Emily Ramage: Improving long-term cardiovascular health in women who have experience pre-eclampsia
Project information:
Globally, ischaemic heart disease (IHD) and stroke are the two leading causes of mortality, and are in the top three leading causes of disability. Pre-eclampsia is a hypertensive disorder of pregnancy associated with significant and sustained cardiovascular risk. A history of pre-eclampsia is associated with a 4-times higher incidence of heart failure, a three-times higher incidence of stroke later in life and a doubled incidence of coronary heart disease.
Lifestyle interventions are recommended to reduce cardiovascular risk. Unfortunately, women after pre-eclampsia face challenges to achieving adequate levels of physical activity and eating healthily (e.g. co-morbidities commonly associated with pre-eclampsia, such as obesity and diabetes, post-natal recovery and pelvic floor symptoms). Programs providing health professional support are needed to facilitate this lifestyle change and reduce cardiovascular risk. However, there are no standardised cardiovascular disease prevention programs for this high-risk cohort and a lack of guidance regarding which strategies and supports optimise acceptability and uptake for women after pre-eclampsia.
Our project aims to close the gap service gap through the co-design of a scalable and engaging lifestyle program and supporting resources to empower women who have experienced pre-eclampsia to make sustained lifestyle changes to reduce their long-term cardiovascular risk.
Three project objectives:
- To identify the the essential elements required for a successful diet and physical activity intervention in women after pre-eclampsia via co-design
- Co-design an evidence-based intervention to support women after pre-eclampsia to achieve adequate levels of physical activity and diet quality to optimise their cardiovascular health and reduce their risk of future cardiovascular disease.
- Develop the resources to support the program, this is likely to include web resources including videos. Educational resources that are online and print and available in different languages.
Dr Ke Doris Cao: PredicTx Colon – a digital health tool to accurately predict chemotherapy dosing preventing side effects and toxicities in colorectal cancer patients
Project information:
Colorectal cancer (CRC) is the second-leading cause of cancer-related death in Australia, with 1 in every 19 Australians being diagnosed with CRC during their lifetime. Over 50% of these patients have evidence of locally advanced disease, which will require chemotherapy treatment, improving overall survival by more than 30%. Unfortunately, many patients have chemotherapy overdosing, leading to severe and life-threatening toxicities. Currently, there is no clinical tool available that can accurately dose patient chemotherapy or detect overdosing.
In our recent published study of 203 CRC patients at Western Health who had chemotherapy treatment, almost 3 out of 5 (60%) of these patients experienced severe chemotherapy overdosing, leading to toxicities and major complications and with females more likely to experience overdosing. While there is little data on the quality of life of these patients, it is undeniable that the difficulties posed by chemotherapy-induced toxicities can have a negative impact on these patients and their families due to chronic complications.
The reason for why significant overdosing occurs is because chemotherapy dosing is based on a patient's body surface area (BSA) rather than their body make up (the amount of muscle or fat which constitutes their body composition). The current one-size-fits-all chemotherapy dosing approach contributes to the development of these toxicities. Our published research on Western Health patients confirms that patient's body composition measurements provide highly accurate predictions of who will likely experience chemotherapy toxicity compared to BSA measurements. These findings underscore the necessity of incorporating body composition measurements into routine chemotherapy dose calculations.
Our research group has developed a novel solution, PredicTx Colon, an artificial intelligence (AI) based digital health tool to identify overdosing and predict chemotherapy toxicity with the aim of mitigating the occurrence of these severe life threatening toxicities and improving quality of life in CRC patients.
Three project objectives:
Our AI digital tool accurately predicts 83% of CRC chemotherapy toxicities via a proof-of-concept study at Western Health.
We will accomplish the following project aims by June 2024:
- Enhance the accuracy of our tool through the development of a fully comprehensive 'top-to-tail' (250 CT images per patient) body composition assessment.
- Collaborate with consumers (clinicians, and patients) to co-develop a user front end digital tool interface which best suits clinical practice using the “Sandbox” and “Simulation Lab” facilities at the Digital Health Validitron https://mdhs.unimelb.edu.au/digitalhealth/our-work/validitron.
- Multicentre Ethics and governance submission for prospective pilot study (Peter MacCallum Cancer Centre and Western Health, Melbourne).
Alex Potter (they/them) and Jan Kilicaslan (she/her): Creating a Safe & Affirming Western Health for our LGBTQIA+ Communities
Project information:
Unlike many of our tertiary hospital peers such as St Vincent’s Hospital, Royal Melbourne Hospital, Barwon Health, Alfred Health, and Monash Hospital; Western Health (WH) does not have any gender or sexuality specific services, current action plan, or funding dedicated to support people who identify as LGBTQIA+[1] consumers, carers, staff or community members across the organisation.
LGBTQIA+ communities are disproportionately more likely than the general Australian population to die early or endure worse morbidity associated with breast and colorectal cancer, suicide and self-harm, diabetes, HIV/AIDS and other sexually transmitted infections, infectious diseases, AOD addiction, eating disorders and mental ill-health (see Appendix 1). This project will improve health equity and inclusion experiences for transgender, gender diverse and non-binary people, and other LGBTQIA+ consumers and staff at WH.
An initial gap analysis was completed by the WH Diversity and Inclusion team in 2023 utilising a peak body organisation National Benchmarking assessment tool; the Health and Wellbeing Equity Index (HWEI) through Pride in Health, an ACON[2] subsidiary. The 2023 HWEI tool scored WH at 24% across 10 domains addressing LGBTQIA+ Health and Wellbeing. Disturbingly, WH scored well below the national average for public health services of 49%, which was also alarmingly low. This project will systematically address identified gaps to improve clinical and cultural safety for LGBTQIA+ people engaging with WH.
At WH, the Diversity and Inclusion team in Nursing and Midwifery Directorate, along with the Diversity, Equity and Inclusion leads in the People and Culture Directorate have some strategic and committee governance roles and there are isolated clinicians with an interest in LGBTQIA+ in allied health, maternity and mental health services. However, there is no specific service for peer support of staff. or patient liaison for consumers, or LGBTIQA+ affirming practice support. The WH LGBTQIA+ steering committee has key clinical and non-clinical staff who would be ideally placed to support the development of a Gender and Sexuality Liaison (GSL) role and the project more broadly.
[1] Lesbian, Gay, Bisexual, Trans and Gender Diverse, Intersex, Queer and Questioning, Asexual, and identities beyond this abbreviation. This includes identities such as First Nations Brotherboys and Sistergirls with a trans experience.
[2] ACON is a leading Australian health organisation specialising in community health, inclusion for people of diverse sexualities and genders. ACON offers a range of services to meet the needs of LGBTQIA+ people – including services in the areas of HIV and sexual health, mental health, alcohol and drugs, safety and inclusion, domestic and family violence, disability, ageing, cancer prevention and screening, training and capacity building.
Three project objectives:
- Person-centred support for consumers and staff:
- The project will involve the trialling of an inaugural Gender and Sexuality Liaison (GSL) role, akin to the Disability Liaison roles and Aboriginal Hospital Liaison roles which have demonstrated great impact in the health service. The GSL will provide direct patient liaison for transgender, gender diverse and other LGBTQIA+ people who attend any WH service.
- Workforce support through the implementation of a WH Pride network and re-invigoration of the LGBTQIA+ Steering Committee to support staff as well as consumers, via in kind operational support roles.
2. Development of policies and procedures to support LGBTQIA+ affirming care at all WH services, with the initial focus on key gendered service such as Custodial Health at DPFC, gendered mental health services, women’s and children’s division and other youth services.
3. Implementation of an organisation wide education strategy to increase staff knowledge in relation to LGBTIQA+ affirming practice. We will also trial the creation of clinician-specialists in key clinical roles to have LGBTQIA+ affirming practice imbedded into the position and therefore the teams they are based in.
I-Lynn Lee: Pregnancy Outcomes of Simplified Screening versus standard 2-hour 75g-Oral glucose tolerance test for diagnosis of gestational diabetes Mellitus (POSSOM) - a feasibility randomised controlled trial
Project information:
This project seeks to address an urgent issue: the outdated, inefficient, and poorly accepted process of Gestational Diabetes Mellitus (GDM) screening using the 2-hour Oral Glucose Tolerance Test (OGTT). GDM is a highly prevalent medical condition in pregnancy, affecting nearly a quarter of pregnancies within the antenatal population served by Western Health— one of the highest rates in Australia. The complications of GDM are not to be underestimated; it elevates the risks of pre-eclampsia, neonatal hypoglycaemia, and birthing a large-for-gestational-age baby for both the mother and the child.
The OGTT, although the current gold standard for GDM diagnosis, presents numerous shortcomings. It is time-consuming, often necessitating half a day from the patient's schedule. The test also faces issues of patient acceptability and analytical reliability. During the COVID-19 pandemic, Western Health implemented a simplified GDM screening process based on a Fasting Blood Glucose (FBG) test, followed by an OGTT only if the FBG result fell within a specific range. An observational study of this process on 15,000 women found that this simplified approach was non-inferior to the traditional OGTT method and cut down the need for OGTTs by 80%. Given the possibility that this outcome was influenced by external factors such as behavioural changes during pandemic restrictions, a more definitive assessment is essential. This project aims to conduct a feasibility study
for a large Randomised Controlled Trial (RCT) that will rigorously compare pregnancy outcomes under the simplified screening approach against the traditional 75g OGTT.
In summary, this project holds significant promise to modernise and streamline the GDM screening process, potentially transforming antenatal care for thousands of women each year and saving the health care system millions of dollars. This is not just a feasibility study; it is a stepping stone towards a more efficient and equitable approach to maternal health care.
Three project objectives:
1. Assess the feasibility of participant recruitment, participant retention rate and data collection procedures.
2. Assess trial design, trial conduct and processes. This will be assessed by understanding the acceptability and perceptions of participants, clinicians and midwives to patient recruitment, randomisation and delivery of the screening method.
3. Measure the GDM incidence, maternal insulin/metformin use, number of obstetric ultrasounds, maternal complications and neonatal outcomes.
