The Role Of GRHL-3, A Mammalian Homologue Of Drosophila Grainyhead, In Neural Tube Development
Funder
National Health and Medical Research Council
Funding Amount
$496,500.00
Summary
Spina bifida and anencephaly are two common human congenital malformations that form part of a wide spectrum of mutations known collectively as neural tube defects (NTDs). Patients with the most severe form of spina bifida have a failure of the vertebral column and skin to close over the spinal cord and therefore suffer from limb paralysis and marked bladder and bowel dysfunction. Infants with anencephaly have an open cranial vault and failure of normal brain development and die within the first ....Spina bifida and anencephaly are two common human congenital malformations that form part of a wide spectrum of mutations known collectively as neural tube defects (NTDs). Patients with the most severe form of spina bifida have a failure of the vertebral column and skin to close over the spinal cord and therefore suffer from limb paralysis and marked bladder and bowel dysfunction. Infants with anencephaly have an open cranial vault and failure of normal brain development and die within the first few hours of life. These abnormalities occur frequently (1-1000 live births) and are a direct result of failure of the neural tube to close during embryogenesis. NTDs are influenced by both environmental and genetic factors. The best characterised environmental factor is the dietary supplement folate, which when administered before conception results in a reduction in the incidence of spina bifida. The genetic complexity is evidenced by the array of mouse genetic mutations that give rise to NTDs. One of these mouse mutations, known as Curly tail (ct), has served as the major animal model of human NTDs. This is because the ct mice are resistant to folate administration (like most of the cases of spina bifida currently seen in patients) and because the mice seem to have normal development in virtually all other organ systems. Ironically, the genetic mutation that causes the curly tail phenotype has remained undiscovered for over 50 years. We have now identified the gene mutated in the curly tail mice. This gene is highly conserved in humans suggesting that it will play a similar role in neural tube development in man. The gene, known as GRHL-3, is a descendant of a fly gene critical for development of the nervous system in that organism. The studies we propose here will examine the developmental pathways involved in normal neural tube closure in mice and humans and will impact on our understanding of these devastating congenital malformations.Read moreRead less
A Randomised Controlled Trial Of Caseload Midwifery Care
Funder
National Health and Medical Research Council
Funding Amount
$761,311.00
Summary
There is concern about the rising levels of caesarean section in Australia and some evidence that women may benefit from caseload midwifery care. This randomised control trial will determine whether caseload midwifery care can reduce interventions and is as safe as usual hospital maternity care. A Cochrane systematic review of midwifery led care versus routine care was designed to answer these questions.This will be the first randomised controlled trial to contribute to this review
A Randomised Controlled Trial Of A Nurse-led Intervention For Less Chronic Heart Failure: The NIL-CHF Study
Funder
National Health and Medical Research Council
Funding Amount
$1,166,160.00
Summary
The overall aim of the unique NIL-CHF Study is to examine the benefits of applying a specialist nurse-led, home and clinic-based intervention to optimise the care of recently discharged hospital patients with heart disease. Involving 950 patients, it will explore whether more flexible and individualised care to apply the best possible medical treatments is able to PREVENT the most deadly and disabling form of heart disease (chronic heart failure - CHF) and save money in the process.
Chronic Disease Outcomes And Enhanced Primary Care In Seniors: A Cross-Jurisdictional Linkage Project
Funder
National Health and Medical Research Council
Funding Amount
$1,077,766.00
Summary
This project will provide evidence on how best to use the efforts of Australian GPs to obtain better outcomes in patients aged 65+ years who suffer from chronic diseases such as diabetes, heart disease and high blood pressure, asthma and emphysema, seizures and stomach disorders. It will also examine the best way that GP visits can promote healthier ageing in all older seniors, aged 75+ years. For each disease and in older seniors, the study will be able to detect which of the following factors ....This project will provide evidence on how best to use the efforts of Australian GPs to obtain better outcomes in patients aged 65+ years who suffer from chronic diseases such as diabetes, heart disease and high blood pressure, asthma and emphysema, seizures and stomach disorders. It will also examine the best way that GP visits can promote healthier ageing in all older seniors, aged 75+ years. For each disease and in older seniors, the study will be able to detect which of the following factors are the most important for better patient health: (i) seeing a GP more times, (ii) seeing a GP at more even intervals, (iii) seeing the same GP, or (iv) seeing a GP with a lot of experience in chronic diseases. Separate investigations will be made in older people living in hostels and nursing homes, because their needs may be different. The study will also evaluate the benefits of a major change that occurred to Medicare in 1999, when GPs were paid to perform health assessments and to prepare health plans (with other health workers) for patients with chronic health problems. The results will enable this important initiative to be further improved. The study will use a unique and new Australian research facility, which has brought together health data on the entire population of WA from both the State and Commonwealth levels, including information on Medicare use, pharmaceuticals, hospital stays and deaths. The facility works in such a way as to preserve patient and GP privacy. A strong feature of this research will be the degree of involvement of a representative and voluntary group of older Australian patients who attend GP clinics, and the GPs themselves, in advising the researchers on what's important to consumers and GPs.Read moreRead less
THE EFFECTS OF TRANSCRANIAL MAGNETIC STIMULATION (TMS) ON RAT MODELS OF DEPRESSION
Funder
National Health and Medical Research Council
Funding Amount
$204,274.00
Summary
Repetitive Transcranial Magnetic Stimulation (rTMS) is the direct stimulation of the brain by using high field magnetic pulses. It is a new technique that has been demonstrated to have some potential as a treatment of depressive illness and possibly other neuropsychiatric disorders. At this early stage of its investigation, the parameters of stimulation that are most likely to be therapeutic, and its mechanisms of action, are not known. Published studies vary in the frequency, duration and exten ....Repetitive Transcranial Magnetic Stimulation (rTMS) is the direct stimulation of the brain by using high field magnetic pulses. It is a new technique that has been demonstrated to have some potential as a treatment of depressive illness and possibly other neuropsychiatric disorders. At this early stage of its investigation, the parameters of stimulation that are most likely to be therapeutic, and its mechanisms of action, are not known. Published studies vary in the frequency, duration and extent of stimulation, with no firm guidelines about optimal parameters. Empirical study of the relative effects of stimulation at different frequencies, at different numbers of stimuli and for different durations is therefore important for the future development of this treatment. Such an investigation is best carried out in an animal model of depression for both ethical and practical reasons, as such studies in patients would possibly take many years and be extremely difficult to conduct. We propose such a study in rat models of depression which have demonstrated validity and utility in drug research. Rat models have a long track record in developing psychiatric treatments and are cost-effective and of proven value. We also plan to investigate the neuroanatomy of the immediate-early genes induced by TMS and compare it with electroconvulsive shock (ECS) and a tricyclic antidepressant, two established treatments of depression. The results will have implications for future human studies in guiding us toward the optimal parameters for therapeutic effects. They will also enhance our understanding of the mechanism of action of TMS in depression.Read moreRead less
Development Of Quality Indicators For The Frail Elderly In Acute Care
Funder
National Health and Medical Research Council
Funding Amount
$372,311.00
Summary
Frail older people are particularly vulnerable to a range of mishaps while in hospital. Good care can reduce the frequency and extent of these problems. Quality indicators (QIs) assist hospitals, and clinical service units within them, to appraise their performance, and to compare it to other hospitals. QIs for the measurement of outcomes for the frail aged in the acute care setting do not exist in Australia or overseas. We aim to develop these indicators during this study.
The Australian Maternity Outcomes Surveillance System: Improving Safety And Quality Of Maternity Care In Australia
Funder
National Health and Medical Research Council
Funding Amount
$820,438.00
Summary
There is currently no Australian system of monitoring severe complications of pregnancy. Many of these complications are rare, making them difficult to study and limiting knowledge as to their true frequency, cause and best treatment. We intend to introduce a national reporting system- Australian Maternity Outcomes Surveillance System which would provide the research structure to study these rare conditions, thus aiming to improve the safety and quality of maternity care provided in Australia.
Improving Medication Safety In Seniors: A Cross-Jurisdictional Linkage Project
Funder
National Health and Medical Research Council
Funding Amount
$636,717.00
Summary
The project will identify priorities for tackling the current epidemic of hospitalisation of Australians aged 65+ years due to side effects of their medications. Two different groups of medications will be investigated. The first will be the prescribed drugs most often recorded as causes of hospital stay, including those taken to stop blood clotting, for high blood pressure and other cardiovascular problems, for rheumatism or strong pain relief, anti-cancer drugs and steroids. The study will exa ....The project will identify priorities for tackling the current epidemic of hospitalisation of Australians aged 65+ years due to side effects of their medications. Two different groups of medications will be investigated. The first will be the prescribed drugs most often recorded as causes of hospital stay, including those taken to stop blood clotting, for high blood pressure and other cardiovascular problems, for rheumatism or strong pain relief, anti-cancer drugs and steroids. The study will examine which of these drugs taken under what circumstances has the highest risk, so prevention can be better targeted. The study will investigate if adequate laboratory monitoring of the anti- clotting drugs is taking place and whether the guidelines should be updated. The second group will be 68 medications that should be avoided in seniors according to an international expert panel. The research will see how often these 'inappropriate medications' are still prescribed in the Australian setting, and the size of their contributions to unplanned hospital stays. The researchers suspect that this problem is much larger than immediately apparent from routine statistics, because many of the side effects of inappropriate medications are non-specific, such as confusion, drowsiness or difficulty standing up, thus putting seniors at risk of falls and neglect of other aspects of their health. The study will use a unique and new Australian research facility, which has brought together health data on the entire population of WA from both the State and Commonwealth levels, including information on pharmaceuticals, Medicare use, hospital stays and deaths. The facility works in such a way as to preserve patient and GP privacy. A strong feature of this research will be the degree of involvement of a representative and voluntary group of older Australian patients who attend GP clinics, and the GPs themselves, in advising the researchers on what's important to consumers and GPs.Read moreRead less
Development Of Diagnostic Tools To Characterise Predictors Of Therapeutic Outcome In Severe Constipation
Funder
National Health and Medical Research Council
Funding Amount
$433,999.00
Summary
This project will use fibre-optic technology to create detailed high resolution maps of colonic motor patterns in both health and in patients with severe constipation. The data will be used in combination with actual patient symptoms to help identify specific markers of disease that can differentiate sub-types of constipation and ultimately guide and improve treatment in constipated patients