What’s new in Research – across the campuses

Monash Health

Yi Ma recently won the best free paper by a junior doctor at the General Surgeons Australia (GSA) meeting for his paper on a Randomised Controlled Trial examining phone review vs traditional outpatient review following appendicectomy and lap cholecystectomy.

Julia Freckelton is continuing her PHD on the effect of body composition on outcome in pancreatic cancer.

Bill Berry is finishing his final year of his PhD examining the utility of Endoscopic Ultrasound and Fine Needle Aspiration (EUS FNA) to guide precision medicine in pancreatic cancer.

The Victorian pancreatic cancer biobank now has ethics and governance approval at Epworth, and the Austin hospital. Governance approval is in process at the Alfred and Cabrini.

Publication
Tranexamic Acid in Patients Undergoing Coronary-Artery Surgery
Published in the New England Journal of Medicine, 23 October 2016.
Authors:  Myles PS, Smith JA, Forbes A, Silbert B, Jayarajah M, Painter T, Cooper DJ, Marasco S, McNeil J, Bussieres JS, McGuinness S, Byrne K, Chan MT, Landoni G, Wallace S for the ATACAS Investigators and the ANZCA Trials Network.

Tranexamic acid reduces the risk of bleeding among patients undergoing cardiac surgery, but it is unclear whether this leads to improved outcomes.  In a trial of over 4600 coronary artery surgery patients this paper confirmed that the use of Tranexamic Acid reduced blood loss without increasing thrombotic complications.  This was a multi-centred international study run through Monash University with significant contributions from Alfred Health and Monash Health.
N Engl J Med 2016; DOI:10.1056/NEJMoal606424;@NEJM.org

Eastern Health

The Eastern Health Surgical Research Group has remained active in surgical research in 2016.  Junior doctors and medical students have been involved in various smaller projects, and two current Master of Surgery students are actively recruiting participants for their research projects.

Mr Andrew Hardley is coming towards the end of his 2nd year of post-fellowship Upper GI Surgical training at Eastern Health. He will soon complete his surgical Masters project which has been to design, construct and run his own randomised controlled trial in the latest question to be asked in endoscopic bile duct stone management. Balloon dilatation of the lower bile duct sphincter has revolutionised ERCP stone management. This allows the exit of the bile duct to be opened widely, enabling large or multiple stones to be extracted with ease. The question of which type of stones, which type of patient, to which type of lower bile duct anatomy this procedure is applicable and whether this can be combined safely with existing techniques, is the underlying substance of his surgical masters. This randomised study will complete recruitment this month and then Andrew will concentrate on finalising this project before the end of his time with us.

Ms Sheryn Cheah is completing her first twelve months as the Upper GI Surgical Research Fellow in the Eastern Health Surgical Research Group. This position provides her with about 50% clinical workload and patient contact.  She has experience with upper gastrointestinal surgery and hepatobiliary surgery, and a healthy experience of ERCP training.  More importantly, this position has scope for regular teaching of medical students and surgical trainees, and wide exposure to the active academic department of the Eastern Health, Monash University affiliated, research division.  Her current research project is part of a Masters in Surgery study on the interface between blood vessel walls and the blood flow known as the glycocalyx.  Her research which utilises state-of-the-art portable video microscopy with patented software called 'GlycoCheck', is used to study these changes in vivo in the awake non-anaesthetised patient.  The project looks at the glycocalyx for the first time in obesity, metabolic syndrome and in the event of significant weight loss from bariatric surgery.  She is actively recruiting normal subjects, subjects with obesity without metabolic syndrome, subjects with obesity and with metabolic syndrome, and patients who have had bariatric surgery and lost at least 50% of their excess weight.  Recruitment will continue into 2017 when she will remain a surgical fellow at Eastern Health, joining the bariatric surgical unit.  Early data was recently presented at a local surgical research meeting in Melbourne.

The junior members (HMOs, interns and medical students) of the Research Group have also been active, presenting three papers at the recent 2016 Victorian Annual Surgeons’ Meeting in Melbourne.  One paper was presented at the national OSSANZ conference which took place in Sydney.

These papers included:
Effectiveness of chemical thromboprophylaxis in obesity: A cross-sectional study of post-operative surgical patients.  Presenter: Matthew Wei.

Efficacy of very low calorie diet in reducing liver volume and body weight prior to laparoscopic bariatric operations: a systematic review.  Presenter: Raphael Park Chae.

Role of Percutaneous Cholecystostomy and the subsequent management of cholecystostomy tubes in high-risk patients with Acute Cholecystitis.  Presenter: Adele Lee.

The Eastern Health Surgical Research Group thanks many contributors and supporters of our group and its research activities, and hopes to increase surgical research activity at Eastern Health next year and beyond.

Cabrini Health

Accepted paper:
Suturing in small-group teaching settings: A modification to Peyton’s four-step approach. Medical Science Educator. (2016) In Press
Raymond Yap, Alayne Moreira, Simon Wilkins, Fairleigh Reeves, Michele Levinson, Paul McMurrick. 

Published abstracts
1. Au, L., Grant, M., Haydon, A., Oliva, K., Wilkins, S., McMurrick, P., Shapiro, J. (2016) Use of chemotherapy and mismatch repair deficiency testing in resected stage-II colon cancer: a retrospective cohort study. Asia-Pacific Journal of Clinical Oncology 12 (Supp. S4) 51.
2. Wilkins, S., Yap, R., Oliva, K., Staples, M., McMurrick, P.J., Carne, P. (2016) Oncological outcome in standard abdominoperineal resection-Do we need to change technique?  ANZ Journal of Surgery 86 (Supp. 1): 28.
3. Wilkins, S., Yap, R., Oliva, K., McMurrick, P.J. (2016) Colorectal cancer surgery in the new extremes of age: nonagenarians ANZ Journal of Surgery 86 (Supp. 1): 31.
4. Yap, R., Moreira, A., Wilkins, S., Reeves, F., Levinson, M., McMurrick, P.J. (2016) Suturing in small-group teaching settings: A modification to Peyton’s four-step approach.  ANZ Journal of Surgery 86 (Supp. 1): 150.

Conference Presentations:
Royal Australasian College of Surgeons Annual Scientific Meeting Brisbane 2-6 May
Oral presentations by Mr Stephen Bell (x2) and Dr Simon Wilkins
Poster presentation by Dr Simon Wilkins (x2)

Several researchers from the Cabrini Monash University Department of Surgery successfully presented new research findings and the latest in surgical technique advancements at the recent Royal Australian College of Surgeons (RACS) Annual Scientific Congress held in Brisbane 2 – 6 May 2016.

Cabrini surgeon Stephen Bell presented at this year’s international scientific congress with an overview of the equipment and techniques involved with the latest surgical procedure, trans-anal Total Mesorectal Excision. He also presented at the video session on “taTME – How I do it”. He was also invited faculty in the educational workshop on taTME, and course director of the workshop: “For Advanced Laparoscopic Solutions in Colorectal Resection Surgery”. Finally, he hosted a meeting for the surgeons and researchers involved in the ADIPOSe clinical trial, an Australian and New Zealand surgical trial investigating the benefits of weight loss prior to rectal cancer surgery in obese patients.

Dr Simon Wilkins presented on a retrospective data review of patients who underwent a particular surgical resection technique (abdominoperineal resection, or APR). To help improve outcomes in cancer treatment, the APR standard technique has been purportedly superseded by a more radical extra-levator abdominoperineal excision (called ELAPE) while patients are in a prone position.

However, Dr Wilkins concluded that the data does not in fact provide justification for change in respect to the technique of APR and that the ELAPE technique is unnecessary. The positioning of a patient in the Lloyd-Davies or the left-lateral position is adequate.

Yap, R., Moreira, A., Wilkins, S., Reeves, F., Levinson, M., McMurrick, P.J. (2016) Suturing in small-group teaching settings: A modification to Peyton’s four-step approach. Royal Australian College of Surgeons Annual Scientific Congress, Brisbane, Australia 2-6th May 2016.

Wilkins, S., Yap, R., Oliva, K., McMurrick, P.J. (2016) Colorectal cancer surgery in the new extremes of age: nonagenarians. Royal Australian College of Surgeons Annual Scientific Congress, Brisbane, Australia 2-6th May 2016.

Association of Coloproctology of Great Britain and Ireland, Edinburgh, UK 4th-6th July
Oral Presentation by Dr Simon Wilkins

“The relationship between the degree of T3 mesorectal invasion in rectal cancer and the complete pathologicval response rate after neoadjuvant long-course chemoradiotherapy”
Poster presentations by Dr Simon Wilkins

Wilkins, S., Yap, R., Oliva, K., Staples, M., McMurrick, P.J., Carne, P. (2016) Oncological outcome in standard abdominoperineal resection-Do we need to change technique? ACPGBI 2016 Annual Meeting, Edinburgh, UK 4th-6th July 2016

Wilkins, S., Yap, R., Oliva, K., McMurrick, P.J. (2016) Colorectal cancer surgery in the new extremes of age: nonagenarians. ACPGBI 2016 Annual Meeting, Edinburgh, UK 4th-6th July 2016

Abstracts in Press
Wilkins, S., Haydon, A., Porter, I., Oliva, K., Staples, M., Carne, P., McMurrick, P., Bell, S. (2016) Complete pathological response after neoadjuvant long course chemoradiotherapy for rectal cancer and its relationship to the degree of T3 mesorectal invasion.  Colorectal Disease In Press

Wilkins, S., Yap, R., Oliva, K., Staples, M., McMurrick, P.J., Carne, P. (2016) Oncological outcome in standard abdominoperineal resection-Do we need to change technique?  Colorectal Disease In Press

Wilkins, S., Yap, R., Oliva, K., McMurrick, P.J. (2016) Colorectal cancer surgery in the new extremes of age: nonagenarians. Colorectal Disease In Press

Grants
Dr Simon Wilkins a recipient of a $2000 Cabrini Travel Grant towards the costs of the UK conference attendance and presentation.

Alfred Health

RACS Scholarship Success
Congratulations to Mr James Lee who was awarded the prestigious RACS Senior Lecturer Fellowship.  This provides funding for 2 years, with funding matched by the Faculty and CCS. Congratulations also to Dr Geraldine Ooi was awarded a RACS Surgeon Scientist Scholarship.

MIME Grant Scheme
The MIME Seed Fund was established to accelerate the development of new medical technologies that address significant unmet clinical needs. 
Congratulations to A/Prof Jeremy Grummet, Prof David McGiffin and Dr Heather Cleland, for being part of the top sixteen successful project teams awarded seed funding by MIME in 2016.

Title of Project	Clinical Champion	Collaborators
Robotic transperineal prostate cancer biopsy	A/Prof Jeremy Grummet Urologist	Lead CI Dr Chao Chen (eng)
Surface modifications prevent driveline infection	Prof David McGiffin Director Cardiothoracic Surgery & Transplantation Alfred Health	Lead CI A/Prof John Forsythe (eng) Additional Team Prof Laurence Meagher (eng), Dr Yue Qu (eng), Dr. Helmut Thissen (CSIRO)
Burn wound management: Bioactive technology	Dr Heather Cleland Director, Victorian Adult Burns Service Alfred Health	Lead CI Dr Jess Frith (eng) Additional Team Prof Laurence Meagher (eng), Prof Neil Cameron (eng) Dr Rebecca Lim (med), A/Prof Mikaël Martino (med)

Central Clinical School Public Lecture:  Innovative systems for improving trauma care
Speaker:  Professor Mark Fitzgerald, Director of Trauma Services at The Alfred and Director of the National Trauma Research Institute (NTRI).

This lecture took place on 12 October 2016 and was attended by 130 people.
Injury causes 5.8 million deaths per year with 90% in low- and middle-income countries. It also causes a significant amount of disability and economic loss. Much of this burden could be decreased by improvements in the care of the injured (trauma care).
Professor Fitzgerald gave an overview of trauma system research and development, how we’re using it here, and how we’re helping other countries, both in the developed and developing world, to either build or improve their own systems of trauma care.

http://ccsmonash.blogspot.com.au/2016/03/ccs-public-lecture-innovative-systems.html

Peninsula Health

Peninsula Health clinical school (PCS) continues its strong commitment to surgical research across all disciplines.

The annual surgical symposium will be held on Friday the 9th of December at the Frankston campus.  Registrars, resident and trainees will present their research and we are fortunate to have Professor Wendy Brown as this year’s keynote speaker. Mr. Ian Young will present his experience in the ADF, drawing on his vast experience in the Middle East.

The Jonathon Serpell prize for surgical research endeavor and excellence will be awarded to the best researcher for 2016.

The Peninsula Health clinical school is fortunate to have Dr Vicky Tobin PhD, as its full time
coordinator/manager of surgical research. We run weekly research meetings and monthly
formal presentation sessions with the aim to foster surgical enquiry at every level of the
surgical career.

This year we have Dr Michael Chae in his second year of PhD research titled ‘Biomedical 3D
modelling in surgery’. Ru Dee Chung and Mitchell Pryce are completing BMedSci projects on
‘Process mapping in Surgery’ and ‘3D upper limb anatomy for surgeons’ respectively.

We have published over 15 peer review papers in 2016, a couple of book chapters and have
presented widely, which is a credit to the team at PCS.

In addition, we have recently been successful in winning the highly competitive seed funding
($50,000) through the Monash Institute of Medical Engineering (MIME) for a project “3D
bioprinted scaffold of trapezium in basal thumb arthritis management”, a project that brings
together basic stem cell science, engineering, biotechnology and surgeons.