A Study Of Advance Care Planning In The Primary Care Context
Funder
National Health and Medical Research Council
Funding Amount
$104,664.00
Summary
Advance care planning (ACP) is the process through which a patient can have an input into the direction of their own medical care in case they lose their ability to make medical decisions at a later time. This research will initially explore the patient, their carers, their family and their General Practitioner's conceptualise and view as the aim of ACP . These findings will then be used to guide the development and testing of a more patient-centered approach to ACP.
Expectations And Barriers In The Ambulance Service And Palliative Care Interface
Funder
National Health and Medical Research Council
Funding Amount
$49,916.00
Summary
There are over 6000 paramedics in Australia. The ambulance service is faced with palliative care on a daily basis throughout the country. Their involvement in palliative care is diverse and may include response to end of life calls, response to aid home care, response to manage acute events, providing health transport and collaborating with other care givers. The nature of this involvement, and the broader policy, operational, clinical and social implications has not been researched in Australia ....There are over 6000 paramedics in Australia. The ambulance service is faced with palliative care on a daily basis throughout the country. Their involvement in palliative care is diverse and may include response to end of life calls, response to aid home care, response to manage acute events, providing health transport and collaborating with other care givers. The nature of this involvement, and the broader policy, operational, clinical and social implications has not been researched in Australia. This study will survey paramedics across two states to describe their involvement in palliative care, and the issues and challenges associated with provision of this service.Read moreRead less
Oxygen To Relieve Dyspnoea In Non-hypoxaemic Patients With End-stage Heart Failure
Funder
National Health and Medical Research Council
Funding Amount
$445,658.00
Summary
Chronic heart failure is a cause of suffering and a major cause of death in the Australian community. Patients who have chronic heart failure suffer from a range of symptoms that severely impacts every aspect of their life. One of the most common and distressing symptoms is breathlessness. As people with heart failure near death, their breathlessness may worsen not only in terms of its frequency, but also in its intensity. This worsening of symptoms is a source of great distress, both to patient ....Chronic heart failure is a cause of suffering and a major cause of death in the Australian community. Patients who have chronic heart failure suffer from a range of symptoms that severely impacts every aspect of their life. One of the most common and distressing symptoms is breathlessness. As people with heart failure near death, their breathlessness may worsen not only in terms of its frequency, but also in its intensity. This worsening of symptoms is a source of great distress, both to patients as well as their carers and family. Breathlessness is also the most common cause of admission to hospital for patients. A key strategy for managing this distressing symptom in the home is the supply of oxygen. However, due to a lack of scientific evidence for the benefit of home oxygen for people with heart failure, who do not necessarily have low levels of oxygen, it is very difficult for clinicians to access this therapy for their patients. This study seeks to assess if a specific breathlessness action plan alone or if the addition of either oxygen or air can relieve this distressing symptom. The scientific evaluation of these strategies will assist in improving the palliative care of people with chronic heart failure.Read moreRead less
Improving Communication Processes And End Of Life Care In The Neonatal Period: Drawing On The Experiences Of Parents And Health Care Professionals
Funder
National Health and Medical Research Council
Summary
The parents of infants who have died in newborn intensive care, as well the professionals who care for these infants, will be invited to share their experiences of the conversations that took place around the time of the infant's death and how these contributed to the care provided. It is intended that the care of future infants who die under the care of the neonatal team will be improved through dissemination of this knowledge and associated improvements in training of professionals involved in ....The parents of infants who have died in newborn intensive care, as well the professionals who care for these infants, will be invited to share their experiences of the conversations that took place around the time of the infant's death and how these contributed to the care provided. It is intended that the care of future infants who die under the care of the neonatal team will be improved through dissemination of this knowledge and associated improvements in training of professionals involved in this field.Read moreRead less
End-of-Life Care And Dying-at-Home: Choices And Needs Of People With Intellectual Disability And Their Carers
Funder
National Health and Medical Research Council
Funding Amount
$104,343.00
Summary
With the continued push towards community living for people with intellectual disability, how best to provide support at the end-of-life remains a neglected research area. This occurs against a backdrop of an increasingly ageing population, in an arena where end-of-life care and dying at home is the preferred option for most people. This research breaks new ground, aiming to establish supports such that people with intellectual disability may remain at home until the end of their life.
Often when people are sick they cannot communicate their wishes regarding medical decisions. This research will explore, through surveys and interviews, how older general practice patients understand these decisions and how their understanding compares with that of their loved ones and their general practitioner. We aim to provide an insight into the meaning people give to these decisions thereby assisting those who wish to plan for their future medical care and their doctors.
Palliative Care In Aged Care Facilities For Residents With A Non-cancer Diagnosis
Funder
National Health and Medical Research Council
Funding Amount
$70,000.00
Summary
Preliminary studies have suggested there may be deficiencies in the care of residents in aged care facilities who have advanced terminal illnesses other than cancer. Aged care residents do not have access to the expertise and resources available to clients of palliative care services where cancer is the major diagnosis. This study aims to investigate the extent and nature of any deficits experienced in aged care facilities and to employ palliative care standards to develop strategies so that any ....Preliminary studies have suggested there may be deficiencies in the care of residents in aged care facilities who have advanced terminal illnesses other than cancer. Aged care residents do not have access to the expertise and resources available to clients of palliative care services where cancer is the major diagnosis. This study aims to investigate the extent and nature of any deficits experienced in aged care facilities and to employ palliative care standards to develop strategies so that any unmet needs can be addressed.Read moreRead less
Glutathione is a natural antioxidant, which is known to protect cells in the body from chemical damage. A small part of the glutathione in cells is found in the mitochondria, a structure that is involved in producing the chemical energy needed for normal cell function. The mitochondria are also involved under some circumstances in promoting the death of cells. Although glutathione in general has been well studied, much less attention has been paid to the function of glutathione in mitochondria, ....Glutathione is a natural antioxidant, which is known to protect cells in the body from chemical damage. A small part of the glutathione in cells is found in the mitochondria, a structure that is involved in producing the chemical energy needed for normal cell function. The mitochondria are also involved under some circumstances in promoting the death of cells. Although glutathione in general has been well studied, much less attention has been paid to the function of glutathione in mitochondria, particularly in cells from the brain. Our recent studies indicate that this mitochondrial pool of glutathione is particularly important in limiting the death of cells from the brain when exposed to damaging substances that are increased in some diseases. Thus, the capacity of mitochondrial glutathione to deal with such substances might be a factor in determining the extent of cell loss in the brain, which is an important determinant of symptoms in some of the major neurological diseases. Consistent with this possibility, we have obtained evidence indicating that decreases in glutathione in the mitochondria contribute to the cell death and brain damage that results from a stroke. In our proposed studies, we will investigate the function of mitochondrial glutathione in the two major cell populations from the brain, neurons and astrocytes. We will characterise the protective role of the glutathione and investigate how it enters the mitochondria and what factors influence the amount that is present. This will provide new insights into the function of glutathione in the mitochondria and could also suggest novel approaches for manipulating this antioxidant pool. We will also study models of stroke and some related brain disorders to more directly test the role of this antioxidant in disease and to assess whether manipulating the content of glutathione in the mitochondria has the potential to reduce damage and improve function in these disordersRead moreRead less
The Regulation And Role Of Puma And P53 In IL-3 Withdrawal Induced Cell Death
Funder
National Health and Medical Research Council
Funding Amount
$527,683.00
Summary
It is the ultimate fate of most of our cells to die by committing suicide, because they are no longer required, are no longer functioning, or are potentially harmful. This normal physiological process is termed apoptosis . When cell death fails to occur, abnormal cells can accumulate and lead to cancer. Signalling from growth-factors is required for many cell types to survive. When these signals are lost, the cells activate their cell death pathways. It is a hallmark of cancer cells that they ha ....It is the ultimate fate of most of our cells to die by committing suicide, because they are no longer required, are no longer functioning, or are potentially harmful. This normal physiological process is termed apoptosis . When cell death fails to occur, abnormal cells can accumulate and lead to cancer. Signalling from growth-factors is required for many cell types to survive. When these signals are lost, the cells activate their cell death pathways. It is a hallmark of cancer cells that they harbour mutations in cell death genes and their dependence on growth factors for survival is diminished or lost. The genes of the apoptosis pathway function either to promote or inhibit cell death. Some genes in the apoptosis pathway allow apoptosis to proceed rapidly, but do not decide the fate of the cell. Other genes are required for a cell to commit to die, and if they are mutated then a functional cell, that is capable of proliferating, survives. This is a crucial distinction because it is only the genes that decide cell fate that can act as cancer genes, and are valid targets for therapy. We have identified one particular gene, Puma, as an important regulator of cell survival. Without this gene, cells survive longer without growth-factor and, importantly, can proliferate when growth factor is restored. Understanding how this gene functions and is regulated will contribute to our understanding of the gene mutations that lead to cancer and may identify valid targets for cancer therapy. In our model we use growth factor dependent cell lines derived from mice lacking particular genes in the cell death pathway, including Puma. These cells proliferate in the presence of growth factor, and allow us to determine the role of the genes when growth factor is withdrawn. Using this system, we will determine how Puma is able to induce cell death, what other genes are required to regulate this process and how loss of Puma function may contribute to cancer development.Read moreRead less