Clinical Trials, Imaging and Informatics Division

About Clinical Trials, Imaging and Informatics (CTI)

The Clinical Trials, Imaging and Informatics (CTI) division of the Stroke and Aging Research Group has several facets. An important focus is the conduct of clinical trials (investigator initiated and industry sponsored) trials in acute and secondary stroke prevention. Members of this division are significant contributors to trials such as the Extending the Time for Thrombolysis in Emergency Neurological Deficits (EXTEND-IV) trial and Tenecteplase versus Alteplase for Stroke Thrombolysis Evaluation (TASTE) trial. A new focus is to explore the utility of knowledge discovery and data mining in stroke and aging research. The CTI group welcomes collaboration on projects other than stroke and aging.

Head of Division

Adjunct Clinical Professor Thanh Phan is an acute stroke specialist and neurologist with clinical and research expertise in stroke thrombolysis, endovascular therapy, and the management of transient ischaemic attack (TIA) and minor stroke. He was integral in setting up the rapid admission pathway for neurology and stroke patients, allowing the Emergency Department to meet their Key Performance Indicators. He is responsible for establishing the Monash TIA Triaging and Treatment (M3T) system, an Australian-first non-admission based cost-saving model of care based on triaging, investigation and treatment in emergency departments with follow-up in TIA clinics. He undertakes ward service at both Clayton and Dandenong campuses, consults at Monash Neurology and in addition runs comprehensive stroke and TIA outpatient clinics. He has unique research expertise in the use of advanced imaging (especially MRI) in the study of cerebrovascular diseases and brain ageing.

Biography

Our staff

Meet the Clinical Trials, Imaging and Informatics-CTI team.

Projects

Process of care

  1. Impact of dysphagia screen on medication compliance
  2. Antihypertensive medication usage and discharge delay in Stroke Unit
  3. Hospital handover
  4. Detecting error propagation in medical record

Models of care

  1. Monash TIA Triaging and Treatment (M3T) system, an alternative model of TIA care to avoid hospital admission
  2. Monash Minor Stroke Pathway

Health service research and Policy

  1. Hospital re-design incorporating spatial information
    1. Mapping hospital catchment
    2. App to direct transport of patients to appropriate hospital
  2. Forecasting of disease morbidity and mortality
    1. Minimum dataset requirement
  3. Telemedicine
    1. Re-evaluating cost effectiveness of telemedicine
    2. Efficiency and resilience of telemedicine network
    3. Optimal design of telemedicine network
  4. Optimal design of advisory board and expert group to advise policy makers-using graph theoretical analysis and cooperative game theory

Acute stroke imaging studies

  1. Computer modelling of collateral circulation
    1. Blood flow in acute stroke
    2. modelling effect of endovascular procedures on blood flow
  2. Mapping of neurological deficit in acute stroke
    1. Bayesian analysis of likelihood of infarct given stroke intervention

Post-acute stroke imaging studies

  1. Post-stroke mood disorders
  2. Mapping of vascular anatomy and infarct topography
  3. DTI:-Impact of corticofugal fibers involvement and motor deficit
  4. Stratifying bleeding risk in atrial fibrillation

Hemorrhage and Aneurysm

  1. Prediction of outcome in intracerebral hemorrhage
    1. Decision tree analysis
    2. spot sign in intracerebral hemorrhage
    3. amyloid angiopathy

Rehabilitation

  1. TMS in stroke recovery
  2. driving after stroke
  3. Applying prediction models to stroke rehabilitation

Stroke mechanism

  1. Atherosclerosis
    1. Carotid artery geometry and risk of atherosclerosis
    2. PET imaging of vulnerable carotid plaque
    3. Glagov phenomenon at the carotid bifurcation
    4. Principle of minimum work at the carotid bifurcation and beyond
    5. Mining literature on atherosclerosis
  2. Small vessel disease
    1. defining lacunar infarct
    2. mapping lacunes in CADASIL (Australian, French, German, Scottish collaboration)
  3. Stroke in young patients
    1. Fabry disease
    2. Patent foramen ovale-in innocent bystander?
    3. cerebral vasculitis

Investigator led Clinical Trials

  1. EXTEND-IV- A/Prof Henry Ma is the principal coordinator of this multicentre trial
  2. TASTE trial-NHMRC funded project grant (collaboration with international team)
  3. STAND-FIRM trial – Improving secondary stroke prevention in the community (led by Prof Amanda Thrift)
  4. Stem cell transplant (collaboration with Dr Rebecca Lim, Prof Euan Wallace, Prof Chris Sobey)
  5. Biomarkers in acute stroke (collaboration between A/Prof Henry Ma and Dr Connie Wong)

Neurological Diseases

  1. Seizure treatment (collaboration with A/Prof Udaya Seneviratne)
    1. Decision making under uncertainty
    2. Theme discovery in medical records of patients with pseudoseizure
    3. Health care burden of pseudoseizure
  2. Gait disorders
    1. Neuroimaging of gait disorders
    2. mining medical records of fall risk
  3. Coma and Disorder of Consciousness
    1. Prediction of outcome following coma
    2. Meta-analysis of studies on predictors of coma
  4. Multiple sclerosis-profiling phenotypes
  5. Motor neuron disease (profiling phenotypes, outcome, service planning, health care survey)
  6. Movement disorder-mitochondrial role in Parkinson disease

Other Diseases

  1. Disease mapping
    1. Hip fracture
    2. Cancer
    3. Birth

Education

  1. Education of junior staff on seizure recognition

Knowledge Discovery and Data Mining projects

  1. natural language processing
    1. Mining literature on atherosclerosis
    2. Theme discovery in publications on lacunar stroke
    3. Theme discovery in medical records of patients with TIA
    4. Sentiment analysis of health care survey eg neurodegenerative disease
  2. Geospatial analysis
    1. Modelling transport system in health care
      Mapping hospital catchment
    2. Disease mapping
      -Stroke
  3. Social network analysis
    1. Impact of social network on health eg stroke
    2. Analysis of tweets following negative trials in major journals
    3. Efficiency and resilience of telemedicine network
  4. graph theoretical analysis
    1. Graph theoretical analysis of relationship between infarct location and disability
    2. Social network and post stroke recovery
  5. Recommender system
    1. Role in physician decision making
    2. Role in junior doctor decision making
    3. profiling multiple sclerosis phenotypes
    4. profiling motor neurone disease phenotypes
  6. Discrete event simulation
    1. Optimisation of hospital network
    2. Optimisation of acute stroke team

Opportunities

If you are thinking of a career in biomedical research The School of Clinical Sciences is a great place to start. We are located at Monash Medical Centre (MMC) Clayton within easy walking distance of both Monash University Clayton Campus and the Clayton Shopping District.

Find out more about current postgraduate opportunities (Honours, Masters, PhD) with the Clinical Trials, Imaging and Informatics (CTI).

Biography

Prof. Phan held the position of Director of the Stroke Unit at Southern Health (2004-2015) and has been Adjunct Clinical Professor of Medicine at Monash University since 2013. Prof Phan obtained his MBBS from University of New South Wales and has subsequently undertaken fellowships in Epilepsy, Neurology, Stroke and Neurocritical care in Cerebrovascular disease, including time at the Mayo Clinic, Rochester. He is a Fellow of the Royal Australian College of Physicians and was an NHMRC Postgraduate Research Scholar. In 2008 he completed his PhD (University of Melbourne) with a thesis entitled Applications of MR Imaging in acute ischaemic stroke.

Currently a full-time staff specialist Neurologist in the Department of Neurosciences at Monash Health, Prof Phan undertakes ward service at both Clayton and Dandenong campuses, consults at Monash Neurology and in addition runs comprehensive stroke, young stroke, TIA and Minor stroke outpatient clinics. He is actively involved in the teaching of Advanced Physician Trainees in both Neurology and Stroke and provides supervision for a Doctorate student and the Monash Stroke Fellowship program.

Prof Phan is also extremely active in conducting research into several aspects of cerebrovascular disease and neurological diseases. He leads the Acute Stroke, Data mining and Imaging Division of the Stroke and Ageing Research Group (STAR) in the Department of Medicine, School of Clinical Sciences at Monash Health. These include neuroimaging studies involving CT, MRI, PET and LORETA transformation of EEG studies, health service modelling and evaluation, basic and computational studies of the cerebral circulation, and clinical trial design. Outside of cerebrovascular diseases, his neurological research interests include video-based neurological teaching (e.g. seizure recognition) prediction of coma outcome and migraine. He is chief investigator on NHMRC grants and co-supervises 2 PhD students and one Dpsych student. He serves as Associate Editor on Frontiers in Neurology (Stroke) and PLOS One.

Biography

A/Prof. Ma holds the position of Director of Stroke Unit at Monash Health (2015-), Adjunct Associate Professor of Medicine at Monash University (2015-), Director of Physician Training at Monash Health and is a senior member of the National Examiner Panel and Adult Medicine Division Basic Training Committee for the Royal Australasian College of Physician (RACP). He undertook his doctoral thesis on imaging of ischaemic penumbra with Profs Donnan and Davis. His work on persistence of penumbra beyond the traditional 3 hour time-frame has generated the idea for the EXtending the time for Thrombolysis in Emergency Neurological Deficits (EXTEND)-IV trial. He published the trial protocol for the EXTEND-IV trial.  He is a clinician and educator who also has the ability to organise collaborative multicentre clinical trials and observational studies as evidenced by his high productivity, role as co-chair of the Australian Stroke Trial Network (ASTN). His major research skill is in the clinical trials and penumbral imaging.

He is Principal Coordinator of the multicentre trial of the clot-busting drug tissue plasminogen activator, EXTEND-IV. The trial is being conducted in Australia and Asia. His role in ASTN puts him in an ideal position to promote this trial to other sites in Phases II and III. He plays a key role in evaluation of biomarkers using stroke data from START-EXTEND trial.