2017 Medical Research Grants Announced

25 Nov 2016

media-1Today, the Chairman of the Clifford Craig Medical Research Trust, Associate Professor Don McTaggart, today announced the successful recipients of medical research grants for 2017.

Eleven (11) new projects will be funded by Clifford Craig in 2017 with the grants totalling $496,000. Associate Professor McTaggart said the combination of the newly announced grants with the existing research program will see the Clifford Craig allocate in excess of $600,000 for medical research in Northern Tasmania next year.

“This announcement today sees the Clifford Craig Medical Research Trust building upon our reputation for facilitating an important clinical medical research program at the Launceston General Hospital which supports local research that is undertaken by medical professionals at the hospital, medical and nursing students, and university researchers”, he said.

Associate Professor McTaggart acknowledged and thanked Clifford Craig’s supporters and donors for their contribution towards funding the latest round of research grants.

The newly announced research grants are;

Effectiveness of platelet rich plasma injections on symptomatic early osteoarthritis of the knee – Dr Jonathan Mulford – $43,450.

Arthritis affects 1 in 5 people. There is speculation that using a part of patients own blood (called platelet rich plasma) and injecting it into early worn out knees (arthritis) may improve patients’ symptoms.  Platelet Rich Plasma (PRP) may provide a positive treatment modality and it is a minimally invasive and simple treatment to provide to patients.

PRP is a blood plasma enriched in platelets. It has several different growth factors and cytokines that are thought to help heal cartilage and soft tissues. Potential mechanisms of action include cellular proliferation, anti-apoptotic activity, cartilage regeneration, angiogenesis, amplifying the activity at the trans-membrane receptors and increase vascular permeability. The mechanism is complex, but for knee arthritis it is thought the growth factors and cytokines within platelets encourage formation of type II collagen, proteoglycans, and other extracellular matrix components, promoting adhesion between chondrocytes and discouraging proteolysis of the extracellular matrix microenvironment.

The only previous study looking at this form of treatment suggested that early multiple injections may give better results in patients with early knee osteoarthritis, but the study had limitations and didn’t return a definitive conclusion.

The aim of the project is to determine the effectiveness of PRP injections for early knee arthritis and if multiple injections give a better clinical response at up to 12 months following treatment.

Improving physical activity, pain and function in patients waiting for hip and knee arthroplasty by combining targeted exercise training with behaviour change counselling. – Dr Marie Louise Bird – $51,965.

Osteoarthritis is a common musculoskeletal problem that affects over 40% of adults over the age of 70 years and is associated with substantial pain and disability. Patients with advanced Osteoarthritis of the hip or knee are often referred to surgery to replace the affected joints. Tasmania has the longest waiting times for elective surgery nationally. At present the average waiting period for hip or knee replacement surgery in Tasmania is more than one year.

While waiting for surgery, many patients experience significant pain leading to a decrease in physical activity which has the potential to increase the development of additional health problems such as diabetes or heart disease. Although regular exercise can help both their joint pain and prevent additional health problems, many patients do not achieve the minimum amount for health benefits.

This study uses principles of behaviour change to promote engagement and individualised exercises for increased uptake of physical activity and may improve health and surgical outcomes. Our intervention is a unique approach to this problem.

Assessment of the impact of an Expanded Scope Physiotherapist (ESP) triaging patients referred to the Launceston General Hospital Orthopaedic Clinic with chronic hip and knee pain. – Dave Jovic – $25,400.

Currently, referrals from primary care for “chronic” lower limb pain/dysfunction to the Orthopaedic Department of the LGH are growing at an unsustainable rate, with hip and knee osteoarthritis at 40 patients per month. Waiting times for initial clinical assessment are beyond 6 months. Patients waiting for knee and hip replacement at the Launceston General Hospital in 2013-14 were 5 – 6 times more likely to wait greater than 1 year for their procedure when compared to other similarly sized Australian public hospital.

 Physiotherapists are increasingly involved in assessment and management of patients referred from the community to Orthopaedic Departments with long-term knee/hip pain.

This projects aims to assess the quality of clinical assessment undertaken by an experienced Physiotherapist compared to an Orthopaedic Surgeon.

If safe and acceptable, this project can reduce the time people wait for seeing an Orthopaedic Surgeon, as well as improve the quality of care delivered to patients with long-term musculoskeletal pain in Northern Tasmania.

 Assessing the influence of chewing gum on the gastric volume in patients for surgery – Dr Gregg Best – $21,015.

The need for a period of fasting (not eating or drinking) before having a general anesthetic is well known and accepted by the community. This measure is necessary to prevent patients from regurgitating and inhaling stomach contents, a phenomenon known as pulmonary aspiration.  Many people find fasting an unpleasant experience with hunger, thirst and dry mouth common complaints.  Some individuals find chewing gum while fasting helps with these symptoms, however, currently there is no significant medical evidence to either support or refute the safety of chewing gum in this period.

Our group proposes to conduct a study in patients who are booked by their gastroenterologist for a gastroscopy (an inspection of the inside of their stomach with a telescope). We intend to randomly divide people into two groups, the first group will fast before their procedure as per the current normal instructions.  The second group will also fast, but will be asked to chew gum during their period of fasting before the endoscopy.  Both groups of patients will undergo their gastroscopy under a general anesthetic.  After insertion of the telescope the stomach will be inspected and then drained of any fluid by sucking it out through the suction channel of the telescope under direct vision by the gastroenterologist.   It is normal for all people to a have a small volume (usually 20-30ml) of fluid in their stomach despite not eating or drinking due to swallowing saliva and the stomach producing its own secretions.   The volume of the fluid sucked is then measured and recorded for each patient.  The data collected during the course of the study will be collated and analysed statistically looking for any differences between the two study groups.  Once completed, the results of the study will be published in the medical literature.

The investigators postulate that chewing gum will make no significant difference in the amount of fluid in the stomach of a patient fasting before an operation. In fact, the action of chewing gum may actually be beneficial in stimulating the stomach to empty its normal residual volume of fluid. The information gained from this study will be valuable to all anaesthetists in streamlining pre-operative fasting guidelines for their patients to ensure safety as well as potentially improving comfort while they are fasting.

 Does Non – Invasive Ventilation (NIV) or High Flow Oxygen Therapy prevent respiratory complications in high risk patients following elective upper abdominal surgery – Ianthe Boden – $80,000

 Upper abdominal surgery is one of the most commonly performed surgeries in Australia. The risk of developing a chest infection following this type of surgery is high.

A breathing machine called BiPAP has been shown to help reduce chest infections after surgery, although unfortunately it is rarely used. There is potential that a more easy to use and more comfortable breathing device called High-Flow Nasal Prongs (HFNP) may reduce chest infections just as well. However, there is no scientific research to confirm this.

This proposed study aims to compare these two therapies to see whether BiPAP is any more effective than HFNP therapy alone. Results of this trial will help guide the targeted delivery of treatments to prevent respiratory complications and save lives following abdominal surgery.

Aiming for PERFeCT trial – Performance evaluation of Robot guided vs. Fluoroscopic guided Cortical Trajectory screws in the lumbar spine – Dr David Edis – $9,600

Spinal fusion surgery involves the placement of screws to gain fixation to the bone and allow rods to be connected and this construct provides stabilization for the spine to allow patients to mobilise immediately after surgery and allow optimal conditions for bone fusion to occur over the following months.

Up until now the procedure to place screws has involved the surgeon having a comprehensive understanding of spinal anatomy supplemented by the use of intraoperative X-ray or fluoroscopic imaging, and using hand guided tools to position screws. It is recognised that even experienced surgeons are unable to place screws perfectly on every occasion.

This project aims to test the use of a Robot to guide surgeons in placement of screws during spinal surgery and compare its accuracy with the conventional X-ray guided technique. The Mazor Spine Robot has been used in over 14,000 cases, and in over 100 centres across the world and has been proven to be highly accurate in a number of human spine surgery scientific studies. This project is looking at a specific application of the Robot technology to place cortical trajectory screws that are placed during lumbar spine fusion surgery.

It is important that screws are placed accurately into the bone to gain optimal strength and avoid other important structures, such as nerves and blood vessels.

The effect of pharmacological agents on smokers and Chronic obstructive pulmonary disease – Dr Sukhwinder Sohal – $80,000

Chronic obstructive pulmonary disease (COPD) is a common, destructive and pre-malignant “smokers” airway disease. It affects up to 10% of the Australian population over age 40 and over twice as many amongst the more elderly group. It is mainly due to cigarette smoke, though environmental atmospheric pollution may play a part. There are no current treatments that affect the development or course of COPD, with current drugs focused on some symptomatic relief and to some extent reducing exacerbation rates.  Furthermore those with COPD are at especially high risk of developing lung cancer in their airways, even when allowing for their underlying smoking. Therefore, we need a better detailed understanding of COPD pathogenesis, in order to better design translational treatment.

In previous research, they have made the striking novel finding of airway epithelial cell plasticity (EMT) in the basal “stem cell” layer of smokers’ airways, most marked in those with COPD. This is present in both large and small airways. This fits with the current understanding about core COPD airway pathology: airway fibrosis and destruction (and also with lung cancer). These observations are really opening up thinking about what exactly is going on: namely, activation of stem cells in the airways and their likely transition into fibrosis – (and perhaps cancer)-inducing cells.

This project will study molecular mechanisms of EMT in COPD and smoking, the current and potential COPD drugs on EMT in vitro, and continue to build the respiratory tissue bank in Northern Tasmania.

Primary health care to emergency, right service, right time, right place – Maria Unwin – $24,210

This project builds upon a previously Clifford Craig funded research study undertaken at the Launceston General Hospital (LGH) in 2015 to determine why people with non-urgent medical conditions had chosen to present to the emergency department (ED) for treatment.

The aim of this study is to identify the service requirements of non-urgent patients presenting to ED at the LGH, with particular focus on patients referred by primary healthcare providers.

This will be achieved by gathering ten years of ED data which will be analysed in order to identify factors which contribute to a patient’s decision-making process when presenting with non-urgent complaints. Further data will be gathered from patient focus groups, with both sets of data combined to provide a deeper understanding of this phenomenon. These findings will subsequently be presented as part of an interactive forum with key stakeholders and service users.

Previous research has indicated that up to 8000 ED presentations could be directed to more suitable services if they were available at time of need.

Can blockade of inflammasomes be a therapeutic option in inflammatory bowel disease (IBD)? A pilot study – Dr Raj Eri – $38,156

Inflammatory Bowel Diseases (IBD) affect over 60,000 mainly younger Australians and costs close to $3 billion per year to our economy. IBD patients suffer from chronic diarrhoea, intestinal bleeding and abdominal pain affecting the quality of life. The incidence of IBD is on an upward trend in Australia. The cause of IBD is unclear.

Recent studies in mouse models of IBD clearly showed a role for a disease causing protein complex known as the Inflammasome. This complex activates two important chemicals namely interleukins 1 and 18 whose role in IBD is unknown in human gut disease.   Using previous Clifford Craig funding, The investigators have identified how activation of inflammasomes occur in IBD.

The overall aim of this project is to precisely understand the results of blocking these inflammasomes in IBD patients. The specific aim is to measure the levels of inflammasome components in biopsies from IBD patients after treating with chemical inhibitors. When the clinician performs colonoscopy for IBD diagnosis, some extra biopsies will be collected specifically for this study as well.  These samples will be treated with inflammasome inhibitors. The collected biopsies will be processed in the UTAS research laboratory in Launceston and the samples will be tested for the effectiveness of the inhibitors.

The knowledge gained from this project will aid in understanding if inhibition of inflammasomes could be a successful strategy in IBD treatment.

Sedation Practices in Intensive Care – The SPICE Study – Dr Matt Brain – $38,000

Every year, more than 50,000 patients receive mechanical ventilation and sedation as part of the critical care treatment in intensive care units across Australia. Sedation is given to promote tolerance of endotracheal intubation and associated life-sustaining interventions, including mechanical ventilation, and to relieve anxiety and reduce stress. Thus, sedation is vital to patient comfort, safety and survival.

The purpose of this study is to investigate if Early Goal Directed Sedation (EGDS) compared with standard care sedation, reduces 90-day mortality in critically ill patients who are expected to require mechanical ventilation for longer than 24 hours.

This research will be conducted at approximately 35 intensive care units across Australia, including the Launceston General Hospital, and will recruit 4000 patients. The study will maximise external validity by including patients admitted to ICU’s in a range of hospitals, including tertiary, metropolitan, rural and regional hospitals.

The SPICE Study (Sedation Practices in Intensive Care Evaluation) is comparing two different ways of managing sedation. Sedatives are calming drugs that are used to provide comfort to patients in the Intensive Care Unit (ICU) who are on ventilators (breathing machines).  Sedation management covers the type of drugs used and also the way they are managed.  During the study the patient is continually checked for levels of comfort and sedation and also assessed once a day for signs of delirium.  This is part of the usual care for patients in the ICU who are on a ventilator and/or receiving sedation.

Currently, there is no agreement amongst doctors around the world about the choice of drug or the ideal depth of sedation for ICU patients. Many of the commonly used sedative medications have side effects and are thought to be associated with longer time on the ventilator, stay in the ICU and increase the risk of delirium (a confused state often including hallucinations) and decreased mental awareness after recovery from critical illness.  Research suggests that ‘light’ sedation (where a patient is kept comfortable but responsive) will shorten the time on the ventilator, shorten the ICU stay and result in less delirium.

The Augmented vs. Reduced Goal for Energy delivery in ICU (TARGET) Randomised Controlled Trial – Dr Matt Brain – $57,000

Nutrition in the Intensive Care Unit (ICU) is provided as liquid food through a feeding tube in the nose or mouth which passes into the stomach; called enteral nutrition. The liquid food is a specialised nutritional formula with all of the components that people need to survive.  The types of enteral nutrition formulae vary with different amounts of calories, vitamins, minerals, proteins, carbohydrates and fats.

Patients in the ICU typically receive about 1000 calories per day. Some research suggests this amount is acceptable while other research suggests this may not be enough.  The TARGET Nutritional Study is investigating whether extra energy or calories improves survival and quality of life after critical illness.  Enteral nutrition or tube feeding is administered via a pump at a set rate dependent on the patient’s weight, via the feeding tube into the stomach for as long as the patient requires enteral nutrition.

The Intensive Care Unit at the LGH will be one of 13 hospitals undertaking the multicentre trial which plans to enroll 4000 patients with the overall aim being to determine if enteral delivery of energy dense nutrition, in mechanically ventilated patients, improves 90 day survival when compared to standard enteral care (which usually results in under-nutrition).

For further information, please contact:

Peter Milne                                                                Rebecca Biggelaar

Chief Executive Officer                                               Events Coordinator

Clifford Craig Medical Research Trust                       Clifford Craig Medical Research Trust

Phone: 6777 6010                                                       Phone: 6777 8039 – 0409 162 028