Christine Jenkins

Government funding for innovative digital platform to diagnose and treat breathlessness

The George Institute has been awarded one of the Australian Government’s Medical Research Future Fund (MRFF) grants to trial an electronic Clinical Decision Support System (CDSS) to improve the diagnosis and treatment of breathlessness. The study, titled BREATHE, will examine the feasibility and benefits of using a CDSS - an electronic system to help clinical decision making - in improving patient outcomes compared to usual care.

Project lead Prof Christine Jenkins, Head of the Respiratory Group at The George Institute, says, “One in every ten Australian adults experiences breathlessness, but it is often misdiagnosed and mismanaged. The BREATHE-CDSS will help reduce the time taken to diagnose the causes accurately and provide patients with a treatment approach tailored to their needs.”

In Australia, around two million people have difficulty breathing. This limits their physical activity, reduces productivity and impacts their wellbeing.

“Our focus groups with GPs have highlighted many challenges in providing the best care for these patients. Misdiagnosis, overuse of medicines and expensive tests are some of the barriers. There is an urgent need for a new approach to tackle them,” explains Prof Jenkins.

Breathlessness has multiple causes. But most can be addressed by accurate diagnosis and comprehensive management of chronic respiratory diseases such as asthma, post-COVID symptoms and Chronic Obstructive Pulmonary Disease (COPD). With each of these conditions requiring a distinct treatment pathway, there is a need for a personalised, multifaceted approach suited to each patient.

“Our CDSS will support patients’ priorities in managing their condition and related co-morbidities, for example, assistance with reducing anxiety with breathing techniques, and support for weight loss. It links to high quality educational materials and mobile apps that patients can use to reduce the impact of their symptoms day by day” adds Prof Jenkins.

The BREATHE project will proceed in three phases. The first will involve testing the feasibility and acceptability of the CDSS. This will be followed by a year-long randomised clinical trial of the system in general practices in New South Wales to see how it fares against current usual care. The last phase of the project will examine its cost-effectiveness for potential scale-up.

Developed by a multidisciplinary team of clinicians and technical experts from across The George Institute, UNSW Sydney and the University of Sydney, the BREATHE-CDSS will be the first clinical electronic support system for breathlessness globally.

This project team includes senior researchers Prof David Peiris and Dr D Praveen who have developed and implemented similar digital tools for cardiovascular disease detection and management. The SMARTHealth and Healthtracker clinical support systems are currently in use in primary care settings across Australia and other countries.

The five-year long BREATHE project will begin in 2023. The Lung Foundation of Australia is a key partner on the project. It will contribute by developing patient-focused resources, building clinicians’ skills and supporting patient engagement and empowerment.

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The George Institute's pre-budget submission 2023 – 2024

The George Institute for Global Health is pleased to contribute a written submission, ‘Supporting chronic disease prevention in Australia’, to the Commonwealth Treasury ahead of the release of the 2023 Commonwealth Budget.

Australia’s healthcare system enables citizens to enjoy world-class treatments and programs, underpinned by a robust research sector. But effective governments don’t just invest in treating health problems – they invest in preventing them, especially for the most at-risk communities.

Chronic diseases cause nine out of every 10 preventable deaths in Australia and account for 85% of years lost due to ill health or early death. Injury is the leading cause of death for Australians aged 1-44 years. These are more than statistics – they reflect the overwhelming burden of preventable disease on the day to day lives of far too many Australians.

This year, our submission focuses on support for three major Commonwealth Government reforms that have the power to significantly reduce the growing burden of preventable disease in Australia.

  1. Implement the National Preventive Health Strategy
  2. Develop the Measuring What Matters Framework
  3. Establish the Australia Centre for Disease Control

The George Institute strongly supports an ambitious reform agenda and calls Upon the Commonwealth Government to fully fund the development and implementation of these recommendations in the May Commonwealth Budget.

Please refer to our full submission on this page. 

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Government Recommendations - 14/03/2023

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Worlds Collide: What does it mean to ‘go viral’?

In this episode of The Scan’s World’s Collide Series, Seye and Jaime discuss what it means to ‘go viral’ and the role social media has in increasing impact of work; they talk about rejection and being brave, and explore the pros/cons of various processes for different journals. Also announcing Jaime’s new position!’

About the series: The Scan ‘Worlds Collide’ feature two well-known global health researchers from different parts of the globe, Jaime Miranda, from Peru, and Seye Abimbola, from Nigeria. Each wears a variety of ‘hats’, holding a number of positions, in different countries. Featuring unstructured conversations as they reflect on daily interactions it offers illuminating insight on navigating work and cultural perspectives. It offers the audience an intimate setting as they share their experiences with each other – and us!

Date published: 07/03/2023
Episode #: 19
Podcast Series: The Scan
Zien

New grant to improve safety of clot-busting treatment in people with cardiovascular disease

The George Institute’s Dr Zien Zhou has been awarded almost $1,000,000 over three years to evaluate the use of brain magnetic resonance imaging (MRI) to identify ‘hidden’ changes to blood vessels in the brain that may predict the risk of bleeding. It is hoped this will help guide the safest choice of anti-clotting therapy in patients with atrial fibrillation (AF), an irregular and often very rapid heart rhythm that can lead to the formation of blood clots.

The funding is from NSW Health’s Elite Postdoctoral Researcher Grants program, awarded to talented emerging cardiovascular research leaders who are ten years or less post doctorate.

The use of medications to treat or prevent thromboembolism - a common condition in patients with heart disease like AF in which blood vessels become blocked by the clumping together of platelets with fibrin and other blood cells - has increased substantially worldwide during the past decade.

Although these medications are effective, concerns remain over the risk of bleeding, especially in the brain - intracranial haemorrhage is a life-threatening complication with no proven treatment and a survival rate of less than 50 percent.

This is particularly important in patients with heart disease, who are two to three times more likely than the general population to have changes in their brain’s vascular system that can be clearly identified by MRI. While not sufficient to cause obvious neurological symptoms, these changes can result in subtle neurological deficits and increase the longer-term risk of stroke or dementia.

But patients with heart disease don’t routinely undergo brain imaging if they haven’t yet suffered a stroke, so these changes are usually overlooked, despite their potentially important role in choosing medications for these patients.

Dr Zhou’s study will help to determine whether hidden blood vessel changes identified by MRI are worth considering when deciding on the safest combination of antithrombotic or thrombolytic treatment for patients with AF.

Dr. Zhou obtained his specialist medical qualification in Neuroradiology from Shanghai Ren Ji Hospital, affiliated with Shanghai Jiao Tong University School of Medicine, China.  He has been a visiting fellow and PhD candidate (UNSW Scientia Scholarship awardee) at The George Institute, Australia for the past six years. He is also a lead investigator for several other George Institute projects including the SAVE meta-analysis, the ENCHANTED imaging project, and secondary analyses for stroke outcome and AF events in the CANVAS/CREDENCE trials.

 

Healthy fresh produce colourful colllage

Submission to WHO public consultation on the draft guideline ‘fiscal policies to promote healthy diets’

The George Institute for Global Health is pleased to contribute to the public consultation on the World Health Organization (WHO) draft Guideline on fiscal policies to promote healthy diets in February 2023.

We applaud the World Health Organization (WHO) for recognising that Member States may benefit from additional guidance to help them establish or strengthen fiscal policies on food and non-alcoholic beverages as part of a larger package of policies to promote healthy diets and, in so doing, reduce the burden of non-communicable diseases (NCDs).

In our response, we shared recommendations including (but not limited) to:

  1. Create a shorter and more concise document that explicitly mentions that evidence availability and certainty are linked to the level of implementation. Therefore ‘conditional’ recommendations, if well designed, would be expected to have a desirable and large effect. Otherwise, the guideline runs the risk of undermining the importance of implementing fiscal policies for healthy diets beyond taxes on sugar-sweetened beverages.
  2. Strengthen adaptation and implementation of the guideline by specifying that its primary audience is Member States and including considerations on substitution and reformulation and its impact on the effectiveness of taxes.
  3. Address more directly the legitimate equity concerns of consumers and other stakeholders; including the affordability and accessibility of healthy foods.
  4. Define the terms ‘healthy diets,’ ‘subsidies,’ ‘non-alcoholic beverages’ and ‘discretionary foods’.
  5. Include recommendations that (1) further research needs to be done to shed a light on this issue, and (2) consider gender-responsive budgeting for fiscal policies.

This submission was prepared by members of the Food Policy, Health Systems Research, and Impact and Engagement Team, in addition to a complementary, joint submission that was co-developed with the NCD Alliance.

We congratulate the WHO on the development of the Guideline and stand ready to collaborate to address research gaps and considerations identified by the WHO.

 

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Policy Papers - 06/03/2023

clinical trial managers job

Strengthening clinical trials to provide high-quality evidence on health interventions and to improve research quality and coordination

In May 2022, the seventy-fifth World Health Assembly (WHA 75.8) voted in favour of a resolution urging all countries to develop their capacity in conducting clinical trials. This resolution, proposed by Argentina, Peru, and the United Kingdom, urges governments to increase the efficiency, financing, reporting, and regulatory and ethical frameworks of clinical trials and tasks the World Health Organization (WHO) with developing a global action plan to strengthen practice in this space.

To support the implementation of resolution WHA 75.8, WHO will review existing - and develop new - guidance for Member States and non-state actors on the design and conduct of clinical trials and in strengthening the clinical trial ecosystem. The George Institute was pleased to contribute to the first round of consultations in October 2022 to inform its forthcoming guidance.

Our key recommendations for best practices to improve the global clinical trials ecosystem are to:

  • Ensure adequate and timely recruitment of participants to trials to meet sample size requirements, so that studies can answer clinical questions and thus avoid waste.
  • Consolidate ethics practices across regions and develop better mechanisms for rapid approval.
  • Ensure participation in clinical trials from sites in rural, regional, remote, marginalised and resource-poor settings, and adequate representation of underserved populations among both trial teams and participants.
  • Report on diversity in trial populations and inclusivity in recruitment as a requirement of funding bodies and peer-reviewed journals.
  • Ensure that trials focus on research questions and include research methods that reflect the priorities, culture, and needs of the communities they seek to serve.
  • Provide universal access to affordable and comprehensive training courses in clinical trial design and conduct.
  • Ensure systematic and transparent registration and reporting of clinical trials.

The full input is accessible on the WHO webpage here, and a supplementary report has been developed with more extensive summaries of the inputs received, available here.

We congratulate the WHO on the development of its guidance and stand ready to collaborate to support the implementation of resolution WHA 75.8.

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Policy Papers - 06/03/2023

Event

Tea with Africa: Chronic Kidney Disease in Africa: Lived experiences and opportunities for improving systems of care

Chronic-Kidney-Disease-Africa

To mark the Word Kidney day, The George Institute for Global Health invites you to the session of the 'Tea with Africa' conversation on Thursday 09th March at 8:00am GMT, 9:00am WAT, 9:00am BST, 10:00am CAT, 11:00am EAT, 1:30pm IST, 6:00pm AEST.

The topic to be explored is, 'Chronic Kidney Disease in Africa: Lived experiences and opportunities for improving systems of care'. The event will provide a brief overview of the current situation, provide insight into what is working with current examples, and discuss ideas for the future.

This event will feature a first-hand account of people living with chronic kidney disease in Zimbabwe, share current efforts to improve the quality of life of people living with CKD in Africa, and identify further opportunities for improving systems of care. 

  • ‘Life as a patient with chronic kidney disease in Zimbabwe’,  Mr Sibanda, is a member of the Kidney Association of Zimbabwe and suffers from chronic kidney failure  
  • ‘Chronic kidney disease challenges, responses and opportunities in Zimbabwe’, Dr. Rumbidzai Dahwa, Head of the Renal department at Sally Mugabe hospital and Lecturer in the Department of Medicine at the University of Zimbabwe College of Health Sciences 
  • ‘CKD-Africa collaboration:  Experiences and opportunities for researching chronic kidney disease in Africa’, Dr Cindy George, Chair CKD-Africa and Senior Scientist at the South African Medical Research Council 

Speakers and audience are invited to: 

  • Reflect on the lived experiences of people living with CKD in Africa  
  • Share potential approaches that may reduce the instances of chronic kidney failure in Africa and beyond 
  • Share interests around collaborative research, policy advocacy, and capacity-building activities related to CKD in Africa 

A reflection blog will follow the event. Audience members are invited to share their thoughts on inclusion. 

This event will be recorded for distribution by:

  • The George Institute for Global Health  
  • The Non-Communicable Diseases Department of the Ministry of Health and Child Care, Zimbabwe 
  • National Physicians Association of Zimbabwe 
  • Social media platforms of partners including Kidney Association of Zimbabwe 

Register here

Speakers

  • Dr. Rumbidzai Dahwa

    She graduated with an honour's degree in Bachelor of Medicine and Bachelor of Surgery from the University of Zimbabwe in 2003. She pursued postgraduate studies in Australia and qualified as a Specialist Physician and Nephrologist in December 2013.  Dr. Dahwa is also Head of the Renal department at Sally Mugabe Central hospital and does consultant renal work at Parirenyatwa Hospital. She is currently a Lecturer in the Internal Medicine Unit  at the University of Zimbabwe Faculty of Medicine and Health Sciences. The University of Zimbabwe (UZ) is a public university in Harare, Zimbabwe. She is also pursuing her PhD under Martin Gallagher at The George Institute. 

  • Lysias Sibanda

    She is a member of the Institute of Chartered Accountants of Zimbabwe with a wide range of experience in the financial sector. He has kidney failure and is passionate about causing a shift in the level of service to Kidney patients in Zimbabwe through the Kidney Association of Zimbabwe and the organization which he leads BBRAUN Zimbabwe ( Pvt) Limited spreading dialysis services though out the whole country.

  • Dr Cindy George (Chair- CKD-Africa)

    Dr George is a Senior Scientist at the South African Medical Research Council and holds a PhD from the University of Stellenbosch, South Africa. Cindy’s research area is centred on chronic kidney disease (CKD) in African populations, focussing on characterizing the burden of CKD and examining the risk factors and underlying mechanisms associated with the disease. She was key in establishing and currently manages the CKD-Africa Collaboration, which is an African network of studies with renal outcomes. The aim of the network is to pool individual participant data (IPD) to, (1) determine the burden of CKD in Africa, (2) create resources that would allow the burden of CKD to be tracked and (3) enable CKD projections to be made in the context of Africa. To date, the network has access to 60126 IPD, from 15 African countries; with more studies in the process of enrolment. Dr George has a good publication history, with 32 of her outputs being published in the past 7 years (post-PhD). She is a South African National Research Foundation-rated scientist, and Africa-Oxford (AfOx) Fellow. 

  • Host: Dr. Sradha Kotwal

    Dr Kotwal is a clinical nephrologist at the Prince of Wales Hospital in Sydney; Program Head of the Renal and Metabolic Division at The George Institute for Global Health. Her research interests include novel and pragmatic clinical trials and she is passionate about increasing clinical trial access for patients with kidney disease. Dr Kotwal has expertise in translating research into clinical practice and in-depth knowledge of statistical techniques, epidemiology and clinical trial design. She has engaged with projects in India and Fiji looking at the burden of kidney disease and renal replacement therapies.

Further reading

Event

Evidence2Policy 2023: From global to local and back again: Perspectives on community engagement in universal health coverage

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The George Institute for Global Health, India, is organising its sixth evidence2policy (e2p) virtual lecture inviting Dr. Justin Koonin to speak on the topic “From global to local and back again: Perspectives on community engagement in universal health coverage.” 

Mark your calendars for 14th March 2023 | Tuesday | 13:30 IST | 08:00 GMT | 16:00 CST | 03:00 EST | 19:00 AEDT

About e2P Lecture

The George Institute India started an annual Evidence2policy (e2p) lecture series in 2017 to mark its 10th year anniversary. The lecture was delivered by a leading global researcher to discuss how to bridge the “know-do gap” when it comes to public health policy implementation. Past lecturers have been Prof K Srinath Reddy, President, Public Health Foundation of India; Prof Ian Jacobs, Vice-Chancellor, UNSW Sydney, Dr Rajani Ved, former Executive Director of the National Health Systems Resource Centre, India,  Dr Ophira Ginsburg, New York University, Professor Frank J Kelly, Imperial College London.

About this year’s lecture

Engaging communities in designing and promoting health and wellbeing is logical - and arguably necessary - to success. But how is it done effectively, at both a local and global level? How can we use the insights provided at a local level to shape policies at a global level, that are relevant and can be implemented in a variety of contexts?

In this lecture, Dr Justin Koonin will draw on his contrasting experiences as both a local community member and steering committee member of global policy bodies, including his role as co-chair of UHC2030 - the international multistakeholder partnership for Universal Health Coverage - to discuss the intrinsic value of community engagement, and outline different levels, depths and breadths in design and implementation of public health programs.

Following the lecture, there will be a fireside chat moderated by Rosemary Mburu, Executive Director, WACI Health, Kenya.

Download the event agenda (PDF 195 KB)

Register here

Speakers

  • Dr Justin Koonin

    Justin is co-chair of the Steering Committee of UHC2030, the international multi-stakeholder partnership for universal health coverage, and is a member of multiple WHO expert panels. At a national level, Justin is president of ACON (AIDS Council of New South Wales), Australia’s largest community organisation dedicated to HIV/AIDS prevention, care and support, as well as to the health of sexuality and gender diverse people more broadly. He is Distinguished Fellow and Honorary Professorial Fellow at The George Institute and Adjunct Associate Professor in the Faculty of Medicine and Health at the University of New South Wales, as well as a Fellow of the Australian Institute of Company Directors. Justin's training is in the field of pure mathematics, and he currently works as an investment analyst.

    Justin Koonin

  • Moderator: Rosemary W. Mburu

    Rosemary Mburu has been a champion for healthy communities for over fifteen years and currently serves as the Executive Director for WACI Health. She is a civil society leader in Africa and has extensively worked on supporting civil society to engage with decision-makers at community, national, regional and global levels. She is a civil society organiser working on building and strengthening civil society networks and platforms for health-related advocacy and campaigning in Africa. She holds a Masters in Public Health from Ohio University, a Masters in Business Administration from Frostburg State University, Maryland, and a Bachelor of Education from Kenyatta University, Kenya. 

    Rosemary Mburu

Further reading

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