NHMRC’s National Institute of Clinical Studies is pleased to announce the 2012 Translating Research Into Practice (TRIP) Fellows. NHMRC gratefully acknowledges the support of their 2012 co-funding partner Western Australia Health.
2012 Translating Research Into Practice (TRIP) Fellows
Professor Andrea Marshall, NHMRC TRIP Fellow (current)
Professor of Acute and Complex, Care Nursing, Griffith University and Gold Coast University Hospital, QLD
OPTimising nutrition by Informing and Capacitating family memberS: The OPTICS study.
Critically ill patients are at an increased risk of developing malnutrition; this is known to adversely influence patient outcome. Enteral nutrition is the preferred method of nutritional therapy in this patient population yet nutritional adequacy is often difficult to achieve in the ICU and following discharge to the ward.
Dr Andrea Marshall’s implementation project proposes to evaluate two family-centred interventions of different intensity, designed to educate families about critical care nutrition and encourage them to advocate for best practices, on behalf of their family member. Information regarding the nature and types of nutrition therapy, both general nutrition and specific nutrients, will be provided to families. They will also be provided with key questions so they can advocate on the patients behalf, to ensure nutritional practice is optimised.
The intervention will systematically elicit a structured nutritional history of the patient, from the family member, which will be made available to the health care team. Families will participate in patient-level audit and feedback where they will monitor nutrition intake from the time the patient is extubated. Questions designed to focus on recommendations from nutrition guidelines will be used to guide the process. The feasibility and impact of the intervention on nutritional adequacy during hospitalisation is the primary focus of this study.
Dr Clement Loy, NHMRC TRIP Fellow (current)
Director & Neurologist, Huntington Disease Service, Westmead Hospital, NSW
REducing AntiPsychotic use in residential care: Huntington Disease as an exemplar (REAP-HD)
Antipsychotics are commonly used for management of behavioural symptoms, among people with dementia in residential care in Australia. This has continued, despite international guidelines recommending antipsychotics as second line, time-limited therapy, subject to regular review. The evidence supporting these recommendations includes: (1) Modest benefit of antipsychotics, (2) Potential harms including increased risk of death and stroke and (3) The absence of detrimental effects when people with dementia were randomized to anti-psychotic withdrawal.
While there has been a reduction in antipsychotic use for dementia in some countries, its use has increased in some areas of Australia and this suggests a significant evidence-practice gap. The complexity of guidelines, disjunction between prescribers (medical staff) and carers facing the behavioural problems, and absence of a system to prompt medication review have been identified as key barriers.
Dr Clement Loy’s project aims to overcome some of the barriers to reducing antipsychotic use in Australian residential care facilities for people with Huntington Disease (HD), a subgroup of people with dementia. It will involve the implementation of an evidence-based behavioural management flowchart with a medication review reminder, as part of staff education. This will be followed by a randomized controlled trial to assess its efficacy. The outcome measure will be the proportion of residents who have had their antipsychotics reduced, six months after the education session.
Dr Gwyneth Rees, NHMRC TRIP Fellow (current)
Senior Research Fellow, Centre for Eye Research Australia, Department of Ophthalmology, University of Melbourne, VIC
Improving outcomes for people with vision impairment by integrating psychosocial care into low vision rehabilitation services.
Vision impairment, largely resulting from age-related eye conditions, is a rapidly growing problem due to the ageing Australian population. Vision impairment is a known risk factor for depression and research has documented that depression in people with vision impairment creates an additional source of disability independent of vision loss.
Whilst evidence-based treatments for depression exist, research of Australian patients with vision impairment has shown that the majority who are also experiencing depression are not receiving any form of psychological support. Psychological services are currently not available within eye care or low vision rehabilitation services across Australia. The current model of addressing physical illness first while referring for psychosocial care has been described as ineffective, inefficient and not best-practice. Dr Gwyneth Rees is examining ways to integrate mental health care with physical health care to create the best outcome possible.
Dr Leanne Sakzewski, NHMRC TRIP Fellow (current)
Postdoctoral Research Fellow, Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, QLD
Increasing intensive activity-based client-centred Upper limb training for children with hemiplegia
Congenital hemiplegia is the most common type of cerebral palsy, accounting for 36% of children diagnosed with this lifelong condition. Children with unilateral cerebral palsy usually present with greater upper limb than lower limb impairment, which impacts on daily independence, societal participation and vocational aspirations. Contemporary rehabilitation approaches have been developed based on motor learning theory and neuroscientific research which has increased understanding of the mechanisms of use-dependent neuroplasticity. However recent surveys of paediatric therapists indicate that non-evidence based therapies are commonly used as standard clinical practice.
Dr Leanne Sakzewski’s project aims to increase the use of best evidence of intensive upper limb training by occupational therapists and physiotherapists for children with unilateral cerebral palsy. A multimodal intervention program will be delivered to occupational therapists and physiotherapists at the Royal Children’s Hospital in Brisbane and one regional rehabilitation hub in Queensland to increase the use of contemporary intensive upper limb training approaches. The intervention will include the audit feedback cycle, identification of barriers to uptake of evidence, development of a procedural manual, training resource and interactive training workshops.
Dr Shelley Wilkinson, NHMRC TRIP Fellow (current)
Senior Research Dietitian, Mater Mothers’ Hospital, QLD
Implementation of Nutrition Practice Guidelines for care of women with Gestational Diabetes Mellitus
Gestational diabetes mellitus (GDM) occurs in 5% of pregnancies and is increasing with the ‘obesity epidemic’. Poorly-controlled GDM can result in significant negative maternal outcomes such as increased caesarean sections, assisted deliveries and an increased risk of Type 2 diabetes mellitus. Associated adverse infant outcomes include macrosomia, hypoglycaemia, shoulder dystocia, and birth defects.
Guidelines recommend Medical Nutrition Therapy as the primary intervention strategy for managing blood glucose levels in women diagnosed with GDM.
Improvements in important outcomes, such as reduced insulin requirements and improved BGL control, have been documented in a study validating American Dietetic Association (ADA) Nutrition Practice Guidelines (NPGs). Australian NPGs for GDM do not exist and a national audit of maternal health dietetic services in 2008 demonstrated that there is no systematic delivery of dietetic care to women with GDM across Australia. These findings have been reiterated in a 2011 survey of Australian dietitians providing GDM care.
Dr Shelley Wilkinson’s project aims to implement and evaluate a dietetic model of care based on the ADA's NPGs schedule of visits, adapted to an Australian setting, using appropriate dietary recommendations. Outcomes of this study will assist wider, state-wide NPG adoption.
Dr Stacey Jankelowitz, NHMRC TRIP Fellow (current)
Senior Lecturer, Central Clinical School, University of Sydney, NSW and Staff Specialist , Department of Neurology, Royal Prince Alfred Hospital, NSW
Bridging the evidence practice gap in secondary prevention in stroke
In Australia, about 50,000 people suffer a stroke annually. Services for stroke care need to be complemented with prevention programmes to reduce stroke risk and the associated health care costs. Secondary prevention strategies for stroke and transient ischaemic attack (TIA) include antihypertensive treatment (even in normotensive subjects), antiplatelet agents, lipid lowering treatment and cessation of smoking.
The Australian National Stroke Audit (2009) showed that despite the evidence for the effectiveness of these measures, a large percentage of stroke/TIA patients are not discharged on the appropriate preventative treatment. It was also reported that many patients seen for other health complaints, and with a history of TIA or stroke, were not taking secondary prevention.
Dr Stacey Jankelowitz’s project aims to improve the use of secondary prevention after stroke both at the time of discharge from hospital and in follow-up in the community. This will involve the implementation of a multifaceted intervention including education, checklists and reminders. The study will be implemented in a large teaching hospital as well as a large regional hospital.
Mr Cameron Phillips, NHMRC TRIP Fellow (current)
Clinical Pharmacist and Educator, Flinders Medical Centre, SA
Improving vancomycin prescribing and monitoring in a tertiary hospital
Vancomycin is the treatment of choice for serious methicillin resistant Staphylococcus aureus (MRSA) infections. If patients do not attain therapeutic vancomycin concentrations through appropriate dosing, there is an increased risk of treatment failure, extended hospital stay, drug toxicity and the development of vancomycin resistance. Australian guidelines provide clear recommendations for dosing and monitoring of vancomycin but these are not always followed. Key factors identified include insufficient support and staff training.
Mr Cameron Phillip’s project aims to address the practice gap between current and recommended therapeutic dosing and monitoring of vancomycin, through the development and provision of guidelines tailored to local practice. The guidelines will be principally implemented using an educational programme, decision support, audit with feedback and engagement from key opinion leaders.
The guidelines will be developed by a multidisciplinary collaborative team from Pharmacy, Infectious Diseases and Clinical Pharmacology; to implement evidence-based recommendations into a local setting. Immediate and ongoing clinical outcomes will be measured and the effects of the project on antimicrobial stewardship will be evaluated.
Assistant Professor Ivan Lin, NHMRC – Western Australia (WA) TRIP Fellow (current)
Assistant Professor , Rural and Remote Allied Health, Combined Universities Centre for Rural Health, University of Western Australia, WA
Improving chronic low back pain in regional and remote Aboriginal populations by implementing condition-specific self-management approaches and health practitioner education
Chronic low back pain (CLBP) is recognised internationally and in Australia as a significant public health issue. Although the inequitable burden of ill health in Aboriginal populations is well known, until recently little was understood about the context of CLBP in Aboriginal people. Recent research has shown that CLBP is a significant issue for some Aboriginal men and women that impacts upon quality of life, that of their families and local community.
An important factor relating to CLBP disability are negative pain related beliefs, strongly influenced by interactions with health practitioners. Such belief systems are a key driver of disability, and literature that the management practice of many health practitioners is discordant with the current evidence base.
Assistant Professor Ivan Lin’s project aims to reduce CLBP disability in Aboriginal people in regional and remote areas by developing, implementing and evaluating evidence based, culturally appropriate CLBP information to enhance self-management for Aboriginal people. The project will also incorporate and deliver this information in an evidence-based education program for health practitioners on the “Context of Spinal Pain in Aboriginal people”. This will accompany an existing evidence based spinal education program delivered by the WA Department of Health Musculoskeletal Health Network (MHN).
Dr Susie Thomas, NHMRC TRIP Fellow (current)
AMU Allied Health Team Leader & Senior Physiotherapist, Flinders Medical Centre, SA
Improving falls risk assessment and management for patients following hip fracture: improving implementation of key guidelines in the acute care setting
There is an established relationship between hip fractures and falls in older people, with up to 90% of fractures occurring as the result of a fall, and up to 53% of people falling again in the subsequent six months. Falls risk factors are often multi-factorial; the best practice guidelines for the prevention of falls recommend the use of a risk assessment tool to guide implementation of individually targeted falls management strategies.
Despite the clear link between falls and hip fractures, a recent study conducted at Flinders Medical Centre identified that the key approaches to reducing falls following hip fracture were not routinely implemented. Barriers included a lack of identification of falls risk; lack of falls risk assessment and management; lack of a rehabilitation approach that encompassed falls risk factors; and lack of follow up to review and progress prescribed interventions.
Dr Susie Thomas’ project aims to improve falls and injury risk assessment and management following hip fracture using recommendations from the 2009 Australian Preventing Falls and Harm from Falls in Older People best practice guidelines. The project will focus on ensuring that a falls risk assessment is conducted early in the recovery phase; that multidisciplinary management strategies are implemented across the continuum of care; and that an individualised strength and balance exercise program is implemented.
Ms The-Phung To, NHMRC TRIP Fellow (current)
Quality Use of Medicines Pharmacist , Austin Health, VIC
Improving the management of medications when patients are fasting or nil by mouth
As many as 50% of patients having surgery take regular medications that are unrelated to their surgical procedure, and almost half of these patients have their medications stopped at the time of surgery. Patients undergoing urgent and elective surgery may be fasted for prolonged periods preoperatively and postoperatively. The interruption of patients’ regular medications during this period exposes each patient to associated complications. Patients who take regular medications have been shown to be 2.7 times more at risk of complications following surgery than those who do not take medications and the complication rate increased as time without regular medications increased.
Ms The-Phung To’s project aims to improve the management of patients’ regular medications before and after surgery, particularly when patients are fasting or nil by mouth. Strategies that will be implemented include an education campaign that distinguishes fasting from ‘nil by mouth’ with respect to medication administration. Interventions will initially be implemented in the Orthopaedic ward/unit.