News & views: February 2023

Taking the heat off the ED

An ambulatory emergency care unit has opened at St John of God Midland Public Hospital to provide urgent assessment and treatment for patients initially presenting to its emergency department. 

Hospital CEO Paul Dyer said the unit had been designed to reduce waiting times, improve patient flow, avoid unnecessary overnight admissions and enhance the patient experience.

“With less patients requiring an overnight stay, it will reduce waiting times in the emergency department and enable more beds to be available in the hospital,” he said.

“Suitable patients will be identified in our ED and prioritised for transfer to the ambulatory emergency care unit for same-day assessment and management.”

The unit allows patients to have diagnostic tests and treatments and, if needed, they can return to the unit the following day for an outpatient appointment for further investigations or to ensure they have not deteriorated.

Robotic surgery gap scrapped

HBF has struck a deal with Ramsay Health Care that will remove some costs associated with robotic-assisted procedures.

Robotic technology is increasingly being used in cancer surgery such as radical prostatectomy and the treatment of kidney and bladder cancer but can mean significant out-of-pocket costs for patients.

The new arrangement for eligible HBF members sees the removal of the co-payment previously paid by those undergoing robotic-assisted surgery.

Psychiatrists back therapy ban

The peak body of psychiatrists has welcomed the decision by the WA State Government to ban LGBTQIA+ conversion therapy.

The decision came after a parliamentary inquiry into Esther House – a private residential rehabilitation facility – revealed that conversion therapy was practised there and residents were subjected to exorcism-type treatment instead of receiving evidence-based care and support to those experiencing distress. 

Royal Australian and New Zealand College of Psychiatrists WA Branch chair Dr Michael Verheggen said the college staunchly opposed the practice of any sexual orientation change efforts and noted the dangerous impact it had on the mental health of people.

“Psychiatrists across the board warn that sexual orientation change efforts risk causing significant harm and trauma to individuals,” he said.

“Practices such as conversion therapy contribute to the misrepresentation of alternative sexualities as mental disorders, and to the broader prejudice and discrimination faced by people who identify as LGBTQIA+.

“The RANZCP has previously highlighted in its position statement on sexual orientation change efforts that there is absolutely no scientific evidence to suggest that sexual orientation can be changed.”

New study throws light on genetic clues

Professor Sulev Koks

Previously under-researched aspects of Parkinson’s disease are revealing new clues on what triggers the degenerative brain disorder and how to slow its progression. 

A paper published in the journal Experimental Biology and Medicine suggests that DNA elements largely ignored in most genetic studies could influence disease development.  

Professor Sulev Koks, head of Genetic Epidemiology Research at the Perron Institute for Neurological and Translational Science and Murdoch University’s Centre for Molecular Medicine and Innovative Therapeutics, said transposable elements made up more than 70% of the human genome, but until recently were thought to not have any meaningful function.

“Our research showed that these elements, known as the ‘dark genome’, may have a much more significant impact on the pathophysiology of this disease than previously thought,” he said.

“Depending on location within the genome, they may speed up or slow disease progression.  

“Our previous studies have indicated that these DNA sequences, which can change their position within a genome, have a significant regulatory role and a major disease-causing capability.” 

Research found that some transposable DNA elements predicted faster progression of the disease, with rapid deterioration of motor or cognitive functions, while others were associated with a slowing of neuronal loss and neurodegeneration.  

“This study builds on our other research, contributing to future development of novel approaches for improved diagnosis and more targeted therapies,” Professor Koks said.

A mixed reality

Hollywood Private Hospital specialist shoulder and elbow surgeon Travis Falconer recently became the first surgeon in WA to use a HoloLens mixed reality headset during surgery. 

Digital holograms are an emerging new tool in operating rooms across the globe. Mixed reality is the merger of real and virtual worlds with enhanced immersion and interaction. 

By wearing the headset during a shoulder replacement surgery, Dr Falconer was able to see a 3D hologram of the surgical plan over the patient’s anatomy in real time. This allowed him to use the planning software and refer to data analysis during surgery. By using hand gestures and voice commands, Dr Falconer was able to interact with the holographic objects. 

The aim of using mixed reality techniques is to enhance precision and simplify complex surgeries. Being able to refer to the surgical plan during surgery also provides another layer of checks and balances for surgeons.

Wide-ranging research gets funds

Parkinson’s disease, multiple sclerosis and mild traumatic brain injury are among the research areas supported in the inaugural round of grants from the Bryant Stokes Neurological Research Fund.  

The fund, made possible by the philanthropic Sarich family, was established in recognition of neurosurgeon Professor Bryant Stokes’s contribution to the Perron Institute and advancement of neurosciences research. 

One of two Parkinson’s projects supported concerns the development of a novel RNA-based treatment for early onset forms of the disease. The other is looking to see whether non-invasive brain stimulation can strengthen connectivity in the motor cortex and reduce tremor in people with Parkinson’s.   

Understanding why immune cell changes occur in people developing multiple sclerosis is one of the studies relating to this neurodegenerative disorder. Another is investigating the potential for preventing damage to and restoring the insulating layer of myelin that forms around nerves.  

Investigating the potential for gene patching therapy to improve cognitive ability in childhood intellectual disorders such as Down syndrome is another project among eight selected for funding.  

More than $700,000 was given in the first round of funding.

Prof Samar Aoun, left, with Drew and Maureen at the Perron Institute clinic (photo credit Kelly Pilgrim-Byrne).

A hard diagnosis for all

A diagnosis of motor neurone disease is obviously devastating for the person on the receiving end and their family caregivers.  

Telling someone that they have the incurable neurodegenerative disorder is also challenging for the neurologist delivering the news. 

Now the experiences of patients, family carers and clinicians have been examined in a recently published study involving UK and Australian researchers.  

Professor Samar Aoun, Perron Institute Research Chair in Palliative Care at the University of WA, was a contributor, with the UK study replicating the Australian study developed by Professor Aoun and colleagues in 2015. 

“A diagnosis of MND and the subsequent progressive loss of independence, uncertain future and changes to everyday life have a profound effect on the person living with MND and their loved ones,” she said.  

“How the diagnosis is delivered can have a significant impact on patient outcomes such as understanding the condition, contributing to decision-making, psychological adjustment and satisfaction with care.” 

Professor Aoun, who is WA’s 2023 Australian of the Year, said the results from the UK study – like those from the Australian study – highlighted the importance of neurologists and neurology services being aware of the needs of people with MND and their caregivers when they are given the diagnosis.  

“An appropriate setting and allowing more time when breaking the news is critically important,” she said.

“Also essential is demonstrating more empathy and clear and honest communication, explaining what the patient can expect, and the care pathway and support services available, such as linking them to MND associations.”

Heart-felt milestone

St John of God Subiaco Hospital recently celebrated 10 years of providing cardiothoracic care and services in WA, marking the milestone with its multi-disciplinary cardiac care team including medical specialists, nurses and allied health professionals.

Cardiothoracic surgeon and Head of Department Associate Professor Jurgen Passage said the establishment of cardiothoracic services at the hospital was a career highlight for him.

Over the past 10 years, the cardiothoracic team had achieved many milestones, including the introduction of the first minimally invasive surgical program, which in 2017 expanded to include the transcatheter aortic valve implantation (TAVI) procedure.

TAVI is a minimally invasive procedure that offers eligible patients with aortic stenosis an alternative to traditional open-heart surgery, improving recovery times and ensuring less discomfort. 

Since the procedure was first introduced at the hospital, more than 250 TAVI operations have been performed.

More than a sore tooth

The WA Health Department is supporting a national study into tooth decay in children, with concerns poor oral health can have wide-ranging effects on their physical and mental health.

Researchers from the University of Adelaide are leading the study which will see more than 30,000 children aged 5-14 from across the country examined as part of a National Child Oral Health Study that will compare findings from the last study in 2012-14. 

The four-year study will also follow-up with about 15,000 teenagers and adults now aged 16-25 years who took part in the previous study. 

The project is supported by various State health departments and the Australian Dental Association. 

It is being led by Professor Lisa Jamieson, Director of the Australian Research Centre for Population Oral Health, which is part of the Adelaide Dental School.

“With the use of oral examinations and questionnaire data, we will be able to put the results side by side against what was found in the most recent study in 2012-14,” Professor Jamieson said. 

“We will be able to test, model, evaluate and disseminate evidence that will enable important questions around child oral health, social and emotional wellbeing, school performance and economic productivity to be answered.” 

Tooth decay, otherwise known as dental caries, is the most common childhood infection in Australia. 

“Dental caries imposes a large cost on the Australian economy, estimated to be up to $1 billion per year,” Professor Jamieson said.

“It also has a direct coloration to poor school performance, inadequate nutrition, problems with sleeping and adverse social wellbeing.”

‘Wonder drug’ could help with type 1 diabetes

West Australian diabetes researchers are investigating if a new medication helping people with type 2 diabetes could also reduce health complications linked to type 1 diabetes. 

Dr Lakshini Herat, pictured, has won a $60,000 grant from Perth-based charity Diabetes Research WA to study the effects of sotagliflozin in type 1 diabetes.

Dr Herat, from UWA’s School of Biomedical Sciences and the Dobney Hypertension Centre, said sotagliflozin was already being used in clinical trials to successfully lower blood glucose levels in people with type 2 diabetes.

“This medication is one of a relatively new class of so-called ‘wonder drugs’ known as SGLT1/2 inhibitors which are helping to protect the heart and kidneys in type 2 diabetes by suppressing the proteins in the body known as SGLT1 and SGLT2,” she said.

“Our team has recently discovered, however, that when SGLT2 is blocked, it leads to an increase of the SGLT1 protein in the kidney, possibly limiting the effectiveness of the SGLT2-only inhibiting drugs.”

Dr Herat said that because sotagliflozin was known to reduce the expression of both SGLT1 and SGLT2, it could be a powerful new way to help people with type 1 diabetes, as well as those with type 2.

“SGLT2 inhibitors are so far not being used in type 1 diabetes due to concerns over the risk of diabetic ketoacidosis, so more needs to be known about how sotagliflozin works in the body before it can be prescribed,” she said.