Western Hospital, Melbourne, VIC.
5
Eastern Health, Melbourne, VIC. 6Pfizer Australia,
Sydney, NSW.
1
2
Introduction: Elderly mRCC patients treated with
sunitinib in clinical trials derived survival benefits
comparable to younger patients with acceptable
tolerability1. We compared the usage and outcome of
sunitinib for mRCC in patients aged <70yo and ≥70yo
treated in five Australian centres.
Methods: 212 mRCC patients had demographic, clinicopathological and treatment data collected. Survival,
estimated by the Kaplan-Meier method, was compared
between <70yo and ≥70yo patients by the log-rank test.
Results: The 50 (24%) ≥70yo patients had similar
baseline characteristics including predominance of clear
cell histology (60%), ECOG <2 (52%) and favourable/
intermediate MSKCC risk (66%), as <70yo patients.
Elderly patients were more likely to receive best
supportive care only compared with younger patients
(46% vs 16%, p<0.0001). Sunitinib was the most
used treatment (n=20, 74%). More elderly patients
commenced at an attenuated dosage than younger
patients (30% vs, 8%, p=0.0261) despite no significant
differences in number of comorbidities. There was a
trend to more frequent dose reduction in ≥70yo than
<70yo (45% versus 32%, p=NS). Median PFS was similar
between <70 and ≥70yo patients on sunitinib (7.8m vs
10m, p=1.0) as was overall survival (27.6m vs 33.1m,
p=0.5). Survival was comparable to trial data (median
PFS 11m, median OS 25.6m)1.
Conclusion: Elderly patients were more likely to be
treated with a lower dose intensity of sunitinib, however,
survival outcome does not appear to be inferior to
younger patients.
References: 1. Hutson TE, Bukowski RM, Rini BI et
al: Efficacy and safety of sunitinib in elderly patients
with metastatic renal cell carcinoma. British Journal of
Cancer 2014: 110(5):1125-32.
121. Acute abdomen in a diabetic patient:
Ischaemic bowel or Metformin
Associated Lactic Acidosis?
122. Trafficking and function of the malaria
protein PIESA2 in parasite-infected
human red blood cells
Nushin R Ahmed and Sivakumar Gananadha
Meng M Zhang1, Alexander AG Maier1 and Melanie M Rug2
Department of Surgery, Canberra Hospital, Canberra, ACT.
1
Background: Metformin associated lactic acidosis is a
rare but known complication of metformin use. Many
of these patients present acutely as ischaemic bowel,
undergoing exploratory surgeries – often without any
pathology found during the surgery.
Results: A case description of a 65-year-old lady,
with a history of diabetes, managed with insulin and
metformin, presented to the emergency department
with abdominal pain and diarrhoea. She had severe
lactic acidosis and a shocked bowel was demonstrated
on abdominal CT scan. She underwent a laparotomy,
which was negative. Based on her acute renal failure
and history of metformin use, a diagnosis of metformin
associated lactic acidosis was made. After supportive
therapy and dialysis in the intensive care unit, the patient
was discharged home with improving renal function.
Discussion: Ischaemic bowel and metformin associated
lactic acidosis present similarly – as an acute abdomen.
Mortality for both is high. However the incidence of
ischemic bowel is greater, it is recommended that
patients should undergo exploratory laparotomy to
avoid missing the diagnosis of ischaemic bowel.
Research School of Biology; and 2Center for Advanced
Microscopy, Australian National University, Canberra, ACT.
Introduction: Plasmodium falciparum is the most
virulent form of malaria parasite infecting humans.
For its survival the parasite remodels its host cell
by using parasite-derived proteins to create novel
structures in the infected host cells, including the
membraneous structures Maurer’s clefts. They are
important intermediate compartments that play a
crucial role in the sorting and trafficking of various
parasite proteins, including the parasite’s major virulence
factor P. falciparum erythrocyte membrane protein 1
(PfEMP1). This project aims to investigate the function
of a parasite-derived protein P. falciparum–infected
erythrocyte surface antigen 2 (PIESA2).
Methods: We have used transgenic parasites,
different microscopy techniques and biochemical assays
for this project.
Results: We have established the localization,
trafficking and role of the protein in the remodelling
process: deletion mutations of PIESA2 display
an altered Maurer’s clefts morphology. We also
established the involvement of the transmembrane
domains for correct trafficking to the protein’s final
destination in Maurer’s clefts.
Conclusion: In conclusion, our data suggests a
role of PIESA2 as a structural membrane protein in
Maurer’s clefts.
August 12th – 15th, 2014 | 113
123. A new function for testis-specific
histone variants in cancer
Yu-Huan Wu1, Jane Dahlstrom2, David J. Tremethick1
and Tanya Soboleva1
Chromatin and Transcriptional Regulation Laboratory,
National University. 2Australian National University
Medical School, Canberra Hospital
1
Chromatin is a highly dynamic and hierarchical structure.
Its main function is to package cellular genome in a
way that will allow the regulation of gene expression
and silencing. The basic subunit of chromatin is a
nucleosome, which is comprised of 8 histone proteins
and the DNA that is wrapped around the histone core. In
order to understand how chromatin regulates genome
function, we study histone variants, which can be viewed
as natural histone mutants, and provide an excellent
platform to investigate alterations in the structure and
function of chromatin in the presence of such variants.
Two histone variants, human H2A.Bbd and its mouse
homolog, H2A.Lap1, are unique tissue-specific histone
variants, which are expressed exclusively in the testis
and in the brain. We have shown that H2A.Lap1 is a
novel component of the Transcription Start Site (TSS)
of active genes expressed during specific stages of
spermatogenesis (1).
Here, we report that human H2A.Bbd histone variant has
an unexpectedly high expression levels in a subgroup
of human blood cancers. We have raised highly specific
polyclonal anti-H2A.Bbd antibodies and showed that
H2A.BBd protein is not only highly expressed in the
cancer cells but also successfully incorporates into the
chromatin of those cells. Considering that its mouse
homolog is involved in the activation of transcription
of testis-specific genes, many of those are the known
cancer-testis antigens (CTAs), it is anticipated that the
presence of H2A.Bbd in the chromatin of cancer cells
also drives expression of CTAs and other oncogenes.
Further experiments will also show if H2A.BBd can be
used is a novel tool for cancer detection/progression.
Reference: 1. Soboleva TA, Nekrasov M, Pahwa A,
Williams R, Huttley GA, Tremethick DJ. A unique H2A
histone variant occupies the transcriptional start site
of active genes. Nature structural & molecular biology.
2012 Jan;19(1):25-30. PubMed PMID: 22139013.
124. Diffuse effects of an endothelin b
receptor (ednrb) mutation: more on
the non-enteric phenotype of
Hirschsprung disease
S Senga, Z-M Song, R Pardal and GDH Croaker
Departments of Paediatric Surgery, Canberra Hospital,
Canberra, The John Curtin School of Medical Research,
And Instituto de Biomedicine de Sevilla, Spain
Background: The spotting lethal (sl) rat carries an
ednrb mutation causing long segment aganglionosis
analogous to human Hirschsprung disease in an
autosomal recessive fashion. The mutation is expected
to cause a range of abnormalities in vagal neural crest
derived structures. Two separate hypotheses were
tested in this study.
1. That carotid body functions including glucose
homeostasis will be abnormal in the sl rat.
2. That there may be immune abnormalities underlying
the tendency for some Hirschsprung disease patients
to suffer from enterocolitis.
Aim of study:
1. To measure circulating blood sugar in newborn rats of
all three genotypes.
2. To measure the relative weight of the spleen in
newborn rat pups of all three genotypes.
Methods: Newborn rat pups were weighed, genotyped,
and then sacrificed under isoflurane anaesthesia.
Genotyping was performed on tail tip tissue, and blood
from that wound was used to measure circulating
blood sugar using a glucometer.Laparotomy was then
performed, and the spleen removed and weighed fresh.
Main results: 71 pups were studied. The average
circulating blood glucose of +/+ rat pups was 4.16667
mmol/l, while the average circulating blood glucose of
sl/sl rats was 2.9077 mmol/l. (p < 0.001). Splenic weight
was likewise affected by the presence or absence of the
mutation, with relative splenic size being mutation dosedependent: +/+ animals 0.698886396% of body weight and
sl/sl animals 0.343804086% of body weight. (p < 0.001).
Conclusion: The results support the hypothesis that the
carotid body function is affected by the ednrb mutation
in much the same proportion as the enteric nervous
system is. By implication likely all vagal neural crest
derivatives and functions will be similarly affected. The
mechanism by which splenic size is affected is less clear.
When this is worked out, it may have some bearing on
treatment of Hirschsprung’s associated enterocolitis.
125. Physician-Led Multidisciplinary
Positive Airway Pressure Therapy
Acclimation Experience from Canberra
Hospital Registry
126. Modeling and parameter identification
of gene regulatory networks in
human osteoblasts
1
Carol Huang, Margaret Cooper, Rosianna Wee and
Annette Carroll
Respiratory and Sleep Medicine, Canberra Hospital, ACT.
Introduction: Sleep apnea is common but patient
acceptance to CPAP is often suboptimal. We investigated
the outcomes of physician-led multi-disciplinary
continuous positive airway pressure (PAP) therapy
acclimation in an unselected sleep clinic population.
Methods: 329 consecutive patients were referred for
multidisciplinary PAP acclimation by a qualified sleep
physician using an initial home auto-titrating approach
over 24 month period. Data were prospectively collected
into a web-based registry during clinic contact.
Results: 79.3% of patients acclimated to PAP. The
average nightly usage at conclusion of the program was
301 minutes for those who acclimated compared with
56 minutes in those who failed to acclimate. Predictors
for acclimation success are high objective daily PAP
usage at first clinic visit and higher number of clinic
visits. Patients with daily PAP use ≥ 180 minutes at first
visit have acclimation success rate of 95% and there is
a dose-response curve between PAP usage at first clinic
visit and rate of acclimation success. The multivariate
model accurately predicted the outcome of PAP
acclimation in 89% of the cases.
Conclusion: Physician-led PAP acclimation is highly
successful using initial home autotitrating approach.
Higher early nightly PAP usage predicts acclimation
success. Early identification and intervention of those
with poor PAP usage after commencement may further
improve acclimation success.
Song Chen, 2Paul Smith, 1Qinghua Qin, and 2,3Rachel Li
Materials and Manufacturing Group, College of
Engineering and Computer Science, Australian National
University, ACT. 2Trauma and Orthopaedic Research
Unit, Department of Surgery, Canberra Hospital, ACT.
3
Department of Immunology and Genetics, John
University, ACT.
1
Objective: A mathematical model to describe the gene
regulatory network based on hysteretic function by
combining the engineering hysteresis model and bone
cells’ response in low-frequency (LF) electromagnetic
fields (EMFs).
Methods: A general dynamical model including the
modified Bouc-Wen hysteresis model as the hysteresis
component was developed. The cultured OBs were
exposed to the LF-EMFs for 3 days in serial doses
of magnetic flux at 0, 0.05, 0.15, 0.25, 0.5, 0.7mT
combined with frequency conditions of 40, 80, 160, 320,
640Hz. Proliferations of OBs were measured using Cell
Counter (Vi-CellTM XR, BECKMAN) and genes related
to osteogenetic pathways were studied using RT-qPCR
Array (PAHS-026Z,QIAGEN).
Results and discussion: The model developed
was capable of describing the gene expression in a
hysteresis loop and generating transient behavior. Our
results showed that the OBs’ response in LF-EMFs
could partially identify the parameters at frequency
response. The number of parameters were reduced
by the frequency response. We also observed that the
proliferations of OBs were influenced by the combination
of frequency and magnetic flux of LF-EMFs. The
coupling effect of EMF on OBs was highly dependent
on the frequency (Hz) of LF-EMFs and genes related
to osteogenetic pathways were up/down-regulated
after LF-EMFs intervention. These results confirmed
that the influence of LF-EMFs on OBs was suitable for
characterising the gene regulatory networks in OBs.
Conclusion: This model was supported by
biological data and has the potential to further
develop as a high throughput program to identify
biomarkers in osteogenesis.
August 12th – 15th, 2014 | 115
CHARM SPONSORS
CHARM SPONSORS
August 12th – 15th, 2014 | 117
CHARM SPONSORS
CHARM SPONSORS
August 12th – 15th, 2014 | 119
CHARM SPONSORS
SPONSORED RESEARCH AWARDS
CANBERRA HOSPITAL PRIVATE PRACTICE FUND AWARD
FOR THE BEST STUDENT POSTER
CANBERRA HOSPITAL PRIVATE PRACTICE FUND AWARD
FOR THE BEST STUDENT ORAL
RADIATION ONCOLOGY PRIVATE PRACTICE TRUST FUND AWARD
FOR THE BEST LABORATORY RESEARCH POSTER
RADIATION ONCOLOGY PRIVATE PRACTICE TRUST FUND AWARD
FOR THE BEST LABORATORY RESEARCH ORAL PRESENTATION
PROFESSOR GUAN CHONG AWARD
FOR THE BEST CLINICAL RESEARCH ORAL PRESENTATION
DISCOVERQUICK AWARD
FOR THE BEST CLINICAL RESEARCH POSTER PRESENTATION
ACT HEALTH HUMAN RESEARCH ETHICS COMMITTEE
DEPARTMENTAL AWARD
ACT HEALTH RESEARCH OFFICE
VIEWERS CHOICE AWARD
ACT HEALTH CHIEF ALLIED HEALTH OFFICE PROFESSIONAL DEVELOPMENT
GRANT FOR THE BEST ALLIED HEALTH POSTER PRESENTATION
ACT HEALTH CHIEF ALLIED HEALTH OFFICE PROFESSIONAL DEVELOPMENT
GRANT FOR THE BEST ALLIED HEALTH ORAL PRESENTATION
UNSW CANBERRA AWARD FOR BEST OVERALL POSTER
August 12th – 15th, 2014 | 121
NOTES
NOTES
August 12th – 15th, 2014 | 123
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