ProfessorGregory Peterson

Project Total: $7,000; Atrial fibrillation (AF) affects nearly 500,000 Australians, with prevalence expected to double within two decades due to population ageing, improved survival from AF-associated risk factors, and enhanced detection. AF increases the risk of ischaemic stroke fivefold, and approximately one-third of all strokes are attributable to AF. These events are disproportionately severemore likely to be fatal, recurrent, and economically burdensomecosting the Australian healthcare system an estimated $5 billion annually. Oral anticoagulants (OACs) reduce stroke risk by 64%, yet real-world persistence remains suboptimal. Our recent study at the Royal Hobart Hospital (RHH), published in the European Journal of Clinical Investigation and supported by the 2023 Royal Hobart Research Foundation (RHHRF) Incubator Grant, demonstrated that multidisciplinary care improved guideline-concordant OAC prescribing from 53.8% at admission to 73.8% at discharge. The studys clinical relevance was further underscored in an invited editorial by Boriani et al, a member of the European Society of Cardiology Guidelines Committee. Despite gains in initiation, continuity of OAC therapy post-discharge, incidence of cardiovascular-related rehospitalisation and stroke, and the implementation of integrated AF management remain unexamined in Tasmania and nationally. This study will generate real-world evidence across the following areas: (i) rates and factors of OAC discontinuation at 12 months; (ii) incidence and drivers of cardiovascular-related rehospitalisation and stroke; and (iii) adherence to the ABC pathway (Avoid stroke, Better symptom control, Cardiovascular/comorbidity management) and its impact on clinical outcomes. By addressing these gaps, the study directly supports Australias national health priority of cardiovascular disease by targeting AF and its common comorbidities. These efforts align with national strategies to reduce stroke risk and improve chronic disease management across high-burden populations. Given that OACs are among the most clinically impactful yet high-risk therapies, enhancing their safe and sustained use is a national imperative. Findings will strengthen evidence-based practice, empower multidisciplinary teams, and promote holistic AF care that extends beyond stroke preventionultimately improving patient outcomes in Tasmania and across Australia. Funded by: Royal Hobart Hospital Research Foundation - Research Project Grant ($7,000); University of Tasmania.

Project Total: $18,421; Ceftazidime is recommended for treating Pseudomonas peritonitis in patients treated with peritoneal dialysis (PD). Our recent in vitro studies show that pyridine is produced in toxic quantities when ceftazidime is mixed with PD fluids. Given the concerns associated with pyridine toxicities, there is an urgent need to confirm our recent findings by measuring in vivo levels of pyridine in patients treated with intraperitoneal ceftazidime mixed with commonly used PD solutions. Available analytical assays can analyse pyridine and ceftazidime in PD solutions but not in the blood due to sensitivity limits and co-elution of endogenous substances with pyridine. To address this, we are pioneering the first-ever international study to develop innovative and non-invasive approaches for quantifying pyridine and ceftazidime levels in whole blood. The developed non-invasive blood sampling technique and novel analytical assay will lay the foundations for clinical research to ensure safer and more effective care for PD patients, minimising toxic side effects and improving health outcomes in real-world practice. Funded by: Royal Hobart Hospital Research Foundation - Grant-Project ($18,421); University of Tasmania.

Project Total: $25,000; Appropriate use of oral anticoagulants (OACs) reduces the risk of stroke and death by 64% and 25%, respectively. In our previous study that compared OAC prescribing at admission (community) and discharge (hospital), we confirmed that, in routine care, the RHH team improved the guideline appropriateness of OAC use in patients with atrial fibrillation. However, half of the patients with guideline-inappropriate OAC prescribing at admission were discharged without correction. The efficiency of correcting inappropriate OAC use varied significantly across RHH admission wards. An intervention that enhances the likelihood of the RHH care team to correct inappropriate OAC use is required. Funded by: Royal Hobart Hospital Research Foundation - Grant-Project ($25,000); University of Tasmania.

Project Total: $10,000; The number of Tasmanians living with cancer is estimated to be over 30,000 and is increasing. A study using the Tasmanian Cancer Registry data found that heart and blood vessel disorders known as cardiovascular disease (CVD) are the leading causes of non-cancer death in Tasmanians with cancer. Over a quarter of all deaths and more than half of all non-cancer deaths are caused by CVD. However, no study examined the use of CVD preventive medications in Tasmanian cancer survivors. This study aims to investigate CVD preventive medication use following acute coronary syndrome admission in Tasmanian cancer survivors. Funded by: Royal Hobart Hospital Research Foundation - Grant-Incubator ($10,000); University of Tasmania.

Project Total: $24,944; The safe and quality use of medicines is a new National Health Priority Area, with significant health consequences, particularly for older people. This innovative project will implement and evaluate a sticker alert system in the patients progress notes to optimise anticholinergic medication therapy to reduce the risk of adverse outcomes. The project also aims to modify the existing anticholinergic medications rating score (high=3, moderate=2, low=1) for the Australian context through a modified Delphi process. Funded by: Royal Hobart Hospital Research Foundation - Grant-Project ($24,944); University of Tasmania.

Project Total: $9,999; The high prevalence of antipsychotic use in aged care has led to concern of inappropriate sedation. Emerging evidence suggests that hospitalisation is contributing to this issue. This study will trial a geriatric antipsychotic stewardship program for non-psychiatric admissions of older people to improve the use and review of antipsychotics during and after hospitalisation. Funded by: Royal Hobart Hospital Research Foundation - Grant-Incubator ($9,999); University of Tasmania ($9,529).

Project Total: $2,767,445; The OPTIMAS-GP study is a program of implementation science research in 3 stages designed to determine the best strategies for reducing inappropriate antibiotic use in Australian general practice. The study will target community acquired respiratory infections. Funded by: Medical Research Future Fund - Grant-Clinical Trial Activity Initiative; Monash University; University of Wollongong; Bond University; University of Tasmania.

Project Total: $1,499,093; The recent Aged Care Royal Commission found systemic flaws in medicines management in Australian residential aged care facilities (RACFs). To combat the widespread overprescribing? of sedative medicines, this landmark inquiry recommended to improve the quality of pharmacist-led medicines reviews in RACFs and implement new care models that embed pharmacists onsite within aged care teams. The government quickly responded with the largest investment in a single pharmacy program in our nation's history ($345M over 4 years) to fund onsite pharmacists from Jan 2023. Yet, no formal structures are in place to monitor the impact of this innovative new care model or equip pharmacists with the information they urgently need to improve medicines safety and health outcomes for the 240,000 Australians who receive RACF care annually. An agreed set of quality use of medicines indicators that span an individual's aged care journey, are suitable for Australian RACFs, and that can be efficiently monitored are urgently needed. Our AIM is to support pharmacists and aged care teams to implement best practice care by developing a national quality monitoring program that improves the health and wellbeing of older Australians in RACFs. Our OBJECTIVES are to: 1. Explore key stakeholder needs and preferences for onsite pharmacist services in RACFs and related quality use of medicines indicators for a national monitoring program. 2. Synthesise and evaluate existing quality use of medicines indicators that are suitable for use in Australian RACFs. 3. Develop an evidence-based national quality framework for pharmacist services in RACFs. 4. Determine feasibility and acceptability by evaluating using multiple real-world population-based data sources and implementing the agreed quality indicators in RACFs. 5. Estimate direct health system costs due to facility-level variation in quality use of medicines. 6. Develop a national dissemination and implementation plan for successful program scaling. Funded by: Medical Research Future Fund - Grant-Quality, Safety, Effectiveness of Medicine; University of Tasmania.

Project Total: $9,985; Our recent studies indicate that many community-based patients with atrial fibrillation and a high stroke risk still do not receive the recommended anticoagulant therapy. This study will examine anticoagulant use in patients with atrial fibrillation upon admission and discharge and determine whether hospitalisation represents an opportunity to improve the quality of care. Funded by: Royal Hobart Hospital Research Foundation - Grant-Incubator ($9,985); University of Tasmania.

Project Total: $9,996; Drugs with anticholinergic properties carry significant risks in older people, including extended hospital admissions, falls, dementia and increased mortality. However, the pattern of anticholinergic drug prescribing in Tasmania is not yet known. This study will investigate the effectiveness of an educational intervention to improve prescribing of anticholinergic-type drugs. Funded by: Royal Hobart Hospital Research Foundation - Grant-Incubator ($9,996); University of Tasmania.

Project Total: $24,943; GLA:D is an international evidence-based education and exercise program for people with knee and hip osteoarthritis. This project will evaluate the implementation of GLA:D through the RHH physiotherapy community outpatient clinics for patients on a joint replacement surgery pathway. It will benefit patients and potentially reduce pressure on elective surgery waiting lists. Funded by: Royal Hobart Hospital Research Foundation - Grant-Project ($24,943); University of Tasmania.

Project Total: $9,497; Blood clots are a serious and often life-threatening complication of cancer that can be largely avoided with appropriate care. We will review preventative practices used locally, as well as associated influences, with the aim to optimise care and reduce this risk in future Tasmanians diagnosed with cancer. Funded by: Royal Hobart Hospital Research Foundation - Grant-Incubator; University of Tasmania.

Project Total: $30,000; The Alcohol, Tobacco and Drug Council of Tasmania (ATDC) has partnered with the Drug Education Network, Pharmacy Guild of Australia, the Pharmaceutical Society of Tasmania and the University of Tasmania to develop and deliver a targeted community place-based initiative to raise awareness of the risks of pharmaceutical use. The ATDC is able to coordinate this work, through the financial support of the Alcohol and Drug Foundation's Local Drug Action Team Program. Funded by: Alcohol and Drug Foundation - Grant-Local Drug Action Team Program; University of Tasmania.

Project Total: $1,294,542; The study will be performed in collaboration with the Wurli-Wurlinjang Health Service (Katherine, NT). Our team has completed a feasibility study at the trial site, and the study protocol has now been published. This randomised controlled trial will examine the clinical efficacy of a simple and low-cost bush medicine (tea tree oil, TTO) treatment against scabies and the prevention of associated secondary bacterial infections. The study will include 208 participants who will be randomised to receive treatment with either 5% v/w TTO gel or an active control (permethrin 5% cream). Both treatments will be applied on day 1 and repeated on day 8 - left on the body for 8 to 12 hrs each time. The primary outcome for the study is clinical cure (complete resolution) at the end of the 30-day follow-up period, as assessed by Aboriginal Health Practitioners blinded to treatment allocation. Secondary outcome measures will include relief of symptoms, recurrence rate, secondary bacterial infections, adverse effects, adherence to treatment regimen and patient acceptability. Our treatment could reduce the burden of scabies and associated secondary bacterial infections leading to improved quality of life and better societal outcomes in vulnerable Indigenous communities. Funded by: Medical Research Future Fund - Grant - Rare Cancers, Rare Diseases and Unmet Need; University of Tasmania.

Project Total: $9,791; The project is a retrospective audit of thromboprophylaxis prescribing for hip and knee arthroplasty patients who have undergone (or will undergo) surgery at the RHH between June 2017 and June 2019. Funded by: Royal Hobart Hospital Research Foundation - Grant-Incubator ($9,791); University of Tasmania.

Project Total: $9,458; Ceftazidime is the first line treatment for Pseudomonas peritonitis. Thus, the production of pyridine, a toxic degradation product of ceftazidime, raises some concern. This study will examine the degradation of ceftazidime in peritoneal dialysis solutions to propose some recommendations in order to minimise the exposure of patients to pyridine. Funded by: Royal Hobart Hospital Research Foundation - Grant-Incubator ($9,458); University of Tasmania.

Project Total: $1,999,135; A randomised controlled trial of the effect of incentive payments general practice care in relation to longer consultations, more continuity of care, the ability to see under 16 year olds on the same day, seeing hospital discharged patients within a week, better antibiotic stewardship and better deprescribing practice. Funded by: Royal Australian College of General Practitioners - Grant; University of Wollongong; University of Tasmania.

Project Total: $69,182; Stroke continues to be a major public health issue. It is the third most common cause of death. The financial cost in Australia is estimated to be $5 billion each year. Tasmania and South Australia are the worst affected States. Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, is a major modifiable risk factor for stroke. AF is associated with a five times increased risk of stroke and is responsible for up to 25% of strokes in elderly adults. Recently, international guidelines and expert consensus statements have recommended more widespread screening for AF in those aged 65 years or older. The case is compelling - AF is common and a leading cause of stroke. Unfortunately, AF often has no symptoms and is commonly undiagnosed or untreated by the time stroke occurs. AF-related strokes are associated with significant morbidity, mortality, and healthcare costs, yet they are highly preventable with the use of warfarin or newer anticoagulant drugs. Given the availability of effective therapy, along with accurate and inexpensive screening technology, population-based AF screening has the potential to become an important public health program. In older age groups, identification and management of AF is the most significant way to prevent stroke. Internationally, there have been recent recommendations for more widespread screening for AF in those aged 65 years or older, as a cost-effective strategy for stroke prevention. This project will raise public awareness of AF and improve its detection, and subsequently lessen the burden of stroke in Tasmania. We intend to screen approximately 3,000 Tasmanians aged 65 years or older, and without previously diagnosed AF. Screening will take place throughout most of 2018 at a range of community venues across Tasmania. Funded by: Tasmanian Community Fund - Grant ($69,182); University of Tasmania ($9,000).

Project Total: $18,851; Funded by: Australian Research Council ($18,851); University of Tasmania.

Project Total: $57,742; This project involves the evaluation of an 18-month community care coordination and telemonitoring project. The project is funded by Primary Health Network Tasmania, and managed by Corumbene Care. Funded by: Corumbene Nursing Home for the Aged ($57,742); University of Tasmania.

Project Total: $54,016; We have developed an innovative smoking cessation mHealth app (Quittr: The Fun Way to Quit) that employs game-based reward systems. In addition to using games as a distraction tool to help smokers deal with cigarette cravings, we have designed a novel approach using addictive in-app games to facilitate engagement with the content. Users are granted virtual currency in exchange for positive behaviours that are known to improve quit attempts, which they can then redeem for bonuses in an enjoyable yet compulsive mobile game. We are now in the process of evaluating this innovative technology amongst suitable cohorts, in an effort to determine both the effect size, and to further refine the content and presentation to ensure optimal engagement and effect. Smokers at risk of cardiovascular disease have been identified as users who are particularly likely to benefit from this approach. They have significant potential for benefit. We believe that our novel approach will appeal to these patients, and improve their success rate. Funded by: Heart Foundation - Grant-Vanguard ($54,016); University of Tasmania.

Project Total: $135,000; Funded by: University of Tasmania - Grant- Research Enhancement Program; University of Tasmania ($135,000).

Project Total: $9,837; Glucosamine is often taken by patients with osteoarthritis, with patients varying in their clinical response. This variation may be due to differences in absorption of the compound, which is known to be poorly absorbed. This study will investigate plasma levels, with a newly developed analytical procedure, in individuals taking glucosamine. Funded by: Royal Hobart Hospital Research Foundation - Grant-Starter ($9,837); University of Tasmania.

Project Total: $127,000; The bequested grant will be utilised over 12 years to support higher degree research student projects being supervised by early-mid career Faculty staff members. The intention, in addition to increasing high-quality research outputs, is to support growth in the number of higher degree research students and supervisor capacity across the Faculty. Funded by: Donation via University of Tasmania Foundation - Donation ($127,000); University of Tasmania.

Project Total: $332,190; Study craving during the first two weeks of a quit attempt Funded by: CHRONO THERAPEUTICS ($332,190); University of Tasmania.