Aged Care, Rehabilitation and Palliative Care

Solowij N, Mills J, Greenwood L-M, Potter J, Croft R, Schira M, Pai N, Miyakis S, Cannabidiol: Treatment of brain repair and depression in early-stage dementia.
Locations: Wollongong Hospital.
External Partners: University of Wollongong.

The prevention and delay of onset of dementia is an important public health initiative. Establishing new, effective and accessible treatments to reduce the impact of the condition and improve quality of life is paramount to improving the prognosis of people living with dementia. Cannabidiol (CBD) is a non-intoxicating compound in the cannabis plant, with accumulating evidence suggesting that CBD is a novel, well tolerated medicine with beneficial neuroprotective, antidepressant and anti-inflammatory effects. CBD may therefore be a promising candidate to help treat early-stage dementia. This study aims to investigate whether treatment with CBD may lead to improvements in brain structure and function, psychological wellbeing and quality of life in people living with early-stage dementia.

McNeill J, Brodaty H, Ahern S, Storey E, Earnest A, Woods R, Nelson M, Liew D, Krysinska K, Ward S, Ayton D, Christley J, Australian Dementia Network (ADNeT) Registry.
Locations: Milton-Ulladulla Hospital.
External Partners: Monash University, Caufield Hospital, The University of New South Wales, University of Tasmania.

The Australian Dementia Network (ADNeT) Registry is a clinical quality registry for people diagnosed with either dementia or Mild Cognitive Impairment (MCI).  The aims of the Registry are to collect and analyse data to monitor and enhance the quality of care and patient outcomes for people diagnosed with either dementia or MCI in Australia, and to facilitate the recruitment of participants into research projects. The Registry is a multi-site, population based, observational cohort study and involves collection of identifiable patient demographic and baseline clinical data and patient and carer reported outcomes, where appropriate. Data linkage will be conducted periodically. The registry is operated as part of the wider NHMRC-funded ADNeT initiative and will be established via a pilot stage whereby methodologies for implementation will be developed and tested at several study sites.  Learnings from the pilot stage will inform the national roll-out of the ADNeT Registry. 

Khou M, Exploration of consumer and patient experience of Telehealth in community palliative care patients.
Locations: David Berry Hospital, Port Kembla Hospital.

Due to the geographical distances between patients, a significant time is spent travelling to deliver specialist palliative care services. Telehealth, as an adjunct to clinical care, will improve efficiency in the timely delivery of palliative care services to patients, improve the number of patients that can be reviewed in a day, enable urgent reviews of deteriorating patients thereby avoiding unnecessary admissions to the acute hospital and reduce cost to the healthcare system. Whilst this seemed intuitive, Telehealth in palliative care has not been adopted more widely due to clinician, technology and patient barriers. There is also a scarcity of research in literature to analyse palliative health outcomes after management via Telehealth. This study aims to identify these barriers and demonstrate how Telehealth may potentially be used to improve palliative health outcomes.

Thomas B, Chan C, Barclay G, Lo A, Nangati Z, DREAMS: Dexmedetomidine for the Reduction of End-of-life Agitation and for optiMised Sedation.
Locations: Wollongong Hospital, Port Kembla Hospital, Shoalhaven District Memorial Hospital.

Delirium is a common symptom at the end of life, requiring sedation to control symptoms of distress, agitation and discomfort. Sedation has classically involved benzodiazepines like valium or neuroleptic medications like risperidone, which appear to alleviate symptoms but leave patients unrousable. Dexmedetomidine provides sedation that is rouseable, meaning patients can still interact with family and medical staff, and has an anti-delirium effect. It has been utilised in a pilot clinical trial to describe effect in the palliative care population as well as analyse dose efficacy and safety profile, with promising signal and minimal harms. The DREAMS study aims to treat patients with either dexmedetomidine or standard care and monitor their sedation status as well as satisfaction scoring during their treatment. It is hypothesised that dexmed will be a non-inferior to benzodiazepines as a sedative, and more efficacious at maintaining interaction.

Aggarwal A, Murray G, Wallman C, Silvester D, Amato M, Spendley P, A Double-Blind, Randomized, Placebo-Controlled, Parallel-Group Phase I/II, First-in-Human Study to Assess the Safety and Efficacy of Two Doses of SX600 Administered by Lumbosacral Transforaminal Epidural Injection in Patients with Radicular Pain Secondary to Lumbar Intervertebral Disc Herniation.
Locations: Port Kembla Hospital.
External Partners: Royal Prince Alfred Hospital, The University of Sydney.

This is a Phase I/II, double-blind, parallel-group, randomized, placebo-controlled multi-center trial in 180 patients randomized 1:1:1 to receive the IMP or Placebo via transforaminal epidural injection to the lumbosacral epidural space at the L4- L5, L5-S1 level, or the S1 nerve root, as an outpatient procedure. Each subject will be followed for 180 days for assessment of any treatment-emergent adverse effects, status of radicular pain, functional assessments, and the use of health care services. Safety and tolerability will be assessed through physical examination, vital signs, laboratory tests, and assessments of adverse events (AEs). Systemic pharmacokinetics of dexamethasone (active moiety) will be evaluated in a subset of 60 patients (across IMP and placebo groups).

Golsorkhtabaramiri M, Predictability of Neutrophil to lymphocyte ratio in Preoperative fractured neck of femur patients for post-operative short term complication: A retrospective study.
Locations: Wollongong Hospital.

There are about 18,600 fracture hip fractures a year in people over 65 years old in Australia. Higher comorbidities in elderly patients increases chance of post-operative complications and mortality. Screening at risk patients is vital for health care team and will help in discharge planning and predicting outcome. There are many scoring systems available in for predicting 30 day and 1 year mortality including Nottingham hip fracture score (NHFS). Neutrophil to lymphocyte ratio (NLR) is a biomarker of systemic inflammatory response and has been use in cancer prognostication. There are multiple systematic reviews and meta-analysis which shows prognostication of NLR in prediction of complications post-surgery. However, there are anecdotal studies in regards to performance of NLR in emergency hip fractures. There is a need to evaluate the performance of NLR in this group of patients. In this study, we aim to measure association of NLR with short term post-operative complications.

Murray G, Potter J, Silvester D, Screening for Osteoporosis in frail elderly patients recently admitted to hospital.
Locations: Port Kembla Hospital.

Frail elderly patients discharged from hospital have high rates of falls, fractures, unplanned readmissions, residential placements and mortality. This case series pilot will study frail inpatients aged 75-89 with Rockwood Frailty scores 4-6 and assess efficacy in managing frailty syndrome features including falls/ fracture risks. The intervention will extend our existing Osteoporosis Refracture Program (ORP).  This proposed program will adopt the protocol for assessment of ORP patients but be more comprehensive. Bone density studies will include vertebral fracture assessments because undiagnosed vertebral fractures amongst frail elderly people are common. Participants who have T scores of -2.5 or less, undiagnosed vertebral fracture or previous fragility fracture will be offered PBS subsidized treatment of osteoporosis with denosumab.

Simpson G, Home S, Wyborn J, Evaluation of the Vocational Intervention Program (VIP) 2.0.
Locations: Illawarra Shoalhaven Local Health District.
External Partners: Agency for Clinical Innovation, Griffith University, Liverpool Hospital.

Tan S, Hewitt L, Cuenca J, Risi D, Illawarra Covid-19 Outcome Study (ICOS).
Locations: Wollongong Hospital, Port Kembla Hospital.

This is a longitudinal study on a cohort of individuals diagnosed with COVID-19 to investigate their clinical status, fuctional outcome and mental state and to identify ongoing health issues and service needs over a 1, 3 and 6 months period.  The study is to test the hypothesis that COVID-19 positive individuals have ongoing health issues and needs after being deemed to have “recovered” under current guidelines.