Fast, Fearless and Future - Showcasing Research Excellence for Queensland Health

Queensland Health is one of the largest employers in the state with some 130,000 full-time employees, geographically dispersed with 16 hospitals and health services across the country. 

The Office of Research and Innovation (ORI) hosts the ‘Queensland Health Research Excellence Showcase’ to celebrate how translating research into practice is advancing medical research, workforce development and healthcare. 

The Showcase’s theme - Fast, Fearless and Future – is a unique opportunity for Queensland Health employees to promote their translation-ready research. 

MTPConnect partnered with ORI to deliver a research poster and pitch session for the Showcase – attracting more than 40 entries from across Queensland.

In this episode, we head to Brisbane for the Showcase event to meet some of Queensland Health’s research champions working on major healthcare challenges in mental health, kidney disease, hand therapy, pain education and diabetes-related ulcer care, to find out more about their posters – Dr Mike Trott (University of Queensland), Emma Taylor (STARS Hospital), Hannah Kennedy (Gold Coast Health), Ifeoluwapo Tokun (Townsville Hospital and Health Service) and Margie Conley (Metro South Hospital and Health Service). 

And Tammy Sovenyhazi Acting Executive Director, Queensland Health’s Office of Research and Innovation, explains what the Showcase is all about! 

NB. Findings from Dr Trott’s research were recently published internationally in a world first in The Lancet Psychiatry journal https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(25)00129-4/abstract

Chapters

• 0:34 Queensland Health Research Showcase Introduction
• 1:21 Tammy Sovenyhazi explains what the Showcase is all about
• 5:59 Dr Mike Trott - Treating Weight Gain in Schizophrenia Patients
• 11:45 Emma Taylor - Innovative Approach to Carpal Tunnel Recovery
• 17:49 Hannah Kennedy - Virtual Reality for Chronic Pain Management
• 24:19 Ife Tokun - Regional Foot Ulcer Treatment Innovation
• 32:43 Margie Conley - Diet Intervention for Kidney Disease Patients
• 42:07 Outro

Transcript

Natalie Vella: 0:01

This is the MTP Connect podcast, connecting you with the people behind the life-saving innovations driving Australia's growing life sciences sector from bench to bedside for better health and well-being. Mtp Connect acknowledges the traditional owners of country that this podcast is recorded on and recognises that Aboriginal and Torres Strait Islander peoples are Australia's first storytellers and the holders of first science knowledge.

Caroline Duell: 0:34

Hello and welcome to the podcast. I'm Caroline Duell. We're taking you up to Brisbane for the Queensland Health Research Excellence Showcase, shining a light on some of Queensland Health's translation-ready research champions. Hosted by the Office of Research and Innovation, this year's theme was Fast, fearless and Future. The showcase celebrates how translating research into practice is advancing medical research, workforce development and healthcare is advancing medical research, workforce development and healthcare. Mtp Connect partnered with the Office of Research and Innovation to deliver a research pitch and poster session for the showcase, and there were more than 40 entries from across Queensland. Let's find out more.

Tammy Sovenyhazi: 1:22

I'm . I'm the Acting Executive Director in the Office of Research and Innovation, which is in the Clinical Planning and Service Strategy Division of Queensland Health. So Queensland Health is one of the largest employers in Queensland. We employ roughly around 100,000 staff, but really what that translates into is about 130,000 full-time equivalents across the state. We're probably one of the most geographically dispersed populations across the country and what that means is that we have 16 hospital and health services that all of those staff do work in, and we have that very, very geographically dispersed population where we serve all of those people as far out as Camerwill, mount Isa area, all the way up into the Torres Strait and down as far as the northern New South Wales border, and we do actually offer services to some northern New South Wales population as well.

Caroline Duell: 2:12

So that's a huge workforce and a huge program of healthcare services. Tell us about the Research Excellence Showcase that you've been putting on today here in Brisbane. What's that all about?

Tammy Sovenyhazi: 2:26

So the showcase itself was an opportunity for our clinician researchers to come together for a couple of reasons.

Tammy Sovenyhazi: 2:32

So one example was for the poster pitching exercise so they can tell us about the research that they've been doing in their fields in the various places across Queensland.

Tammy Sovenyhazi: 2:41

We received something around 43 pictures from all across Queensland actually, so it was really really lovely to see so many. Last year, when we held the showcase, we received 20 poster pictures, so we've more than doubled that from last year and really what that explains what that shows us is that there is so much research out in the field every single day and what it's translating for the clinician research is what they're seeing on the, on the coalface, on the front line of service delivery, and they're looking at the problems that they're seeing every other day, taking research, doing the research, so they're trying to solve the problems you know that they're seeing in their patients every day. What they're bringing to us here is so they can get research grants, so they can continue doing that research and and that's what we've done today taking those pictures, having a look at the research and then offering up those grants. Today we've announced $1.6 million in research grants as a part of the showcase, with around 450 people here today joining us.

Caroline Duell: 3:39

That's just fantastic news, and I know that you've had a theme today for this type of translation-ready research. So we're talking about research that's easily scalable, that can be applied around not just sort of locally, but perhaps more broadly, even across Australia and beyond. Talk to us about this theme.

Tammy Sovenyhazi: 4:01

So the theme was Fast, Fearless and Future. Really, it's about translating from accelerating the pathways out into practice, from discovery to impact. Fearless is about being bold. So thinking about extending beyond what we do and what we've always done, thinking about the hard things, translating that into what do we need to do differently, what can we do differently, thinking fiercely about that. And then future is thinking about beyond the cutting edge. We want to be you know we want to, and we are a world-class, you know leader in health care. But going beyond those breaches, you know.

Caroline Duell: 4:33

Thinking about the future and what can we do differently now so we continue to deliver health care into the future what a great day for everyone involved and it's been really interesting meeting a lot of the different groups that have been presenting today and the team, so congratulations, thank you.

Tammy Sovenyhazi: 4:50

it's been wonderful to have so many people here with us today from the far reaches of Queensland.

Tammy Sovenyhazi: 4:54

You know, we've had speakers come from Townsville jumping on the red eye in the morning so she could join us and present on her particular research. We've had international speakers today joining us giving some fascinating speeches, yeah, so it's been wonderful having so many people come together. It just shows us the diversity and the breadth and the intelligence and the smarts that we have with our clinician researchers that we have in Queensland Health. We are so very fortunate that we have them leading the way in terms of, you know, fixing the problems that we have and the challenges that face our consumers, and it's really heartening to know that they're thinking every single day about how it is that we can face those challenges and what we can do to help gain equitable access for our consumers, no matter where they live. We have clinical trials that we have all of the time. We're leading the Australian Teletrials Program here in Queensland and that's all about getting access to, you know, to trials and access to equitable care for our patients in Queensland.

Caroline Duell: 5:50

Well, it's been great to talk to you, Tammy. Thank you very much for coming on the MTP Connect podcast.

Tammy Sovenyhazi: 5:54

Thank you so much for having me. It's been great.

Dr Mike Trott : 6:00

My name is Mike Trott and I'm a statistician. I work for Metro South Addiction and Mental Health Services.

Caroline Duell: 6:06

And you're here today at the showcase in Queensland to talk about treating people with schizophrenia to help them lose weight while they're on treatment. Can you tell us a little bit about your research poster?

Dr Mike Trott : 6:20

So our clinical trial was for people who had schizophrenia on clozapine, which is a very potent but pretty nasty antipsychotic medication, who are also obese. We tested them on semaglutide which you may recognize Ozempic or Wegovy, for 36 weeks and we monitored them and see whether they lost weight and actually, more importantly, whether it affected their medications. What we found was, yeah, they lost weight. They lost almost 14% of their body weight, which about 15 kilos, or two bowling balls or a case of 12 bottles of wine, is about the same as that's how much they lost. But no changes were found in their medication levels. So not only was it effective, it's clearly safe for this population, and that was the big unknown which we've hopefully confirmed.

Caroline Duell: 7:12

So the idea of people suffering from schizophrenia and gaining weight because of the antipsychotic medication that they're on has obviously been a very big problem for people, because it results in things like cardiovascular disease. What is the impact of this obesity on this group of people?

Dr Mike Trott : 7:29

The long and short of it is is it kills these guys and girls early. The people with schizophrenia tend to die 15 to 20 years younger than the general population. So the bottom line is is the side effects of some of these antipsychotic medications actually kill the population sooner? And the whole reason why they're on these toxic drugs essentially is because they really do help with their psychosis.

Caroline Duell: 7:56

So today you're here presenting your poster and you've brought with you a backpack. Can you tell me a little bit about that?

Dr Mike Trott : 8:03

Yes. So last night I was awake at about 3 am and thought, oh, I've got some weights in the garage. These people lost 15 kilos. Yes, I can say it's like two bowling balls. Yes, I can say it's like a case of wine. But what if I could actually have people lift it up and find out actually how much weight that is? Luckily I have a sturdy backpack at home, so I decided to pack it up this morning and bring it in and I was asking people to lift it up. I was giving it to some people who didn't want to lift it, just so that people can contextualize how much weight these people lost, and it was considerable.

Caroline Duell: 8:39

So this is a first in Australia clinical trial.

Dr Mike Trott : 8:42

It's the world's first in this population. So, yes, it is a first in Australia clinical trial. It's the world's first in this population. So, yes, it is the first in Australia, but it's also the first globally to look at this drug in this population. And, yeah, we got over the line first.

Caroline Duell: 8:56

So what's next for you with this particular piece of research?

Dr Mike Trott : 9:03

There's a few different projects that we're working on to make it go forward. The first one is that we've just published the guidelines for prescribing in schizophrenia, of which is included a suggestion of prescribing this drug. So that's the first one and that's going to, and that it's basically a flow chart that is on the desks of psychiatrists now it's actually up on walls of psychiatry offices. The second one is there are a couple of other teams doing essentially the same study internationally with the same population, and we are all working together, we're all friends and we're sharing the data so that we can combine the results and essentially create more robust findings, which will then give us a strong case to present to the likes of TGA and PBS to make this drug available for people on this medication.

Caroline Duell: 9:47

Because in the past the interactions with the antipsychotic medication have been quite extensive. So the key part of your trial has been around looking at whether there are any other additional safety issues Is that correct?

Dr Mike Trott : 10:01

Yeah, exactly. So essentially, the way that these drugs interacted with antipsychotic medications is unknown. All of the big trials that pharmaceutical companies do to then bring the drug to market are all done in the general population, so they explicitly exclude people in our case with schizophrenia, but also with other severe mental illnesses as well. So the honest answer is we just didn't know whether there was any interactions. So that's what we looked at and gladly there weren't.

Caroline Duell: 10:29

So where have you been doing this trial, particularly just all over Queensland?

Dr Mike Trott : 10:32

Southeast Queensland, mainly so. We recruited from six sites across Southeast Queensland.

Caroline Duell: 10:38

And what do patients think about this particular outcome?

Dr Mike Trott : 10:42

Well, firstly, the patients on placebo weren't that happy that they're on placebo, because actually the drug worked so well in people who weren't on placebo. But aside from that, the main thing that we found was that people were more likely to stay on their antipsychotic medications because they weren't gaining weight, so their quality of life was slightly up. But, more importantly, they were more likely to adhere to their medications and therefore not relapse, and that really is the key. That's why we're here.

Caroline Duell: 11:09

So what are the next steps for you, Mike.

Dr Mike Trott : 11:11

Well, we're delighted to say that we've just had this published in the Lancet Psychiatry, one of the world's leading psychiatry journals, and what this is going to lead to is the ability for psychiatrists to prescribe really effective antipsychotic medications like clozapine without worrying so much about the side effects, and also, hopefully, meaning they don't have to prescribe this drug off-label and that it will be an approved medication.

Caroline Duell: 11:38

Wonderful. Well, thanks for coming on the podcast.

Dr Mike Trott : 11:40

Thanks for having me.

Emma Taylor : 11:45

So my name is Emma Taylor and I'm a hand therapist at STARS Hospital in Brisbane. I'm an accredited hand therapist, so it's a specialist area that you go into and I have my qualifications in occupational therapy and physiotherapy.

Caroline Duell: 12:00

Tell us what sort of poster you've presented today, what sort of research you're working on?

Emma Taylor : 12:05

So it's all about carpal tunnel syndrome.

Emma Taylor : 12:07

So carpal tunnel syndrome is where a nerve gets compressed through your wrist and causes a lot of problems like tingling, numbness and burning pain, and it's actually as common as one in 10 worldwide and we do over 195,000 carpal tunnel release surgeries in Australia each year.

Emma Taylor : 12:27

So it's very, very common. My research is all about looking at how we normally manage people after the surgery and we normally get them into hospital and do one-on-one sessions and what we've done with this research is developed a new model of care that just looks at seeing people in a group for the first appointment, and that's really about efficiency. I was seeing lots of people, one after the other, because they'd done multiple carpal tunnel release surgeries, and that's where the research stemmed from, where we started seeing people in groups to make it more efficient, and from there the model of care was developed where we are not only looking at doing that group appointment, but we're doing an app-based home program with video guided exercises, which people loved, and then a telehealth follow-up. So, again, people are not having to come to hospital, but they're still receiving really good healthcare.

Caroline Duell: 13:24

So what you've done is try and have a big impact with less one-to-one interventions. Would that be right?

Emma Taylor : 13:30

Yeah, that's right, and it's all about meeting the surgery demands so that we can see everyone. It's about increasing the service efficiency, but also increasing patient access and, of course, reducing healthcare costs as well.

Caroline Duell: 13:45

And, of course, reducing healthcare costs as well. So how has the app at home rehab going? How has that sort of been received by patients?

Emma Taylor : 13:52

People love it, so they love both components. So the app-based home program is a very easy-to-use app and, as I mentioned, all the exercises are video guided, whereas we normally give people handouts with just pictures that are static pictures and a bit hard to follow sometimes, and then people can carry around these exercises on their phone. They can do it anywhere. So they've really loved it and also found the tech part of it very easy, where people that haven't been feeling confident have very easily been able to use the app. Telehealth is very well ingrained in health now where we use it really since COVID, and again, patients love that that they don't have to come into hospital and we really can achieve a lot over video, a lot more than what we ever realised. So again, a lot over video, a lot more than what we ever realised. So again, they're getting that treatment but not having to drive into hospital to take time off work or pay for parking or public transport.

Caroline Duell: 14:54

Perhaps you can just give us the highlights of why this trial is so important.

Emma Taylor : 15:00

I think the model of care was really well accepted by patients, so they liked each component. They liked the group appointment because they had that peer sharing and support, so they were able to listen to other people talk about their experiences. They were able to support each other during the group, and so a lot of patients commented on that. They really liked the app because it was easy to use videos within it. Then again telehealth and telehealth. A lot of patients are used to using telehealth now because we use them at the GP and other sort of appointments. So again, they liked the ease and the convenience of that.

Emma Taylor : 15:39

The other big thing is the impact that it has in terms of service efficiency, and when we talk about that, you know cost always comes into it, and what we found is that TEG, this new model of care, was $42 less per participant in terms of cost versus abnormal patients coming one-to-one, face-to-face, and so over a year that's up to $8 million in cost savings. So it's not just about that dollar value of looking like it is on the page. It's about the fact that $8 million can then be used in healthcare in other areas so that we make health more efficient and accessible to everyone, and the patients are still happy. Yeah, exactly, it's easier, it's convenient, it's enjoyable.

Caroline Duell: 16:25

And obviously it's going to help people living in regional areas as well.

Emma Taylor : 16:29

That's right. Yeah, and we are looking at. This was a pilot and feasibility randomised control trial. We're looking at doing a multi-centre trial which will include those rural and regional areas and again really tailor to them where they've got to travel long distances to come to therapy.

Caroline Duell: 16:48

Do you think this will work for other healthcare problems like carpal tunnel syndrome?

Emma Taylor : 16:53

So we do have common elective hand surgeries that we do. So there's other things like trigger finger release, removal of wrist ganglions and other common elective surgeries, and so again, those high demands of surgeries. We could apply this model just to be able to meet all that demand but also make it a lot easier for patients.

Caroline Duell: 17:17

So where at the moment are you running this program?

Emma Taylor : 17:21

So at the moment we're just doing it at Starrs Hospital. It was a single centre study but, as I mentioned, we're in the preliminary stages of planning a multi-centre trial and we've already had some of the Queensland sites really interested, particularly hospitals where they do a lot of these elective surgeries and they do high volumes of the carpal tunnel release surgeries.

Caroline Duell: 17:43

Well, thanks for talking to the podcast. It's been really interesting. Thank you for having me.

Hannah Kennedy : 17:51

My name's Hannah Kennedy. I'm a clinician researcher with a background in occupational therapy at Gold Coast Health. I work at the Gold Coast Persistent Pain Centre and our research that we've been doing is using a virtual reality pain education platform to help people with chronic pain.

Hannah Kennedy : 18:07

Tell us about the research that you've presented today. What I've presented today is the findings from two studies that we're running at the moment. The first was a randomized control trial at Gold Coast Health using a virtual reality pain education program. The intervention is a six session program where a patient wears a virtual reality headset and does education modules and rehabilitation games, and the whole purpose of it is to provide immersive experiential learning about the pain system and how we can retrain the pain system through rehabilitation and movement and other pain management strategies. We ran it as a trial at Gold Coast Health with really great feedback from the participants, some really lovely outcomes, and now we're currently piloting it across Queensland Health. We're running it at six different pain management services from Townsville, sunshine Coast, metro North, metro South, the Children's Hospital and Gold Coast at the moment.

Caroline Duell: 19:05

What do you think makes a difference here for people that are suffering from chronic pain using a headset, a VR headset? Why is this so effective?

Hannah Kennedy : 19:15

So we know from the evidence that having people understand the mechanisms behind persistent pain has been a critical factor in their recovery and rehabilitation. But delivering pain, education, the science and complex concepts can actually be really tricky. So the use of vi provides this really immersive way of learning complex concepts in a really engaging way. So our participants have been finding that after they do their education modules they have a good understanding of some of the reasons behind their ongoing pain, and then their willingness to engage in the multidisciplinary rehab approaches really has increased. So it's still we see some lovely outcomes from goals that people want to get back to doing in terms of being able to do things around their home, go on holidays, participate with their family, move easier. All of these really lovely outcomes we're seeing as a result of the program.

Caroline Duell: 20:11

So what sort of rehab activities will people be doing as part of their sort of virtual reality rehab program?

Hannah Kennedy : 20:18

They're quite fun. I think that's been one of the other main feedbacks from participants is that they're a really fun way of moving. One is when they've got the VR headset on and they have a laser and they're connecting different coloured dots in space, which really encourages a wide amount of movement through the head, neck and shoulder areas. Another game is sorting items into different baskets and each time it gets lower and lower to the ground. So people are moving at a greater range. But when they're in the VR headset might not be realizing how easily they're moving and how smooth their movements are, which becomes a really powerful feedback loop to then see how much they can do. And people are then translating what they're doing in the VR sessions into daily life and other ways of, you know, vacuuming or driving and shoulder checking. So they're bridging that gap from what they've done in the clinic to then their day-to-day life.

Caroline Duell: 21:12

What sort of feedback have you had from the patients involved?

Hannah Kennedy : 21:15

It's been really positive. People have said how can we get this to more people? How could I get this into my workplace? What about in the aged care industry? So even the people themselves with pain are seeing a wide range of opportunities for it. Some of our main themes from our qualitative study was that it was really fun, they enjoyed it, they learnt things and they've been able to remember this information at the six-month follow-up mark, which I think is something powerful. Around this use of VR in the education space too.

Caroline Duell: 21:46

And what about their pain level? How has it helped manage their pain symptoms? It's helped people.

Hannah Kennedy : 21:53

I suppose, understand and have a different approach and awareness of their pain. It can take some of the fear away of what their pain is feeling when they're understanding some of the mechanisms behind our protective system and our pain and the neuroplastic system as well. So they're shifting their understanding of what their pain means and then giving them confidence to do those things that they want to desperately be able to get back to doing with support and guidance.

Caroline Duell: 22:22

So they're doing these types of activities under the guidance of a medical professional? Yeah, so we've been using it with allied health and nursing clinicians at the Persistent.

Hannah Kennedy : 22:28

So they're doing these types of activities under the guidance of a medical professional? Yeah, so we've been using it with allied health and nursing clinicians at the persistent pain management services across Queensland and do you think it's got applications for remote areas? Absolutely. Both the clinicians and the services, as well as the participants, have been saying. This has great applicability to regional and remote areas. So looking at options such as how we could get the VR headsets out to people's home and then still have that clinician support through a telehealth model.

Caroline Duell: 22:55

And who are you working with on the VR, the virtual reality headset, sort of medtech?

Hannah Kennedy : 23:00

Yes, so it's an Australian company called Reality Health who developed the software, and they worked with the leading team of pain science experts. Professor Lorimer Mosley helped develop the content, and so we've been working with them to deliver this program.

Caroline Duell: 23:15

So what are the next steps for you and your team in trying to, I suppose, expand this model?

Hannah Kennedy : 23:20

Right now we're piloting the implementation across the six pain management services, so this has involved clinician training, research, governance, getting participants and evaluating that, and we're evaluating that from an implementation space. But what we would love to have is this treatment offered as long-term care for people coming to pain management services and then look at areas such as regional and rural health. But there's a great need for innovation in chronic pain. There are so many areas of pain that we think this could be applicable to as well, so obviously, this is a bit of a team approach that you're taking with this program.

Caroline Duell: 23:57

Tell us who's involved.

Hannah Kennedy : 23:58

Yeah, couldn't make this happen without our team, so really thankful to both the hospital and health services that are involved in the study, as well as Griffith University, who've been supporting us with this study.

Caroline Duell: 24:08

Wow, that sounds really exciting. Thanks for sharing your research innovations with us today.

Hannah Kennedy : 24:13

The showcase. Thank you for the opportunity.

Ifeoluwapo Tokun : 24:19

My name is Ife . I'm a podiatrist and a clinician researcher at Townsville Hospital and Health Service.

Caroline Duell: 24:26

So you've come all the way to Brisbane today to present your research. Tell us all about it.

Ifeoluwapo Tokun : 24:31

Well, so within podiatry, within a hospital setting, podiatrists work with diabetes-related foot ulcers and one of the key components to healing especially a weight-bearing diabetes-related foot ulcer is offloading.

Ifeoluwapo Tokun : 24:44

Previously, the gold standard of offloading was exclusively what we call a total contact cast or a knee-high cast.

Ifeoluwapo Tokun : 24:51

Recently, the guidelines have changed to state that gold standard is now just a knee-high irremovable device. So this is quite an ambiguous term and this is quite helpful because it allows us to be flexible with how we create a knee-high irremovable device, particularly in regional areas, because the traditional total contact cost is very resource and skill intensive, which is fine in a very large tertiary center. But when you work out regionally, whether it be Northwest or in a Torres Strait Cape, clinicians are already strapped of time. So if you have a intervention that's very time and skill intensive, it's not going to be done, which means that people in regional and remote areas won't have access to the care. So what we've done is found a less skill and less time intensive alternative, which we call the instant total contact cast, and we're trying to implement that in Townsville and now we're hoping, with the success of the implementation, we are hoping to expand to the other rural sites in Townsville and then eventually to spread the love.

Caroline Duell: 26:00

So, talking about this, love, this concept that you've created. The idea is that anyone with a foot ulcer, the sooner they get the cast on, the more chance they have of the wound healing. Is that correct? So this is all based on really trying to manage the ulcer in the fastest possible way.

Ifeoluwapo Tokun : 26:18

So diabetes-related ulcers have a very high burden of disease, and particularly with plantar ulcers. Essentially, the longer you have a plantar ulcer, the more chance you have of an infection, and oftentimes infections lead to superficial infections, at least lead to what we call osteomyelitis, which is a bone infection, and unfortunately the definitive management of a bone infection is an amputation. So we know that the quicker we can heal an ulcer and the quicker we use gold standard care, the better healing rates we will get. And the gold standard standard of healing at Planta also is a knee-high removal device. So the more that regional patients have access to it, the better chance they have access to gold standard care, therefore better healing rates, which we're trying to do.

Caroline Duell: 27:06

So your innovation. I've seen some photos of it. Do you want to explain it? So?

Ifeoluwapo Tokun : 27:11

the traditional total contact cast is, like I said, very time and skill intensive, so much so that even podiatrists typically don't create it. We typically leave it to a plaster technician, which is all fine when, again, you're in a tertiary center, but if you're in, let's say, mount Isa, they may not have a plaster technician, then that device can't be made. So then we really looked back and said may not have a plastic technician, then that device can't be made. So then we really looked back and said okay, how do we get this intervention to be implemented everywhere? So we looked at what the guideline stated. So the guideline stated that gold standard only had to be knee high and irremovable. So knee high, because the higher, the bigger and heavier, unfortunately, a device is, the more pressure it can offload. And irremovable for adherence.

Ifeoluwapo Tokun : 27:53

Oftentimes we find that in human nature, when you give someone a device that they can take off, they usually take it off. We still want patients to take it off in an emergency, but oftentimes what you find is you give a patient a removable device, they'll wear it in clinic and as soon as they leave the door they take it off and then when they come back to clinic they put it back on. So with this device, when we put the door, they take it off, and then when they come back to clinic, they put it back on. So with this device, when we put it on, you can take it off in an emergency, but you can't put it back on. And so if the patient takes it off, then we can then have the discussion about okay, why are you taking it off? So on and so forth.

Ifeoluwapo Tokun : 28:27

So our innovation is getting a readily available moon boot which is knee knee high and making it irremovable. So we do that by getting synthetic wool and wrapping it around the moon boot and then using plaster cast and wrapping it around the wall. We did that because initially, when we were creating the device, we found that if the plaster stuck straight on the boot, when we remove the plaster, it destroyed the boot. So we wanted to. Again, for managing costs, we wanted to be able to use the boot. For when we remove the plaster, it destroyed the boot. So we wanted to. Again, for managing costs, we wanted to be able to use the boot for as long as possible. So that wall, essentially, is just a barrier between the boot material and the plaster. So when we saw it off or cut it off with large scissors. We only cut off the wall and the plaster, maintaining the boot, which means that the boot can be reused over and over again.

Caroline Duell: 29:12

So you're looking at a number of sort of cost savings, better treatment for the patient as well in terms of adherence. So there's a whole lot of benefits to this innovation that you've created.

Ifeoluwapo Tokun : 29:23

Yes. So you can look at it from many perspectives. From, I guess, the health payer perspective. You will get its cost saving in terms of, you know, devices that are less costly for the service, because obviously, you know, finances isn't is a thing, but also, the best implementation is one that can be readily used.

Ifeoluwapo Tokun : 29:44

A complex implementation only benefits the creator. At the end of the day, you have to ask yourself what is the purpose of this. You know this research and the purpose of the research is to improve outcomes. So if we have a device that is very, very complex, although that benefits me and makes me feel good, it doesn't benefit the people on the ground.

Ifeoluwapo Tokun : 30:03

So we want to make sure that within any clinic space, you know, these items that we've used are readily available, which means that we lowered the barrier to implementation, which is what we really want to do is lower the barrier to gold standard care so that, whether you're in toowoomba or manizer or dumaji, that as a podiatrist in that clinic, you have access to this. And even now we're even incorporating allied health assistants, because we know that, for example, there's a shortage of podiatrists and we're trying to incorporate allied health assistants and telehealth to be able to train the allied health assistants up to be able to create the device in the absence of a podiatrist. So it's about being innovative and it's about you know. Try to find ways to make things more effective and more efficient and ensure people everywhere can still have access, because that is our main focus is access to care.

Caroline Duell: 31:00

So this is Townsville and beyond, we hope.

Ifeoluwapo Tokun : 31:02

Yeah, currently it's just in Kirwan Health Campus and the main hospital, tuh. We're hoping, with a CERTA grant we are trying to expand it to towns within the Townsville catchment, like Charters Towers, ingham and Ayr, but really we're just hoping to expand it more and make it more accessible to every service. It's not something that we want to keep in Townsville, something that we want other services to innovate, and I'm sure there are smarter people out there than me and I'm sure that the more this gets around, other people will find even more efficient and effective ways to make air removal offloading and obviously beyond Queensland as well into other remote areas in Australia.

Ifeoluwapo Tokun : 31:46

Yeah, I mean again, we don't want any barriers to this. So obviously I presented it here, and there is the Diabetes Foot Conference in October and you find that the more you talk about things, the more the word gets around and you want other people to see what I'm doing and essentially say well, what is he doing that I can't do? And then they can take their spin around the spin of it Again. The guidelines just state that gold standard offloading is knee-high and irremovable. If another service in another state wants to make it their own way with whatever tools they have, that is fine, as long as they satisfy those two requirements. And that's really my take-home message fantastic.

Caroline Duell: 32:30

Well, all the best with sort of spreading the word and getting this innovation implemented, hopefully across Queensland and beyond.

Ifeoluwapo Tokun : 32:38

Yeah, thank you very much.

Margie Conley : 32:43

I'm Margie. I'm a clinical dietitian and researcher at the Princess Alexandra Hospital in Brisbane, Australia, and I work with all things kidney nutrition.

Caroline Duell: 32:54

So tell us about the research that you've presented today here at the Queensland Research Showcase.

Margie Conley : 32:59

Yeah. So as a dietician I'm really one of the biggest things that people come to talk to me about is what can they eat or what can they do to help their kidney health? Is what can they eat or what can they do to help their kidney health? People with kidney disease is a lifelong condition. There is no cure, so the aims around treatment are slowing down progression, as, once your kidneys stop working, we do need some kidney replacement therapy, so a kidney transplant or dialysis, which is quite a costly and time-consuming treatment for people where they're attached to a machine for many hours a week just to live.

Caroline Duell: 33:45

What sort of led you to put together your research program?

Margie Conley : 33:49

I suppose many years ago there was a big study in the UK at the time, a really world-first study that showed a diet using meal replacements could put diabetes into remission, could help people lose enough weight to not need any medication to treat their diabetes anymore. So we're inspired by this to see whether we could replicate that diet in people with kidney disease and could it help delay the need for dialysis or, you know, make some big in gains in their kidney health.

Caroline Duell: 34:25

And so tell us about the research program that you undertook.

Margie Conley : 34:29

Yeah, so basically, we started from the very beginning. So these types of diets low energy diets using products like a meal replacement, like a weight loss shake haven't always been as popular as people might think. There's a perception that people might not be able to stick to them or like them not be able to stick to them or like them, and in people with kidney disease, they haven't always been used, as we've been a bit worried about whether they're safe for people with kidney disease. So our study started right at the beginning by simply asking people, you know, getting them to trial these particular diets using meal replacements and monitoring them over a short term, looking at the safety and asking them to basically take us on their journey of what it was like to follow them. And so what were the outcomes of the study?

Margie Conley : 35:26

Yeah, so, this little pilot study where we got 10 people to follow this diet and we we call it a low energy diet because it's a set amount of energy or calories a day and, like I said, it can normally be done with these meal replacements.

Margie Conley : 35:42

But, being a dietician, I was also keen to say well, actually, does it have to be a meal replacement? Could it be a healthy, balanced meal that we could buy from the supermarket or that we can involve a delivered meal company. So we partnered with industry to test some products already out there, one being meal replacements and one being pre-prepared delivered meals straight to their house. So they followed this special diet two weeks with the meal replacements, two weeks with the low energy meals, and we tracked their weight loss. We took blood tests weekly. We asked them to write down honestly, just for us, whether they could stick to it or not, with this idea in theory that it might work if in practice, because of the nature of their condition and disease and their life, that it wouldn't fit into what they were trying to do. So that was really important to get that preliminary data.

Caroline Duell: 36:43

And what were the results?

Margie Conley : 36:44

So from that we then took that work and what they told us was that they actually liked both options. So they loved the meal replacements for the ease, the convenience, not having to think about it, but they missed the inclusion of real food. They wanted to chew food. Understandably, with the meal replacements you could get four opportunities to eat a day, versus two with the meal replacements. So they told us they'd like a flexible, patient-focused approach with a combination of both. So from that work we launched our larger study of 50 people testing the low-energy diet using a combination of meal replacements and food items available at the supermarket, with the inclusion of some fruit and vegetables, and looked at then the effect of that diet on weight loss, kidney function and a range of other health markers that mattered to people, like strength and fitness.

Caroline Duell: 37:46

And were the group successful in losing weight or better managing their weight?

Margie Conley : 37:50

Yes. So we had some really pleasing weight loss results in terms we had most participants just under half lost over 10 kilos in just three months and what we were really pleased to see was they were able to keep that weight off after we transitioned them off this intensive diet. So they maintained their weight at six months. But what we really loved seeing was the stories that people told us. So, yes, they were happy to see 10 kilos on the scales, but they told us because of this weight loss they had less pain, better sleep, more movement. So that translated into really important health outcomes like being able to get more work.

Margie Conley : 38:32

So one gentleman was a cleaner. He had to sit down every 10 or 15 minutes but now that he's lost the weight, improved his health. He lost 17 kilos. Now he's doubled the amount of work that he could do. So he's feeling much better within himself because there's less financial strain. He's fitter, healthier and happier. People told us that they'd lost a lot of their hobbies. Living with both kidney disease and excess weight it's a huge burden to live with both those chronic diseases. People miss things like camping, caravanning, fishing. So people spoke about losing the weight and being able to go back to those activities playing with their grandchildren on the floor, because they weren't able to do that, because they didn't have the function to be able to get back up off the floor. So we're seeing some really important, you know, patient real-life health outcomes, rather than just numbers on scales, which us researchers do love. But you know we wanted to see these other important health outcomes as well.

Caroline Duell: 39:44

So how do you hope to translate this research beyond your clinic to other places in Queensland and Australia?

Margie Conley : 39:52

Yeah, so actually one of our participants actually spoke about how the phone call changed his life, how I actually rang him one day and you know, prior to me giving him a call inviting him to participate in this study, he'd gone to his local GP and said look, can I use these meal replacements to try and lose weight? I've come to a point where I want to improve my health. And his GP actually looked at him and said I'm sorry, we don't know whether they're safe for people in kidney disease. So he said he remembered feeling quite deflated and thinking you know, I want to take some steps forward but I'm hitting barriers. So you know, we want to see, now that we know this diet is safe, that it can be effective for people, we want the next people that are going to their GP, to their dietician, to their specialist, to say the answer to be yes.

Margie Conley : 40:49

Actually we know that these diets can be safe. We know that people like them if we make these little tweaks with meal replacements and meals and we can be flexible and you know, they can have good outcomes for people. So more education is a start to Queensland health and private sectors where people may go and see a health professional. Not within Queensland Health and education. There's a lot of dietitians and other health professionals that aren't as upskilled as they could be in the area with these types of products, as there is a little bit more risk with these intensive diets than other nutrition interventions. So that's the first point. Let's get the message out there and let's see if we can get education and toolkits about how to roll these diets out safely for those that want to stick to them. We understand this might not be an approach for everyone, but for those like this particular participant that thought this is the option for him, he wasn't able to go ahead and do it.

Caroline Duell: 41:55

That sounds really life-changing for people and I hope that you can spread the word with your research beyond Queensland and keep making a difference.

Margie Conley : 42:04

Yes, we hope so too, so thank you for your time.

Caroline Duell: 42:08

That was Margie Conley from the Metro South Hospital and Health Service in Woolloongabba talking about her research innovation. We're delighted to feature some of the translation-ready research champions behind the posters presented at the Queensland Health Research Excellence Showcase held in Brisbane in May. You've been listening to the MTP Connect podcast. This podcast is produced on the lands of the Wurundjeri people here in Narm, melbourne. Thanks for listening to the show. If you love what you heard, share our podcast and follow us for more Until next time.