Michael J Dooley

Alfred Hospital, Melbourne, Victoria, Australia

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Publications (92)254.18 Total impact

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    ABSTRACT: Introduction: ED overcrowding has been associated with increased mortality, morbidity and delays to essential treatment. It was hypothesised that hospital-wide reforms designed to improve patient access and flow, in addition to improving ED overcrowding, would impact on clinically important processes within the ED, such as timely delivery of antibiotics. Methods: A single pre-implementation and post-implementation prospective cohort study was conducted prior to and after a hospital-wide reform (Timely Quality Care (TQC)). Among patients who had intravenous antibiotics prescribed in the ED, data were prospectively collected on times of presentation, prescription and administration of antibiotics. Demographics and discharge diagnoses were retrospectively extracted. Results: There were 380 cases included with 179 cases prior to introduction of the TQC model and 201 cases after its introduction. Time from presentation to administration of antibiotics improved significantly from 192 (99-320) min to 142 (81-209) min (P < 0.01). The time from presentation to prescription pre-TQC and post-TQC was 120 (51-230) min and 92 (49-153) min, respectively (P < 0.01). The times from prescription to administration pre-TQC and post-TQC were 43 (20-83) min and 34 (15-66) min, respectively (P = 0.03). Conclusion: Following implementation of hospital-wide reform directed at mitigating ED overcrowding through improved access and flow, times to administration of antibiotics were significantly reduced. These findings suggest that improved quality of care in this area may be achieved with processes aimed at improved hospital access and flow. Ongoing evaluation and vigilance is necessary to ensure sustainability and drive further improvements.
    No preview · Article · Dec 2015 · Emergency medicine Australasia: EMA
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    ABSTRACT: Background: The prevalence and impact of antimicrobial "allergy" labels and Adverse Drug Reactions (ADRs) on antibiotic usage and antimicrobial stewardship initiatives is ill defined. We sought to examine the rate of antimicrobial "allergy labels" at our tertiary referral centre and impacts on antimicrobial usage and appropriateness. Methods: Two inpatient antimicrobial prevalence surveys were conducted over a 1-week period in November 2013 and 2014 as part of the prospective National Antimicrobial Prescribing Survey (NAPS). Post survey, patients recorded in the NAPS database were assigned to two groups based upon recorded antimicrobial "allergy label" and ADR: (i) Antimicrobial Allergy/ADR (AA) or (ii) No Antimicrobial Allergy/ADR (NAA). Antimicrobial usage and antimicrobial appropriateness were compared between AA and NAA groups. Results: From 509 identified patients the prevalence of an antimicrobial allergy or ADR was 25 %. The prevalence of "allergy labels"/ADR was 10 % (51/509) for penicillin V/G, 5 % (24/509) cephalosporins, 4 % (22/509) trimethroprim-sulfamethoxazole and 3 % (17/509) aminopenicillins. One thousand and seventy antimicrobials were prescribed during the study periods, the median antimicrobial duration was longer in the AA versus NAA group (6 days vs. 4 days; p = 0.018), and proportion of inappropriate antimicrobial prescribing higher in the AA group compared with NAA (29 %; 35/120 vs. 23 %; 86/367, p = 0.22). Oral antimicrobial administration was higher in the NAA than AA group (60 %; 177/297 vs. 46 %; 356/793, p = 0.0001). The proportion of patients that received a β-lactam was lower in the AA versus NAA group (60 % vs. 79 %, p = 0.0001). Conclusions: In an Australian tertiary referral centre an antimicrobial "allergy" or ADR label was found to significantly impacted on rate of oral antimicrobial administration, beta-lactam usage, antimicrobial duration and antimicrobial appropriateness.
    Full-text · Article · Dec 2015 · BMC Infectious Diseases
  • Melanie Kowalski · Erica Y. Tong · Gary S. Yip · Michael J. Dooley
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    ABSTRACT: Valproate is commonly prescribed as part of combination therapy in antiepileptic or mood stabilising regimens. Although generally well tolerated, valproate has potential to cause serious adverse effects, one of which is valproate-induced hyperammonaemic encephalopathy (VHE). The risk of developing VHE is rare; however, this can increase when valproate is used in conjunction with other medications. This report aims to highlight the importance of early diagnosis of VHE and emphasise the potential deleterious effects of polypharmacy and certain hazardous drug combinations. A 58-year-old woman with a 1-week history of increasing lethargy, confusion and drowsiness presented to the emergency department. Blood tests showed a raised ammonia level and liver function test (LFT) derangement. She had been on a long-term antiepileptic regimen which included sodium valproate. The only recent change to her medications was the introduction of atorvastatin. A diagnosis of VHE was made and valproate was discontinued. Atorvastatin was also stopped on account of its likely role in LFT derangement. After discontinuation of both agents attributed to her presentation, serum ammonia and LFTs returned to within normal range. The patient also gradually resumed her usual level of alertness and functional state. This report describes a case of VHE and emphasises the detrimental role of polypharmacy associated with this presentation. This illustrates the potentially complex pharmacy issues that must be considered in the management of a patient on chronic valproate therapy.
    No preview · Article · Dec 2015 · Journal of Pharmacy Practice and Research
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    ABSTRACT: Objectives: The objective of our study was to describe spontaneously reported haemorrhagic adverse events associated with rivaroxaban and dabigatran in Australia. Methods: Data were sourced from the Australian Therapeutic Goods Administration (TGA) Database of Adverse Event Notifications between June 2009 and May 2014. Records of haemorrhagic adverse events in which rivaroxaban or dabigatran was considered as a potential cause were analysed. Results: There were 240 haemorrhagic adverse events associated with rivaroxaban and 504 associated with dabigatran. Age was specified for 164 (68%) haemorrhages associated with rivaroxaban, of which 101 occurred in people aged ⩾75 years. Age was specified for 437 (87%) haemorrhages associated with dabigatran, of which 300 occurred in people aged ⩾75 years. Time from treatment initiation to haemorrhage was specified for 122 (51%) haemorrhages associated with rivaroxaban, with 69 (57%) haemorrhages occurring within 30 days of rivaroxaban initiation. Time from treatment initiation to haemorrhage was specified for 253 (50%) haemorrhages associated with dabigatran, with 123 (49%) haemorrhages occurring within 30 days of dabigatran initiation. Gastrointestinal (GI) haemorrhages were the most frequent type of haemorrhages associated with both rivaroxaban (n = 105, 44%) and dabigatran (n = 302, 60%). Data were available on the severity of haemorrhage for 101 (42%) haemorrhages associated with rivaroxaban, with haemorrhage leading to death in 17 people. The severity of haemorrhage was specified for 384 (76%) haemorrhages associated with dabigatran, with haemorrhage leading to death in 61 people. Conclusions: Our study highlights the need for research on the haemorrhagic complications of anticoagulation in clinical care. A considerable proportion of reported haemorrhagic events occurred within 30 days of rivaroxaban and dabigatran initiation. This highlights the importance of considering bleeding risk at the time of treatment initiation.
    No preview · Article · Nov 2015 · Therapeutic Advances in Drug Safety
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    ABSTRACT: Aims: To evaluate the effectiveness of a pharmacist-led multicomponent smoking cessation program (GIVE UP FOR GOOD) compared with usual care in hospitalised smokers. Design: Randomised, assessor blinded, parallel group trial. Setting: Three tertiary public hospitals in Australia. Participants: 600 adult inpatient smokers (mean [±SD] age 51±14 years; 64% male) available for 12 months follow-up. Interventions: Multicomponent hospital pharmacist-led behavioural counselling and/or pharmacotherapy provided during hospital stay, on discharge and one month post-discharge with further support involving community health professionals (n = 300). Usual care comprised routine care provided by hospitals (n = 300). Measurements: Two primary endpoints were tested using intention-to-treat analysis: carbon monoxide (CO) validated one month sustained abstinence at six months follow-up and verified six months sustained abstinence at 12 months follow-up. Smoking status and pharmacotherapy usage were assessed at baseline, discharge, one, six and 12 months. Findings: Sustained abstinence rates for intervention and control groups were not significantly different both at six months [11.6% (34/294) vs 12.6% (37/294); OR 0.91, 95% CI 0.55-1.50] and 12 months [11.6% (34/292) vs 11.2% (33/294); OR 1.04, 95% CI 0.63 to 1.73]. Secondary endpoints, self-reported continuous abstinence at six and 12 months, also agreed with the primary endpoints. Use of pharmacotherapy was higher in the intervention group, both during hospital stay [52.3% (157/300) vs 42.7% (128/300); P=0.016] and after discharge [59.6% (174/292) vs 43.5% (128/294); p<0.001]. Conclusions: A pharmacist-led multicomponent smoking cessation intervention provided during hospital stay did not improve sustained abstinence rates at either six or 12 months compared with routine hospital care. This article is protected by copyright. All rights reserved.
    No preview · Article · Nov 2015 · Addiction
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    ABSTRACT: Clinical medication review (CMR) is a structured and collaborative service aimed at identifying and resolving medication-related problems (MRPs). This is the first systematic review of CMR research in Australia. To systematically review the processes and outcomes of CMR in community-settings in Australia. MEDLINE, EMBASE, International Pharmaceutical Abstracts (IPA), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library and the grey literature were searched from 2000 to February 2015. All study designs were considered. Data extraction and quality assessment were performed independently by two investigators. Nine controlled studies, 34 observational and uncontrolled studies, 11 qualitative studies (focus groups and interviews) and nine survey studies were included. The CMRs resulted in identification of MRPs (n = 15 studies, mean 3.6 MPRs per CMR) and improved adherence (n = 3). Reductions in numbers of medications prescribed (n = 3 studies), hospitalizations (n = 3), potentially inappropriate prescribing (n = 3) and costs (n = 6) were demonstrated. Comparisons to a control group, predominately non-recipients of CMR, were made in eleven of 43 studies. Evidence supports additional models that promote interprofessional collaboration and timely referral following hospital discharge. Qualitative research identified low awareness of CMR among eligible non-recipients, while benefits were perceived to outweigh barriers to implementation. Underserved populations include indigenous and culturally and linguistically diverse people, recipients of palliative care, those recently discharged from hospital, people with poor medication adherence, those in rural and remote areas, older males, and younger people with long-term, persistent or serious health problems. The available evidence suggests CMR is beneficial in improving the quality use of medications and health outcomes. However, lack of comparator groups in many observational studies limited the strength of conclusions in relation to the impact on clinical outcomes. Addressing access gaps for underserved populations, implementing additional referral pathways, and facilitating greater collaboration between the health professionals represent opportunities for further improvement. Copyright © 2015 Elsevier Inc. All rights reserved.
    No preview · Article · Jul 2015 · Research in Social and Administrative Pharmacy
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    ABSTRACT: A partnered medication review and charting model involving a pharmacist and medical officer was implemented in the Emergency Short Stay Unit and General Medicine Unit of a major tertiary hospital. The aim of the study was to describe the safety and effectiveness of partnered medication charting in this setting. A partnered medication review and charting model was developed. Credentialed pharmacists charted pre-admission medications and venous thromboembolism prophylaxis in collaboration with the admitting medical officer. The pharmacist subsequently had a clinical discussion with the treating nurse regarding the medication management plan for the patient. A prospective audit was undertaken of all patients from the initiation of the service. A total of 549 patients had medications charted by a pharmacist from the 14th of November 2012 to the 30th of April 2013. A total of 4765 medications were charted by pharmacists with 7 identified errors, corresponding to an error rate of 1.47 per 1000 medications charted. Partnered medication review and charting by a pharmacist in the Emergency Short Stay and General Medicine unit is achievable, safe and effective. Benefits from the model extend beyond the pharmacist charting the medications, with clinical value added to the admission process through early collaboration with the medical officer. Further research is required to provide evidence to further support this collaborative model. Copyright © 2015. Published by Elsevier Ltd.
    No preview · Article · May 2015 · Australasian Emergency Nursing Journal
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    Susan G Poole · J Simon Bell · Michael J Dooley · Carl M Kirkpatrick

    Full-text · Article · May 2015 · European Journal of Clinical Pharmacology
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    ABSTRACT: Introduction: It is not known to what extent medication use has been comprehensively assessed in prospective cohort studies of older Australians. Understanding the varying methods to assess medication use is necessary to establish comparability and to understand the opportunities for pharmacoepidemiological analysis. The objective of this review was to compare and contrast how medication-related data have been collected in prospective cohorts of community-dwelling older Australians. Methods: MEDLINE and EMBASE (1990-2014) were systematically searched to identify prospective cohorts of ≥1000 older participants that commenced recruitment after 1990. The data collection tools used to assess medication use in each cohort were independently examined by two investigators using a structured approach. Results: Thirteen eligible cohorts were included. Baseline medication use was assessed in participant self-completed surveys (n = 3), by an investigator inspecting medications brought to a clinic interview (n = 7), and by interviewing participants in their home (n = 3). Five cohorts sought participant consent to access administrative claims data. Six cohorts used multiple methods to assess medication use across one or more study waves. All cohorts assessed medication use at baseline and 12 cohorts in follow-up waves. Twelve cohorts recorded prescription medications by trade or generic name; 12 cohorts recorded medication strength; and 9 recorded the daily medication dose in at least one wave of the cohort. Seven cohorts asked participants about their "current" medication use without providing a definition of "current"; and nine cohorts asked participants to report medication use over recall periods ranging from 1-week to 3-months in at least one wave of the cohort. Sixty-five original publications, that reported the prevalence or outcomes of medication use, in the 13 cohorts were identified (median = 3, range 1-21). Conclusion: There has been considerable variability in the assessment of medication use within and between cohorts. This may limit the comparability of medication data collected in these cohorts.
    Full-text · Article · Apr 2015 · PLoS ONE
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    ABSTRACT: Objective: The objective of the study was to investigate the prevalence of, and factors associated with, polypharmacy in long-term care facilities (LTCFs). Methods: MEDLINE, EMBASE, International Pharmaceutical Abstracts, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library were searched from January 2000 to September 2014. Primary research studies in English were eligible for inclusion if they fulfilled the following criteria: (1) polypharmacy was quantitatively defined, (2) the prevalence of polypharmacy was reported or could be extracted from tables or figures, and (3) the study was conducted in a LTCF. Methodological quality was assessed using an adapted version of the Joanna Briggs Institute Critical Appraisal Checklist. Results: Forty-four studies met the inclusion criteria and were included. Polypharmacy was most often defined as 5 or more (n = 11 studies), 9 (n = 13), or 10 (n = 11) medications. Prevalence varied widely between studies, with up to 91%, 74%, and 65% of residents taking more than 5, 9, and 10 medications, respectively. Seven studies performed multivariate analyses for factors associated with polypharmacy. Positive associations were found for recent hospital discharge (n = 2 studies), number of prescribers (n = 2), and comorbidity including circulatory diseases (n = 3), endocrine and metabolic disorders (n = 3), and neurological motor dysfunctioning (n = 3). Older age (n = 5), cognitive impairment (n = 3), disability in activities of daily living (n = 3), and length of stay in the LTCF (n = 3) were inversely associated with polypharmacy. Conclusions: The prevalence of polypharmacy in LTCFs is high, varying widely between facilities, geographical locations and the definitions used. Greater use of multivariate analysis to investigate factors associated with polypharmacy across a range of settings is required. Longitudinal research is needed to explore how polypharmacy has evolved over time.
    Full-text · Article · Apr 2015 · Journal of the American Medical Directors Association
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    ABSTRACT: Objective Understanding smokers’ quit experiences and their preferences for a future quit attempt may aid in the development of effective cessation treatments. The aims of this study were to measure tobacco use behaviour; previous quit attempts and outcomes; methods used to assist quitting; difficulties experienced during previous attempts; the motives and preferred methods to assist quitting in a future attempt; identify the factors associated with preferences for smoking cessation. Design Face-to-face interview using a structured questionnaire. Setting Inpatient wards of three Australian public hospitals. Participants Hospitalised smokers enrolled in a smoking cessation trial. Results Of 600 enrolled patients (42.8% participation rate), 64.3% (n=386) had attempted quitting in the previous 12 months. On a scale of 1 (low) to 10 (high), current motivation to quit smoking was high (median 9; IQR 6.5–10), but confidence was modest (median 5; IQR 3–8). Among 386 participants who reported past quit attempts, 69.9% (n=270) had used at least one cessation aid to assist quitting. Nicotine replacement therapy (NRT) was most commonly stated (222, 57.5%), although the majority had used NRT for <4 weeks. Hypnotherapy was the most common (68, 17.6%) non-pharmacological treatment. Over 80% (n=311) experienced withdrawal symptoms; craving and irritability were commonly reported. Most participants (351, 58.5%) believed medications, especially NRT (322, 53.7%), would assist them to quit in the future. History of previous smoking cessation medication use was the only independent predictor of interest in using medications for a future quit attempt. Conclusions The majority of smokers had attempted quitting in the previous 12 months; NRT was a popular cessation treatment, although it was not used as recommended by most. This suggests a need for assistance in the selection and optimal use of cessation aids for hospitalised smokers. Trial registration number Australian and New Zealand Clinical Trials Registry: ACTRN12612000368831.
    Full-text · Article · Apr 2015 · BMJ Open

  • No preview · Article · Dec 2014 · Asia-Pacific Journal of Clinical Oncology
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    ABSTRACT: Purpose Prospective surveillance of invasive mold diseases (IMDs) in haematology patients should be standard of care but is hampered by the absence of a reliable laboratory prompt and the difficulty of manual surveillance. We used a high throughput technology, natural language processing (NLP), to develop a classifier based on machine learning techniques to screen computed tomography (CT) reports supportive for IMDs. Patients and Methods We conducted a retrospective case-control study of CT reports from the clinical encounter and up to 12-weeks after, from a random subset of 79 of 270 case patients with 33 probable/proven IMDs by international definitions, and 68 of 257 uninfected-control patients identified from 3 tertiary haematology centres. The classifier was trained and tested on a reference standard of 449 physician annotated reports including a development subset (n = 366), from a total of 1880 reports, using 10-fold cross validation, comparing binary and probabilistic predictions to the reference standard to generate sensitivity, specificity and area under the receiver-operating-curve (ROC). Results For the development subset, sensitivity/specificity was 91% (95%CI 86% to 94%)/79% (95%CI 71% to 84%) and ROC area was 0.92 (95%CI 89% to 94%). Of 25 (5.6%) missed notifications, only 4 (0.9%) reports were regarded as clinically significant. Conclusion CT reports are a readily available and timely resource that may be exploited by NLP to facilitate continuous prospective IMD surveillance with translational benefits beyond surveillance alone.
    Full-text · Article · Sep 2014 · PLoS ONE
  • Ruth Chieng · John Coutsouvelis · Susan Poole · Michael J. Dooley · Diana Booth
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    ABSTRACT: Allogeneic stem cell transplantation (SCT) is a complex procedure that requires specialized medication management. Providing clinical pharmacy services in the ambulatory setting is warranted, as medications are a common source of confusion for SCT patients and their carers. These patients were routinely managed via traditional ambulatory dispensary services. The successful implementation of a clinical pharmacy service to the SCT unit ambulatory clinic allowed for regular contact and review by an experienced clinical pharmacist. This new service was evaluated within the context of a research project. The clinical pharmacist's presence in the ambulatory setting resulted in the identification and rectification of many medium to high risk medication related problems. The clinical pharmacist also contributed towards improved overall adherence. Other institutions are encouraged to implement and evaluate clinical pharmacy services to their ambulatory settings for SCT and other complex chronic patients.
    No preview · Article · Sep 2014
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    Erica Y Tong · Melanie Kowalski · Gary S Yip · Michael J Dooley

    Preview · Article · Apr 2014 · The Medical journal of Australia
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    ABSTRACT: The purpose of this study was to define the pulmonary and systemic pharmacokinetics of colistin methanesulfonate (CMS) and formed colistin following intravenous (IV) and inhalation administration in cystic fibrosis (CF) patients. Six CF subjects were administered nebulized CMS doses of 2 and 4 million international units (IU) and IV CMS infusion of 150 mg of colistin base activity. Plasma, sputum and urine samples were collected for 12 to 24 h post-dose. To assess tolerability, lung function tests, serum creatinine concentrations and adverse effect reports were undertaken. All doses were well tolerated in subjects. The pharmacokinetic parameters for CMS following IV delivery were consistent with previously reported values. Sputum concentrations of formed colistin were maintained below 1.0 mg/L for 12 h post-dose. Nebulization of CMS resulted in relatively high sputum concentrations of CMS and formed colistin when compared to IV administration. The systemic availability of CMS was low following nebulization of 2 and 4 million IU (7.93 ± 4.26% and 5.37 ± 1.36%, respectively) and plasma colistin concentrations were below the limit of quantification. Less than 2 - 3% of the nebulized CMS dose was recovered in urine in 24 h. The therapeutic availability and drug targeting index for CMS and colistin following inhalation when compared to IV delivery were significantly greater than one. Inhalation of CMS is an effective means of targeting CMS and formed colistin into the lungs as high lung exposure and minimal systemic exposure were achieved in CF subjects.
    Full-text · Article · Feb 2014 · Antimicrobial Agents and Chemotherapy

  • No preview · Article · Feb 2014 · Australian Critical Care
  • M. J. Dooley · J. McGuiness · S. Choo · E. Tong · K. Neave · S. Poole

    No preview · Article · Oct 2013 · International Journal of Clinical Pharmacy
  • M. J. Dooley · E. Dean · J. McGuiness · K. Corben

    No preview · Article · Oct 2013 · International Journal of Clinical Pharmacy
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    ABSTRACT: Patients having undergone allogeneic stem cell transplantation (SCT) require complex medication regimens. To ensure the safe and effective management of this patient group, specialised care in a centre with a dedicated and experienced healthcare team is essential. The aim of this study was to evaluate the effectiveness of a specialty clinical pharmacist working in an ambulatory SCT clinic. A prospective cohort study was conducted on patients post SCT and discharged to the ambulatory setting. Patients were reviewed by a clinical pharmacist weekly for six visits. At these visits a medication review was undertaken. Interventions from these reviews were recorded. Interventions were then assigned a risk rating by a multidisciplinary panel. Adherence was also assessed by a Morisky questionnaire and review of dose administration aids. Comparison of data over the six-visit period was undertaken. In total 23 patients were enrolled in the study. All six visits were completed in 17 patients and 161 interventions were recorded at an average of 1.4 interventions per patient visit. The panel rated 40 % of interventions as high risk, 46 % as medium risk and 14 % as low risk. At all visit points high- and medium-risk interventions constituted >80 % of the total. Morisky scores improved by an average of 1.53 (p < 0.0001) between visits 1 and 6. All patients were scored as highly adherent by visit 6. A specialist clinical pharmacist in the SCT outpatient clinic resulted in regular and effective intervention contributing to improved medication management and adherence.
    No preview · Article · Aug 2013 · Supportive Care in Cancer

Publication Stats

874 Citations
254.18 Total Impact Points


  • 2008-2015
    • Alfred Hospital
      • Department of Pharmacy
      Melbourne, Victoria, Australia
  • 2004-2015
    • Monash University (Australia)
      • Faculty of Pharmacy and Pharmaceutical Sciences
      Melbourne, Victoria, Australia
  • 2003-2015
    • University of Vic
      Vic, Catalonia, Spain
  • 2014
    • Melbourne Health
      Melbourne, Victoria, Australia
  • 2012
    • Alfred University
      Alfred, New York, United States
  • 2007
    • Institut Paoli Calmettes
      Marsiglia, Provence-Alpes-Côte d'Azur, France
  • 2002-2007
    • Victorian College for the Deaf
      Melbourne, Victoria, Australia
  • 2000-2005
    • Peter MacCallum Cancer Centre
      • Pharmacy Division
      Melbourne, Victoria, Australia