237 general newsletter no 15 august 2012

7/30/2019 237 General Newsletter No 15 August 2012

1/8

Weareverypleasedto

announce that our

director,Assoc.Profes

sor Julie Bernhardt

was recently awarded

theveryprestigiousChurchillFellowship.The

Churchill Trust was established in 1965 to

honourthememoryofSirWinstonChurchill

by awarding overseas research fellowships

knownas'ChurchillFellowships'.

Since its inception The Churchill Trust has

awardedChurchillFellowships tomore than

3,700Australianswho, likeChurchill,are in

novative,filledwithaspiritofdetermination

andpossess a strongdesire tobenefit their

community.

Churchill Fellowships allow recipients tode

sign their own research project, travel the

Biannua l News le t t e r Edi t ion 15 August 2012

AVERT NEWSLETTERA VERY EARLY REHABILITATION TRIAL

Patients currently

enrolled

1359

Ins ide th is i ssue:

Churchill Fellowship Page 1

Trial Progress/Message from our Director Page 2

A Very Exciting Riding Trip Page 3

AVERT in UKSite profiles Page 4-5

Our Swedish Connections/Alan's Story Page 6-7

Meet our Trial Manager/Connecting/Contact us Page 8

Churchi l l Fe l low ship Aw ard - Ju l ie Ber nhardt

world and further their knowledge in their

chosen field,before returning tomakea real

contributiontoAustraliansociety.

Juliewilltakeaonemonthsabbatical inearly

2013 to further research ways of enriching

healthcare

environments

to

improve

brain

recovery.Shewillbesuretokeepyouallupto

datewithherfindings.CongratulationsJulie!

Julie receiving her award from The Hon.Alex Chernov, Governor of Victoria


2/8

TheAVERT trial started recruitingpa

tientsbackin2006,andaimstodeter

mineif

early

exercise

after

stroke

will:

reducedisabilityandcomplications

afterstroke

improvethe rateofrecovery and

thenumberofpeopleabletowalkun

assistedafterstroke

reducecognitiveproblemsandre

sultinbetterqualityoflifeforstroke

patients

becosteffectivecomparedtocur

rentstandardtreatmentofstroke.

Whilstweareoverhalfwaywiththe

trial,thereisstillconsiderableworkto

dotogettoourfinalnumberof2104.

Since our last newsletter we have

reachedanothermajormilestonethe

recruitmentofpatientnumber1300to

the AVERT trial. The Austin hospital

team,whohavebeen involved in the

trialfromtheverybeginning,recruited

thecelebratedpatient.

Theongoing

commitment

from

our

involvedhospitalshasbeen critical to

the success of the trial so far. The

number of hospitals who have re

cruited patients to the AVERT trial is

now51.

There are inevitable staff changes at

hospitals for many reasons including

maternityand

family

leave,

travel

and

other job opportunities. This helps to

explain why over 1000 clinicians have

been involved in AVERT so far! You

might also be interested to learn that

we now have over 60 babies born to

staff who have worked on the AVERT

trialandthisnumbercontinuestogrow!

AlargetrialsuchasAVERTrequiresalot

ofdaytodaymaintenanceinareassuch

as

data

management,

training

and

on

going supportof all involved staff, and

endless listsof administrative tasks.To

allow this support to continue we re

mainveryactive intryingtosecuresuf

ficient funding toallowus to complete

thetrialinthenext2years.

Overthelast6monthsithasbeenexcit

ing to celebrate 16 new UK hospitals

joiningtheAVERTcollaboration.Allhos

pitalsintheregionarenowfullytrained

andmost

are

now

recruiting

patients.

We hope that the contribution from

our northern partners will help us to

reach our target number of patients

withinourprojectedtimeframes.

inspired by the AVERT community, an

amazinggroup

of

committed

individuals

who shareour vision.Now thatwe are

welloverthehalfwaymarkinthetrial,it

isgettingveryexciting.Wedohowever

need to finish the study as planned to

ensure that the results of the trial are

credibleandrespected.

SoforthoseinvolvedinthetrialIaskyou

toholdontothevisionofhowmuchbet

tercaremightbe ifwesucceed.And to

thosewhohaveparticipatedor support

thetrialinotherwaysIsayTHANKYOU!

Researchers need to have courage

andvision:

the

courage

to

follow

their

convictions and to not give upwhen

theyfail(afairlyfrequentevent,espe

ciallywhen itcomes tograntwriting)

andaclearvisionofabetterfuture if

theirworkchangesthingsforthebet

ter.

AVERTisthefirstglobaltrialofareha

bilitation intervention forpeoplewith

stroke. We thought big, and are de

lightedthatthestrokecommunityand

people affected by stroke have feltexcitedbytheproject.Iamconstantly

Tr ia l Progr ess

Page 2 AVERT NEWSLETTER

Ourrecruitmentthermometer

iswarmingup!

A message f rom our Di rect orJul ie Bernhardt


3/8

On 31st May this year, the AVERT

teamrode

around

the

Capital

City

TrailinMelbournetohelpraisesome

additional funds for the AVERT trial.

16ridersralliedfriendsandfamilyto

sponsor them to take part, donned

lycra and helmets, and enjoyed a

pleasant days ridetaking in the

many wonderful sites of Melbourne

alongtheway.

Thecourse took the ridersmeander

ingalong

the

Yarra

River,

past

acon

vent, farms and falls, before leading

intotheheartofthecitysparksand

gardens. A lunch stop at Southgate

was followedby a tourof theDock

lands area, through the industrial

West along the Maribyrnong Creek

andpastthezooandthendownand

alongtheMerriCreekandsurrounds.

Our efforts were rewarded as we

ended up raising a very impressive

$8,745.00for

the

trial.

We

were

thrilled tohavean additional$4,000

subsequently donated to the trial

fromaphilanthropic

source

because

ofourfabulouscyclingeffort.

Themoneythatwasraisedwillbeput

towards improving our data collec

tionprocessesfortheAVERTtrial.We

aimtomakeoursecurewebsite eas

ier for our research team and our

hospitalstafftouse,whichinthelong

runwillsaveustimeandmoney.Our

hospitals in Australia, New Zealand,

UK,Singapore

and

Malaysia

use

this

essential tool every day. We are

changingourupdatesbasedonfeed

backfromouruserstomakethesys

temmore easytouse.

Wewillalsousesomeofthismoney

tofurthersupportoursiteswithaddi

tional training and equipment. We

hope that this in turn will help the

hospitals to increase recruitment of

stroke patients to the trial and help

usreach

our

target.

Fundrais ingA Very Exc i t ing Riding Tr ip

Our effortswere rewardedas we ended upraising a very

impressive$8,745

Page 3AVERT NEWSLETTER

Pictured are:JanChamberlain,AlanEllery,FionaEllery,CarolynPhiddian,Annastrand,JennyKulin,CharlieSaxin,JulieBernhardt,TobyCumming,TonyCross,Aaron,JaniceCollier,Kit,andKarenBorschmann.(notpicturedCarmenLahiffJenkinsandQuinn)


4/8

At

Aberdeen

Royal

Infirmary

we

have

enjoyed

beingpartoftheAVERTteamoverthepastyear

andahalf.Thestudyhashelpedus interactwith

eachothermore and appreciate everyones dif

ferentroleintheteam.Ithasalsoreinforcedhow

every interaction with a patient can be made

meaningful in terms of contributing to their re

covery.

Ourunithas16bedsandthereare

over600acutestrokeadmissionsa

year,whichmeansthattherecanbe

quiterapidthroughput. Alltheclinical

staffare

aware

of

the

AVERT

study

and

contributetoidentifyingpotentialpa

tients. Havingthestudystaffonduty

atthesametimeasasuitablepatient

comesincanbequitechallenging! Last

yearwestruggledtorecruit,duetoa

combinationofstaffshortagesandbed

pressures. AsourMainInvestigator

DrMaryMcLeodsays,itnowlookslike

theplanetshaveallaligned andwe

arebackinthegamewithregularre

cruitmentin2012.

Theyear

saw

some

staff

changes.

A

big

thank

you

to Maggie Bruce (AVERT Nurse) Susan Cathcart

(AVERT Occupational Therapist) and Rebecca

Duncan (AVERTPT) forbeingpartofAVERTand

helping us get going. They have nowmoved to

differentdepartments. Wehavealsohad afew

additions

to

the

team

Mari

Drummond

and

Suz

anneRattrayasAVERTNurses,HeatherGowasRe

searchNurse,andDeirdreONeillasAVERTOccupa

tionalTherapistand theyhavemadehugecontribu

tionstotheteam.

WenowhavetwoAVERTbabies(anAVERTbabyisa

babyborntoanAVERTinvestigator).

Our babies are Ellen Jennifer Robertson,

daughterofJennyRobertsonourAVERTPT,

whoisnowbackfrommaternity leaveand

Ailsa Ann Davies, daughter of Joy Davies

ourOccupationalTherapist.

OurAVERTnurseshavebeenveryproactive

andhavehadagroupsessiontocomeup

withfreshideasofdifferentactivitiesthat

couldbeusedfortheAVERTpatients. Ini

tiallythepaperworktookabitofgetting

usedto,butwecanconfidentlysaythat

nowwearemuchmorerelaxedwiththe

trialandhaveworkedouthowtointegrate

itintodailylifeintheunit.

The sconesbakedbyDrMary JoanMacleod atour

catchupmeetingprobablywentalongwaytowards

helpingrecruitment!

DrRebeccaClarkeourblindedassessorhasbeena

star,tryingtoseeallthepatientswithinthetarget

timeinwhatisalargegeographicalarea.

UK Hospi t a l Prof i leAberde en Royal Inf i rm ar yby Anu Joyson

Our AVERTnurses have beenvery proact ive coming up w i thf resh ideas on

d i f fe ren tac t i v i t i es

Page 4 BIA NNUA L N EWSLETTER EDITION 1 5

Fromleft

to

right:

Nicola

Murphy,

Jenny

Robertson,

Dr

Rebecca

Clarke,

Jacqui

Bell,

Anu

Joyson,

Kathleen

Bennett,DeirdreONeill,HeatherGow,DrJacquelineFurnaceandDrMaryJoanMacleod.


5/8

Yeovil

District

Hospital

is

an

acute

hospital

lo

cated inoneof the larger towns inSomerset a

ruralareaofEnglandknownforitsciderorchards,

helicopter manufacture and a naval airbase

nearby.

Althoughwe are a relatively small hospital, the

stroketeamstrivestostayattheforefrontofbest

practiceincludingactiveinvolvementinanumber

of stroke research trials sowealready

hadafantasticteamofstrokeresearch

nurses inplacewithgoodcommunica

tion links into the Emergency Depart

mentand

Stroke

Unit.

We

have

also

developed, and are researching, an

innovative poststroke exercise, infor

mationandsupportprogrammeknown

asASPIRE.Whenwe firstheardabout

theAVERTtrialwethoughtitwouldbe

an exciting opportunity to become in

volvedinamulticentrestrokerehabili

tationtrial.

After our sitetraining day with Rose

mary Morrison last autumn we were

finally ready to start recruitingonNovember30

2011.We

decided

to

take

the

approach

that,

as

AVERTlookedchallengingtorecruitto,wewould

considernewarrivalswithstroke forAVERT first

andthenotherstroketrialsiftheywereineligible

for AVERT. Amazinglywe recruited our first pa

tient late intheafternoononthatveryfirstday.

TherewasthenabitofalulltilltheNewYearbut

since thenwe havemanaged to recruit steadily

twopatientsamonthapartfromMarchwhenwe

found four despite only about 300 new stroke

admissionseachyear.

We

found

we

had

to

increase

the

number

of

AVERTNurses(knownassecretsquirrels)onthe

StrokeUnit tomakesure therewasat leastone

availableonmostshifts.Wealsohad to identify

and train a second physio to allow the AVERT

Physio to attendoffsitemeetings and have an

nual leave.We have learnt all sorts ofways to

ensure thatparticipantsget the rightamountof

inputwithoutcompromising the studyorhaving

other patients feeling that AVERT patients get

moreattention!

As

the

Principal

Investigator

for

our

site

I

have

found

itcanbechallengingtomakesurethattheresearch

paperwork is filled in and this has occasionally re

quiredsomedetectivework! Ontheotherhandwe

havehad lotsofenthusiasticstaffdutifullycomplet

ingpaperworkinthemiddleofthenightandonSun

days.Whathasmade life somuch easier forme is

the strokeresearchteamsbrilliantBlindedAssessor

EmmaJones,whotracksdownandfollowsupallour

participants. In addition, the Research

Nurses Donna Hayward, Sarah Board and

Hayley Smithwhodomostof the recruit

ing,enterdataanddealwiththedataque

ries that arise, are an integral part of the

team. The number of queries we get are

reducing after16patientswearegetting

much better as a team at getting it right

firsttime!

AstheAVERTPhysiothemostexcitingpart

ofthetrialformeisthecreativityrequired

to ensure participants have interesting,

varied and relevant therapy at every ses

sion. It has also been a real privilege to

meet so many patients and their family members

whoare

willing

to

sign

up

for

AVERT

and

to

share

in

thoseearlydifficulthoursanddaysaftertheirstroke

Itiscommonthoughthatmanyrememberlittleor

nothingaboutthatbusytime!

WehavehadsomesadnessastwoofourAVERTpar

ticipantshavepassedaway.

WithoutexceptionallofourAVERTparticipantshave

beenlovelyandinterestingpeople.

UK Hospi t a l Prof i leYeovi l Dist r ic t H ospi t a lby Debbie Neal

I t has a lso beena rea l p r iv i lege tomee t so many

pat ien ts and the i rfami ly members

w ho a re w i l l ing t os ign up fo rAVERT ...

Page 5BIAN NUAL NEWSLETTER EDITI ON 15

Lefttoright:DebbieNeal(AVERTPhysioandPI),JacquelineHarrup(AVERTparticipant),DonnaHayward(StrokeResearchNurse),HayleySmith(StrokeResearchNurse),PaulWood(AVERTparticipant)andseatedinfrontGeorginaPark(AVERTparticipant).


6/8

Quote

Weare

two

lucky

Swedish

physiotherapy

stu

dents from the University of Gothenburg who

got the opportunity to spend 10weeks at the

FloreyNeuroscienceInstituteattheAustinhospi

tal inMelbourne.With thehelpand supportof

theAVERTteamwewroteourfinalthesisforour

degreeinphysiotherapy.

When aperson suffers from a stroke theymay

needalongerperiodofrehabilitationaftertheir

initialhospitalisation.Theacutephaseofhospi

talisation is oftenwhere patients undergo suit

ablemedical

assessments

and

early

treatment,

butforlongertermongoingtherapy these

patients often go to inpatient rehabilita

tion. During their rehabilitation stay the

aimisforpatients torelearnskillslostdue

tothestroke.Thisoccursthroughdifferent

typesofactivitiesandtherapywithphysio

therapists,occupationaltherapists,speech

therapistsandotherrehabilitationspecial

ists.

Ourinitialthoughtwasthatpatientswould

bemuchmore activewhen theyhad en

tered the rehabilitation hospital, com

paredtowhentheywereintheacutehos

pital. Inourthesiswewereinterestedinlooking

at strokepatients levelofphysical activity and

socialinteractioninthesetwodifferentstagesof

their care: at the acute ward and during their

rehabilitationperiod.Ouraimwastodetermine

if therewasadifference inpatientactivitypat

ternsbetween

the

two

settings.

Were

the

re

habilitation patients really more active?

We compareddata collected from104 stroke

patients in rehabilitationwards at fourdiffer

enthospitals in theWestGothia region,Swe

den,with86patientsatanacutestrokeward

inStockholm,Sweden.Therewasnodifference

inage,sexorabilitytowalkbetweenthefour

hospitalgroups.Thedatawascollectedbyob

serving each patient during a typical day be

tween8amand5pm. In10minutes intervals,

the

physical

activity,

location

and

social

inter

actionofthepatientwasascertained.

Interestingly, the resultsdidnotmatch

ourinitialthoughtthatpatientsinreha

bilitation would spend more time in

physicalactivitiesthanthoseinanacute

setting. Patients in the acute setting

spentmore time in theirbeddoingno

activityatall,butwhenlookingatmore

demanding activities such as sitting

without support, standing andwalking,

therewas

no

difference

between

the

acuteandtherehabilitationsetting.Pa

tientswere also observed to be alone

morethan50percentofthedayatboth

settings. A major difference between the

groupswas that patients in the rehabilitation

setting spent less time in their bedroom and

moretimeintheunitsloungearea.

Manyfactorsmightcontributetohowactivea

patient is: the hospital environment, the pa

tientscognitivestatusandotherissuessuchas

physicalandmentalfatigue.Itisthereforedifficulttodrawanyconclusionsastowhypatients

in rehabilitation were not much more active

thanthoseinacutecare.

Theresultsofourworksuggestthatthe levels

ofphysical activity in rehabilitationmightnot

beashighaswebelievethemtobe.

Our Sw edish Connect ionsChar l ie Sax in and Anna st rand

Page 6 AVERT NEWSLETTER

CharlieSaxinandAnnastrand ourSwedishphysiotherapystudents.

Pat ien tsw ere a lso

observed tobe a lone

more than50% of theday a t bo thset t ings.


7/8

Alanis

in

his

early

seventies

and

he

is

semi

retired.AlanagreedtojointheAVERTrehabilitation research trial when he firstcametohospitalbecausehefelthecouldhelpand that itwouldbenefitotherpeoplewithstrokeinthefuture.ThisisAlansstrokestory.

Ihadbeensleepingonmybackandas I

awokeinthemorninginJanuary2011my

firstthoughtwasthatsomethingwaslying

acrossmystomach.Pullingback thecov

ersIfound

it

was

my

left

arm,

it

was

de

voidof feelingandmy lefthandwasnot

functioningatall.

BeingonmyownatthetimeIphonedmy

partner to let her know of this butwas

unabletocontacther,soIdecidedtoget

dressed,whichwasdifficultwithonlyone

functioningarm,andtohavesomebreak

fast.

It did not occur tome that I had had a

stroke.Ithought

the

lack

of

sensation

wouldprobablywearoff,abit likewhen

yourhandorfootgoestosleep.

Afterbreakfast itwas still the same so I

rangmyGPssurgeryandspoketothere

ceptionist.

She told me to Call an ambulance

straightawaywhich Ididandwastaken

to theAlfredwhere I receivedexpertat

tentionfromthestrokeclinicteamofdoc

tors,physiotherapists

and

occupational

therapists.

Iwas givenmany diagnostic testswhich

showedmy right carotid arterywas80%

blocked.AnMRIscanofthebrainshowed

thatIhad indeedsufferedastroke,but it

also showed that therewasagrowthon

mypituitarygland.

Ihadsurgerywithinafewweekstoclean

out the artery. I am very fortunate that

the

stroke

was

not

more

severe

and

made

worsebymydelay inseekingmedicalat

tention. Ihada fewproblemsgettingmy

bloodpressure

stable,

as

it

could

be

too

high or too low. This has settled and I

have a blood pressure unit at home. I

checkmybloodpressureathomeoncea

week,anddoadailyBPchartforaweek

orsoformyGPbeforeIseehim.

Iwasfortunatehavingthediagnosticscan

for the stroke so that the growth was

found. It needed to be treated so I had

surgeryto

remove

the

growth

afew

monthsafterthestroke.

There were quite a lot of hospital and

doctorsvisitsforseveralmonthsafterthe

stroke. By Christmas 2011, Iwas feeling

completelywell again,back todoing the

shopping, cooking, vacuuming, trimming

the hedges and managing my invest

ments. Iamalsomakingapointofexer

cising by walking for 30 minutes every

day.

Par t ic ipant Prof i leAlans s tor y

I t d id no t

occu r t o me

that I had had

a s t r oke

Page 7AVERT NEWSLETTER


8/8

A Very Ear ly Rehabi l i tat ion Tr ia l

Would you l i ke t o Cont r ibu te?

Thisnewsletter showcases someof thewayspeo

plehavebecome involved in theAVERTResearch

Program.Wethankyouallforyourcontributions.If

youwould liketoassist inanywaywewould love

tohear

from

you.

PleaseemailJanChamberlain:[email protected]

orcallJaninMelbourneon(+613)90357000.

Would you l i ke to s t ay in touch?

IfyouareaparticipantintheAVERTtrial,youmay

want togiveyour contactdetails toyourassessor

at12months so thatyou can continue to receive

furtherupdatesaboutthetrial.

Would you l i ke t o Donate?

Ifyouareinterestedindonatingtothe

AVERTprogram, alldonations are tax

deductibleandcanbemadebycalling

the Florey Neuroscience Institutes

(Phone:+61390357000).

Connect ing

Fionahasanursingbackgroundandearlyinher

careerbecameinvolvedwithcoordinating clini

caltrials

with

afocus

on

neuroscience

at

anum

berofhospitals.Shelatermovedtoindustryand

was involved in the management of trials for

various pharmaceutical companies. She joined

theAVERTCentralteamastheAVERTTrialMan

ager in 2006.Her rolewith the team includes

thedevelopmentof trialprocessesand theon

going training and management of trial staff

bothinAustraliaandinternationally.

Fionahas2girlsandspendsmuchofherleisure

time at netball, swimming and dance venues

withthem!Occasionallyshegetstopotterinhergarden.

Fiona and her family re

cently raised and trained

aGuideDogpuppyfor18

months . Al though

Geanie did not make

the grade it was a very

rewardingexperienceand

Geanie has now become

amuch

valued

family

pet!

Meet Fiona El lery

We have been updating our section of the FNIwebsite and you can find out much more

about the trial at: http://bit.ly/AVERT1

Our Websi t e

The Florey Institute of Neuroscience andMental Health

Melbourne Brain Centre - Austin Campus

245 Burgundy Street

Heidelberg VIC 3084

Contac t Us

237 general newsletter no 15 august 2012

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