Robert West

University College London, Londinium, England, United Kingdom

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Publications (213)917.83 Total impact

  • [show abstract] [hide abstract]
    ABSTRACT: A network meta-analysis of randomized trials and real-world comparative studies strongly suggest that varenicline is more effective in aiding smoking cessation than single form nicotine replacement therapy (NRT). Modeling the health benefits attributable to this difference relies on extrapolation to lifetime cessation, but to date, follow-up has only extended to 12 months. Longer term follow-up data are helpful in checking these assumptions. This study aimed to compare the sustained abstinence rates of smokers using varenicline versus nicotine patch in their quit attempt up to 36 months. Five hundred eighty-seven smokers were recruited at Kaohsiung Veteran General Hospital between Feb 2006 and Aug 2009. Participants received counseling from a physician and received either varenicline (N = 296) or the nicotine patch (N = 291) for smoking cessation. Both varenicline and nicotine patch users could receive their medications for a maximum of 8 weeks. Participants were followed up by telephone at 3, 6, 12, and 36 months from the first visit. The primary outcome measure was self-reported sustained abstinence up to 36 months. Measures were also taken of smoking characteristics, cigarette dependence, and sociodemographic characteristics. Multiple logistic regression of 36-month sustained abstinence on to medication adjusting for other baseline variables showed a significant advantage for varenicline, OR = 7.94 (95 % CI 1.87-33.74). An 8-week course of varenicline appears to yield higher abstinence rate up to 3 years than a similar length course of nicotine transdermal patch in routine clinical practice where behavioral support is available.
    Psychopharmacology 02/2014; · 4.06 Impact Factor
  • Joanne Neale, Peter Miller, Robert West
    Addiction 02/2014; 109(2):175-6. · 4.58 Impact Factor
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    ABSTRACT: Background: It is assumed that smokers rarely quit without ‘attempting’ to do so but the assumption does not appear to have been adequately tested. This study assessed the prevalence of reporting having stopped without reporting a quit attempt and the reasons given for this discrepancy. Methods: Data were collected from ex-smokers who said they had quit within the last 12 months during nationally representative household surveys conducted monthly between 2006–12. Results: Of the 1,892 ex-smokers who said that they had quit within the last 12 months, 13.9% (95%CI = 12.4%–15.5%) reported having made no serious quit attempts in that period. In a sub-group of 24 smokers who were asked why they had reported stopping without also reporting an attempt, nine cited inconsistency over timing; three reported stopping without attempting to do so; four did not consider it an ‘attempt’ because they had succeeded; and six had not ruled out the occasional cigarette in the future. Conclusions: A substantial minority of people who report having stopped in the past year may fail to report a corresponding quit attempt. However, quitting smoking without considering that one has tried appears to be rare. Instead, the most common reason for the discrepancy is inconsistent reporting of the timing of quit attempts.
    The Journal of Smoking Cessation 01/2014;
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    ABSTRACT: India has 275 million adult tobacco users and tobacco use is estimated to contribute to more than a million deaths in the country each year. There is an urgent need to develop and evaluate affordable, practicable and scalable interventions to promote cessation of tobacco use. Because tobacco use is so harmful, an increase of as little as 1 percentage point in long-term quit success rates can have an important public health impact. This protocol paper describes the rationale and methods of a large randomized controlled trial which aims to evaluate the effectiveness of a brief scalable smoking cessation intervention delivered by trained health professionals as an outreach programme in poor urban communities in India. This is a pragmatic, two-arm, community-based cluster randomized controlled trial focused on tobacco users in low-income communities. The treatment arm is a brief intervention comprising brief advice including training in craving control using simple yogic breathing exercises (BA-YBA) and the control arm is very brief advice (VBA). Of a total of 32 clusters, 16 will be allocated to the intervention arm and 16 to the control arm. Each cluster will have 31 participants, making a total of 992 participants. The primary outcome measure will follow the Russell Standard: self-report of sustained abstinence for at least 6 months following the intervention confirmed at the final follow-up by salivary cotinine. This trial will inform national and international policy on delivery of scalable and affordable brief outreach interventions to promote tobacco use cessation in low resource settings where tobacco users have limited access to physicians and medications.
    Addiction 01/2014; · 4.58 Impact Factor
  • Jamie Brown, Robert West
    BMJ (Clinical research ed.). 01/2014; 348:g1378.
  • Source
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    ABSTRACT: There have been few rigorous studies on the effects of behavioural support for helping smokers to reduce who do not immediately wish to quit. While reduction may not have the health benefits of quitting, it may lead smokers to want to quit. Physical activity (PA) helps to reduce cravings and withdrawal symptoms, and also reduces weight gain after quitting, but smokers may be less inclined to exercise. There is scope to develop and determine the effectiveness of interventions to support smoking reduction and increase physical activity, for those not ready to quit. To conduct a pilot randomised controlled trial (RCT) [Exercise Assisted Reduction then Stop (EARS) smoking study] to (1) design and evaluate the feasibility and acceptability of a PA and smoking-reduction counselling intervention [for disadvantaged smokers who do not wish to quit but do want to reduce their smoking (to increase the likelihood of quitting)], and (2) to inform the design of a large RCT to determine the clinical effectiveness and cost-effectiveness of the intervention. A single-centre, pragmatic, pilot trial with follow-up up to 16 weeks. A mixed methods approach assessed the acceptability and feasibility of the intervention and trial methods. Smokers were individually randomised to intervention or control arms. General practices, NHS buildings, community venues, and the Stop Smoking Service (SSS) within Plymouth, UK. Aged > 18 years, smoking ≥ 10 cigarettes per day (for ≥ 2 years) who wished to cut down. We excluded individuals who were contraindicated for moderate PA, posed a safety risk to the research team, wished to quit immediately or use Nicotine Replacement Therapy, not registered with a general practitioner, or did not converse in English. We designed a client-centred, counselling-based intervention designed to support smoking reduction and increases in PA. Support sessions were delivered by trained counsellors either face to face or by telephone. Both intervention and control arms were given information at baseline on specialist SSS support available should they have wished to quit. The primary outcome was 4-week post-quit expired air carbon monoxide (CO)-confirmed abstinence from smoking. Secondary outcomes included validated behavioural, cognitive and emotional/affective and health-related quality of life measures and treatment costs. The study randomised 99 participants, 49 to the intervention arm and 50 to the control arm, with a 62% follow-up rate at 16 weeks. In the intervention and control arms, 14% versus 4%, respectively [relative risk = 3.57; 95% confidence interval (CI) 0.78 to 16.35], had expired CO-confirmed abstinence at least 4 and up to 8 weeks after quit day; 22% versus 6% (relative risk = 3.74; 95% CI 1.11 to 12.60) made a quit attempt; 10% versus 4% (relative risk = 92.55; 95% CI 0.52 to 12.53) achieved point-prevalent abstinence at 16 weeks; and 39% versus 20% (relative risk = 1.94; 95% CI 1.01 to 3.74) achieved at least a 50% reduction in the number of cigarettes smoked daily. The percentage reporting using PA for controlling smoking in the intervention versus control arms was 55% versus 22%, respectively at 8 weeks and 37% versus 16%, respectively, at 16 weeks. The counsellors generally delivered the intervention as planned and participants responded with a variety of smoking reduction strategies, sometimes supported by changes in PA. The intervention costs were approximately £192 per participant. Exploratory cost-effectiveness modelling indicates that the intervention may be cost-effective. The study provided valuable information on the resources needed to improve study recruitment and retention. Offering support for smoking reduction and PA appears to have value in promoting reduction and cessation in disadvantaged smokers not currently motivated to quit. A large RCT is needed to assess the clinical effectiveness and cost-effectiveness of the intervention in this population. ISRCTN 13837944. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment, Vol. 18, No. 4. See the NIHR Journals Library website for further project information.
    Health technology assessment (Winchester, England). 01/2014; 18(4):1-324.
  • Jamie Brown, Martin Jarvis, Robert West
    BMJ (Clinical research ed.). 01/2014; 348:g1946.
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    ABSTRACT: Background E-cigarettes may be effective smoking cessation aids and their use by smokers has been growing rapidly. It is important to observe and assess natural patterns in the use of e-cigarettes while experimental data accumulates. This paper reports the prevalence of e-cigarette awareness, beliefs and usage, including brand choice, and characterises the socio-demographic and smoking profile associated with current use, among the general population of smokers and recent ex-smokers. Methods Data were obtained from 3538 current and 579 recent ex-smokers in a cross-sectional online survey of a national sample of smokers in Great Britain in December 2012. Differences between current and recent ex-smokers in the prevalence of e-cigarette awareness, beliefs and usage were examined and the socio-demographic and smoking profile associated with current use of e-cigarettes was assessed in a series of simple and multiple logistic regressions. Results Ninety-three per cent of current and recent ex-smokers (n = 3841) were aware of e-cigarettes. Approximately a fifth (n = 884) were currently using e-cigarettes, while just over a third (n = 1507) had ever used them. Sixty-seven per cent of the sample (n = 2758) believed e-cigarettes to be less harmful than cigarettes; however, almost a quarter (n = 994) remained unsure. Among both current and recent ex-smokers, the most popular reasons for using were health, cutting down and quitting (each > 80%) and 38% used the brand ‘E-lites’. Among current smokers who were aware of but had never used e-cigarettes, approximately half (n = 1040) were interested in using them in the future. Among current smokers, use was associated with higher socio-economic status (OR = 0.68, 95%CI = 0.57-0.80), smoking more cigarettes (OR = 1.02, 95%CI = 1.01-1.03) and having a past-year quit attempt (OR = 2.82, 95%CI = 2.38-3.34). Conclusions There is a near universal awareness of e-cigarettes and use appears to be common among smokers in Great Britain although a quarter of all smokers are unsure as to whether e-cigarettes are less harmful than cigarettes. E-lites – a brand that delivers a low dose of nicotine – is the most popular. E-cigarette users appear to have higher socio-economic status, to smoke more cigarettes per day and to have attempted to quit in the past year.
    Addictive behaviors 01/2014; · 2.25 Impact Factor
  • Daniel Kotz, Jamie Brown, Robert West
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    ABSTRACT: There is a need for more evidence on the 'real-world' effectiveness of commonly used aids to smoking cessation from population-level studies. This study assessed the association between abstinence and use of different smoking cessation treatments after adjusting for key potential confounding factors. Cross-sectional data from aggregated monthly waves of a household survey: the Smoking Toolkit Study. England. A total of 10 335 adults who smoked within the previous 12 months and had made at least one quit attempt during that time. Participants were classified according to their use of cessation aids in their most recent quit attempt: (i) medication (nicotine replacement therapy, bupropion or varenicline) in combination with specialist behavioural support delivered by a National Health Service Stop Smoking Service; (ii) medication provided by the prescribing health-care professional without specialist behavioural support; (iii) nicotine replacement therapy (NRT) bought over the counter; and (iv) none of these. The main outcome measure was self-reported abstinence up to the time of the survey, adjusted for key potential confounders including tobacco dependence. Compared with smokers using none of the cessation aids, the adjusted odds of remaining abstinent up to the time of the survey were 3.25 [95% confidence interval (CI) = 2.05-5.15] greater in users of prescription medication in combination with specialist behavioural support, 1.61 (95% CI = 1.33-1.94) greater in users of prescription medication combined with brief advice and 0.96 (95% CI = 0.81-1.13) in users of NRT bought over the counter. After adjusting for major confounding variables such as tobacco dependence, smokers in England who use a combination of behavioural support and pharmacotherapy in their quit attempts have almost three times the odds of success than those who use neither pharmacotherapy nor behavioural support. Smokers who buy nicotine replacement therapy over the counter with no behavioural support have similar odds of success in stopping as those who stop without any aid.
    Addiction 12/2013; · 4.58 Impact Factor
  • Fabiana Lorencatto, Robert West
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    ABSTRACT: Objectives: Behavioral support for smoking cessation is delivered through different modalities, often guided by treatment manuals. Recently developed methods for assessing fidelity of delivery have shown that face-to-face behavioral support is often not delivered as specified in the service treatment manual. This study aimed to extend this method to evaluate fidelity of telephone-delivered behavioral support. Method: A treatment manual and transcripts of 75 audio-recorded behavioral support sessions were obtained from the United Kingdom's national Quitline service and coded into component behavior change techniques (BCTs) using a taxonomy of 45 smoking cessation BCTs. Interrater reliability was assessed using percentage agreement. Fidelity was assessed by comparing the number of BCTs identified in the manual with those delivered in telephone sessions by 4 counselors. Fidelity was assessed according to session type, duration, counselor, and BCT. Differences between self-reported and actual BCT use were examined. Results: Average coding reliability was high (81%). On average, 41.8% of manual-specified BCTs were delivered per session (SD = 16.2), with fidelity varying by counselor from 32% to 49%. Fidelity was highest in pre-quit sessions (46%) and for BCT "give options for additional support" (95%). Fidelity was lowest for quit-day sessions (35%) and BCT "set graded tasks" (0%). Session duration was positively correlated with fidelity (r = .585; p < .01). Significantly fewer BCTs were used than were reported as being used, t(15) = -5.52, p < .001. Conclusions: The content of telephone-delivered behavioral support can be reliably coded in terms of BCTs. This can be used to assess fidelity to treatment manuals and to in turn identify training needs. The observed low fidelity underlines the need to establish routine procedures for monitoring delivery of behavioral support. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Journal of Consulting and Clinical Psychology 12/2013; · 4.85 Impact Factor
  • Addiction 12/2013; 108(12):2045-7. · 4.58 Impact Factor
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    ABSTRACT: A national smoking cessation campaign based on behaviour change theory and operating through both traditional and new media was launched across England during late 2012 ('Stoptober'). In addition to attempting to start a movement in which smokers would quit at the same time in response to a positive mass quitting trigger, the campaign set smokers the goal of being smoke-free for October and embodied other psychological principles in a range of tools and communications. Data on quit attempts were obtained from 31,566 past-year smokers during nationally representative household surveys conducted monthly between 2007 and 2012. The effectiveness of the campaign was assessed by the increase in national quit attempt rate in October relative to other months in 2012 vs. 2007-2011. Relative to other months in the year, more people tried to quit in October in 2012 compared with 2007-2011 (OR=1.79, 95%CI=1.20-2.68). In 2012 there was an approximately 50% increase in quitting during October compared with other months of the same year (9.6% vs. 6.6%; OR=1.50, 95%CI=1.05-2.15), whereas in 2007-2011 the rate in October was non-significantly less than in other months of the same period (6.4% vs. 7.5%; OR=0.84, 95%CI=0.70-1.00). Stoptober is estimated to have generated an additional 350,000 quit attempts and saved 10,400 discounted life years (DLY) at less than £415 per DLY in the modal age group. Designing a national public health campaign with a clear behavioural target (making a serious quit attempt) using key psychological principles can yield substantial behaviour change and public health impact.
    Drug and alcohol dependence 11/2013; · 3.60 Impact Factor
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    ABSTRACT: To assess extent of electronic cigarette use by smokers attending Stop Smoking Services, the advice given about electronic cigarettes and whether this usage is recorded. Fifty-eight managers and 1284 practitioners completed an online survey. Questions covered use of electronic cigarettes, the advice given and whether use was recorded in client databases. Ninety per cent (n=1150) and 95% (n=1215) of practitioners respectively, reported that their clients were using electronic cigarettes and that they had been asked about them. Seventy-one per cent (n=41) of managers reported that they had a policy on the advice to be given; of whom 85% (n=35) said that practitioners should say that products were unlicensed. Fifty-five per cent (n=707) of practitioners reported giving such advice and 11% (n=138) said they warned smokers about their safety. Only 9% (n=119) reported that they recorded clients' use. Although use of electronic cigarettes by smokers in Stop Smoking Services is common, few provisions are in place to record their use. Practitioners mostly advise that products are not licensed. There is a need to consider additional training for practitioners on use of e-cigarettes and harm reduction generally to ensure that advice is consistent and evidence-based.
    Patient Education and Counseling 11/2013; · 2.37 Impact Factor
  • Lion Shahab, Leonie S Brose, Robert West
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    ABSTRACT: Nicotine replacement therapy (NRT) has been used in the treatment of tobacco dependence for over three decades. Whilst the choice of NRT was limited early on, in the last ten years there has been substantial increase in the number of nicotine delivery devices that have become available. This article briefly summarises existing forms of NRT, evidence of their efficacy and use, and reviews the rationale for the development of novel products delivering nicotine via buccal, transdermal or pulmonary routes (including nicotine mouth spray, nicotine films, advanced nicotine inhalers and electronic cigarettes). It presents available evidence on the efficacy, tolerability and abuse potential of these products, with a focus on their advantages as well as disadvantages compared with established forms of NRT for use as an aid to both smoking cessation as well as harm reduction.
    CNS Drugs 10/2013; · 4.83 Impact Factor
  • Robert West, Jamie Brown
    Second 10/2013; Wiley Blackwell., ISBN: 978-0-470-67421-5
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    ABSTRACT: Understanding how prompts for quit attempts relate to quitting methods and success may improve smoking cessation interventions. This study aims to establish whether prompts for quitting are associated with quitting method and success. Using a cross-sectional design, 6,126 past-year smokers who had tried to quit in the last 12 months, were asked to identify prompts contributing to their most recent attempt. Attempts prompted by health professional advice were significantly more likely to involve use of treatments and gradual rather than abrupt cessation (odds ratios (ORs; 95 % confidence interval (CIs)) = 3.64 (3.14-4.22), 0.68 (0.59-0.78); respectively) but were not more likely to succeed. Attempts prompted by concern about current or future health, or cost, were more likely to succeed (OR (95 % CIs) = 1.79 (1.38-2.32), 1.25 (1.01-1.54), and 1.41 (1.13-1.76)). Quit attempts prompted by health professional advice appear to be more likely to involve gradual reduction and use of treatments. Those prompted by health concerns and cost appear more likely to succeed.
    Annals of Behavioral Medicine 09/2013; · 4.20 Impact Factor
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    ABSTRACT: It has been proposed that positive smoker identity may be an important factor undermining smoking cessation but very little research exists on this. This study tested the hypothesis that a simple measure of positive smoker identity would predict quit attempts over and above other known predictors in a population sample. More tentatively it explored whether this measure would also predict quit success. A representative sample of adult smokers in England (n=9456) was included at baseline and 2099 were followed-up at six months. Demographic and smoking characteristics, a single item measure of positive smoker identity (endorsing the statement: 'I like being a smoker'), measures of smoking-related attitudes, quit attempts and quit success were included. A total of 18.3% (95% CI=17.5-19.2) of smokers reported a positive smoker identity. Adjusting for all other predictors, those with a positive smoker identity were more likely to be older (p<0.001), male (p=0.013), more nicotine dependent (p<0.001), have lower motivation to stop (p<0.001), have not made a quit attempt in the past year (p=0.025), enjoy smoking (p<0.001), and consider themselves to be addicted (p<0.001). Having a positive smoker identity independently predicted failure to make a quit attempt at six months (p=0.007). The independent association with quit success was similar in magnitude but did not reach statistical significance (p=0.053). Only a minority of smokers in England have a positive smoker identity. However, where it is present it may be an important barrier to quitting smoking and merits further study.
    Drug and alcohol dependence 09/2013; · 3.60 Impact Factor
  • Addiction 09/2013; · 4.58 Impact Factor
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    ABSTRACT: Lack of adherence to smoking cessation medication regimens is assumed to play a significant role in limiting their effectiveness. This study aimed to assess evidence for this assumption. A systematic search was conducted, supplemented by expert consultation, of articles reporting on randomised trials and observational studies examining the association between adherence to cessation medication and the success of quit attempts. To rule out reverse causality, only studies where adherence was assessed prior to relapse were included. Five studies met the inclusion criteria and results were extracted independently by two researchers. Heterogeneity between studies precluded a pooled analysis of the data. Studies varied widely with regard to both the definition of adherence and outcome measures. Included studies only addressed adherence to nicotine replacement therapy. One study of lozenge use found that amount of medication used between 1 and 2 weeks after the quit date predicted abstinence at 6 weeks (adjusted OR for 'high' versus 'low' lozenge use 1.25; 95% confidence interval (CI) = 1.05-1.50; p<0.02). Similarly, one study found a significant impact of oral nicotine consumption during the first week on abstinence at four weeks (adjusted OR per additional mg/d: 1.05%; CI = 1.01-1.10). Another study found that participants using nicotine replacement therapy for at least five weeks were significantly more likely to self-report continuous abstinence at 6 months. The remaining two studies failed to find a significant effect of treatment duration on outcome at one and two years but had very low power to detect such an effect. There is modest evidence to support the assumption that lack of adherence to nicotine replacement therapy regimens undermines effectiveness in clinical studies.
    Addiction 08/2013; · 4.58 Impact Factor
  • Source
    Paul Aveyard, Robert West
    Thorax 08/2013; · 8.38 Impact Factor

Publication Stats

2k Citations
917.83 Total Impact Points


  • 2005–2014
    • University College London
      • • Department of Epidemiology and Public Health
      • • Cancer Research UK Health Behaviour Research Centre
      Londinium, England, United Kingdom
    • Brunel University
      अक्सब्रिज, England, United Kingdom
  • 2013
    • University of Queensland 
      • UQ Centre for Clinical Research
      Brisbane, Queensland, Australia
    • UConn Health Center
      • Department of Community Medicine and Health Care
      Farmington, Connecticut, United States
    • University of Oxford
      • Department of Primary Care Health Sciences
      Oxford, ENG, United Kingdom
    • Georg-August-Universität Göttingen
      Göttingen, Lower Saxony, Germany
    • ICL
      Londinium, England, United Kingdom
  • 2011–2013
    • St George's, University of London
      • Division of Population Health Sciences and Education
      London, ENG, United Kingdom
  • 2009–2013
    • Maastricht University
      • • Department of General Practice
      • • Department of Health Promotion
      Maastricht, Provincie Limburg, Netherlands
    • University of Sussex
      • School of Psychology
      Brighton, ENG, United Kingdom
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France
    • University of Pittsburgh
      • Psychology
      Pittsburgh, PA, United States
  • 2012
    • Cardiff University
      Cardiff, Wales, United Kingdom
    • King's College London
      • Florence Nightingale School of Nursing and Midwifery
      London, ENG, United Kingdom
    • UK Department of Health
      Londinium, England, United Kingdom
  • 2010–2011
    • Goldsmiths, University of London
      Londinium, England, United Kingdom
    • Queen Mary, University of London
      • Barts and The London School of Medicine and Dentistry
      Londinium, England, United Kingdom
  • 2007–2011
    • University of Birmingham
      • Department of Primary Care Clinical Sciences
      Birmingham, ENG, United Kingdom
    • Centrum Onkologii-Instytut im. Marii Skłodowskiej-Curie
      Warszawa, Masovian Voivodeship, Poland
  • 2003–2011
    • University of London
      Londinium, England, United Kingdom
  • 2007–2009
    • University of East London
      • Psychology
      London, ENG, United Kingdom
  • 2005–2007
    • University of Michigan
      Ann Arbor, Michigan, United States
  • 2006
    • RTI Health Solutions
      Durham, North Carolina, United States
    • University of Geneva
      • Institute of Social and Preventive Medicine
      Genève, Geneva, Switzerland
  • 2004
    • University of Surrey
      • School of Psychology
      Guildford, ENG, United Kingdom
  • 2002
    • St. George's School
      • Department of Psychology
      Middletown, Rhode Island, United States
  • 2001–2002
    • St George Hospital
      Sydney, New South Wales, Australia