Monday, 27 February 2017

A summer interest contributes to safe drug repository


Yi Sien Koo thought he might be bored during the summer holidays so he applied for a summer research scholarship at Monash Rural Health Churchill. The final year medicine student might joke about his reasons for wanting to undertake a short research project, but this wasn’t the first time he’d applied and he was pleased to be awarded the scholarship.

Over the course of his studies, Yi Sien developed an interest in women’s and children’s health. So the project – Milking the evidence: improving medicine information for lactating women about infant risk – supervised by Associate Professor Shane Bullock and Dr Adelle McArdle felt like a natural fit.

Creating an evidence repository

The project involved reviewing the evidence available for women and clinicians about the safety profiles of medications while breastfeeding. Working with another student, Jacoba van Wees, Yi Sien looked at the kind of evidence available, and what level of recommendations, if any, the literature offers. In addition, they wanted to know where people were looking for information and the factors driving their behaviour.

Reviewing one drug group can take up to several days, and in some cases there may be no end to the availability of literature to scour through. Nonetheless, they tried to compare the types of evidence offered across the drug groups. “For example, there was more literature on antibiotics use for mastitis during breastfeeding as compared to say drugs for asthma, and this is possibly because of the relationship breastfeeding has on the incidence of mastitis in the post-natal period,” he explained. The students found there  were differences in the type of information available to guide clinical judgement across the drug groups, and hence had to arrive at a consensus and agree on certain parameters to assess their safety profiles. This would allow a more targeted literature search and a focused agenda.

Communication and collaboration

It quickly became clear to Yi Sien that collaboration and communication skills in research are important at all levels. “Communicating with Adelle and Shane was really important. They did guide us a lot, but they gave us a lot of freedom as well,” he said. “It’s something that Jacoba and myself benefited a lot from because it allowed us to explore different drugs, or even different areas of parameters that we might not have focussed on. I learned to think, not solely of the project but of certain things we can do in the future too.”

“Shane and Adelle have been brilliant supervisors, not just in this project, but they’ve offered help beyond the project as well,” he said.

Learnings beyond the literature

Reading so much literature in a concentrated time gave Yi Sien more than an overview of medication evidence. “We also got the flavour of population health such as barriers to information that patients may encounter. I also read about cultural practices that have been ongoing which could influencehow women feel about lactation and drugs. On top of the medical information you get to understand how and why people behave in particular ways and the  aspects influencing people’s access to health information.”

He also developed skills in reviewing literature itself. “Going through tons of information over time allowed me to gradually learn to pick things up that were more relevant.”

Developing a mobile app

Collating the important information into an easily accessible source was the desired aim of the project. Associate Professor Bullock thought a mobile application that would be user friendly and convenient for both mothers and clinicians might achieve that. He drew on the expertise of another Monash Rural Health researcher in Mildura, Dr Naj Soomro, who has expertise in mobile apps for research and was very willing to help.

An app is a major project in itself, but by the end of the scholarship project, Yi Sien and Jacoba had at least drawn designs for a prototype application with Naj’s help: the home page, a drug page, the important parameters, and how a user might interact with the app.

While designs for a prototype were underway, Associate Professor Bullock approached an academic colleague from Monash Rural Health - Anne Leversha, an experienced senior pharmacist - to seek guidance from a contact of hers - another pharmacist at the Monash Medical Centre, who is one of the learning experts in lactation drugs, to review the parameters the students had developed.

Continuing the work beyond summer

Five weeks’ work established a good base for the evidence repository, but there’s a lot more to be done. Unsurprisingly, Yi Sien feels he’s invested a lot in the project and would like to continue working on it when his studies allow. And he’d certainly recommend the experience to other students. “As health professionals we always have to go into some sort of research these days,” he said. “But for students, it’s important to find something that interests you because it may not go as you expected.”

It’s a busy year for Yi Sien. His first rotation is in Frankston, he heads overseas for an elective and travels to Bendigo later in the year for another rotation. Coming from metropolitan Melbourne he really enjoyed his stay in the Monash Rural Health accommodation in Moe which is a short drive from Churchill where he was based for the project over the summer. “I really enjoyed staying in the rural setting coming from a metro life the past few years. So that’s something I was looking forward to when I applied for the project. I actually like the countryside, living there was great.”

And he certainly wasn’t bored over his summer break.

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