Medical research grants to look at falls, smoking and improving outcomes

Six new projects will be funded by Clifford Craig Foundation in 2021.
This is in addition to a previously announced research funding into COVID 19 - The ASCOT trial. This support enables the Launceston General Hospital to take part in a large multicentre trial, which will recruit patients in more than 70 hospitals across Australia.
Clifford Craig has also granted additionalfunding for the continuation of a previously announced project - Effect of photo biomodulation on Cardiac and Inflammatory Biomarkers after Percutaneous Coronary Intervention led by Cardiologist Dr Rohit Barthwal and GP Dr Michael Fox.
The newly announced research grants are:

1. Early detection of early small airway abnormalities in apparently normal smokers
 – Associate Professor Andrew Williams.

Chronic Obstructive Pulmonary Disease (COPD) is currently the fourth leading cause of death in the world and projected to  be the third leading cause of  death by 2020 making it a major public health concern. COPD is characterised by persistent respiratory symptoms and irreversible airflow limitations due to airway and/or alveolar abnormalities usually associated with exposure to noxious particles and gases.
The most important risk factor for COPD in the developed world is cigarette smoking with studies demonstrating the deterioration of pulmonary function associated with COPD is directly related to the duration and number of pack-years of smoking. Dysfunction of the airways, lung and fine blood vessels is common in smokers yet early abnormalities are not detected with spirometry. It is believed that small airways (<2mm) are the initial sites of damage in COPD however current diagnostic tools such as spirometry are not sensitive enough to measure early changes in the small airways before the disease process becomes irreversible.
This project is the first in a proposed series of studies, each producing results necessary for the next stage, that will investigate new methods of measuring lung damage at an earlier stage of the disease process while it is still potentially reversible. The identification of reliable and valid methods of measuring early lung damage has important implications for diagnosis, development, and implementation of early treatment strategies and could potentially change the disease trajectory.

2. Cognition in multiple sclerosis: Associations with gut-brain biomarkers and exploration of cognitive symptoms change in response to nutritional intervention.
 – Dr Cynthia Honan

Cognitive dysfunction is common in people with multiple sclerosis (pwMS) and can impact significantly on everyday functioning and quality of life. Recent studies have also found changes in the gut bacteria (gut microbiome) of pwMS. Importantly, gut bacteria are linked with inflammatory process, the brain's kynurenine pathway and resultant brain cell death. It is therefore probable that an imbalance in gut bacteria underlies the changes in cognition that occur in pwMS.
This research will investigate the effects of a probiotic intervention on cognitive symptoms in pwMS. It will also examine the extent to which inflammatory markers along the kynurenine pathway and an imbalance in gut bacteria is associated with cognitive dysfunction and cognitive changes over time. Benefits of the research outcomes will include reduced economic and health burden, improved clinical care, and improved patient health and quality of life. The research outcomes will also direct future research examining the gut-brain connection.

3. Does regular phone call follow up for adults who have completed a supervised Strength and Balance exercise program, enhance motivation, increase home exercise adherence, improve functional ability and prevent hospital admissions due to falls?
 – Olivia Mitchell  

Falls prevention is a national priority. Falls are a leading cause of morbidity and mortality in older adults. Approximately 30 per cent of adults over 65 years of age experience at least one fall per year. The risk of falling increases with age. This is set to increase as Australia's population ages, the proportion of people aged over 65 is predicted to increase from 15 per cent (3.8 million people) in 2017, to up to 23 per cent (10.2 million people) in 2066.
The Tasmanian Health Indicators (2013) reported a significant number of hospitalisations occur in people aged 65 years and over had increased by a total of 13 946 hospitalisations in males (59 per cent) and 9 770 hospitalisations (42 per cent) in females between 2002 and 2011. Falls in the elderly could be potentially preventable hospitalisations.
The aim of this project is to increase exercise adherence and reducing falls and hospitalisation following a strength and balance program by employing a telephone follow­ up strategy for 12 months following group completion. The project will measure whether monthly telephone support for clients following completion of the Community Physiotherapy delivered Strength and Balance exercise program, result in improved Home Exercise Program (HEP) adherence, improved functional ability, reduction in community falls and reduced hospital admissions. It will also explore what motivates or discourages participation in ongoing exercise to be able to provide the right treatment approach to the right cohort of people and enhance the treatment effect.

4. Impact of nurse-led monitoring of Category 2 and 3 transurethral resection of the prostate (TURP) or holmium laser enucleation of the prostate *HoLEP) surgical patients during surgery waiting periods on prioritisation of care and satisfaction levels post-surgery.
- Annett Barrett

Benign prostatic hyperplasia (BPH) is extremely common among middle-aged men, affecting approximately 50 per cent of men aged 50 years old, and up to 90 per cent of men aged 90 years or older. BPH can lead to lower urinary tract (LUT) dysfunction and have an impact both on general health conditions and on quality of life. Research indicates 95 per cent of men would prefer not to live with symptoms for the rest of their life and, 79 per cent of men reported that BPH negatively influenced their life.

Consequently, it is not surprising that urological conditions pose a significant burden of disease, ranking 15th by disease group and accounting for 35,520 disability-adjusted life years in Australia, or 1.5 per cent of the total disease burden. The high incidence of BPH which increases with age, the impact on quality of life and the burden of disease indicate the importance and impact of appropriate, effective management and care.

The project aims to determine if nurse-led monitoring  for patients awaiting elective Category 2 and  3 transurethral  resection of the prostate (TURP) or holmium  laser enucleation of the prostate (HoLEP) in North and North-West Tasmania impacts on clinical outcomes pre-and post-surgery and client wellness and quality of life. It will also determine the most beneficial aspects of pre-operative nurse-led monitoring of men waiting for surgery. The project will also investigate if there are specific client factors  which correlate to an increased likelihood of a need for escalation of care or early surgical intervention during the pre-operative period and which could inform prioritisation  of  pre-operative  nurse monitoring and support  or development  of  additional  monitoring  or surgical prioritisation categories.

5. Are newly introduced electronic smoking devices safe for smoking cessation and implications for SARS-CoV-2 infection (COVID-19).
- Dr Sukhwinder Sohal  

Every year tobacco kills more than 15,500 Australians with a consistently upward trajectory (Cancer Council Australia). While cigarette smoking remains one of the most pressing global health issues of our time, newer forms of smoking devices have been introduced across the globe in the last decade.
Electronic cigarettes (ECs), which heat a solution Ce-liquid) to create vapour are commonly used, and the latest addition to this list is the introduction of heat-not-burn (HnBs) tobacco products branded as IQOS (I Quit Ordinary Smoking) by Philip Morris  International  (1, 2). HnBs are hybrids between ECs and traditional cigarettes i.e. they are equipped with a device that heats the product, without burning to generate aerosol and the product being heated is not a liquid but real tobacco. They are collectively known as electronic nicotine delivery systems (ENDS). ECs use is increasing at an alarming rate; it is believed it will surpass the use of traditional cigarettes in next 5 years, with global sales reaching US$10 billion. Electronic smoking devices are often considered a safer alternative to cigarettes; however, the risks are significant, including increased risk of COVID-19 vulnerability.
This project will evaluate the effects of electronic nicotine delivery systems on inducing airway inflammation, evaluate the effects of electronic nicotine delivery systems on airway changes and investigate the susceptibility to COVID - 19. In addition, the project will generate increased awareness of these risks within the community, to deter established smokers from using these devices for smoking cessation and prevent young people from using them in the first instance. This research will have direct implications for patient health and will inform clinical practice.

6. Improving outcomes for babies born in North-West Tasmania: a quality improvement study
- Associate Professor Heinrich Weber  

It has been well recognised that events in early life, foetal programming, influences the development of chronic disease in adult life. Furthermore, lung development during pregnancy affects respiratory disease and health in later life. Pregnancy therefore presents an opportunity to influence not only the immediate health outcomes of babies, but also chronic disease in adulthood. In a recent local audit of all pregnancies in North-West Tasmania, it was determined that the major antenatal factors associated with poorer outcomes in newborn babies were smoking, obesity (body mass index (BMI) before pregnancy) and gestational diabetes mellitus (GDM) during pregnancy. Obesity and smoking in pregnancy both lead to potentially preventable morbidity and mortality in both mothers and babies.
North-West Tasmania has the highest rate of smoking during pregnancy in Tasmania which is also high compared to the rest of Australia. While smoking rates are declining overall, the decline was slowest in North-West Tasmania and there has been no significant decline since 2013. Further, approximately 25 per cent of pregnant women do not report that they are smoking.
This study will be the first Australian research project evaluating the impact of a Carbon Monoxide (CO) monitoring and obesity interventions during pregnancy on the outcomes of babies in an opt out program. If proven successful, this protocol will have immediate positive health implications for participants and their unborn children. This is of relevance to North-West Tasmania where we have higher proportion of chronic diseases such as obesity, diabetes mellitus, asthma and COPD. It will further explore pathophysiologic mechanisms, which includes collaborating with other researchers to extend the study which could potentially lead to identifying specific interventions for future use.
As these are relatively low-cost interventions it could have wider appeal and be realistically implemented into State-wide antenatal settings, and similar regions worldwide. If found to be successful, this could further impact chronic diseases in adulthood. Also, the detailed processes for continuous quality improvement would be available for use in the paediatrics department and elsewhere to inform future improvement activities.
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