The CCRE-IBMH is a multi-centre research collaboration aimed at improving outcomes in malignant haematology and bone marrow transplant recipients, with a focus on bioethics and infection.

The CCRE consists of 4 primary research sites affiliated with the University of Sydney, including the Western Clinical School at Westmead Hospital, The Children’s Hospital Westmead, the National Centre for Immunisation Research and the Centre for Values Ethics and Law in Medicine. Collaborative sites include St Vincent’s Hospital, Sydney Children’s Hospital, Faculty of Medicine University of New South Wales, the Post-graduate Nursing Foundation and The Faculty of Health Sciences, University of Western Sydney.

The research collaboration will develop and evaluate surveillance methods, new diagnostics and interventions, such as vaccination and cell-based therapies, to improve infection-related outcomes in malignant haematology and bone marrow transplantation. Bioethics will underpin all major research themes.

Nursing, medical and allied health personnel working in the areas of malignant haematology and/or Infectious Diseases are invited to apply for scholarships (PhD and Masters) and Honours Projects for research commencing in 2006. Areas of potential research include:

PhD Topics 

Cell-based therapies

Adoptive immunotherapy is a novel therapeutic and prophylactic strategy aimed at reducing the morbidity and mortality caused by opportunistic infections such as CMV, EBV, VZV, Aspergillus. PhD related projects will include:

v     Generation of cellular immunity to VZV in vitro

v     Generation of cellular immunity to Aspergillus in vitro

v     Assessment of promising candidate immune cells in clinical trials

Bioethics

Consent to high-risk procedures: transplantation

v     Autonomy, agency and dependence in health care

v     Intuition in medical decision making “Cults” in health and medicine

v     Patient experience of survival following allogeneic stem cell transplant.

Patient & Health Care Worker Beliefs About & Attitudes to Health-Care Associated Infections / Multi-resistant Organisms.

v     Benefits and risks and disclosure of risks and infection rates (qualitative research)

v     Benefits, risks and professional, social, legal conflicts related to the administration of toxic therapies (eg aerosolised ribavirin) that have therapeutic potential, and the isolation and infection control measures used to limit the spread of nosocomial infections (eg community respiratory viruses, multi-resistant organisms).

Clinical Infectious Diseases/Microbiology

Predicting and Preventing Therapeutic Failure in Neutropenic Sepsis

v           A project is available to analyse the epidemiology of resistance to the major antibiotics (aminoglycosides and the newest beta-lactams including the carbapenems) and its transferability by analysing the epidemiology of associated genetic vehicles (integrons, transposons and plasmids), their host range and their phenotypic variability.

v     Defining the diversity of resistance genes and their vehicles in order to develop early warning systems (both for detection of resistance potential in the commensal microflora, and for recognition of key resistance in blood culture isolates as much as a day before conventional results are available) and to determine the specific planning of empiric antibiotic regimens with a view to managing the selection of resistance within the microflora both within the individual patient and within the Unit as a whole.

v     Developing and testing screening and diagnostic systems and their impact on prescribers would be an important emphasis. This would be supported by parallel projects with strong molecular genetics components and may particularly suit those with a clinical background.

Invasive fungal infections(IFI) in paediatric HSCT and haematological malignancies

The incidence and risk factors for IFIs is not well-documented in paediatric patients. There are differences in antifungal use between major centres and with the introduction of voriconazole there is evidence that zygomycoses are increasing.

v     This project will involve a retrospective case controlled study in paediatric patients in Sydney and Melbourne followed by a prospective study of host factors, diagnostic tests, treatments, co-infections etc to determine clinical prediction rules for diagnosis of invasive fungal infections.

v     A sub-study will focus particularly on pulmonary disease to determine predictors of invasive aspergillosis, zygomycosis, fusariosis and candidiasis.

v     Molecular and other tests will be developed, applied to respiratory secretions and blood and evaluated.

Vaccinology

v     A randomised controlled trial comparing the immunogenicity of polysaccharide and conjugated pneumococcus vaccines in BMT patients.

 Masters Projects

Cell based therapies

v     Assess effect of immunosuppressive agents on function of CMV specific CTL.

v     Assess role of cytokines in expansion of CMV specific CTL.

v     Assess role of CD3/28 co-stimulation in expansion of CMV specific T cells.

v     Generation of adeno CTL using Ad5f35pp65.

Bioethics

Contribution of bioethics to contemporary health care

            Transplantation and Cancer

v     Literature review donor perceptions in Cord Blood banking in Australia.

v     Benefits and disadvantages of cancer support groups.

v     The use and utility of metaphors by patients, carers and clinicians to describe illness / cancer.

v     Care of institutionalised people, eg. Prisoners, psychiatric patients, demented patients, children with developmental disability, asylum seekers etc with leukaemia.

v     Ethical issues in the active management of dying in the palliative care and ICU settings (including terminal sedation).

v     The role of palliative care in transplantation

v     Perceptions of intensive care, specialists / nurses to patients with haematological malignancies.

v     Consent and understanding in clinical research in haematology, transplantation and infectious diseases.

v     Systematic review of evidence for complementary therapy in haematological and solid malignancies.

v     Use of complementary therapies and therapists by transplant patients in Australia.

v     Survey of complementary therapists eg. Traditional Chinese therapists regarding interaction with conventional medicine / care in haematology.

v     Survey of uses of “self help” literature by transplant patients. The use of the Internet by transplants patients.

v     Perceptions of donors regarding participation in research: altruism and risk.

v     Review of health professionals’ attitudes to the use of potential harmful agents.

v     Isolation of children and adult transplant patients:

v     Evidence and impact

v     Experience of patients with myeloma following autologous transplantation.

v     Planning for end-of-life care and death (literature review).

v     Experience of bereavements following transplantation.

v     Meaning and ambiguity of the term “transplant”

Infectious Diseases/Microbiology

Infection Control- Central Line Infections

v     Literature review of risk factors and of interventions to prevent (and / or treat) Central Venous Catheter infections in malignant haematology and Bone Marrow Transplantation.

v     Preliminary trial of risk assessment tool.

An Investigation of the effects on clinicians’ decision-making of access to varying levels of information about the incidence, risks and characteristics of CVC-BSI using simulated case scenarios.

Surveillance for invasive infections – Minimum data sets

Surveillance for infections that contribute substantially to morbidity and mortality in HSCT recipients has the potential to influence policy and practice but has not been implemented at a state or national level.

v     This project aims to define and develop minimum data sets for bacterial, fungal and viral infections, evaluate their acceptance in a restricted number of centres and determine benchmarks for incidence of the different infections by comparison of outcomes in different centres.

Diagnostics-TB

v     Evaluation of new diagnostic tests for diagnosis of latent TB infection in BMT recipients.

v     Utility of M.Tb diagnostic assays in the assessment of immune reconstitution in BMT recipients with latent TB / past BCG exposure.

Vaccinology

v     Impact of pneumococcal vaccination on nasopharyngeal colonisation.

Independent Learning Projects/Honours Projects 

Diagnostics-TB

v     Literature review of diagnostic tests for latent TB (Mantoux, Elispot, Quantiferon) in BMT and immunocompromised haematology patients.

v     Risk factors for latent TB/TB reactivation in malignant haematology & BMT.

Infection Control-Central Line infection

v     Literature review of risk factors and / or interventions to prevent and / or treat CVC infection.

Infection, Immunology and transplantation

v     Assess role of co-stimulatory molecules in T cell responses.

v     Review of international guidelines for vaccination in BMT patients.

v     Survey of zoster incidence following auto/allogeneic BMT and immunosuppressive chemotherapy.

v     Review of international guidelines for vaccination in BMT patients.

Mycology

v     Review of paediatric literature on invasive fungal infections

Bioethics

v     Historical review of “duty to treat”

v     Historical review of Quarantine measures for infection control.

v     Ethical issues in tuberculosis/ respiratory virus control/ Influenza pandemic planning (Risk, management, prevention )

v     Influence of gender on risk perception.

v     Systematic review of exclusion criteria for stem cell harvest.

v     Systematic review of evidence for haematopoietic progenitor cell (HPC) transplantation in HIV.

v     Systematic review of quality of life following stem cell transplant.

v     Systematic review of adverse events in bone marrow / HPC donation (children & adults).

v     Systematic review of positive thinking in cancer.

v     Systematic review of the benefits of exercise following transplantation (exercise and recovery from cancer). Issues raised by emergence of CRO’s in research.

v     Systematic review of existing consent protocols and practices in transplantation.

v     Review of guidelines for scientific review of research

v     Social justice issues in stem cell donation and banking Australia (with particular reference to Indigenous Australians).

v     Social justice issues in access to emerging technologies / medical therapies.

v     Indigenous perceptions of and responses to cancer / haematological malignancy and transplantation.

v     Review of guidelines for management of dying in ICU.

v     Systematic review of treatment of respiratory viral infection following HPC transplant.

v     Evidence for interaction between complementary therapies and chemotherapeutic agents, antimicrobial agents and immunosuppressants.

v     Evidence for behavioural / lifestyle advice for reducing the risks of infection following transplantation.

v     Systematic review of research participants’ understanding of research concepts eg. Equipoise and randomisation.

For further information contact Dr Nicole Gilroy (02) 9845 5891 or Professor Tania Sorrell (02) 9845 6012